ICUにおいて抑制を受ける高齢患者に対する看護ケア

Nursing Care for Restrained Elderly Patients in ICU

抄録

　本研究の目的は，ICUにおいて抑制を受ける高齢患者に対し，看護師が日常的に実践している看護ケアを明らかにすることである．12人の看護師を対象にケア場面の参加観察およびケアの意図についての半構成的面接を行い，質的帰納的に分析した．その結果【患者の状態に応じた効果的な抑制を用いて患者の命を守る】【患者が現状を理解することを助ける】【思うように表出できない患者の思いをつかみとる】【患者の欲求を満たすことを支援する】【回復に向かうための患者の気力を支える】【合併症を予防し，生活機能を維持する】【患者が穏やかにすごすことのできる環境を整える】【患者と家族の関係を保つ】【患者の回復に向けて家族と方向性をひとつにする】の9つの看護ケアが見いだされた．これらの看護ケアは，ICUで抑制を受ける高齢患者の生活機能を維持するための予防ケアであると同時に，患者の回復への意欲を促し，ICUにおける高齢患者家族の思いの揺れに添ったケアであると意味づけられた．

　The purpose of this study was to clarify nursing care provided by nurses for restrained elderly patients in ICU. The study subjects were 12 nurses. Data were collected through participant observation and semi-structured interviews concerning nurses' intentions about the care they provide. The collected data were qualitatively and inductively analyzed. As a result of the analysis, nine categories of care were identified: 【protecting patients' lives by using the effective restraint according to patients' conditions】, 【helping patients understand their current condition】, 【trying to understand the patients' thoughts and feelings that they are unable to express adequately】, 【providing support to satisfy patients' desires】, 【supporting patients' energy in order to recover】, 【preventing complications and maintaining their life function】, 【creating a calming environment for patients】, 【maintaining the relationship between patients and their families】, and 【creating directionality for patients' recovery with their family】.

　These types of nursing care were given the meaning of preventive care to maintain restrained elderly patients' life function. It was considered that these types of care enhanced patients' motivation to recover and complied with the desire of the families of the elderly patients' under treatment in ICU.