がん患者のPain Managementに必要な看護知識の検討—学習教材における教育項目の選定

Nursing Knowledge of Cancer Pain Management

要旨

　がん専門病院の1病棟に勤務する看護職27人を対象に，がん患者のPain Managementに必要だと認識する知識を問う調査を半構造的質問紙を用いて行った．その結果，Pain Managementに必要な知識は「疾患に関する知識」「痛みに関する知識」「がん患者の痛みに関する理論・概念の知識」「情報収集の実施に関連した知識」の4つの大項目に大別された．各大項目はいくつかの中・小項目から構成され，「痛みに関する知識」を構成する中項目「疼痛緩和ケア」の小項目「薬物治療」は全記述の半数近くを占めていた．そこで「薬物治療」に関する項目を中心とした「Pain Managementに必要な知識項目リスト」（全19項目）を作成し，このリストを用いてがん専門病院2施設に勤める看護職316人を対象に，各項目の重要度，精通度，および知識を問う調査を行った．その結果，「強オピオイド鎮痛薬（モルヒネ）の副作用及びその対応」「癌患者が持つ痛みの原因」「痛みの閾値に影響を及ぼす因子」の3項目は重要度，精通度共にスコアが高く，精通度についてはがん専門病院における臨床経験満5年以上が5年未満より全項目でスコアが高かった．知識テストの平均は10.4点（19点満点）で満5年以上と5年未満との間で得点に有意差が認められた．対象全体の正答率が40％を切る設問は「痛みの発生機序」に関する設問（正答率17％），「異なる鎮痛薬に変更する際の換算方法」に関する設問（正答率26.9％）等であった．本研究の結果をもとに，がん患者のPain Management初心者を使用対象に想定した学習教材を作成することとした．

Abstract

　The purpose of this study was to identify the nursing knowledge which clinical nurses need for cancer pain management. The study consisted of two steps. The first step was implemented in order to make a "List of knowledge criteria needed for cancer pain management", and the second step was done to identify the items an educational program(made by Computer Assisted Instruction: CAI)should contain.

　Data was collected from 25 clinical nurses at one cancer center using a semi-structured questionnaire for the first study purpose. The study analyzed the data qualitatively and four major groups were identified by practicing nurses, as being those important for cancer pain management. These were: "Knowledge of disease", "Knowledge of pain", "Knowledge about the theory and concept of cancer pain", and "Knowledge of collecting data and assessment". Each major group consisted of categories and subcategories. From 122 descriptions, approximately half of them fell into "Pharmacological care", a sub-category of "Knowledge of pain". The "List of 19 knowledge items needed for cancer pain management" was mainly taken from this "Pharmacological care" sub-category, and the second survey was implemented using this list .Data was collected from 227 clinical nurses at two cancer centers using a structured questionnaire and a knowledge test. The questionnaire asked subjects the improtance of and the familiarity with each item, whilst the knowledge test checked the expertise of each subject. Three items, "Side effects of opioids prescribed for severe pain(morphine)and care", "Causes of cancer pain", and "Factors that effect cancer pain" represented high importance and were most familiar to the nurses. All of the average importance scores nurses who had more than 5 years clinical experience of cancer nursing(group 1 nurses)marked were higher than those of the other nurses'(group 2 nurses)average scores. The average points of the knowledge test was 10.4(out of 19 points), and the group 1 average(11.4 points)was significantly higher than that of group 2 (9.78 points, p ＜.001). Two questions, regarding "Mechanism of pain" and "Conversion to different drugs(narcotics)" showed low percentages of correct answers. With these results, an educational program was made (from which clinical nurses can obtain nursing knowledge about cancer pain management).