造血幹細胞移植患者に看護師が提供している看護援助と課題

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  • Support provided by nurses to patients undergoing blood stem cell transplantation and open issues related to this type of nursing care
  • ゾウケツ カンサイボウ イショク カンジャ ニ カンゴシ ガ テイキョウシテイル カンゴ エンジョ ト カダイ

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本研究は看護師が造血幹細胞移植(以下,移植)患者に提供している看護援助およびその課題を明らかにすることである.研究者の所属機関および研究協力施設の倫理委員会で承認を得た後,近畿圏内の移植に携わり,研究参加に同意の得られた看護師20名(平均年齢34.9歳)を対象に,半構成的面接を行い類似した内容をカテゴリー化した。特徴的な看護援助内容について,移植前は, ≪移植に対する理解を効果的に促す≫≪無菌室でのセルフケアの教育を行う≫などが,移植後は≪無菌室でのセルフケアを促す≫≪無菌室収容中の患者の家族への支援≫などが抽出された。移植前の援助に関する課題は,≪移植についての情報の過不足≫≪移植に対する自己決定の難しさ≫などが抽出された。患者は簡単に移植の情報を得ているが,患者に理解できるように専門的な知識を提供されていないことから,移植が患者によって自己決定したとは言い切れないこと,前向きに取り組めていないことが考えられた。

The present study was designed to investigate the support currently provided by nurses to patients undergoing blood stem cell transplantation (hereinafter "transplantation") and to identify open issues related to this type of nursing support. After approval by the Ethics Committees of our university and each participating facility, semi-structured interviews were performed with 20 nurses (mean age: 34.9 years) involved in transplantation at facilities in the Kinki District and who gave informed consent to participate in this study. The responses to the interview were analyzed by categorizing similar responses. Characteristic support provided by nurses before transplantation included "helping the patient understand transplantation in an efficient way," "education of the patient in self-care in the clean room," and others. After transplantation, characteristic nursing support identified in this study included "guiding the patient to practice self-care in the clean room," "support of the patient's family during the patient's stay in the clean room," and others. Open issues related to support before transplantation were "shortage of information about transplantation supplied to the patient," "difficulty for patients in making decisions about transplantation," and others. These findings suggest that although patients scheduled to undergo transplantation can easily access some information about transplantation, the information accessible to them does not include expert information supplied in easy-to-understand fashion. It thus seems likely that, under the current system, patients are unable to make decisions regarding transplantation in the true sense of the term, and that it is difficult for patients to face transplantation in a positive and active fashion.

identifier:大阪府立大学看護学部紀要. 2008, 14(1), p.1-7

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