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2報：看護介入の影響と介入プログラムの提唱

Development of a Nursing Intervention Program to Support Preschool Child Autonomy toward Day Surgery in Collaboration with the Parents：Second Report：The Impact of Nursing Intervention and Proposal for a Nursing Intervention Program

要旨

　第2報における研究目的は，第1報で試作し施行した看護介入が日帰り手術に向けての幼児の自律性と親の自己効力感に与える影響と，看護介入を通して親と看護師が協働することについて，第1報で抽出された【親子の相互主体】の4つのありようごとに記述し，それらを基に看護介入の内容や方法を再検討して看護介入プログラムを提唱することである．その結果，看護介入は日帰り手術に向けての幼児の自律性と，医療体験に向けての幼児の自律性に関する親の自己効力感に肯定的な影響を与えることが記述された．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こととは，親と看護師がお互いに医療体験に取り組む幼児との間に形づくる関係性や支援のあり方に働きかけ合いながら，その後の活動に活かしていくことであると捉えられた．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は，手術前に看護師が親に子どもの支援法を提案し，親が手術に向けて子どもに実施した支援を手術後に看護師と共有するという内容によって提唱された．

Abstract

　The research objective of this second report is to describe, according to each of the four patterns of the [intersubjective parent-child relationship] derived from the first report, the effects that the nursing intervention, which was designed and implemented in the first report, had on the preschool child's autonomy and parental self-efficacy in preparation for day surgery as well as the collaboration that parents and nurses engaged in during the course of the nursing intervention, and to propose a nursing intervention program through a reexamination, using those patterns as a basis, of the methods and composition of the nursing intervention reported in the first report. The results describe the affirmative effects of nursing intervention on the preschool child's autonomy in preparation for day surgery as well as on parental self-efficacy coincident with the preschool child's autonomy approaching the medical experience. In addition, the collaboration that the parents and nurses engaged in to support the preschool child's autonomy in preparation for day surgery was demonstrated in the continuing mutual influence that the parents and nurses had on each other in regard to the manner of support and the relationship formed with the preschool child who was facing the medical experience, and both intended to apply such experience to future activities. Accordingly, a nursing intervention program to support preschool child autonomy leading up to day surgery in collaboration with the parents is proposed that consists of the nurse, prior to the operation, suggesting a method of supporting the preschool child to the parent, and the parent, after the operation, sharing with the nurse the support implemented in regard to the child to prepare for the day surgery.