性感染症女性患者の看護における患者 : 看護師関係の構築

type:text

[要旨] 【目的】看護職者が性感染症女性患者に対して看護を提供するために，患者‐看護師関係をどのように構築しているかを明らかにする．【方法】産婦人科の外来・病棟で３年以上勤務経験がある看護職者６名を対象に半構成的面接を実施し，得られたデータを質的・帰納的に分析した．【結果】性感染症女性患者の看護において，看護師は，【出会いから場面を重ねて患者像を探っていく】，【患者像を明確化し，看護の方向性を見極めようとする】，【患者の受診行動を受け止め寄り添い振り返る】，【患者像と照らし合わせて患者の反応をみながら性感染症の説明を行う】，【看護に向けてこの患者の環境調整や準備をする】，【患者との関係を築きかかわりを持てない障壁や困惑を感じる】の６カテゴリーから，患者－看護師関係を構築していた．【考察】性感染症女性患者‐ 看護師関係の構築における以下の４つの特徴が明らかになった．(1)患者からの強い訴えに応じて患者－看護師関係が受動的に始まる．(2)看護師は患者像を明確化し，看護の方向性を見極めるが，患者のセクシュアリティに対する躊躇によって，患者と看護ニーズを共有し，共に問題解決に向かうような患者－看護師関係が構築されないことがある．(3)患者と看護目標を共有できるような患者－看護師関係でないため，看護評価が曖昧になり，次回の看護につながらない．(4)プライバシーを保護してセクシュアリティに配慮することで，患者－看護師関係が構築され，患者の行動を方向付けることができる．

[Abstract] 【Aim】 The aim was to clarify how nursing professionals build patient-nurse relationships for the purpose of providing care to female patients with sexually transmitted infections(STI). 【Method】 A semi-structured interview was conducted with 6 nursing professionals with at least 3 years of experience working in an obstetrics and gynecology ward/outpatient clinic; and qualitative, inductive analysis was conducted on the acquired data. 【Results】 When caring for female patients with STI, nurses build patient-nurse relationships by practicing the following 6 categories: Deepening their patient image from the start and after each encounter; clarifying their patient image to ascertain the approach to care; accepting patient consultation behavior, getting close, and reflecting on the care; explaining the STI while watching patient response and comparing to patient image; controlling the environment and preparing for care; and sensing quandaries and obstacles not associated with building relationships with patients. 【Discussion】 This research clarified the following 4 characteristics in building patient-nurse relationships with female STI patients. (1) The patient-nurse relationship begins passively by responding to strong requests from the patients. (2) Nurses formulate patient images to ascertain the approach to care, but the kind of patient-nurse relationship where care needs are shared with the patient to jointly approach problem-solving is not built due to uncertainty about patient sexuality. (3) Since the patient-nurse relationship is not one of jointly striving with the patient for care goals, the care assessment is vague and does not link to subsequent care. (4) The patientnurse relationship is built by ensuring sufficient patient privacy while taking sexuality into consideration to enable nurses to guide the orientation of patient behavior by gaining patient trust.