[研究報告] がん相談に従事する看護師の就労支援の困難の内容分析

要旨：就労年齢におけるがん罹患者の増加に伴い、医療機関と企業や労働機関が連携する包括的な就労支援が2016年に始まった。そこで、本研究はがん相談に従事する看護師の就労支援とその困難の実態を明らかにすることを目的とした。　がん診療連携拠点病院426施設の看護師を対象として質問紙調査を実施し、106名（回収率24.9%）の回答を得た。　就労先との情報共有や就労可否の判断の調整など連携する支援内容、進行・再発・転移時や緩和ケア移行時など身体状況が変化する支援時期は、他の支援内容・時期と比べて困難を感じる割合が高かった。　困難を感じる理由を分析した結果、就労先との連携に関する支援の困難の要因は、看護師の知識・経験不足、就労先の就労支援に対する理解不足、就労支援の体制整備・連携不足と考えられた。身体状況が変化する時期の就労支援の困難の要因は、先の見通しの不確かさの中で時期に応じた就労可否の判断や多様で個別性の高い対応が求められることに加えて、医療者の病状認識と就労者の就労意欲とのズレがあることが考えられた。　がん就労支援の課題解決で重要なのは、就労がん患者自身の症状のセルフケア能力と職場との調整能力が向上するよう支援することである。そのためには、就労がん患者自身が疾患・治療に伴う症状や生活の障壁となるものを具体的にアセスメント・対処ができ、今後の治療や病状管理の見通しをイメージできるよう支援することが必要である。Abstract：With the increasing number of patients with cancer within the working-age population, a comprehensive working support system was initiated in 2016 as a collaborative effort between medical institutions, companies and labour organizations. This study aimed to discuss and clarify the working support system provided by nurses and the difficulties they face while engaging in cancer consultations.A questionnaire survey that included nurses at 426 core hospitals that deliver collaborative cancer treatment was conducted, and answers were collected from 106 respondents（collection rate, 24.9%）.Based on the survey, nurses were found to have relatively more difficulties in terms of providing assistance such as sharing information with employers, coordinating assessment on patients’ ability or inability to work and the timing of providing assistance when physical condition changes including progression, recurrence, metastasis or transition to palliative care were involved compared to other types of assistance.In the analysis, factors that have contributed to the difficulties in cooperating with employers were a lack of knowledge and experience of nurses, a lack of understanding of the working support system by employers, the inadequacy of the working support system and insufficient cooperation. Conversely, factors that influenced the difficulties of the working support system, regarding the timing of providing assistance were assessment of patients’ working ability or inability while facing an uncertain future and the requirement of providing highly personalized assistance. In addition, it was suggested that there is a gap between medical personnel’s ability to recognize the disease condition and the patient’s motivation to work.To resolve these difficulties, it is important to provide assistance in order to improve the self-care agency of working patients with cancer, as well as their ability to adjust to workplaces. To this end, it is necessary to support working patients with cancer by assessing specific symptoms of their disease and symptoms post treatment, and helping them cope with obstacles of daily life to ensure that they can anticipate future treatment and disease management

[その他] 専門看護師教育課程修了後のがん看護専門看護師育成に向けた支援活動

要旨：　本活動の目的は、専門看護師教育課程修了後のがん看護専門看護師候補生及び新人がん看護専門看護師（以下、修了生）に対し、がん看護専門看護師としての役割遂行に必要な能力向上のための支援をすることである。　本活動は2018年度より開始となり、2020年度からは日本赤十字秋田看護大学大学院（以下、本学）の学長裁量教育・事業活動促進助成を受け、「はばたけ秋田のCNS」として現在も活動を継続している。その主な活動内容は事例検討会や研究活動、社会貢献への支援である。事例検討会においては、修了生が専門看護師として関わった困難事例に対して、修了生及び本学高度実践看護学（がん看護）教育課程の教員間で討議を行い、事例の分析や専門看護師としての思考過程の整理を行った。また研究支援では、修了生が共同で取り組んでいる研究のデータ分析に対して支援を行った。加えて、本学における授業の非常勤講師やがん看護学実習での臨床指導を依頼し、後進の育成を通して社会貢献ができるよう支援を行った。　修了生からは、本活動ががん看護専門看護師の役割遂行に必要な能力向上につながったとの報告が寄せられており、本活動の目的にかなった成果が得られたと考える。本活動は、臨床の場で修了生ががん看護専門看護師としての役割開発をしていく上で、重要な役割を果たしていると考えられ、今後も継続していくことが求められている。Abstract:　This activity aimed to support candidates and newly certified nurse specialists in cancer nursing (hereinafter referred to as “graduates”) who have completed the professional nursing education program for improving the necessary skills to perform effectively as professional nurses.　This activity started in the financial year 2018, and from the financial year 2020, it has been funded by the Japanese Red Cross Akita College of Nursing Graduate School (hereinafter referred to as “the College”) through the President’s Discretionary Grant for the Promotion of Education and Project Activities, and continues as “Habatake Akita no CNS.” The primary activities of the program are supporting case study meetings, research activities and social contributions. At the case study meetings, the graduates and faculty of the Advanced Practice Nursing (Cancer Nursing) Education Program discussed difficult cases that the graduates were involved in as professional nurses, analyzed the cases, and organized their thought processes as professional nurses. Concerning research support, we provided support for the data analysis of the research. Furthermore, we requested part-time lecturers for classes in our program and clinical instructors for oncology nursing practice, and provided support so that they can contribute to society through the development of future generations.　Students who have completed the program have commented that this activity has led to the improvement of their abilities necessary to carry out their roles as certified nurse specialists in cancer nursing, and we believe that the results have met the purpose of this activity. This activity is considered to play an important role in helping graduates develop their roles as certified nurse specialists in cancer nursing in clinical settings, and is expected to be continued in the future