子どもと大人の混合病棟で働く看護師の意識とケアの変化―アクションリサーチを通して

The Process of Change in the Nurses' Perception of Their Care in the Child and Adult Ward：Through Action Research

要旨

　目的：子どもと大人の混合病棟における看護について，小児看護の立場から研究者と看護師が共に考える機会を創り出すことによって，看護師の意識やケアにどのような変化が起こるのかを記述し，そのプロセスを考察する．

　方法：アクションリサーチの方法を用いて，研究参加者である混合病棟の看護師15名と勉強会を開催しながら，看護師の意識やケアへの変化をみた．

　結果：看護師は日々必要とされている看護をこなすだけで精一杯になり，それ以外の看護の課題を考えないようにすることで，その場を乗り切る働き方を身につけていた．看護師のこのやるせない思いは，看護師に無力感を抱かせていた．看護師は看護の知識とともに患者の声が伝えられたことで，看護の知識と看護実践を結びつけることができた．そして看護師たちは病棟の現状を現実的に見直し，自分たちでできる工夫を考えて実行に移すことで，無力感を少しずつ変化させていた．

　結論：自分の看護に満足せず無力感を抱える看護師が，看護を変化させるきっかけをつかむためには，看護師同士で語り合いながらよりよい看護を実践していけるような支援が必要である．

Abstract

　Purpose: The purpose of this study was to describe the process of change in the nurses' perception of their care and their nursing practice.

　Method: The research was conducted based upon the action research. Participants were fifteen nurses in the child and adult ward. The researcher facilitated the “Kobanashi”(study sessions) where the data from the observations and interviews with patients and their families and the results of the various nursing researches were presented to the nurses.

　Results: At the beginning of this study, the nurses' attitudes appeared as though they had acquired a work style in which they focused only on performing at a minimum and ceased concerning themselves with other issues in the care of the patients. They constantly experienced feelings of frustration and helplessness. Until starting those sessions, they were not entirely open-minded about the remarks from the patients because they took them as criticism. Through the collaborative work, the nurses found a different point of view when considering patients' opinions and reviewing their work. They started to integrate their professional knowledge and nursing practice by participating in the Kobanashi. They discussed the issues among themselves, conceived ideas of actions for improvement.

　Conclusion: The study findings suggest that support and an environment for open discussion among nurses are necessary to improve the care of both children and adults.