訪問看護師に必要とされる判断力の概念分析

Concept Analysis of Judgment Abilities Required in Home Visiting Nurses

要　　旨

　目的：訪問看護師に必要とされる判断力の概念を明らかにすることである。

　方法：38文献を対象に、Rodgersの概念分析方法を用いて分析した。

　結果：先行要件として5つのカテゴリー【単独訪問により支援を求めにくい】【多職種と情報を共有し連携する】【訪問看護師としての専門的知識と実践の積み重ね】【利用者の危機的な変化への対応】【訪問看護師としての利用者・家族に向き合う姿勢】、属性として3つのカテゴリー【訪問看護師が行える相対的医行為】【訪問看護師が備えるアセスメント力と看護技術】【リスクを伴う看護ケアを導く決定】、帰結として3つのカテゴリー【利用者・家族のニーズに応えた意思決定支援】【訪問看護師にかかる責任と負担】【訪問看護師としての実践での成長】を抽出した。

　結論：訪問看護師に必要とされる判断力は「訪問看護師特有の役割として備えなければならないアセスメント力と看護技術であり、相対的医行為の範囲において看護ケアを導く重要な決定能力である」と定義された。

　Objectives: The objective of this study was to clarify the concepts of judgment abilities required in home visiting nurses.

　Methods: A total of 38 references were analyzed using the Rodgers evolutionary concept analysis method.

　Results: Five categories were identified as prerequisite requirements. There are being difficult to ask for help because of a solo visit, sharing information and collaborating with multiple parties in other professions, accumulating expertise and experience as home visiting nurses, addressing critical changes in users, and having an attitude of facing users and families as home visiting nurses. Three categories were identified as attributes and entailed relative medical practices to be performed by home visiting nurses, assessment ability and nursing skills with which home visiting nurses are equipped, and decisions leading to nursing care with risks. Finally, the following three categories were classified as consequences: supporting a decision making that meets the needs of the users' and family, responsibilities and burdens on home visiting nurses, and growth as a home visiting nurse through practical experience.

　Conclusion: The judgment abilities required for home visiting nurses were defined as “the assessment ability and nursing skills specifically needed by visiting nurses to perform their roles and the critical decision-making capacity to guide nursing care in the scope of relative medical practice.”