Odachi Ryo, Tamaki Tomoko, Ito Mikiko, Okita Taketoshi, Kitamura Yuri, Sobue Tomotaka
Department of Nursing and Laboratory Science, Graduate School of Medicine, Yamaguchi University, Yamaguchi, Japan; Division of Health Sciences, Graduate School of Medicine, Osaka University, Osaka, Japan.
Division of Health Sciences, Graduate School of Medicine, Osaka University, Osaka, Japan; Department of Nursing, School of Nursing, Mukogawa Women's University, Nishinomiya, Japan.
Asian Nurs Res (Korean Soc Nurs Sci). 2017 Sep;11(3):207-215. doi: 10.1016/j.anr.2017.08.004. Epub 2017 Aug 14.
In Japan, about 80% of deaths occur in hospitals, especially long-term care beds. The purpose of this study was to clarify the nursing practices used for such older patients at the end-of-life stage in long-termcare wards via the modified grounded theory approach (M-GTA).
Data were obtained through semi-structured interviews of nineteen nurses working in cooperating long-term care wards, acute care wards, or hospice services (to allow for constant comparison between these types of wards) in western Japan in 2014. We analyzed the transcribed data using M-GTA.
The core category that emerged from the analysis was "Balancing enhancement of patients' daily life quality and life-sustaining care in the face of uncertainty about the patients' character." Eleven categories emerged, such as Seeking older patients' character with their family, Supporting families' decision making, Rebuilding patients' daily life in the ward, and Sustaining patients' life span through medical care.
Nurses experienced uncertainty about the care needs of older patients, the ethical problems of Enhancing the patients' QOL by using risky care, and the evaluation criteria used to judge their own nursing care after the patients' death. All nurses had the goal of ensuring a natural death for all patients. Nurses' acceptance and evaluation of their own care was critically influenced by the patient's family's responses to their care after patients' death. Further research is necessary to develop evaluation criteria and educational programs for end-of-life nursing care of older adults.
在日本，约80%的死亡发生在医院，尤其是长期护理床位。本研究的目的是通过改良扎根理论方法（M-GTA）阐明长期护理病房中此类老年患者在临终阶段所采用的护理实践。
2014年，通过对日本西部合作的长期护理病房、急性护理病房或临终关怀服务机构（以便对这些类型的病房进行持续比较）工作的19名护士进行半结构化访谈来获取数据。我们使用M-GTA对转录数据进行分析。
分析得出的核心类别是“在面对患者特征不确定性时平衡提高患者日常生活质量与维持生命的护理”。出现了11个类别，如与老年患者家属探寻患者特征、支持家属决策、在病房重建患者日常生活以及通过医疗护理维持患者寿命。
护士在老年患者的护理需求、通过使用有风险的护理提高患者生活质量的伦理问题以及患者死亡后用于评判自身护理的评估标准方面存在不确定性。所有护士都有确保所有患者自然死亡的目标。护士对自身护理的接受和评估受到患者家属在患者死亡后对其护理反应的严重影响。有必要进一步开展研究，以制定针对老年人临终护理的评估标准和教育项目。
