集中治療室に緊急入室した意識障害のある患者の家族援助に影響するエキスパートナースの直観に関する研究

The Effects of Expert Nurse Intuition on Support for Families of Patients with Consciousness Disorder Urgently Admitted to the Intensive Care Unit

要旨

　目的：集中治療室に緊急入室した意識障害のある患者の家族に対し，エキスパートナースの直観は，その家族への援助にどのように影響しているのかを明らかにする．

　方法：集中治療室のエキスパートナース6名を対象に半構造化面接を行った．Bergsonの直観を前提とし，直観を示す言葉，それに関連した思考や行為を抽出し，それぞれを質的記述的に分析した．また，場面全体を時系列に直し，直観から捉えた家族援助への影響を分析した．

　結果：エキスパートナースの直観は家族の状況を瞬時に捉えていたことが明らかになった．その直観は，無意識に家族の目や口元などから家族の心情を推論していた．エキスパートナースは直観により家族の不安定な状況や気持ちの変化などを認識しており，それに応じて観察や声かけなどの援助を行っていた．また，家族と出会った最初の直観と，以降の思考，行為がつながっていた．

　結論：エキスパートナースは直観により動的な家族の内面を捉え，その解釈を踏まえながらより確かな援助へと導いており，思考と援助が連関していると考えられる．

　Objective: The aim of this study was to elucidate how the intuition of expert nurses affected support for the families of patients with consciousness disorder urgently admitted to the intensive care unit.

　Methods: Semi-structured interviews with six expert nurses working in an intensive care unit were conducted. On the basis of Bergson's notion of intuition, we extracted words indicative of intuition along with the associated thoughts or actions and analyzed these qualitatively and descriptively. We also chronologically arranged entire scenarios of nursing support and analyzed their effect on intuition-based support for families.

　Results: We found that the intuition of expert nurses allowed them to instantaneously understand a family's situation. This intuition enabled the nurses to unconsciously infer the feelings of the family based on each family members' expressions, such as movements of eyes and mouth. The expert nurses used their intuition to also recognize insecure and fluctuating feelings of the family to provide support in the form of observation or communication in accordance with the recognitions. Another finding was that the initial intuition of the nurses on meeting the family influenced subsequent thoughts and actions.

　Conclusion: The expert nurses understand the family members' fluctuating feelings using their intuition and consequently provide sensitive support based on their interpretation of these feelings. The findings of this study also indicate that the nurses' thoughts influenced by intuition are associated with their actions for support.