Development and evaluation of asbestos related health consultation for public health nurses.

由于间皮瘤的数量迅速增长，人们对石棉感到焦虑。然而，没有针对公共卫生护士的石棉相关健康咨询指南。NPO对344份石棉相关咨询记录的分析显示，石棉患者的担忧因素多种多样，如暴露焦虑（包括儿童在学校的暴露）、对石棉相关疾病发病的担忧、患者的问题、丧亲者的悲伤等。咨询需要医学、建筑、法律、心理学等方面的知识。尤其，家长担心孩子的暴露；为家长和儿童建立了一个关于石棉的网站。对各卫生院的调查显示，某卫生院每年有3名卫生员进行石棉相关咨询，每年有5.3例。超过70%的医疗中心有护士担任顾问。在顾问中，只有14%的人参加过培训，35.4%的人根本没有使用过手册。约70%的石棉相关健康咨询人员因对需要多种专业知识的罕见会诊不能保留知识而对自己的职责没有信心。这些结果表明需要制定石棉相关健康咨询指南。然而，其他研究小组制定了一个很好的指导方针，我们关注的是病人的痛苦，这是医疗中心工作人员最困难的问题。我们对14例恶性胸膜间皮瘤患者进行了研究，发现其存在恶性、罕见和石棉诱发的多重困难。由于间皮瘤进展迅速，在一个问题解决之前，新的问题不断出现。此外，由于医护人员缺乏对间皮瘤的知识和经验，患者认为他们没有得到很好的治疗。

Because the number of mesothelioma grew rapidly, people are anxious about asbestos. However there was no guideline of asbestos related health consultation for public health nurses. Analysis of 344 asbestos related consultation records by NPO showed many kinds of worriers,such as anxiety on exposure, including children's exposure in school, worriers of onset of asbestos related diseases, problems of patients, grief of bereaved. Consultation requires knowledge such as medical, construction, law, psychology and so on. Especially, parents worried children's exposure; a website for parents and children about asbestos was established. The survey on all health centers showed a health center put 3 health staffs for asbestos related consultation and had 5.3 cases in previous year. More than 70 % health centers put nurses as consultants. Among consultants, only 14% attended training and 35.4% did not used manual at all. About 70% of staffs of asbestos related health consultant were not confident on their duty because they cannot keep their knowledge for rare consultation that requires many kinds of special knowledge. Those result indicated the needs of guideline of asbestos related health consultation. However other research group developed an excellent guideline, we focused a patients' distress that was most difficult issue for health center's staffs. According to our research on 14 malignant pleural mesothelioma patients, they were in multiple difficulties caused by malignancy, rareness and happened by asbestos. Since mesothelioma progress fast, new problems keep happening before one problem was solved. Also, patients felt they were not well treated because medical staffs were lack of knowledge and experience in mesothelioma.