緩和ケア病棟看護師の専門的緩和ケア実践能力の実態とその関連要因—クリティカルシンキングとレジリエンスの側面から

Current Status of Clinical Competence in Specialized Palliative Care Among Nurses in Palliative Care Units and Associated Factors From the Critical Thinking and Resilience Aspects

要旨

　【目的】緩和ケア病棟看護師の専門的緩和ケア実践能力の実態と，その関連要因をクリティカルシンキングとレジリエンスの側面から検討する．

　【方法】緩和ケア病棟看護師を対象に質問紙調査を実施した．質問紙は，専門的緩和ケア実践能力は，専門的緩和ケアを担う看護師に求められるコアコンピテンシーで測定し，臨床看護師のクリティカルシンキング測定尺度，精神的回復力尺度，属性から構成した．専門的緩和ケア実践能力を従属変数とする重回帰分析を実施した．

　【結果】1,392の有効回答が得られた（有効回答率71％）．専門的緩和ケア実践能力の実態として，「がん患者・家族のありのままを理解し尊重する」「がん患者・家族のスピリチュアルな苦悩に向き合い支える」は得点が高く，「意欲的に専門的緩和ケアを担う看護師としての役割・責任を果たす」は得点が低かった．実践能力の関連要因においては，「創造的思考」「論理的思考」「直観」「感情調整」「緩和ケア病棟経験年数」「緩和ケアの学習経験」の6要因の関連が示唆された（調整済 R²＝0.37）．

　【考察】実践能力の実態として，患者・家族の価値観の尊重やスピリチュアルケアへの意識は高く，質の向上への意欲的な取り組みには課題があることが示唆された．関連要因の特徴から，現象の本質や変化を見抜き個別的なケアを創造できる思考力，内省し感情調整できる力，実践や学習の積み重ねの重要性が示唆された．

　Purpose: This study examined the current status of and factors associated with clinical competence in specialized palliative care among nurses in palliative care units from the critical thinking and resilience aspects.

　Methods: A questionnaire survey was administered to nurses in palliative care units. Clinical competence in specialized palliative care was measured by the core competence required of nurses in charge of specialized palliative care. The questionnaire consisted of clinical competence in specialized palliative care, scales to assess the critical thinking of clinical nurses, the Adolescent Resilience Scale and attributes. Multiple regression analysis was performed with clinical competence in specialized palliative care as a dependent variable.

　Results: In all, 1,392 valid responses were obtained (valid response rate: 71%). In terms of the current status of clinical competence in specialized palliative care, nurses scored highly for the items “understand and respect cancer patients and their families just as they are” and “face and support spiritual distress in cancer patients and their families”, but scored low for the items “actively fulfill their roles and responsibilities as a nurse in charge of specialized palliative care”. Six factors were found to be associated with practical competence: “creative thinking”, “logical thinking”, “intuition”, “emotional regulation”, “years of experience in palliative care units”, and “experience of learning palliative care” (adjusted R2 = 0.37).

　Discussion: The results regarding the current status of practical competence suggest that nurses respect the values of the patients and their families while showing a high level of awareness of spiritual care, but that there are issues with active engagement in quality improvement. The characteristics of the factors associated with practical competence indicate the importance of: (1) being able to identify the essence of and changes in the palliative care nursing to provide individualized care; (2) being able to reflect and regulate emotions; and (3) repeated practice and learning.