大江 理英

Intensive care unit (ICU) nurses' professional autonomy is a critical factor affecting their ability to sustainably provide high-quality care to patients who are critically ill and to their families. However, in the absence of a systematic or scoping review of ICU nurses' professional autonomy, limited information and evidence are available on this topic. The aim of this scoping review was to clarify the extent and type of evidence on ICU nurses' professional autonomy. This scoping review was conducted in accordance with the Joanna Briggs Institute methodology for scoping reviews. The following research questions were addressed: (1) Which areas of interest and trends regarding ICU nurses' professional autonomy have been explored in studies published in scientific journals? And (2) What is known about ICU nurses' professional autonomy? The data sources included MEDLINE, CINAHL Ultimate, PsycINFO, Cochrane Library, and Ichushi-Web of the Japan Medical Abstracts Society databases. Identified studies were mapped based on their aim, design, methodology, and key findings and categorized according to their focus areas. Of the 734 identified studies, 16 were analyzed. The identified categories were as follows: "relationship between professional autonomy and mental issues," "experiences and processes of exercising professional autonomy," "relationship between professional autonomy and nurse-physician collaboration," "relationship between professional autonomy and demographic characteristics," "concept of professional autonomy," "barriers to professional autonomy," and "team approach to improve professional autonomy." Most studies have focused on the relationship between professional autonomy and mental health issues and nurse-physician collaboration and few included interventions to enable or promote the exercise of professional autonomy, highlighting a research gap. Future research should identify factors that inhibit the professional autonomy of ICU nurses and that can be changed through interventions and should develop educational and organizational change-based interventions to modify the factors.

災害拠点病院は事業継続計画（BCP）の策定が必要である．本研究はICUにおけるBCPの策定，運用，点検に関する状況から集中治療室の災害に対する備えに関する実態を明らかにすることを目的とした．全国153のICUから回答を得た．BCPを策定しているのは119施設（77.8％）であり，そのうちICUの内容を記載しているのは69施設（58.0％）であった．BCPを策定する特定のチームがあるのは101施設（84.9％）であり，策定チームには治療室所属の看護師や災害有識者が半数以上を占めていた．BCPの運用経験を有しているのは実災害で7施設（6.0％），訓練で68施設（58.7％）であり，BCPを点検しているのは94施設（81.7％）であった．BCPを策定している施設は多いが，ICUに関する記載がある施設は半数程度であった．災害に対する備えとしては，策定したBCPの運用，点検も含めた管理が重要である．

【目的】救急看護師の自律性尺度の開発と尺度の信頼性と妥当性を検証する． 【方法】救急看護師の自律性尺度原案の表面妥当性と内容妥当性を確認し，救急看護師の自律性尺度案77項目について3408名の救急看護師を対象に無記名自記式質問紙調査を実施し信頼性と妥当性を検証した． 【結果】有効回答は434名．救急看護師の自律性尺度案は探索的因子分析で3因子33項目が抽出され，信頼性としてCronbachのα係数による内的一貫性，再テスト法により安定性，妥当性として看護の専門職的自律性測定尺度・DPBS・職務満足測定尺度との基準関連妥当性が確認された． 【考察】救急看護師の自律性尺度は救急患者と家族の擁護と治療推進と回復支援を自ら考え行動する尺度項目で構成された． 【結論】救急看護師の自律性尺度は，信頼性と妥当性を有する尺度であると確認された．

【目的】集中治療の効果がなく死にゆく患者の家族の悲嘆への看護実践の内容を明らかにする。 / 【方法】ICUの看護師11名に半構造化面接を行った。逐語録の内容からコードを抽出し、カテゴリへ高次化した。 / 【結果】本研究の参加者は、…… [Purpose] This study aimed to analyze the content of nursing practice for grief of families of patients dying after unsuccessful intensive care, and clarify the specific nursing practice. / [Methods] A semi-structured interview was conducted with 11 nurses who worked in the ICU. The code was extracted from the contents of the verbatim, and it was made higher in the category. / [Results] The Research Participants were ......

BACKGROUND: We aimed to clarify usefulness of the modified Frailty Index 11 (mFI-11) for assessing risk of postoperative complications (POCs) and effectiveness of perioperative management team (POMT) intervention for improving postoperative status of frail aged patients requiring colorectal cancer (CRC) surgery. METHODS: We compared, retrospectively, surgical outcomes among 151 consecutive CRC surgery patients aged ≥80 years. Patients were grouped by mFI-11 scores and by POMT intervention (vs. no POMT intervention). RESULTS: POCs were more prevalent, postoperative stays were longer, and discharge status was poorer among high-risk (mFI-11 ≥ 3/11) patients without POMT intervention than among low-risk (mFI-11 ≤ 2/11) patients (p = 0.04, p = 0.02, p < 0.01). Multiple POCs occurred less frequently and performance of activities of daily living was better for high-risk patients with (vs. those without) POMT intervention (p = 0.04, p = 0.03). CONCLUSION: POMT intervention appears beneficial for frail aged patients scheduled for CRC surgery.