Building a model for a support methodology based on expertise acquired during provision of palliative care

根据在提供姑息治疗期间获得的专业知识构建支持方法模型

• 批准号: 21390586
• 负责人: MORITA Minako
• 金额: $ 9.24万
• 依托单位: Japanese Red Cross College of Nursing
• 依托单位国家: 日本
• 项目类别: Grant-in-Aid for Scientific Research (B)
• 财政年份: 2009
• 资助国家: 日本
• 起止时间: 2009 至 2012
• 项目状态: 已结题
• 来源: https://kaken.nii.ac.jp/grant/KAKENHI-PROJECT-21390586/
• 关键词: 緩和ケア; がん; 実践知; 援助方法; 事例研究; 援助方法論; 事例分析; 看護; 看護援助; ケアリング

The purpose of this study was to develop a model for care methodology by analyzing the experience of nurses, specifically the clinical wisdom acquired during the provision of palliative care, and using it to improve the overall process. Taking our cue from Benner’s methods of studying clinical wisdom (1999/2005), we interviewed 20 nurses with three or more years of experience of providing palliative care. The characteristics of the nurses’ judgments and actions were analyzed in relation to 30 episodes that were reconstructed as narratives and given themes, then categorized according to their characteristics into the following nine major themes: judgment on pain/suffering and coping with it; conflict regarding sedation; continence support to protect the patient’s dignity; care that responds to the patient’s wishes; palliative care carried out using teamwork; care for the patient’s mental suffering; deathwatch; challenges faced by family carers; and the need for nurses to understand and respond to the wishes of home-cared patients and their families. The 30 episodes were categorized and organized according to their major themes, then compiled into a collection of cases, based on which we discussed support methodology from four viewpoints and obtained suggestions for practical application. The four viewpoints were (1) the relationship between nurses’ past practical experience and their attitudes to nursing, (2) how nurses understood patients and their families, (3) characteristics of practical judgments that are made considering what will happen next and how these judgments are acted on, and (4) the clinical wisdom both needed and acquired during the practice of team medicine.

本研究的目的是通过分析护士的经验，特别是在提供姑息治疗过程中获得的临床智慧，并利用它来改善整个过程，从而建立一个护理方法论模型。根据Benner的临床智慧研究方法（1999/2005），我们采访了20名具有三年或三年以上姑息治疗经验的护士。通过对30个重构叙事主题的护理事件的判断和行动特征进行分析，并根据其特征将其分为以下9大主题：对疼痛/痛苦的判断和应对；关于镇静的冲突；控制支持，以保护病人的尊严；满足病人愿望的护理；通过团队合作开展姑息治疗；关心病人的精神痛苦；临终看护;家庭照顾者面临的挑战；护士需要理解并回应居家护理病人及其家属的愿望。将这30集按照主题进行分类整理，整理成案例集，在此基础上，我们从四个角度对支持方法进行了探讨，并得出了实际应用的建议。这四个观点是(1)护士过去的实践经验与其护理态度之间的关系，(2)护士如何理解患者及其家属，(3)考虑接下来会发生什么以及如何采取这些判断的实际判断的特征，以及(4)团队医学实践中需要和获得的临床智慧。

项目成果

見取りと間身体性

米基米与肉体间性

• 发表时间: 2011
• 作者: H.Kawakami;et.al.;守田美奈子
• 通讯作者: 守田美奈子

緩和ケアの実践知に関する研究方法の検討-看護師の体験事例の分析を通して

姑息治疗实践知识研究方法的思考——通过护士经历案例分析

• 发表时间: 2011
• 作者: 守田美奈子、吉田みつ子;他6名
• 通讯作者: 他6名

見取りのケアと間身体性

三鸟无忧与肉体间

• 发表时间: 2012
• 期刊: メルロ・ポンティサークル研究
• 作者: 林直子;鈴木久美;大畑美里;他4名;鈴木久美;鈴木久美,林直子,大畑美里;MIKA NOMURA & FUSAKO NAKAMURA;FUSAKO NAKAMURA & MIKA NOMURA;守田美奈子;守田美奈子
• 通讯作者: 守田美奈子

緩和ケアにおける看護師の実践知-チーム全体でより良いケアを行う病棟文化の創出に向けて

护士在姑息治疗方面的实用知识 - 创造一种整个团队提供更好护理的病房文化

• 发表时间: 2013
• 作者: 奥原秀盛;守田美奈子;吉田みつ子;樋口佳栄;新藤悦子;福井里美;寄森梓
• 通讯作者: 寄森梓

緩和ケアにおける看護師の実践知その2-患者の尊厳を守り生前の意思を貫くことをチームで支えた看護実践の特徴.

姑息治疗护士的实用知识第 2 部分 - 护理实践的特点，其中团队支持患者保护他们的尊严并在死前实现他们的愿望。

• 发表时间: 2012
• 作者: 吉田みつ子;守田美奈子;樋口佳栄;奥原秀盛;新藤悦子;福井里美;寄森梓;田中孝美;安達裕子;坂井詩織;鈴木治子
• 通讯作者: 鈴木治子