A mixed-methods approach to clinical reasoning of nurses regarding the spiritual pain of terminal cancer patients

• Project/Area Number: 16K12064
• Research Category: Grant-in-Aid for Scientific Research (C)
• Allocation Type: Multi-year Fund
• Section: 一般
• Research Field: Clinical nursing
• Research Institution: Yamaguchi University
• Principal Investigator: TANAKA Aiko 山口大学, 大学院医学系研究科, 教授 (10285447)
• Co-Investigator(Kenkyū-buntansha): 後藤 みゆき 純真学園大学, 看護学科, 教授 (30547972) ; 永田 千鶴 山口大学, 大学院医学系研究科, 教授 (50299666)
• Project Period (FY): 2016-04-01 – 2020-03-31
• Project Status: Completed (Fiscal Year 2019)
• Budget Amount: ¥4,160,000 (Direct Cost: ¥3,200,000、Indirect Cost: ¥960,000); Fiscal Year 2019: ¥1,690,000 (Direct Cost: ¥1,300,000、Indirect Cost: ¥390,000); Fiscal Year 2018: ¥1,170,000 (Direct Cost: ¥900,000、Indirect Cost: ¥270,000); Fiscal Year 2017: ¥650,000 (Direct Cost: ¥500,000、Indirect Cost: ¥150,000); Fiscal Year 2016: ¥650,000 (Direct Cost: ¥500,000、Indirect Cost: ¥150,000)
• Keywords: 終末期看護 / がん患者 / 気がかり / スピリチュアルケア / 混合研究法 / 看護師の臨床推論 / 共分散構造分析 / 多母集団同時分析 / スピリチュアルペイン / 臨床推論 / 一般病棟 / 緩和ケア病棟 / 訪問看護ステーション / 気がかりや本当の思い / アンケート調査 / がん / 看護師 / 質問紙 / CVI / 在宅 / M-GTA / 終末期 / 終末期がん患者 / 介入モデル

Outline of Final Research Achievements

The objective of this study was to clarify the actual situation of how nurses involved in terminal cancer care infer the “concerns and true feelings” of their patients and to create a model for clinical reasoning related to these concerns and true feelings. A mixed-methods research design was used. We conducted semi-structured interviews with nurses working in general wards, palliative care wards and home-visit nursing stations. Data were analyzed qualitatively, and a 25-item scale was created. A questionnaire survey using the scale was then conducted among nurses nationwide.
Covariance structure analysis was used to examine the scale from 1864 responses to construct a path model for clinical reasoning. “Basic care” was related to “clinical reasoning”, and “knowledge and communication skill” contributed to that process. Furthermore, a simultaneous multi-population analysis showed no difference in clinical reasoning between the three models.

Academic Significance and Societal Importance of the Research Achievements

本研究の結果から、表出困難な終末期がん患者の「気がかりや本当の思い」に対する看護師の臨床推論の過程を導き出し、看護介入への示唆を得る。このことは、患者のスピリチュアルペインの軽減や生活の質の維持向上につながる。

Research Products

• [Journal Article] A model of Spiritual Care of Home Visiting Nursines for Patiants with Terminal Cancer Using Qualitative Study (2019)
  • Author(s): Chizuru Nagata, Aiko Tanaka, Rosanna McMaster
  • Journal Title: The bulletin of the Yamaguchi Medical School Volume: 65 Pages: 45-54
  • Peer Reviewed / Open Access
• [Presentation] がん疾患で人生の最終段階にある患者の「気がかりや本当の思い」に対する看護師の臨床推論の実態 (2020)
  • Author(s): 田中愛子、永田千鶴、後藤みゆき、安達圭一郎
  • Organizer: 日本看護研究学会第46回学術集会
• [Presentation] Nurses' assessment of spiritual pain for patients with terminal cancer in Japan: Questionnaire development (2019)
  • Author(s): Tanaka Aiko, Nagata Chizuru, Goto Miyuki, Adachi Keiichiro
  • Organizer: RCN International Nursing Research Conference
  • Int'l Joint Research
• [Presentation] Hospital Nurses' Involvement with Clinical Reasoning and Spiritual Care of Patients with Terminal Cancer (2018)
  • Author(s): Aiko Tanaka. Chizuru Nagata, Miyuki Goto, Rosanna McMaster
  • Organizer: The 7th Gloval Congress for Qoalitative Heath Research
  • Int'l Joint Research
• [Presentation] An Exploration of Spiritual Care of Home Visiting Nurses for Patients with Advanced Cancer (2018)
  • Author(s): Chizuru Nagata, Aiko Tanaka, Rosanna McMaster
  • Organizer: Sigma Theta Tau International's 29th International Nursing Research Congress
  • Int'l Joint Research
• [Presentation] 末期がん患者のスピリチュアルペインに対する緩和ケア病棟看護師の介入 (2018)
  • Author(s): 後藤みゆき、田中愛子
  • Organizer: 第42回日本死の臨床研究会
• [Presentation] 看護師のインタビューからみたスピリチュアルペインのアセスメントと向き合い方 (2017)
  • Author(s): 田中愛子、後藤みゆき
  • Organizer: 第41回 日本死の臨床研究会