A Comparison between Needs of Family Members and Nursing Careof Nurse Practitioners to the Needs in the Emergency Department

The purpose of this study was to compare needs of family members with nursing care of nurse practitioners to the needs in the Emergency Department/ Emergency Center. We investigated nurses working at the ED/EC, by sending questionnaire by mail. Based on results of needs of the emergency patients\u27 family members whom we investigated in 2000 and 2001, we set 20 items as follows; explanations, psychological aspect of the family members, physical aspect of the family members, facilities and environment, waiting time, and actions of the medical staff. The subjects of the present study were 333 emergency nurses, 11 males and 322 women, and average age was 32.8±7.9 years old. As a result of studying the nursing practice for needs of the family members, it was \u22explanation\u22 that was the highest in practice degree. However, the nursing practice degree did not necessarily accord with needs of the family members. There were two elements that were the lowest in practice degree though highest in necessity on the part of family members. The first one was the mental care to make family members \u22feel that the best care was done\u22 and the second was the positive attitude to \u22listen to family members and get rid of their anxiety about the risk of the patient.\u22 On the contrary, what was high in practice degree though low in necessity on the part of family members was to \u22deal with the anxiety and fear of the family members\u22 and to \u22care for their fatigue and health\u22 It is necessary to improve of quality of family support by feeding back the problems shown in actions and practice of nurses themselves.救急患者家族のニーズとニーズに対する看護実践度の実態を明らかにすることを目的とし， 救急外来/救命救急センター勤務している看護師を対象とした郵送法による自記式質問紙調査 を実施した。調査内容は2000 年，2001 年に調査した救急患者の家族のニーズに対応させて， 説明に関する項目，家族の心理的側面・身体的側面への配慮に関する項目，設備・環境に関 する項目，待ち時間や医療従事者の行動に関する項目など20 項目を設定した。 調査対象は救急看護師333 名であり，男性11 名，女性322 名，平均年齢は32.8 ± 7.9 歳であっ た。救急患者の家族のニーズに対する看護実践度を比較した結果，「説明に関する項目」が最 も看護実践度が高く，家族のニーズと一致していた。しかし，救急患者の家族のニーズとそ の看護実践度は必ずしも一致せず，家族の高いニーズに対して看護実践度が低かったのは「最 善のケアが行われていると感じることができる」や「患者の生命の危機に関する不安の相談」 であった。逆に家族のニーズの順位は低かった「家族の不安やつらい思いを聞いてもらえる」 「家族の疲労や健康への配慮」の実践度は比較的高かった。今後，施設や部門の取り組みを通 して看護師自身の行動や看護実践をフィードバックすることによって，家族援助の質の向上 につなぐ必要性が示唆された。 Ⅰ．はじめに 急性疾患対応型の救急外来や救命救急センター における患者や家族への対応は，その病院全体の 評価を左右するともいわれている１）。しかし，初 期救急患者を診療する一方で，重症患者が搬入さ れるなど待ち時間が延長し，患者および家族の不 安や苦痛も増強するといった悪循環に陥ることも 多くみられる２-４）ことから，その援助の困難性が 指摘されている。そのため，患者のニーズ５），満 足度の調査６-８)や患者や家族に対する対応の検討 および改善の試み２）がなされてきた。 救急外来における満足度には，情報提供，待ち 時間あるいは待ち時間の説明などが影響すること８） が明らかにされ，またそれらが満足度だけでなく 救急外来受診時の不安にも影響を及ぼすことも報 告されている４）。さらに救急外来では，受診する 患者だけでなく家族の不安も強い９）10）。筆者らは 先行研究で救急外来を受診した患者の家族の不安 やニーズに関する研究を行い，患者の突然の予期 せぬ傷病が家族にも多大な心理的影響を与えてい ることを明らかにしてきた。 その上，救急患者や家族の多くは緊急度という 判断ができないため，とにかく診てもらいたいと 受診あるいは患者の付き添いとして来院すること が多い。そのため，特に待合室で患者を待つ家族 にとっては，患者の病状や主訴により

救急患者の家族のニーズとニーズに対する看護実践度の比較

The purpose of this study was to compare needs of family members with nursing care of nurse practitioners to the needs in the Emergency Department/ Emergency Center. We investigated nurses working at the ED/EC, by sending questionnaire by mail. Based on results of needs of the emergency patients' family members whom we investigated in 2000 and 2001, we set 20 items as follows; explanations, psychological aspect of the family members, physical aspect of the family members, facilities and environment, waiting time, and actions of the medical staff. The subjects of the present study were 333 emergency nurses, 11 males and 322 women, and average age was 32.8±7.9 years old. As a result of studying the nursing practice for needs of the family members, it was "explanation" that was the highest in practice degree. However, the nursing practice degree did not necessarily accord with needs of the family members. There were two elements that were the lowest in practice degree though highest in necessity on the part of family members. The first one was the mental care to make family members "feel that the best care was done" and the second was the positive attitude to "listen to family members and get rid of their anxiety about the risk of the patient." On the contrary, what was high in practice degree though low in necessity on the part of family members was to "deal with the anxiety and fear of the family members" and to "care for their fatigue and health" It is necessary to improve of quality of family support by feeding back the problems shown in actions and practice of nurses themselves.救急患者家族のニーズとニーズに対する看護実践度の実態を明らかにすることを目的とし， 救急外来/救命救急センター勤務している看護師を対象とした郵送法による自記式質問紙調査 を実施した。調査内容は2000 年，2001 年に調査した救急患者の家族のニーズに対応させて， 説明に関する項目，家族の心理的側面・身体的側面への配慮に関する項目，設備・環境に関 する項目，待ち時間や医療従事者の行動に関する項目など20 項目を設定した。 調査対象は救急看護師333 名であり，男性11 名，女性322 名，平均年齢は32.8 ± 7.9 歳であっ た。救急患者の家族のニーズに対する看護実践度を比較した結果，「説明に関する項目」が最 も看護実践度が高く，家族のニーズと一致していた。しかし，救急患者の家族のニーズとそ の看護実践度は必ずしも一致せず，家族の高いニーズに対して看護実践度が低かったのは「最 善のケアが行われていると感じることができる」や「患者の生命の危機に関する不安の相談」 であった。逆に家族のニーズの順位は低かった「家族の不安やつらい思いを聞いてもらえる」 「家族の疲労や健康への配慮」の実践度は比較的高かった。今後，施設や部門の取り組みを通 して看護師自身の行動や看護実践をフィードバックすることによって，家族援助の質の向上 につなぐ必要性が示唆された。 Ⅰ．はじめに 急性疾患対応型の救急外来や救命救急センター における患者や家族への対応は，その病院全体の 評価を左右するともいわれている１）。しかし，初 期救急患者を診療する一方で，重症患者が搬入さ れるなど待ち時間が延長し，患者および家族の不 安や苦痛も増強するといった悪循環に陥ることも 多くみられる２-４）ことから，その援助の困難性が 指摘されている。そのため，患者のニーズ５），満 足度の調査６-８)や患者や家族に対する対応の検討 および改善の試み２）がなされてきた。 救急外来における満足度には，情報提供，待ち 時間あるいは待ち時間の説明などが影響すること８） が明らかにされ，またそれらが満足度だけでなく 救急外来受診時の不安にも影響を及ぼすことも報 告されている４）。さらに救急外来では，受診する 患者だけでなく家族の不安も強い９）10）。筆者らは 先行研究で救急外来を受診した患者の家族の不安 やニーズに関する研究を行い，患者の突然の予期 せぬ傷病が家族にも多大な心理的影響を与えてい ることを明らかにしてきた。 その上，救急患者や家族の多くは緊急度という 判断ができないため，とにかく診てもらいたいと 受診あるいは患者の付き添いとして来院すること が多い。そのため，特に待合室で患者を待つ家族 にとっては，患者の病状や主訴により

Investigation of the Present Circumstances and Emergency Nursing Care System in the Emergency Department.

The purpose of this study was to examine the emergency circumstances and nursing care system in the Emergency Department（ED）．The subjects of the present study consisted of 181 patients and 214 their family members in the ED．The patients comprised 137 non-urgent and 44 urgent．The mean age of non-urgent patients was 32.6±25.6 years old and urgent patients 51.1±27.3 years old．28.2％ of 181 patients were under 15 years old and 18.8％over 70 years of age．The mean age of family members was 41.4±12.0 years old．The family members of the urgent patients were significantly more anxious than those of the non-urgent. Conclusions were considered as follows; 1． For promoting nursing quality and systematic efficiency，telephone counseling and triage nursing should be offered． 2． It is important to support family members as well as the patients, because they suffered from a grate psychological shock. 3． Education about judgment of emergency and home nursing care should be facilitated in the community.本研究では，九州北部の3病院の救急外来を受診した患者181名とその家族214名を対象に，その実態を調査し，救急外来における看護体制について検討した。患者は初期救急患者が137名，2次救急が44名，平均年齢はそれぞれ32.6±25.6歳，51.1±27.3歳であった。患者は15歳未満の小児が28.2％と最も多く，ついで70歳以上の患者が18.8％と多かった。患者の家族では，平均41.4±12.0歳であった。家族は不安が強く，初期救急患者の家族よりも2次救急患者の家族の不安が有意に強かった。 実態調査の結果より，①電話相談での対応およびトリアージナース配置の必要性，②家族援助の重要性，③家庭でできる看護の教育を行う場作りの必要性，が示唆された

初期・2次救急患者の実態と看護体制の検討

The purpose of this study was to examine the emergency circumstances and nursing care system in the Emergency Department（ED）．The subjects of the present study consisted of 181 patients and 214 their family members in the ED．The patients comprised 137 non-urgent and 44 urgent．The mean age of non-urgent patients was 32.6±25.6 years old and urgent patients 51.1±27.3 years old．28.2％ of 181 patients were under 15 years old and 18.8％over 70 years of age．The mean age of family members was 41.4±12.0 years old．The family members of the urgent patients were significantly more anxious than those of the non-urgent. Conclusions were considered as follows; 1． For promoting nursing quality and systematic efficiency，telephone counseling and triage nursing should be offered． 2． It is important to support family members as well as the patients, because they suffered from a grate psychological shock. 3． Education about judgment of emergency and home nursing care should be facilitated in the community.本研究では，九州北部の3病院の救急外来を受診した患者181名とその家族214名を対象に，その実態を調査し，救急外来における看護体制について検討した。患者は初期救急患者が137名，2次救急が44名，平均年齢はそれぞれ32.6±25.6歳，51.1±27.3歳であった。患者は15歳未満の小児が28.2％と最も多く，ついで70歳以上の患者が18.8％と多かった。患者の家族では，平均41.4±12.0歳であった。家族は不安が強く，初期救急患者の家族よりも2次救急患者の家族の不安が有意に強かった。 実態調査の結果より，①電話相談での対応およびトリアージナース配置の必要性，②家族援助の重要性，③家庭でできる看護の教育を行う場作りの必要性，が示唆された

A Study on the Factors Influencing the Anxiety of Family Members in the Emergency Department

The purpose of this study was to determine the factors which affect anxiety of family members in the emergency department (ED). 174 family members of patients participated in this study. The age of family members was a mean of 43.1 (range : 20 to 84) years and 59.8 % of them were women. The informations were obtained from a questionnaire filled out by the family members when they were waiting during examination and treatment of the patients. In this study, we divided the factors that influence the anxiety of family members into 4 categories ; demographic factors, the family\u27s individual factors, factors associated illness, and environmental factors in the ED. Multiple regression analysis with SPSS was used to identify the va riables contributing to the variance in anxiety. We used the State Anxiety Inventory (S-STAI) to measure anxiety. As a result, 8 variables involving in severity of illness, situation in the emergency room, disagreement between perceived severity of illness and actual severity of illness, having symptoms of trauma, neurological, heart, and respiratory problems, waiting time, family needs, naturally anxious personality and a first visit patient were identified as significant predictors of anxiety. These variables accounted for 46.9 % of total variance. These results suggest that nurses need more interaction with family members to reduce their anxiety

Promotive Factors and Obstructive Factors that Influence Adjustment to Disability in Patients Undergoing Home Oxygen Therapy

The purpose of this study was to explore factors which promote and obstruct the process of the disability adjustment in patients undergoing Home Oxygen Therapy (HOT). The study period was from September to October, 1999. We interviewed 27 patients who agreed to participate in this study. Each interview required approximately 40 minutes. The participants were asked to express their thought/feelings about the disability it\u27s course and progression. Data taken from the interviews were analyzed with a qualitative description method. As a result, 291 items were extracted from the interviews. The 13 following categories were found to promote the process of disability adjustment:positive attitude towards individuals with disability, absence of worry, passion for life, having a role, discovery of self-worth, a sense of disability self-management, carefulness from oxygen inhalation in public, family support, communication with friends, sharing the pain with other patients suffering from the same disease, having a hobby / a definite aim, increasing social activity, and having a longer history of illness (total 136 items). On the other, the following 11 categories (155 items) were found to obstruct the process of disability adjustment. These are prejudice towards disabled individuals, anger, shock, a feeling of loss, depression, fear of disease, being worried about oxygen inhalation in public, lack of family support, decreasing social activity, decreasing of social contact, and lack of stress management. The results of this study suggest the need for psychosocial intervention, namely a sense of symptom management, family support, social awareness/role maintenance, having a positive attitude to life, and self-acceptance.本研究の目的は，在宅酸素療法施行患者の障害受容の促進要因と阻害要因を明らかにすることである。実施期間は1999年9月～10月。主治医を介して協力を依頼し，同意の得られた患者27名に対して面接を行った。所要時間は平均40分。面接では，障害発生前～障害発生時～障害発生後に至るまでの時間的経過に沿って障害に対する気持ちを自由に語ってもらい，その結果を帰納的に分析する質的記述的研究法を用いた。 分析の結果，障害受容の影響要因について総計291のコードが得られ，障害受容の促進要因としては，【障害者へのプラスイメージ】【くよくよ悩まない】【生への執着心がある】【役割維持】【新たな価値の発見】【症状をコントロールできる感覚】【酸素吸入時に人目を気にしない】【家族サポートがある】【友人との交流がある】【同病者との交流がある】【趣味・生きがいがある】【行動範囲の拡大】【罹患歴が長い】の，13のカテゴリー（計136コード）が見出された。また，障害受容の阻害要因としては【障害者への偏見・同情】【怒り】【ショック】【喪失感】【抑うつ】【疾病脅威】【酸素吸入時，人目を気にする】【家族サポートがない】【外出頻度の減少・行動範囲の狭小化】【人付き合いの減少】【ストレス発散・気分転換不足】の，11のカテゴリー（計155コード）が見出された。本研究の結果から，症状をコントロールできる感覚，家族サポート，社会性・役割維持，プラス思考への転換，ありのままを受け入れること，以上の心理社会的介入の必要性が示唆された

在宅酸素療法施行患者の障害受容の促進要因と阻害要因

The purpose of this study was to explore factors which promote and obstruct the process of the disability adjustment in patients undergoing Home Oxygen Therapy (HOT). The study period was from September to October, 1999. We interviewed 27 patients who agreed to participate in this study. Each interview required approximately 40 minutes. The participants were asked to express their thought/feelings about the disability it's course and progression. Data taken from the interviews were analyzed with a qualitative description method. As a result, 291 items were extracted from the interviews. The 13 following categories were found to promote the process of disability adjustment:positive attitude towards individuals with disability, absence of worry, passion for life, having a role, discovery of self-worth, a sense of disability self-management, carefulness from oxygen inhalation in public, family support, communication with friends, sharing the pain with other patients suffering from the same disease, having a hobby / a definite aim, increasing social activity, and having a longer history of illness (total 136 items). On the other, the following 11 categories (155 items) were found to obstruct the process of disability adjustment. These are prejudice towards disabled individuals, anger, shock, a feeling of loss, depression, fear of disease, being worried about oxygen inhalation in public, lack of family support, decreasing social activity, decreasing of social contact, and lack of stress management. The results of this study suggest the need for psychosocial intervention, namely a sense of symptom management, family support, social awareness/role maintenance, having a positive attitude to life, and self-acceptance.本研究の目的は，在宅酸素療法施行患者の障害受容の促進要因と阻害要因を明らかにすることである。実施期間は1999年9月～10月。主治医を介して協力を依頼し，同意の得られた患者27名に対して面接を行った。所要時間は平均40分。面接では，障害発生前～障害発生時～障害発生後に至るまでの時間的経過に沿って障害に対する気持ちを自由に語ってもらい，その結果を帰納的に分析する質的記述的研究法を用いた。 分析の結果，障害受容の影響要因について総計291のコードが得られ，障害受容の促進要因としては，【障害者へのプラスイメージ】【くよくよ悩まない】【生への執着心がある】【役割維持】【新たな価値の発見】【症状をコントロールできる感覚】【酸素吸入時に人目を気にしない】【家族サポートがある】【友人との交流がある】【同病者との交流がある】【趣味・生きがいがある】【行動範囲の拡大】【罹患歴が長い】の，13のカテゴリー（計136コード）が見出された。また，障害受容の阻害要因としては【障害者への偏見・同情】【怒り】【ショック】【喪失感】【抑うつ】【疾病脅威】【酸素吸入時，人目を気にする】【家族サポートがない】【外出頻度の減少・行動範囲の狭小化】【人付き合いの減少】【ストレス発散・気分転換不足】の，11のカテゴリー（計155コード）が見出された。本研究の結果から，症状をコントロールできる感覚，家族サポート，社会性・役割維持，プラス思考への転換，ありのままを受け入れること，以上の心理社会的介入の必要性が示唆された

救急外来受診患者の家族の不安に影響を及ぼす要因に関する研究

The purpose of this study was to determine the factors which affect anxiety of family members in the emergency department (ED). 174 family members of patients participated in this study. The age of family members was a mean of 43.1 (range : 20 to 84) years and 59.8 % of them were women. The informations were obtained from a questionnaire filled out by the family members when they were waiting during examination and treatment of the patients. In this study, we divided the factors that influence the anxiety of family members into 4 categories ; demographic factors, the family's individual factors, factors associated illness, and environmental factors in the ED. Multiple regression analysis with SPSS was used to identify the va riables contributing to the variance in anxiety. We used the State Anxiety Inventory (S-STAI) to measure anxiety. As a result, 8 variables involving in severity of illness, situation in the emergency room, disagreement between perceived severity of illness and actual severity of illness, having symptoms of trauma, neurological, heart, and respiratory problems, waiting time, family needs, naturally anxious personality and a first visit patient were identified as significant predictors of anxiety. These variables accounted for 46.9 % of total variance. These results suggest that nurses need more interaction with family members to reduce their anxiety