中小規模病院の看護師長の経験に含まれる倫理的問題とその対応

Ethical issues experienced by head nurses in small or medium-sized hospitals and measures to solve them

　目的：中小規模病院の看護師長の経験に含まれる倫理的問題に焦点をおき、倫理的問題とその対応、さらにその特徴について明らかにする。方法：中小規模病院（200床未満）の看護師長8名を対象とし、半構造化面接で得たデータを質的帰納的に分析した。結果：倫理的問題として【病院の経営上の方針に対し問題を感じるが従わざるを得ない】【自施設での治療の継続・ケアの提供が患者にとって適切な医療かどうか悩む】を含む6カテゴリーが、対応として《自分の考えを伝え、スタッフと共に考える》を含む6カテゴリーが抽出された。考察：【自施設での治療の継続・ケアの提供が患者にとって適切な医療かどうか悩む】は、設備・医療体制が整っている大病院にはみられない中小規模病院の看護師長に特徴的な倫理的問題と考えられた。上司や他看護師長に相談する対応はみられず、倫理的問題を話し合うフォーマルな機会と場の構築の必要性が示唆された。

　Purpose: The purpose of this study is to elucidate the ethical issues experienced by Head Nurses in small or medium-sized hospitals, and the measures taken by them to solve the issues including the characteristics of the measures. Method: Data were collected by semistructured interviews from 8 Head Nurses working in hospitals with less than 200 beds. And they were analyzed in a qualitative and an inductive manner. Results: Six categories of ethical issues were identified including: “they have no other option than obeying their hospital's management policy, while they doubt it” and “they have anxieties about whether it is appropriate to continue or to provide treatments for patients in their hospitals.” And, six categories of measures were identified including: “they should tell their ideas to the staff, and consider the issues collaboratively.” Discussion: The issue that “they have anxieties about whether it is appropriate to continue or to provide treatments for patients in their hospitals” is thought to be a characteristic ethical issue for Head Nurses working in small or medium-sized hospitals. This suggests a need for the nurses to have formal opportunities to discuss their anxieties with other Head Nurses and their superiors.