看護学生が捉えた倫理問題―基礎看護学実習の体験の中で

Ethical Problems that Nursing Students Observed：Through the Experience of Basic Science-of-Nursing Clinical Practicum

要旨

　本研究では, 学生の実習体験に関する記述から, 学生が捉える倫理問題の内容を明らかにすることを目的に質問紙調査を行った. 対象は, A医科大学医学部看護学科において基礎看護学実習を終了した1・2年生の中から協力が得られた29名が記述した33事例であり, トンプソンの「倫理問題を明確化するカテゴリー」を使用し質的に分析した. 学生が捉えた倫理問題の内容として,[倫理的責務・義務に関する問題][倫理的権利に関する問題][倫理的忠誠に関する問題]が多く抽出された. 学生は, 臨床での実習期間は限られており免許をもたない学生という立場であるために, 自ら中途半端な立場の者と位置づけることが多かった. このため医療者側の視点より患者の立場に身を置いて倫理問題を捉えることが 多かった. 学生は臨床現場でさまざまな疑問や違和感を抱き, それらの多くは倫理問題の発見につながった. 将来の倫理的感受性・判断力をもった看護師を育成していくために, 学生が臨床現場の中で捉えた倫理問題の明確化や倫理問題と捉えた理由についての言語化およびそれに関する思考を促すような教育的関わりが重要であると考えられた．

Abstract

　In order to capture the ethical issues that nursing students observed in their clinical practicum, a survey was conducted for the first and second grade students in a four-year nursing college. Twenty nine nursing students who completed the first clinical practicum participated in the study. Thirty three episodes that the participants wrote about their experiences in the nursing practicum were qualitatively analyzed, using Thompson's “Categories for ethical issues” as a framework. Dominant ethical issues that the students identified included “duties and responsibilities of health care providers”, “patients' right”, and “fidelity of health care providers”. The students were not certain about their roles and positions in the clinical site and felt awkward because of the limited practicum time and their lack of a license. Therefore, the students' perceptions regarding the ethical issues tended to be closer to the one of the patients rather than that of the health care providers. The questions and perceptions that the students had through the experiences in the practicum sensitized them to the ethical issues existing in the real life health care system. It is critical to develop educational approaches to encourage the students to reflect, motivate, and verbalize the ethical issues they observe to train future nurses who are ethically sensitive and capable of making ethical judgment.