在宅で緩和ケアが必要ながん患者を支援する訪問看護師の困難感

This study aimed to identify difficulties of visiting nurses who provide assistance to home-based cancer patients requiring palliative care. In survey１, a questionnaire survey was conducted involving３０visiting nurses working for visiting nursing stations（valid response rate :９０％）, and the data were analyzed using descriptive statistics. In survey ２, a semi-structured interview based on an interview guide was conducted involving４visiting nurses working for visiting nursing stations, and the data were analyzed using a qualitative and inductive approach. The results of survey１showed that the visiting nurses were more likely to experience difficulties with the worsening of a patient’s health status and at the initiation of home-based care. They also experienced difficulties with understanding medical conditions of patients and their families, supporting decision-making, and cooperating with visiting physicians. Their level of understanding about the explanation given by physicians and the sense of value of patients and families were factors that affected such difficulties, and so, in order to resolve them, the importance of cooperating to secure medical and nursing personnel and creating a setting where they can share their knowledge of patients’ conditions and treatments was indicated. In survey ２, the following ６ categories were extracted as difficulties encountered by visiting nurses providing assistance to home-based cancer patients requiring palliative care :［dealing with the worsening of the disease］, ［predicting the end of life］, ［being unable to care for patients without cooperation］,［being involved with patients by understanding their life before illness］,［preparing a home care environment for a patient’s end-of-life］, and［limits of current work situations］. The findings suggest the need not only to provide palliative care knowledge for the prediction and understanding of illness, but also to establish a system that allows multiple medical providers to assess patients’ conditions, in order to deal with their difficulties.