呼吸器を装着した子どもの生活場所に対する親の意思決定

Parents' Decision Making in Determining the Living Setting of Respirator-Dependent Children

要旨

　本研究は，Mishelの不確実性理論（1988；1990）を基盤に考えた，子どもの生活場所に対する親の意思決定を表わす概念枠組みにおける変数間の関係を6つの仮説すなわち，仮説1）子どもの反応を感じ取れる親ほど不確実性に挑戦し，その結果，子どもの生活場所に対する親の意思決定の質が高くなる，仮説2）子どもの反応を感じ取れない親ほど不確実性へのとらわれが強くなり，その結果，子どもの生活場所に対する親の意思決定の質が低くなる，仮説3）子どものケアに自信がある親ほど不確実性に挑戦し，その結果，子どもの生活場所に対する親の意思決定の質が高くなる，仮説4）子どものケアに自信がない親ほど不確実性へのとらわれが強くなり，その結果，子どもの生活場所に対する親の意思決定の質が低くなる，仮説5）子どものケアを負担に思わない親ほど不確実性に挑戦し，その結果，子どもの生活場所に対する親の意思決定の質が高くなる，仮説6）子どものケアを負担だと思う親ほど不確実性へのとらわれが強くなり，その結果，子どもの生活場所に対する親の意思決定の質が低くなる，に基づき検討することを目的とした．対象は3か月以上呼吸器を装着している全国の子ども（0歳から15歳）の親の内，すでに子どもの生活場所を決断した101名であった．データ収集は，6つの質問紙を用いた．分析は重回帰分析を行い次に，他の変数の影響を取り除いた変数間のパス係数を表すことによって行った．分析の結果，仮説2）の「反応の感じ取り」と「不確実性へのとらわれ」との関係，仮説5）の「ケアの負担」と「不確実性への挑戦」との関係は支持されなかった．本研究結果は，看護者が子どもの置かれている状況への親の不確実性を「不確実性への挑戦」にし，今後における子どもの生活場所を親自らが考え，納得した決め方をしていけるような支援のあり方を検討するための重要な手がかりになると思われる．

Abstract

　The purpose of this study was to investigate the interactions among variables in a theoretical framework derived from the Mishel Theory of Illness Uncertainty (1988; 1990), which represents parents' decision making about the setting of living for their children based on the following hypotheses. Hypothesis 1) Parents who can notice the changes in the reaction of their own children tend to challenge to the uncertainty in illness, resulting to raise the quality of decision making about the living setting of children. Hypothesis 2) Parents who can not notice such changes in their children's reaction tend to persist in the uncertainty in illness, resulting to lower the quality of decision making about the living setting of children. Hypothesis 3) Parents who are confident in the care of their own children tend to challenge to the uncertainty, resulting to raise the quality of decision making about the living setting of their children. Hypothesis 4) Parents who are little confident in the care of their own children tend to persist in the uncertainty, resulting to lower the quality of decision making about the living setting of children. Hypothesis 5) Parents who are not burdened down with the care of children tend to challenge to the uncertainty, resulting to raise the quality of decision making about the living setting of children. Hypothesis 6) Parents who are burdened down with the care of children tend to persist in the uncertainty resulting to lower the quality of decision making about the living setting.

　A total of 101 parents who had decided the living setting for their respirator-dependent children (0-15 years old) wearing a respirator for more than 3 months were used as the subjects. A survey was made using six forms of questionnaire and the statistical analysis was performed by multiple regression analysis and the interactions between two variables except for the influence of other variables were expressed with path coefficient. The present results supported neither of the correlation between the notice of children's changes and the persistence in the uncertainty for Hypothesis 2) nor the correlation between the burden of care and the challenge to the uncertainty for Hypothesis 5). The present study provided useful information to establish a support system for parents by which it would become easy for parents to decide the living setting of children to satisfaction through converting the uncertainty as to the children's illness to a challenge to it by nursing professionals in future.