看護師による終末期患者の死の予測：スコーピングレビュー

Nurses' Predictions of the Death of Terminal Patients: A Scoping Review

要旨

　目的：看護師が終末期患者の死をどのような項目・視点で予測しているかを整理し，用語に表れる死の捉え方の違いを踏まえ，今後の研究への示唆を得ることを目的とした．

　方法：JBI Manual for Evidence Synthesisに基づくスコーピングレビューを実施し，医中誌Web，CiNii，PubMed，CINAHLから文献を検索した．看護師による死の予測に関する文献（日本語・英語）を対象に，検索期間を設けずに収集・分析した．

　結果：22編を抽出した．看護師は，客観的な医学的変化に加え，患者の表情や死に関する発言，家族や他職種の所感といった多面的な要素を活用していた．用語は疾患特性に応じて使い分けられており，判断の視点や構えに反映されていた．

　結論：看護師の臨床判断は客観的評価と内面的感受性を統合していることが示唆された．判断過程の構造化は，終末期ケアの質向上と死の予測における臨床的理解に寄与する可能性がある．

　Purpose: To clarify how nurses predict the death of terminally ill patients using the factors and viewpoints they employ, while considering variations in how death is conceptualized through terminology, and to obtain suggestions for future studies.

　Methods: A scoping review, guided by the JBI Manual for Evidence Synthesis, was conducted. Literature was sourced from Ichushi-Web, CiNii, PubMed, and CINAHL. Literature(in Japanese and English)focusing on nurses' prediction of death was collected and analyzed without publication date restrictions.

　Results: Twenty-two pieces of literature were identified. Nurses utilized multifaceted elements, including objective medical changes, the patient's facial expressions and statements about death, as well as the observations of family members and other professionals. Terms were chosen based on illness-specific traits, mirroring distinct perspectives and stances on judgment.

　Conclusion: The findings suggest that nurses' clinical judgment integrates objective assessments with intuitive sensitivity. Structuring this decision-making process could improve end-of-life care quality and contribute to clinical insight into predicting death.