大腿骨骨折術後の高齢患者における排泄行動の見守りを止めて良いと判断した看護師の着眼点

Nurses' viewpoints regarding decisions to discontinue observation of excretion behaviors of elderly

抄録

　本研究の目的は，大腿骨骨折により手術を受けた高齢患者の排泄行動において，見守りを止めて良いと判断した看護師の着眼点を明らかにすることである．大腿骨骨折手術を受けた高齢患者への看護に3年以上携わった経験がある看護師14人を対象に，「見守りを止めて良いと判断した看護師の着眼点」について，フォーカス・グループ・インタビューを行い，質的記述的に分析した．その結果，15のサブカテゴリーが抽出され，6つのカテゴリー【活力が蓄えられている】【自立へと気持ちが向かっている】【看護師と意思疎通が図れている】【自分のペースを調節できている】【注意力が高まっている】【動作にしなやかさがある】に集約された．これらのカテゴリーは，日常生活全般のケアを通してとらえられる患者の状況を判断材料にしたものであり，新人看護師をはじめとする看護師にとって，大腿骨骨折術後の高齢患者において排泄行動の見守りを止めて良いかどうかを判断する際の指針になり得るものと考える．

　The purpose of our study was to clarify viewpoints of nurses on the timing of decisions to cease observation of bowel movement or urination of elderly patients who have undergone surgery after femoral fracture. Qualitative and descriptive analyses were performed by conducting focus group interviews of 14 proficient nurses with over 3 years of experience in providing nursing care for elderly patients having undergone surgery for femoral fracture, in terms of the nurses' points of view in their determination to end their observation. The results noted 15 subcategories, which were summarized into 6 categories: “Having sufficient reserves of vital power”, “Having independence of spirit”, “Having ability to communicate with nurses”, “Having ability to control their own pace”, “Having increased alertness”, and “Having ability to perform flexible motions”. These viewpoints were based on the comprehensive understanding of a patient's condition, including overall daily life care. We consider that these judgment-based points of view offer a guideline for nurses, particularly for recently-graduated or less-experienced nurses, in the decision-making process for determining when to discontinue observation of excretion behaviors of elderly patients after undergoing surgery for femoral fracture.