がん患者のPain Managementに影響を及ぼす看護婦の判断根拠及び因子の検討

Effect of Nurses' Judgement and Factors on Cancer Pain Management

要旨

　臨床でがん患者のPain Managementに携わる看護婦のうち，効果的なPain Managementを行う看護婦が疼痛緩和ケアを行う際に判断根拠としていることを明らかにすること，さらに疼痛緩和をもたらす看護婦とそうでない看護婦との相違を明らかにすることを目的として調査を行った．がん専門病院に入院中の患者3人とそのケアにあたった看護婦23人を調査対象とし，参与観察，自記式調査票およびインタビューにて患者の痛みの経時的変化，ケア内容とケア施行者，ケアの判断根拠に関するデータを収集し，看護記録の内容と併せて分析の対象とした．その結果，患者に疼痛緩和をもたらす看護ケアの判断根拠は「専門的知識」「患者のアセスメントによって得られた情報」「看護婦自身の経験」の3つに大別された．また疼痛緩和をもたらすケアを行った看護婦と行わなかった看護婦について知識テストを用いて比較したところ，前者は後者に比べ得点が有意に高かった（p＜.01）．本研究の結果からも，がん患者のPain Managementにおいて，ケアに携わる臨床看護婦が適切な知識を得ていることがいかに重要であるかが示唆された．

Abstract

　The purpose of this study was primarily to identify the clinical judgement used by practicing nurses, who could manage cancer pain effectively, and secondly to compare the differences between nurses who could manage cancer pain ettectively and those who could not.

　Data was collected from three cancer patients and 23 clinical nurses at one cancer center using participant observation, pain flow charts, questionnaires (including a knowledge test of cancer pain management), and interviews with the subjects. The study analyzed the data and evaluated the nurses' pain management both qualitatively and quantitatively.

　Three categories were identified as the basis of the clinical judgement for effective pain management. There are "expertise", "information gained by the assessment of patients", and "nurse's experience".

　Nine of 23 nurses(group A)successfully brought cancer pain-relief to the patients during the course of the trial period and the others(14 nurses: group B)were not able to manage cancer pain effectively.

　There were no significant differences in the demographic data between both groups of nurses. However the group A knowledge score was significantly higher than that of group B(p＜.01). When administering morphine to the patients, Group B especially expressed a significantly greater fear than Group A of the patients becoming psychologically dependent(p＜.05). The study suggests that appropriate knowledge about cancer pain management is needed for the clinical nurses.