高齢者の臨死期における看取りケア : 熟練看護師のナラティブから

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  • Palliative and end-of-life care for the elderly based on signs of approaching death : Findings from narratives of expert clinical nurses
  • コウレイシャ ノ リンシキ ニ オケル ミトリ ケア : ジュクレン カンゴシ ノ ナラティブ カラ

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[要旨]本研究は，看護師が高齢者の臨死期の兆候をどのように捉えて看取りケアを実践しているかを明らかにするために，老人看護専門看護師を含む熟練看護師15名にインタビューした．質的統合法を用いて分析した結果，逐語録から作成した188枚のラベルは，10段階のグループ編成を経て，最終ラベルの【臨死期の兆候：経験知から判断】【余命を見極める難しさ：臨死期に近づく兆候を捉える】【看取りへつなぐ：臨死期が近い現実を医師や家族と共有】【後悔しない看取り：高齢者の意思や家族の意向を尊重】【看取りの場所：高齢者や家族の希望を叶える難しさ】【看取りの体制に応じたケア：看護師は困難を感じつつも最善を尽くす】に統合された．看護師は，高齢者は突然何が起こるかわからないと認識しながら，臨死期に近づく様々な兆候を捉え，医師や家族と共有して看取りへつなぎ，高齢者の意思や家族の意向を尊重した，後悔しない看取りを選択できるように看取りケアを実践していた．

The purpose of this study was to clarify how nurses provide palliative and end-of-life care for the elderly based on signs of approaching death. Focus group interviews were conducted with 15 expert clinical nurses in gerontological nursing. The interview data were analyzed using the Qualitative Synthesis method. After conducting group formation in 10 steps, a total of 188 labels were integrated into the following six final labels: [Appearance of signs just before death: Assessment using the nurse’s practical knowledge], [Difficulty in judging life expectancy: Capturing signs of approaching death], [Connect to palliative care: Accepting the elderly person nearing death along with doctors and his/her family], [Not regretting end-of-life care: Respecting the will of the elderly and the intentions of his/her family], [Place to spend end-of- life: Difficulty of fulfilling the wishes of the elderly and his/her family ], and [Palliative care according to the management system of each facility: Nurses experience difficulties but do their best]. Nurses observe signs of approaching death in the elderly while considering the possibility that their condition will suddenly change to requiring a switch to palliative care with the consent of doctors and his/her family. Nurses then provide palliative care by allowing the elderly and his/her family to choose end-of-life care that they will not regret.

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