心不全と糖尿病を併せもつ人に対する慢性疾患看護専門看護師のセルフケア支援の内容

• Published in: 日本看護科学会誌 Vol. 44; no. 1; pp. 567 - 577
• Main Authors: 山﨑 優介, 黒田 寿美恵
• Format: Journal Article
• Language: Japanese
• Published: 日本看護科学学会 2024; 公益社団法人 日本看護科学学会
• Subjects: Certified Nurse Specialist; Comorbidities; diabetes; heart failure; self-care; セルフケア; 併存疾患; 専門看護師; 心不全; 糖尿病
• ISSN: 0287-5330; 2185-8888
• DOI: 10.5630/jans.44.567

要旨　目的：心不全と糖尿病を併せもつ人に対する慢性疾患看護専門看護師のセルフケア支援の内容を明らかにすることで，両者を併せもつ人のセルフケアを促進する看護支援への示唆を得る．　方法：慢性疾患看護専門看護師19名を対象に半構造化面接を行い，質的帰納的に分析した．　結果：【心不全と糖尿病の優先度決定における本人の意向の最大限尊重】【病状の慎重な見極めによるセルフケアの優先性・厳密性の調整】【心不全と糖尿病の相互関係に対する認識強化】【両立しづらく複雑な心不全と糖尿病のセルフケアの一体化・簡素化】【心不全と糖尿病の専門性に依拠した支援方針の差異統一】等の10カテゴリが得られた．　結論：心不全と糖尿病のセルフケアの優先度決定において医学的判断と本人の意向との妥協点を探ること，セルフケアの一体化・簡素化などが，心不全と糖尿病を併せもつ人のセルフケアを促進する上で重要な看護支援であることが示唆された． 　Purpose: To promote self-care for people with concurrent heart failure and diabetes mellitus(HF-DM), this study aimed to elucidate the content of nurses' self-care support by certified nurse specialists in chronic care nursing and obtain suggestions for nursing support for people with HFDM.　Methods: Semistructured interviews with 19 nurse specialists certified in chronic care nursing were conducted, and data were qualitatively and descriptively analyzed.　Results: Ten categories were obtained, including "maximum respect for the people's wishes in determining the priority of HF-DM," "adjustment of priority and rigor of self-care through careful assessment of medical conditions," "reinforcing awareness of the interrelationship between HF and DM," "unifying and simplifying self-care for HF-DM that are difficult and complex to manage together," and "unifying different support policies that rely on the expertise of HF and DM."　Conclusion: Seeking a compromise between people's wishes based on medical judgment in deciding self-care priority for HF-DM and integrating and simplifying self-care for HF-DM are important nursing support in promoting self-care for people with HF-DM.