重症心身障害児施設で働く看護師が経験を基盤に親への関わりにおける認識と実践を変化させていくプロセスに関する質的研究

The Process of Changes in the Recognition and Practices towards Parents by the Nurses Who Work at the Facilities for Patients with Profound Multiple Disabilities；A Qualitative Study

要旨

　重症心身障害児（者）看護の質向上に資するため，重症心身障害児施設で働く看護師が経験を基盤に親への関わりにおける認識と実践を変化させていくプロセスを記述することを目的に，重症心身障害児施設で働く20名の看護師に半構造化面接を行い，グラウンデッド・セオリー・アプローチの手法を用いて分析を行った．その結果，子のケアをしっかりすることで親も満足すると考え〈子へのケアの充実〉を行う段階，できる限り親の要望を表出させ，子のケアに生かす〈親の要望の反映〉の段階，看護師と親がお互い納得できるケアを模索する〈共通認識の模索〉の段階，施設の限られた資源の中でスタッフ間のケアの統一と子一人ひとりを尊重しようとする意識をもつことを目指す〈平等性の追求〉の段階の4段階のプロセスが抽出された．《親には安心して子を預けてもらいたい》という思いがこのプロセスを推し進める原動力となっていた．

Abstract

　To improve the quality of nursing care for patients with profound multiple disabilities, the present study was conducted in order to investigate the process of changes in the recognition and practices towards parents by nurses who work at the facilities for patients with profound multiple disabilities. Semi-structured interviews were conducted on 20 nurses working at the facilities for patients with profound multiple disabilities, and interview data were analyzed in accordance with the grounded theory approach. The nurses' recognition and practices towards the parents changed with their experience as follows: 〈Taking good care of the patient〉 〈Understanding parents' need〉 〈Trying to reach a consensus with parents and nurses〉 and 〈Seeking the equality of nursing care〉. Although nurses' recognition and practices were different at each stage, all the participants held a common view on the purpose of nursing care 《Providing good care so that parents can leave their children without worry》. This view promoted the change of their recognition and practices.