日帰り手術に向けての幼児の自律性を親と協働して支援する看護介入プログラムの開発―第1報：看護介入の試作と介入後の親の取組み

Development of a Nursing Intervention Program to Support Preschool Child Autonomy toward Day Surgery in Collaboration with the Parents：First Report：Designing Nursing Intervention and Describing Post-Intervention Parental Involvement

要旨

　本研究の目的は，日帰り手術に向けての幼児の自律性を支援するために，親と看護師が協働する看護介入プログラムを開発することである．第1報では，日帰り手術についての物語を子どもに読み聞かせるケアと，子どもの気持ちや言動に合わせた援助法を記述した絵本を看護師が作成して，親に子どもの個性や過去の経験を土台に活用を促す看護介入を試作し，外来診察で日帰り手術が計画された25名の幼児（3～6歳）の親に実施した．介入後の半構造的面接調査から，介入後の親の取組みは4つの型：〈擁護型〉〈共有型〉〈模索型〉〈同調型〉に分類され，親は日帰り手術に向けて，子どもに〔親の相互主体的ケア〕を提供し，【親子の相互主体】を形作っていた．〔親の相互主体的ケア〕は，5つのケア要素：《子どもへの姿勢と接近》，《子どもなりの理解への気づき》，《子どもの気持ちを読むこと》，《子どもの要求に沿っていくこと》，《親の要求や意図を子どもにわかるように伝えること》で構成されていた．【親子の相互主体】は，子どもの医療体験に向けて，親と子どもが自身の個性や能力，可能性を実現できるように，お互いの個性や能力，可能性に働きかけ合うことであった．

Abstract

　My objective is to develop a nursing intervention program where parents and nurses collaborate to support the autonomy of preschool age children toward day surgery. In the first report, a picture book was prepared describing the care in which the parent reads a story about day surgery to the child along with explaining the support method which has been adjusted to the feelings speech and behavior of the child. A trial was also conducted of nursing intervention that encouraged the parent to apply the picture book on the basis of the child's character and past experience. The intervention was effectuated with the parents of 25 children aged 3~6 years-old for whom day surgery was scheduled on an outpatient basis. From the semi-structured interviews after the intervention, the parental care after the intervention was classified into four patterns: protecting, sharing, groping, and conforming. After the intervention, the parents provided their children with [parental intersubjective care] and formed [intersubjective parent-child relationships]. The parental intersubjective care was comprised of five care elements: 《attitude and approach to the child》, 《awareness of the child's particular way of understanding》, 《reading the child's feelings》, 《according the child's demand》 and 《conveying the parents' requests and intentions to the child in an understandable way》. For the medical experience of the child, the intersubjective parent-child relationship exerts an influence on the personality and ability, possibility of each so that parent and child may actualize their own personality and ability, possibility.