専門看護師の倫理調整に関する役割開発の契機となった経験

Certified nurse specialists' narratives that have led to role development in ethical coordination

　本研究の目的は、専門看護師（CNS）の倫理調整に関する役割開発の契機となった経験を明らかにすることである。CNS9名にナラティヴ・アプローチに基づくインタビュー調査を行った。CNSらのナラティヴから4つのテーマ、1）相手の本当の声に耳を傾け続け、手だてを尽くす経験、2）今、ここでの自分の判断と行為に全力でかける経験、3）自分の存在・価値観が患者やスタッフにもたらす影響を自問する経験、4）組織・職種間の価値観の違いを超えようと模索する経験が明らかになった。出来事の語り方の特徴から役割開発の契機となった経験は、1）CNSの予想に反する転機がおとずれ、急転的に変化する、2）役割開発の契機はCNSが構築してきた医師・他職種との関係性の構築やシステムづくりに関連する、3）倫理調整役割を比喩的に表現し、自らの言葉で表現する、という特徴があることが明らかになった。

　This study's objective was to examine certified nurse specialists' (CNS) narratives that led to development of role development in ethical coordination. An interview survey was conducted with nine CNSs based on the narrative approach. The findings suggested four themes within their narratives: 1）Experience keeping listening to the real voice of others and doing as much as possible. 2）Experience believing in myself and believing in judgment and action of “now and here.” 3）Experience asking themselves about the influence of their existence or sense of values on patients and staff. And 4）Experience seeking to overcome the differences in values that arise between organizations and other professionals. From the results of the structural analysis, the narrative of experiences that gave rise to role development was characterized as follows. 1）Contrary to the CNS' expectations, turning points can emerge unpredictably. 2）The opportunity for practical knowledge / role development arose from the establishment of relationships built with doctors / other professionals and system creation. 3）CNS described their role in ethical coordination metaphorically and in their own words.