日帰り手術に向けて取り組む過程における幼児の自律性に関する研究―幼児と母親の相互作用に注目して

Autonomy of Preschool Children in the Process of Preparation for Day Surgery: Focused on the Interaction of Child and Mother

要旨

　本研究の目的は，日帰り手術に向けて取り組む過程における幼児の自律性とその構造を，幼児と母親の相互作用を通して探求することである．下腹部の疾患のため日帰り手術を受ける3～6歳の40名の幼児の母親を対象に，手術当日に半構造的質問紙を用いた面接調査を行い，内容分析によって要素とその関係性を探索した．日帰り手術に向けて取り組む過程における幼児の自律性は，9つの要素：＜関心＞＜疑問＞＜受容＞＜拒否＞＜再現＞＜交渉＞＜探索＞＜警戒＞＜主導＞を包含する，3つのカテゴリー：｛健康問題や治療への関与｝｛治療に対する自由な意思表示｝｛自分で規定し方向づける過程｝によって構成されていた．また，幼児は4つの自己のあり方：【状況期待に乗せられる】【状況期待に乗れない】【状況期待に乗る】【状況期待に乗せる】を表わし，親の2つのケア：［やる気や好奇心の拡大］［安心や自信の拡大］を得ることで自己のあり方を変化させながら，日帰り手術に向けて自律性を向上させていた．

Abstract

　The purpose of this study is to explore the autonomy of preschool children in the process of preparation for day surgery and the structure of that autonomy through the interaction of child and mother. The subjects were mothers of 40 children between the ages of 3 and 6 years undergoing day surgery for lower abdominal disease. Data was collected through an interviewstyle survey using a semi-structured questionnaire. Factors and the relationships were explored through content analysis. The autonomy of preschool children in the process of preparation for day surgery included nine elements：＜interest＞, ＜doubt＞, ＜acceptance＞, ＜refusal＞, ＜reenactment＞, ＜negotiation＞, ＜search＞, ＜alarm＞, and ＜initiative＞；and was constituted according to three categories：｛concern about health problems and treatment｝,｛the expression of free will in regard to the treatment｝, and｛the process that regulates and directs the self｝. In addition, children showed their mothers four modes of self-control in the process of preparation for day surgery：【the feeling of being manipulated by the expectations of the situation】, 【the feeling of being out of tune with the expectations of the situation】,【the feeling of being in tune with the expectations of the situation】, and【the intention to be in tune with the expectations of the situation】. Children received two types of care from their parents：［the extension of motivation and curiosity to the child］and［the extension of security and confidence to the child］. Consequently, children flexibly shift the four modes of self-control to improve autonomy.