日常の看護実践で遭遇する倫理的問題に対する看護師の行動の背景にある思い

Thoughts and feelings behind nurses' behaviors against ethical issues in daily practice

　本研究は、日常の看護実践で遭遇する倫理的問題に対する看護師の行動の背景にある思いを明らかにすることを目的として、臨床経験5～10年目の看護師10名を対象に半構成的面接による質的帰納的研究を行った。その結果、行動の背景にある思いは、【自らの看護行為の省察】から【患者の置かれている状況がよりよくなることを希求】を抱き、その行動によって患者から得られる【援助へのよい反応に満足】し、さらに【自らこうあるべき・ありたいと考える看護】という、倫理的問題への行動を導く思いがあった。一方、【考えの違うものや現状にもつ否定的な感情】は、それにより【主体的な問題関与からの回避的志向】を招き、【患者の関わりへの自責の念】を抱くという、回避的行動を導く思いがあった。しかし、【患者の関わりへの自責の念】は、そこに留まらず、【自らの看護行為の省察】へとつながり、倫理的問題への行動を導き出すことが示された。

　The purpose was to clarify the feelings behind nurses' behavior against ethical issues in daily practice. An inductive qualitative study using semi-structured interviews was conducted on 10 ward nurses in their 5th to 10th year of clinical experience. The results showed that the feelings behind their behaviors consisted of “a reflection on their own nursing actions”, leading to “a desire to see improvements in patients' statuses”, “satisfaction from patients' favorable responses to nursing care” through their actions, as well as thoughts and feelings that led them to act on ethical issues pertaining to “how they think nursing should be and how they want nursing to be”. Meanwhile, this has resulted in the presence of thoughts and feelings that led to an avoidance behavior toward ethical issues, “negative feelings toward the current situation or toward those who think differently”, which led to “a proactive intention to avoid involvement in issues”, and which nourished a “feeling of guilt in regard to their involvement with patients”. However, the findings showed that by leading to “a reflection on their own nursing actions”, the “feeling of guilt in regard to their involvement with patients” led to actions in regard to ethical issues.