医療的ケア児の育ちを支える：保育所における医療的ケア児への看護師による支援

Providing Nursing Care for Children With Medical Complexities in Nursery Schools: A Grounded Theory Approach

要旨

　目的：医療的ケア児の保育中に看護師が行っている支援とは何かを明らかにすることにより，看護師の専門性に関する示唆を得る．

　方法：医療的ケア児が利用する保育所に勤務する看護師9名へ半構造化インタビューを実施し，収集したデータをグラウンデッド・セオリー・アプローチを用いて分析した．

　結果：看護師は《保育の状況確認》によって《保育者が抱く困難感の推測》や《医療的ケア児の状態に悪影響が及ぶリスクの査定》を行い，《保育者と医療的ケア児の関わりを支える》《医療的ケア児の状態を整える》《保育の環境を整える》ことを通じて【医療的ケア児の育ちを支える】支援につなげていた．

　結論：看護師によるいずれの支援も保育の内容や保育者の状況を考慮した支援であり，医療的ケア児の保育における看護師の専門性が示唆された．

　Objective: To explore the expertise of nurses by delineating the support they provide in caring for children with medical complexities(CMC) in nursery schools.

　Methods: The participants of this study were nine nurses who cared for CMC at a nursery school. Data were collected through semi-structured interviews and analyzed using the grounded theory approach.

　Results: The findings indicate that the role of nurses in caring for CMC is to "support the development of CMC. " Initially, the nurses engaged in "checking childcare activities. " Subsequently, they assessed "the risks related to safety and the condition of CMC" and estimated "the challenges that nursery teachers may encounter." This helped them "support the interaction between nursery teachers and CMC," "coordinate the health conditions of CMC for childcare activities," and "organize the childcare settings for CMC"; thus, "supporting the development of CMC." When nurses were involved in childcare and could sense the nurturing of CMC, they experienced "meaningful support"; however, when they did not know how to support such children, they felt "a lack of meaning in being a nurse."

　Conclusion: The support provided by nurses considered the content of childcare and the situation of nursery teachers, highlighting the expertise of nurses caring for CMC.