『保健医療科学』2026 Vol.75 No.2 p.192－193
＜研修報告＞
令和 7 年度専門課程Ⅰ
保健福祉行政管理分野
オンライン診療（D to P with N）における看護師の医行為等の現状と課題に関する研究―
原田昌範
A Study on the Current Status and Challenges of Medical and Related Practices Performed by Nurses in Online Medical Care (Doctor-to-Patient with Nurse)
HARADA Masanori
抄録
目的 人口減少・高齢化が進むへき地での医療アクセス確保に向け，看護師同席型オンライン診療（D to P with N）における看護師が実施する医行為等の実態，課題，および今後のニーズを明らかにすることを目的とした．
研究デザインと方法 2025 年に実施された，D to P with N経験のある医師・看護師 81 名を対象としたオンライン調査データを二次利用し，医行為等の実態や属性別の実施状況等について割合を算出し，勤続年数と医行為経験数の関連について分析した．
結果 看護師はアセスメントに加え，遠隔指示下での検体採取や創傷処置等の医行為を幅広く実践していた．特に特定行為研修修了者は未修了者より侵襲的な医行為を有意に多く実施しており，勤続年数と医行為等の経験数にも正の相関が認められた．また，今後の実施意向も高く，潜在的なニーズが示された．
結論 D to P with Nは，へき地医療の質向上に資する可能性が示唆された．普及には，教育体制の整備に加え，責任の明確化や診療報酬上の適切な評価といった制度的課題の解決が求められる．
キーワード: オンライン診療，D to P with N，医行為，特定行為研修，へき地医療
Abstract
Objective To ensure sustainable medical access in remote areas facing population decline and aging,online consultations where a nurse is present with the patient (D to P with N) are highly anticipated. This study aimed to clarify the current status, challenges, and future needs regarding medical procedures performed by nurses within the D to P with N model.Methods This study utilized secondary data from an anonymous, self-administered online survey conducted in 2025, involving 81 physicians and nurses with experience in D to P with N. Descriptive statistics were calculated for the status and challenges of medical procedures, and correlations with factors such as
years of service were analyzed.Results In addition to assessment, nurses performed a wide range of medical procedures, such as specimen collection and wound treatment under remote instructions. In particular, those who completed specific procedure training performed significantly more invasive medical procedures than those who did not, and a positive correlation was also observed between years of service and experience with medical procedures.
There was also a high intention to perform these procedures in the future, indicating a potential need.Conclusion D to P with N can be an effective model for improving medical quality in remote areas. For its widespread adoption, it is essential to establish educational systems to ensure safety and resolve institutional issues, such as clarifying legal responsibility and ensuring appropriate medical fee reimbursement.
keywords: Telemedicine, Doctor to Patient with Nurse (D to P with N), Clinical procedures, Specified Medical Acts Training, Rural Medicine