ターミナルケアに携わる看護師の“肯定的な気づき”と態度変容過程

“Positive Awareness”and Process of Attitude Change of Nurses in Terminal Care

要旨

　ターミナルケアに携わる看護師に必要な態度とは，患者やその家族から死にまつわる言葉や態度が示されても，行為的にも心理的にも彼らから逃げずに関わり続けられることである．本論文では，看護師がこのような態度をとるための動機づけの要因でもある《肯定的な気づき》と，態度変容過程を明らかにすることを目的とした．

　研究方法は，研究の趣旨に賛同を得られたターミナルケアの実践者である看護師30名に個人面接をし，その内容をGrounded Theory Approachにて分析した．

　その結果，ターミナルケアの実践が辛く苦しい経験だけではなく，患者や家族との相互関係から看護師自身が彼らからケアされるような経験でもあるといった《肯定的な気づき》が，患者やその家族から逃げずに関わることができる態度に結びつき，この《肯定的な気づき》は，《臨床での経験》や《教育的な働きかけの享受経験》や《ライフヒストリーの経験》によって促されることが明らかとなった．このためターミナルケアに携わる看護師に対して《肯定的な気づき》ができるように，これらの要因を意識化させ肯定的に意味づけることが看護師への援助となると言える．

Abstract

　Nurses who are engaged in terminal care should be able to continue doing their job without distancing themselves physically and psychologically from their patients and families even when they touch upon topics related to death. The main purpose of this report is to discuss, among other related factors, the concept of “positive awareness,” which motivates nurses to maintain positive involvement in their work. Personal interviews were conducted with 30 experienced nurses engaged in providing terminal care. The results were analyzed based on the Grounded Theory Approach.

　It was found that becoming involved in terminal care was difficult and demanding, but it also provided a good opportunity for the nurses to become aware that they themselves, in turn, receive care through their relationship with patients and families. This “positive awareness” encouraged nurses to become involved in their work without distancing themselves, and was fostered by “clinical experience,” “educational overtures” and “life history.” The findings indicate that nurses who are engaged in terminal care can be supported by helping them recognize this “positive awareness.” Consider whether you want to add any suggestions for how this can be achieved in practice?