思春期青年期世代がん患者に対する看護実践とその難しさ

Nursing Practices and Difficulties in Caring for Adolescent Cancer Patients

要旨

　本研究の目的は，思春期青年期世代がん患者に対する看護実践の内容と看護師がとらえた難しさについて明らかにすることである．日本がん看護学会の小児・AYA世代がん看護SIGに所属する看護師8名を対象に，半構造化面接を行い，Krippendorffの内容分析法を用いて分析した．

　分析の結果，4つの大カテゴリーが生成された．思春期青年期世代の看護の専門性が高い看護師の根幹には【思春期青年期のがんと発達過程の理解】があり，患者の権利擁護に努めながら【主体性を尊重しながらニーズを探る姿勢】で看護をしていることが明らかになった．一方で，看護師は，発達過程にある【患者の核心に迫り切れないことへの苦慮】があり，これに対して，多職種間の情報共有や自律を促す年齢相応の環境整備，患者と両親の気持ちのずれを埋めるための仲介をしながら，治療終了後に【がんとともに生きる患者の自律を支えるケア】をしているという看護実践の内容とその難しさが明らかになった．

　思春期青年期世代がん患者の看護には，この時期に治療を受ける患者の心情の理解が求められており，そのために成人看護の観点に加えて，小児看護の観点を併せ持った看護が必要であると考える．また，思春期青年期世代がん患者が，がんとともに生きる患者の自律を支えるケアは，この世代のがん患者の看護に重要な観点である．

　This study aimed to understand nursing practices toward caring for adolescent cancer patients, and the difficulties faced by nurses. Semi-structured interviews were conducted with eight members of the Childhood, Adolescents and Young Adult Cancer Nursing SIG (Special Interest Group) in the Japanese Society of Cancer Nursing. The data were analyzed using Krippendorff's content analysis method.

　The results generated four categories. “Understanding cancer and developmental process in adolescents” was at the core of nurses with expertise in caring for adolescents. They were nursing with “an attitude to explore the needs while respecting independence” as they were striving to protect the patients' rights. Conversely, nurses had “difficulty understanding what patients want in their process of development.” Nurses shared information among medical professionals to prepare age-appropriate surroundings that encourage autonomy and bridge the disagreements between patients and parents. It was clarified that nurses “support the autonomy of patients living with cancer” after their treatment is completed. Nursing for adolescent cancer patients requires an understanding of the feelings that patients experience during their treatment period. Therefore, in addition to the adult nursing perspective, the pediatric nursing perspective is also necessary. Additionally, supporting the autonomy of adolescent patients living with cancer while caring for them is essential.