| Budget Amount *help |
¥1,500,000 (Direct Cost: ¥1,500,000)
Fiscal Year 2006: ¥500,000 (Direct Cost: ¥500,000)
Fiscal Year 2005: ¥600,000 (Direct Cost: ¥600,000)
Fiscal Year 2004: ¥400,000 (Direct Cost: ¥400,000)
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| Research Abstract |
It may not be appropriate to evaluate the emergency care system in Japan based on indicators of structure and results alone, due to differences in form depending on regional characteristics and the fact that continuation of care following emergency treatment depends on patient characteristics. Therefore, we focused on indicators of processes, specifically the types of assistance provided to patients by nursing personnel during emergency treatment. Interviews regarding actual nursing care during emergency visits were conducted with secondary and tertiary emergency patients with cardiovascular disorders upon stabilization of overall condition. Matters indicated by these patients focused on their personal experiences during treatment, rather than the care provided by nurses. Analysis using the grounded theory approach was conducted after processing interview contents. Patient experiences comprised the following four categories : "entrusting the doctor with one's life" ; "sensation of not
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being oneself ; "shock of reality" ; and "desire for information on envisioning the future". In the struggle for survival during emergency treatment, which involved confusion and uncertainty, patients attempted to maintain their identity despite dependency on medical personnel, and to make sense of their experience. Nurses should thus support patients in critical condition by providing them with relief and comfort at each phase of emergency treatment, to enable patients to accept the continuing course of treatment. These findings deepened the understanding of the subjects of care in emergency nursing. In addition, these findings indicate the importance in emergency nursing of communication skills oriented toward consensus building for obtaining understanding and consent from patients in critical condition, as well as education for cultivating human understanding, which supports these skills. Unlike critical intensive care nursing, in which patients have already received definitive diagnoses, emergency nursing is characterized by the increased need for responses not only to present problems but also potential problems, as well as careful observations by nurses with caution and consideration for patients, due to the instability of overall condition caused by the lack of definitive diagnosis. Patients may experience anxiety and fear associated with physical pain, as well as confusion, upon the sudden onset of health problems, due to the inability to understand the situation. Nurses involved in initial treatment are responsible for paying attention and responding to these reactions, which may occur in patients in critical condition, and should ideally provide intervention from the time of initial treatment. While increased demands for promotion of functional differentiation and specialization among medical institutions have resulted in a greater emphasis on the role played by emergency care, various problems have been indicated. The present study is a basic study that aims to elucidate indicators for evaluating the quality of emergency nursing care from the perspective of deepening the understanding of the subjects of care by elucidating the actual conditions of patients undergoing initial treatment, and providing effective nursing practice. Less
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