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緩和ケアに関わる一般病棟看護師の心身の負担度とその要因

By 中村 悦子, 中村 圭子 and 清水 理恵

Abstract

8施設の一般病棟の看護師を対象に、緩和ケアを受ける患者・家族、医師との関わりを中心に心身の負担度とその影響要因について質問紙調査を行った。心身の負担度は、「悩み」「辛さ」「逃避」「無力」「不眠」「疲労」「イライラ」とし、5段階で評価した。心身の負担度は、全体では「一日の仕事を終え疲労を感じる」「患者とどのように関わっていいのか悩む」が高かった。若い年代ほど負担度が高い傾向にあった。心身の負担度に影響する因子は、ロジスティック回帰分析より3つの尺度の影響因子が抽出された。「職場環境」「患者との関わり体験」「生き方」が強く影響していた。また、患者が「後どのくらい生きられるか」と聞いてきたなど、患者のスピリチュアルな問いに対し、どのように答えるのか、死にゆく患者の運命に、意味や価値を見いだせない苦悩が看護師の心身の負担を強くしていると考えられた。看護師の心身の負担軽減には、緩和ケア教育の推進、緩和ケアを十分に提供できる職場環境、チームアプローチの効果的運用の必要性が示唆された。We carried out a questionnaire survey among women nurses in the general ward at eight hospital institutions on the topic of physical and mental burden and the factors influencing it, focusing on the nurses\u27 relationship with patients who are taking palliative care and their families, and with the doctors. The burden was evaluated on a five-point scale regarding “distress”, “painfulness”, “escape”, “helplessness”, “sleeplessness”, “fatigue”, and “frustration”. Overall, high ratings were given to “feeling fatigue after finishing work for the day” and “distressed at how to get along with patients”. The younger generation showed a tendency of higher levels of burden. As factors influencing the physical and mental burden, three lower level scales were picked out according to logistics regression analysis. “Workplace environment”, and “Experience of communication with patient " “A way to live” had a strong influence. In addition, it was believed that the physical and mental burden of the nurses was intensified by the agony that they cannot find meanings and values in the fate of dying patients, wondering how to respond to the spiritual questions they asked, such as "How long can I survive?" The necessity for the promotion of education on palliative care, the working environment in which the care can be fully provided, and the effective operation of a team approach were suggested for lightening the physical and mental burden of nurses

Topics: palliative care, nursing staff in the general ward, physical and mental burden, 緩和ケア, 一般病棟看護師, 心身の負担度
Publisher: 新潟青陵学会
Year: 2010
OAI identifier: oai:n-seiryo.repo.nii.ac.jp:00001570
Journal:

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