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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.

Purpose: This study aimed to develop an autonomy scale for emergency nurses and verify its reliability and validity. Method: Upon confirming the face and content validity of the initial draft of the autonomy scale for emergency nurses, an anonymous self-report questionnaire of the 77-item draft scale was administered to 3408 emergency nurses. The scale’s reliability and validity were examined thereafter. Results: A total of 434 valid responses were obtained. Following an exploratory factor analysis of these responses, 33 items were extracted across three factors within the draft scale. For reliability, internal consistency was confirmed by Cronbach’s alpha coefficient, and stability was confirmed by the test-retest method. For validity, criterion-related validity was confirmed using the Professional Autonomy Scale, Dempster Practice Behavior Scale, and Job Satisfaction Scale. Discussion: The autonomy scale for emergency nurses encompasses items that evaluate independent thinking and actions aimed at advocating for, treatment of, and support for the recovery of emergency patients and their families. Conclusion: The reliability and validity of the autonomy scale for emergency nurses is confirmed in this study.

【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.

The mortality rate after thyroid surgery is extremely low at less than 0.4%, and the prognosis of thyroid cancer is relatively good among the malignant diseases. Outpatient thyroidectomies have been often performed. The important complications of thyroid surgery include critical upper airway obstruction, bleeding and hematoma, and recurrent laryngeal nerve palsy. Although the incidence of these complications is low, intensive care is required when they do occur. The incidence of critical upper airway obstruction after thyroid surgery is as low as approximately 1%. However, postoperative upper airway obstruction after thyroid surgery can be a life-threatening problem. The possible mechanisms of critical upper airway obstruction are as follows: compression by postoperative bleeding or hematomas, edema from venostasis and lymphostasis, recurrent laryngeal nerve palsy, and a combination of these. The risk factors for critical upper airway obstruction are still unclear. It is difficult to estimate the probability of its occurrence. The key to its successful management is “early detection and intervention”. The medical team needs to fully understand the dangers and the management of the critical upper airway obstruction.

本研究の目的は,救命救急センターに勤務する看護師の自律性を明らかにすることである.救命救急センター5施設に勤務する看護師15名に対して看護師の自律性について半構成面接調査を行った.得られたデータを質的帰納的に分析し,自主的・主体的な判断に基づき,イニシアチブや責任を取っている行動の特徴を探り,自律性の構成要素を検討した.【救急患者と救急の場への判断に基づく救命のための行動】【救急患者・家族の人格を尊重するための行動】【救急患者と家族のニーズを引き出し充足するための行動】【救急看護師と救急患者・家族との協働を促進する行動】【救命のために医療チームで協働すること】【看護ケアの質を維持・向上させるための行動】の6つのカテゴリが抽出された.救急患者の家族との協働や医療チームのメンバーを支援する行動は,既存の自律性測定尺度の構成要素に含まれていなかった.(著者抄録)

近年、当院では高度な技術を必要とする手術が増加する一方、ASA3以上の重症患者の割合が増加し総手術(麻酔)件数の13%を超えている。しかし、入院は手術前日に行われることが多いため手術を受けるための準備期間は極めて短く、疼痛緩和を含めた術後管理も効果的に行われているとはいえなかった。重症患者に対する高度な医療を安全に行うためには質の高い周術期管理が求められており、急性・重症患者看護専門看護師を中心に歯科を含めた医師、手術室、摂食・嚥下障害看護認定を含む看護師、薬剤師、歯科衛生士、管理栄養士、理学療法士、医事課を含む多職種による周術期管理チームを立ち上げ各々連携することで能率的、集学的なアプローチを可能にした。対象手術は術後に呼吸嚥下障害を来しやすい食道癌根治術、甲状腺癌気管合併切除術としたが、チームが介入した患者は全員誤嚥性肺炎を起こすことなく退院可能であった。チームを立ち上げる上で重要なポイントは、視野の広い看護師をチームの中心に配置すること、病院長を含めた組織の各部署どうしの情報伝達を良くして充分な相互理解を得ること、口腔機能管理料、リハビリテーション総合計画管理料、栄養食事指導料などを含め利益を生むシステムにすることであると思われた。(著者抄録)