医療的ケアの必要な重症心身障害児に対する訪問看護師による遊びの認識

Cognition of Visiting Nurses Regarding Play Activities for Children with Severe Motor and Intellectual Disabilities in Need of Medical Care

要旨

　目的：訪問看護師における重症心身障害児の遊びの実践に対する認識を明らかにし，訪問看護師の遊びの実践に関する示唆を得る．

　方法：医療的ケアの必要な重症心身障害児の訪問看護で遊びの実践経験がある訪問看護師10名に遊びに対する認識や実践状況について半構成的面接を行った．データは，質的帰納的に分析した．

　結果と結論：訪問看護師は重症心身障害児との遊びを，『訪問看護師と子ども，母親とのつながりづくり』であると認識していた．訪問看護師の【遊びは子どもの全て】であるという思いが遊びの拠り所となっていた．訪問看護師は，子どもの《心と身体に働きかける遊び》と《子どものサインの読み取り》をしながら【遊びの選択と調整】を繰り返していた．訪問看護師は，遊びを通して子どもの自発性を引き出し，子どもが表出するサインの読み取り，さらに母親とのつながり作りに発展させていくことが重要であるといえる．

　Purpose: The purpose of this study was to examine visiting nurses' cognition and practical knowledge of play activities for children with severe motor and intellectual disabilities and to obtain suggestions for nurses to improve their practical knowledge.

　Method: Participants were 10 visiting nurses that had experience with play activities for children with severe motor and intellectual disabilities in need of medical care. Participants responded to semi-structured interviews, allowing them to express their cognition of the practical situation of play activities for children with severe motor and intellectual disabilities. A qualitative and inductive method was applied to analyze responses.

　Results and conclusions: We found that visiting nurses recognized the need for play activities with children with severe motor and intellectual disabilities in order to make a connection between visiting nurses, children, and mothers. Visiting nurses reported recognizing that all children need play and based their play activities around the needs of the children with severe motor and intellectual disabilities.

　Visiting nurses reported repeatedly selecting and adjusting play activities to suit the children's needs and stimulate their bodies and minds. Nurses reported grasping the children's communicative expressions during these activities. Suggestions for visiting nurses regarding play activities for children with severe motor and intellectual disabilities are that the nurses must actively get the children to engage with them, and that they must also correctly grasp the signs children use to express themselves during play. Lastly, visiting nurses must develop play activities to form a good relationship with the child's mother.