熟練外来看護師のやりがい獲得の過程に潜在する実践知の可視化

An Investigation into the Importance of Practical Knowledge for Expert Outpatient Nurses'‘Job Satisfaction’

要旨

　目的：熟練外来看護師がやりがいを獲得する過程を明らかにし，その過程にある外来看護の実践知を明らかにすることである．

　方法：対象は総合病院一般外来に勤務する外来経験年数5年以上の熟練看護師6名である．面接法によりデータ収集を行い，分析には木下によるM-GTAを用いた．

　結果：熟練外来看護師は【空間全体を見渡し，把握し，動かす実践知】を用いて外来全体をマネジメントしながら，常に患者からの電波をキャッチできるアンテナを張り，適時を逃さず【点で関わる実践知】を用いて適切に患者と関わっていた．それが次の受診につながり，【線で関わる実践知】を用いて，効果的に継続した関わりが持てるよう工夫をしていた．点と線の関わりの中の患者の反応から患者が社会で生きることを支えている実感を持ち，自らの存在価値を感じ【やりがい獲得】していた．また，やりがいを得たことにとどまらず，実践を省察し【自律への道】を切り開き熟練看護師へと成長していた．

　結論：熟練外来看護師のやりがいを獲得するプロセスには「時間」「空間」の概念を基軸とした実践知があり，実践の省察により洗練されることが明らかになった．

Abstract

　Purpose：This study intends to clarify the practical knowledge of outpatient nurses by the verbal expression of expert nurses to reveal latent experiences.a process of that can measure nurses' job satisfaction.

　Method：Data were collected using interviews conducted with six outpatient nurses who each had five years experience and worked in a polyclinic hospital. They talked about their “job satisfaction” experienced while practicing. The results were analyzed using the modified grounded theory approach, suggested by Dr. Y Kinoshita.

　Results：Expert outpatient nurses manage the entire space with ［practical knowledge to view, understand, and control the entire outpatient space］. They are always sensitive to the needs of their patients, and ［use practical knowledge related to the event at hand］ to care for patients appropriately. Such effort provide a connection with future examinations, allowing the ［use of practical knowledge over a series of events］ to provide continuous and effective nursing care. Nurses experience actual feelings based on patient's reactions during such individual events and series of events, providing support for patients during their normal lives in society, and thereby ［attaining a sense of job satisfaction］. Moreover, nurses who feel satisfied with their jobs do not remain content with current circumstances, and instead work hard to achieve self-growth ［and the path to nurse autonomy］.

　Conclusion：The following became clear by this study. Practical knowledge of outpatient nursing is practiced based on the general ideas of “time” and “space,” and it is refined through actions that require a great deal of skill.