精神看護学実習において学生が抽出した倫理的課題の内容と学び：記述内容の分析

Ethical challenges perceived by students and their learning during psychiatric nursing practice: A descriptive content analysis

　精神看護学実習中、臨床指導者の参加を得て開催している倫理的課題に関するカンファレンスの学修効果を明らかにすることを目的に学生の記録を質的帰納的に分析した。結果〈病状や行動制限範囲などの情報とエビデンスに基づいたケアの必要性（判断）〉〈患者の思いをくみ尊重する姿勢の認識〉〈患者が望みや自信をもって、自己決定の権利を行使できるような支援〉〈精神症状による影響と患者・家族・地域のつながりは退院支援の鍵〉〈多職種尊重、連携・協働がケアに不可欠〉〈患者のニーズとリスクの二面を見据えた看護師の実践〉〈複数の価値が対立する中で根気よく最善の解決方法を模索する看護師〉〈倫理的感受性の高まりと新たな問題意識の芽生え〉〈看護師・学生からの複数の視点を得て深まる考え〉の9カテゴリーが生成された。学生は対話により倫理的感受性が高まり倫理的能力が促進された。効果的なカンファレンスには臨床指導者の参加が不可欠である。

　To clarify the learning effects of conferences on ethical challenges, which are held with clinical instructors participating during psychiatric nursing practice, student records related to such challenges were qualitatively inductively analyzed, and 9 categories were identified: 〈(assessing) the necessity of care based on information regarding pathological conditions, behavioral restrictions, or other important items and evidence〉, 〈understanding of appropriate attitudes to consider and respect patients' thoughts and feelings〉, 〈support for patients to exercise their right to decision-making with hope and confidence〉, 〈influences of mental symptoms and patient-family-community connections as key to discharge support〉, 〈interprofessional collaboration and cooperation with respect which are indispensable for care〉, 〈nurses' practices focusing on both patients' needs and risks〉, 〈nurses who persistently seek the best solutions during values conflicts〉, 〈promoted ethical sensitivity and awareness development about problems〉, and 〈thoughts that are deepened with multiple perspectives from nurses/students〉. The results indicate that students' ethical sensitivity and ethical competence are promoted through dialogues, and clinical instructors' participation in conferences is indispensable.