精神科病棟で働く看護師が体験する倫理的問題と価値の対立

Ethical problems and value conflicts experienced by nurses working in psychiatric wards in Japan

日本の精神科病棟で働く看護師が体験している倫理的問題と価値の対立を明らかにするとともに、倫理的問題状況の背景にある因子を抽出することを目的に、3年以上の精神科臨床経験を有する看護師28名に集団および個人面接を行い、収集された68のエピソードを質的に分析した。分析の結果、看護師が体験している倫理的問題として「患者の権利」「治療」「退院・長期入院」など8カテゴリーが抽出された。看護師が体験する価値は「患者の権利」「患者の尊厳」「患者の安寧」「専門的価値」「個人的価値」「文化的価値」「他の人々の権利」の7つから構成されており、価値間に対立がみられた。価値とは別に「現実の制約」が、看護師の持つ価値と対立していた。

The purpose of this study was to clarify ethical problems and value conflicts experienced by nurses working in psychiatric wards in Japan and to elucidate the factors influencing these problems. Focus group interviews and individual interviews were conducted with 28 nurses with at least 3 years of clinical experience in psychiatric wards. Content analysis was performed for each episode recounted during the interviews. An analysis of 68 pertinent episodes yielded eight categories of ethical problems, including “patients'rights,” “medical treatment” and “discharge and long-term hospitalization.” The values experienced by the subjects consisted of seven categories; “patients' rights,” “patients' dignity,” “patients' well-being,” “professional values,” “personal values,”“cultural values” and “rights of other persons.” Value conflicts were found between these different values. In addition, “actual constraints,” which were not value factors, conflicted with nurses' values.