ターミナル期にある小児がんの子どもの意思決定を支援する看護師の倫理的苦悩についてのナラティヴ

Narratives of ethical distress of nurses supporting decision-making in terminally ill children with cancer

　ターミナル期にある小児がんの子どもの意思決定を支援する看護師の倫理的苦悩を明らかにすることを研究目的とし、看護師を対象にした半構造化面接を行った。分析対象となったのは9名の語りで、ナラティヴ研究法によるテーマ分析と構造分析を行った。その結果、構造分析により6つの語りの構造とその語りの特徴が見出され、テーマ分析により9名の倫理的苦悩のテーマと5つの意思決定の内容と13の行いたいと考えた行動と17の行動の妨げが見出された。看護師は倫理的苦悩を語る際に、迷いながら、言葉を選び、自身の行動を語る特徴があった。また、看護師は子どもの意向を確認したり、説明する必要性を認識していたとしても、行動を妨げる要因があるために、倫理的苦悩を抱えていた。看護師は子どもや家族とともに揺らぎ、悩みつつ、倫理的苦悩に対峙し続けていくことで、看護師としての成長があるのではないかと示唆された。

　The purpose of this study was to identify the ethical distress experienced by nurses who support the decision-making of children with cancer in the terminal phase. Semi-structured interviews were conducted with nine nurses. Narrative research methods were used to perform thematic and structural analyses of the interview content. As a result, six narrative structures and narrative characteristics were identified by the structural analysis. Nine themes of ethical distress, five themes related to decision-making, thirteen actions the nurses thought about taking, and seventeen obstacles to action were identified by the thematic analysis. A characteristic of the interviews was that the nurses were hesitant when talking about ethical distress, choosing their words carefully and talking about their own actions. Even though the nurses were aware of the need to confirm or explain a child's wishes, they had ethical distress due to obstacle to action. These results suggest that for the nurses, vacillating and worrying together with the children and their families while continuing to confront their ethical distress may aid in their development as nurses.