概要(Abstract)
本研究の目的は,診療看護師が介護老人保健施設で実施する医療的判断と介入を記述することである。診療看護師の活動場面の参加観察と半構造的面接を実施した。A施設の診療看護師に同行し,行動や入所者や他職種との対応を記録し,半構造的面接によって思考を確認した。分析は,質的帰納法を用いた。その結果,記述された医療的判断と介入は,【生活に密着した日常的な病態管理】,【異常症状の病態鑑別と介入】,【家族への介入】の3つであった。診療看護師は,高齢者の生活リズムの中で,日常的に病態をアセスメントし,チーム員と情報共有していた。異常症状に対し,検査・治療・受診の必要性を判断し介入していた。また,家族への病態報告や治療の方向性の確認を行っていた。これらより,老健の診療看護師の医療的な判断と介入プロセスは,【生活に密着した日常的な病態管理】,【異常症状の病態鑑別と介入】,【家族への介入】があり,診療看護師の活動により老健における看護師の役割が強化されている可能性が示唆された。
1. Introduction
The purpose of this study is an attempt to document the medical decisions and interventions performed by nurse practitioners(NPs) at long-term care facilities for the elderly.
2. Methods
Data were collected by conducting semi-structured interviews with NPs and through the researcher observation of NPs performing their activities. NPs from Facility A were instructed to record their behavior and interactions with residents and other staff. The thoughts of NPs were then confirmed through semi-structured interviews.
3. Results
Qualitative and inductive analyses were performed. Three medical decisions and interventions were described:" daily disease management intimately entwined with lifestyle," "pathological differentiation of abnormal symptoms and interventions," and "interventions with the families of residents." NPs assessed the condition of elderly residents on a daily basis with regards to their lifestyles and shared information with other members of their team. NPs also determined the need to examine, treat, refer atypical symptoms, and intervene if necessary. NPs additionally reported residents' conditions to their families and confirmed families' intentions regarding treatment.
4. Conclusions
The results of this study suggest the following new models for nursing roles at long-term care facilities for the elderly: 1) daily disease management that emphasizes the lifestyles of residents and that is based on clinical reasoning from nursing and medical points of view; 2) the role of promoting the early discovery of abnormalities and cooperation between NPs and doctors; 3) the central role of providing satisfactory explanations to families in a timely manner.
キーワード(Keywords)
NP,医療的判断,臨床推論,介護老人保健施設,病態管理
nurse practitioners, medical decisions, clinical reasoning, nursing home, disease management