当院ICU における意思決定支援の変化～公認心理師が入院時重症患者対応メディエーターの役割を担って～

市立函館病院集中治療部において，公認心理師が入院時重症患者対応メディエーターとして１年間に介入した患者57例について検討した．患者・家族の心理的動揺が大きいために，重篤な病状の受容支援が中心となったが，１/３は意志決定支援まで行うことができた．支援を重ねる過程で，意思決定支援の中心的な役割は，病棟看護師へと移行していった．重症患者支援の中でも特に意思決定支援については，病院全体で取り組むことが望ましく，公認心理師は支援者支援や悲嘆ケアなど専門性を活かした役割を担うべきである．We examined 57 severely ill patients who were supported by Certified Public Psychologists as Critical Care Mediator in the intensive care unit of Hakodate Municipal Hospital over a year. Because of the great psychological turmoil experienced by patients and their families, the primary focus was on support for acceptance of serious medical conditions. However, one third of the patients were able to receive support for decision-making.Gradually the central role of decision-making support shifted to ward nurses. Specifically, in the support for critically ill patients, decision-making support should be addressed by the hospital. Additionally, Certified Public Psychologists should utilize their expertise in areas such as person support and grief care.journal articl