「検査・処置を受ける子どもへの説明と納得」に関するケアモデルの実践と評価（その2）―子どもの力を引き出す関わりと具体的な看護の技術について

The Practical Application and Evaluation of a Care Model for Informing and Reassuring Children Who Are to Undergo Medical Examinations and/or Procedures (Part 2): Methods of Relating and Practical Nursing Techniques That Best Bring Out the Potential of Children

要旨

　過去の調査から子どもたちや親が主体となり尊厳が守られている「よいケア場面」を検討して抽出し「検査・処置を受ける子どもへの説明と納得に関するケアモデル」(以後ケアモデル)を作成した．次に，関東と関西地区の5病院8病棟で「ケアモデル」の活用を試みてもらった結果，調査の協力者となった看護師たちにより82件の事例が提出された．本報告は，この82件の内容を分析し4つのカテゴリーに分類されたもののうち，「子どもの力を引き出す：子どもの力を引き出そうとして看護師たちが試みた関わりや具体的な看護の技術としてとらえられたもの」という2番目のカテゴリーを中心に述べる．このカテゴリーはさらに8つのサブカテゴリーに分けられた．その中の5つのサブカテゴリーは，【説明を受けることでがんばれた】【子どもが自分で選択することでがんばれた】【予測的実況中継的説明でがんばれた】【子どものタイミングに合わせることでがんばれた】【気をそらすことでがんばれた】で，ケアモデルの内容を反映していた．3つのサブカテゴリーは，【子どもとの交渉】【母親や家族の協力を得てがんばれた】【最初の対応が影響する】で，ケアモデルの実践によって新たに見出されたものであった．看護師たちはこれらの技術を組み合わせたり，継続させたりしながら，子どもの力を引き出し，尊厳を守る姿勢で関わっていることがわかった．

Abstract

　The purpose of this study was to determine methods of relating to children and practical nursing techniques that best bring out the potential ability of children about to undergo a medical procedure(for example, venepuncture, or IV cannulation), using an original care model for providing pediatric patients with an appropriate explanation suited to their comprehension level. For six months,we enlisted the cooperation of seven pediatric wards in five hospitals in the Kanto and Kansai areas in applying the care model on a trial basis and evaluating its effect. The effectiveness of the care model was evaluated in monthly meetings held with nursing staff participating in the study (nurses who executed our Care Model). From nursing discussions of 82cases in such meetings, four categories were extracted. This study presents second category that has eight subcategories. First, factors related to effectiveness of the care model formed five subcategories. Children performed best when：provided with an explanation；able to select treatment circumstances by themselves；explanations took the form of continuous predictions while procedures were performed, and every aspect of the procedure was timed optimally, using a distraction technique. Second, considerations not included in the care model formed three subcategories：negotiations with children；cooperation of the mother and family, and children were influenced by their first impressions of and relationships with health care providers. We found that nurses executed procedures while accumulating experience and could best bring out the potential of children while protecting patient dignity.