主体的な闘病生活の促し―情報提供を受ける小児がんの子どもに対する看護師の働きかけ

Encouragement to Act with Autonomy: The Nursing Support for The Children Who Receive Information about Their Cancer and Its Treatments

要旨

　病気や治療についての説明を受ける小児がんの子どもに対して, 看護師がどのような介入や援助を行っているかを明らかにすることを目的として研究を行った. 小児がん領域で4～11年の臨床経験をもつ看護師6名に半構成的面接による聞き取りを行い, 録音されたデータから逐語録を作成し, grounded theory approach を用いて分析した. その結果, 看護師は「状況の査定」「介入の基盤作り」「通常の指導」「情報の補足と整備」「介入の効果を捉える」という5つの働きかけをしていることが示された. これらの働きかけは, 単に子どもが闘病生活上適切な行動を取れるようになるためだけでなく, 理解力や関心に合わせた説明によって, 子どもが主体的な闘病生活を送れるようになることを目指したものであった. 働きかけを効果的に行うためには, 看護師が多くの情報を集めて子どもの視点から情報提供を評価することと, 働きかけの目的や効果を意識して取り組むことが必要だと考えられる．

Abstract

　The aim of this study is to understand the supports nurses provide children who receive information about their cancer and its treatments.

　The study sample consisted of six nurses who have four to eleven years of clinical experience in pediatric cancer field. They were asked to participate in semi-structured interviews that were tape recorded. The recorded data were transcribed word for word, and analyzed using a grounded theory approach.

　The data indicated that the nurses impact the children in five ways: by assessing the situation, by preparing the foundation for intervention, by providing guidance in daily life, by maintaining and supplementing information, and by judging the effects of interventions. The nurses did not merely encourage the children to do the appropriate behavior to fight the illness. Rather, their object was for the children to act with autonomy in their struggle with illness by getting information appropriate to their ability to comprehend and their level of interest. In order to be effective, nurses need to do two things: The first is to collect a variety of information and, keeping in mind the child's perspective, assess how the information should be presented. The second is to be constantly conscious of their objectives and how their actions affect their patients.