最期の場を整える：看護技術としての子どもの死の時期の予測

Preparing for a Child's Death：Intuiting the Time of the Death as a Nursing Skill

要旨

　この研究では，看護婦が子どもの死の時期を予測する方法とそれをおこなう意味とを検討した．25人の看護婦から聞き取ったデータを分析した結果，子どもの全身状態の変化と言動の変化とが予測の指標になっていることがわかった．このうち，言動の変化は意識していなければ見過ごしてしまう可能性が高く指標として使いこなしている看護婦は少なかったのだが，看護婦独自の指標であると共に，全身状態や検査データの変化に先立って表れることが多いものなので，子どもの死が近くなったことをいち早く知るための重要な指標であると考えられた．

　死の時期の予測は，最期の場を整えるという働きかけにつながっており，看護婦は他の看護婦や医師との間で自分の予測を共有することで観察を強化し，迅速に対応して子どもの苦痛を緩和できるように準備をすると同時に，最期の場に医師が間に合うように状況を整えていた．また，家族とも情報を共有することで子どもの死を受け入れることを促し，最期の場にいてほしい人を揃えるというような働きかけをおこなっていた．これらの状況から，子どもの死の時期を予測する技術は最期の場を整え，家族に『よい看取り』をおこなってもらう働きかけの基本になるものだといえるだろう．

Abstract

　The purpose of this study was to investigate how and why nurses intuit the time of death of the child. By analyzing interviews of twenty-five pediatric nurses, it was discovered that they intuit the time of the death by observing charges in both the physical condition and the actions of the child. Although many nurses could make their assessments by observing a child's physical condition, fewer could make their assessments based on a child's actions since this required more sensitive observation. However, nurses that are able to make these sensitive observations possess a unique and valuable skill since they become able to predict an imminent death before it is detectable in the physical condition and medical tests.

　Intuiting the time of death is associated with the task of preparing for the death. The nurses shared their intuitions with other nurses and physicians in order to make sure everyone is on alert, they can reduce the child's agony, and to make sure the physician will be present at the time of death. The nurses also share their intuitions with family members to encourage them to come to terms with the situation and to arrange for people to be at the bed side at the time of death. For these reasons, intuiting the time of death is the fundamental skill needed by nurses to make sure the death occurs in a well controlled situation according to the terms of a 'good death'.