がん自壊創を有する患者に関わる看護師の困難感の要素

Elements of Nurses' Sense of Difficulty when Caring for Patients with Malignant Fungating Wounds

要旨

　本研究の目的は，がん自壊創を有する患者に関わる看護師の困難感の要素について明らかにすることである．

　がん自壊創のケア経験のある看護師14名に面接前に，自壊創を有する患者のケア場面を想起してインタビューに臨めるように調査用紙に記述を依頼後，インタビューガイドを用いて半構造化面接を実施し内容を質的帰納的に分析した．結果，がん自壊創を有する患者に関わる看護師の困難感の要素に関する内容は，41コード，15サブカテゴリー，6カテゴリーを抽出した．そして【可視化したがんが人体を破壊していく姿に脅威を受ける】【どうにもならない自壊創の悪臭緩和への限界をつきつけられる】【患者の自尊心を傷つける可能性に恐れをもつ】【自分には到底考えもできない自壊創がもたらす辛さを思うと胸が締め付けられる】【自壊創から逃れようとする患者の心理状況に踏み込めない】【精神的苦痛に直結する創処置ゆえに失敗できないという重圧感がともなう】という6つのカテゴリーを抽出した．

　これらの困難感の要素の特徴として，人体を破壊する自壊創への脅威は，看護師にとって衝撃的で脅威になるという困難感の要素を示していた．そして，看護師はこのような自壊創から必死に逃れ生きたいと願う患者を自分の言動で傷つけてしまう恐れをもち，自壊創に囚われた患者の日常を救い出したいと思うが専門性が求められ対応できない苦悩が困難感の要素として示唆された．

　The purpose of this study was to clarify elements of nurses' sense of difficulty when caring for patients with malignant fungating wounds (MFWs).

　We previously asked 14 nurses with experience of MFW care to recall the settings of such care, and describe them in a survey form. Then, we conducted semi-structured interviews with these nurses using an interview guide, and qualitatively and inductively analyzed the obtained data. Elements of nurses' sense of difficulty when caring for patients with MFWs were classified into 41 codes, 15 sub-categories, and the following 6 categories: "being threatened by the visualized cancer destroying the human body", "facing the limitations of measures to reduce the uncontrollable odor of MFWs", "being fearful of the possibility of hurting patients' self-esteem", "finding the hardships patients are facing due to MFWs unimaginable and heart-wrenching", "hesitating to adopt psychological approaches for patients who are in dire straits struggling to be freed from MFWs", and "feeling pressured by wound care, where errors are not allowed, as they directly lead to mental anguish".

　These elements of nurses' sense of difficulty were characterized by their perception that MFWs, which destroy the human body, are shocking and threatening to themselves. The nurses were fearful of the possibility of their statements and behaviors hurting patients, who desperately struggle to be freed from MFWs and survive. Although they desired to help patients suffering from such a condition feel relieved in daily life, they faced difficulty due to specialization needed, and such distress was suggested to be an element of their sense of difficulty.