ターミナル期の看護行動に影響を与える看護師の感情

The Effects of Nurses' Emotions for Terminally Ill Patients and Their Families

要旨

　ターミナル期の看護場面に対して，看護師のどのような感情が看護行動に影響しているかを調べることが本研究の目的である．

　ターミナル期の患者や家族と関わりがある病棟の看護師を対象に自記式質問紙調査を行った．場面想定法を用いて，看護師が関わる際に感情管理を必要とするようなターミナル期の看護場面を5つ設定し，各場面に対して感情9項目と看護行動13項目を質問した．

　感情9項目から，「否定感情」，「共感性」，「感情分離」の3個の感情因子が抽出された．また，ターミナル期の患者や家族に関わる看護師の感情と看護行動との関連においては，「否定感情」が看護行動に強く影響していた．患者－看護師関係の中心的な要素として看護に浸透している「共感性」の影響は小さかった．

　看護師の抱く否定的な感情は，共感性の問題とは別個に検討されなければならない感情であること，および，この否定的な感情は看護行動に影響していることが明らかになった．今後は看護師の抱く否定的な感情そのものに着目し，否定的な感情が看護行動に与える影響を明らかにしていく必要がある．

Abstract

　The purpose of this paper is to investigate what emotions most influence nurses in their nursing practices for terminally ill patients and their families.

　A questionnaire asking nurses to describe themselves was administered to nurses who regularly cared for terminally ill patients and their families. Five hypothetical situations in the form of vignettes were constructed for the survey. All vignettes were designed such that nurses would need emotional management skills in caring for terminally ill patients and their families. Nurses were asked nine emotional questions and 13 nursing practice questions after they read each vignette. Each of the nurses read all five vignettes and answered all questions.

　Three emotional factors were extracted from the nine emotional questions, which were ‘negative feeling,’ ‘empathy,’ and ‘suppression.’ In addition, ‘negative feelings’ had the greatest influence on nursing practices in terms of the nurses' emotions and their nursing practices when they cared for terminally ill patients and their families. ‘Empathy,’ which had been considered a central component in the nurse-patient relationship, was in fact not so closely related to their nursing practices.

　It was clear that the negative feelings which nurses had must be examined separately with an issue of empathy and the negative feelings had an influence on nursing practices.

　So we have to focus on the negative feelings themselves, which nurses have during their daily care for patients and their families. Furthermore we have to focus on the influences of their negative feelings upon their nursing practices.