NICUの看護師が認識する家族中心のケア（Family-Centered Care）の利点および促進・阻害要因

Benefits, Promotion and Barriers that Nurses' Perceived for Implementing Family-Centered Care in Neonatal Intensive Care Units

要旨

目的：新生児集中治療室（NICU）の看護師が認識する家族中心のケア（FCC）の実践，利点，促進および阻害要因を明らかにする．

方法：便宜的に抽出された首都圏内の総合／地域周産期母子医療センター10施設のうち，承諾の得られた6施設のNICUの看護師12名を対象にフォーカス・グループ・インタビューを実施した．

結果：NICUの看護師が認識する〈FCCの実践〉として7つ，〈FCCの利点〉として4つ，〈FCC実践の促進要因〉として【FCCに関する教育の充実】【ケアの方針決定への参画しやすさ】【FCCに関するチーム活動】【FCCに対する医師の理解・協力】【FCC実践に対する家族からの肯定的な反応】の5つ，〈FCC実践の阻害要因〉として6つのカテゴリーがそれぞれ抽出された．

結論：FCCの実践を促進するためには，家族の面会時間の拡大やコミュニケーションスキル・FCCに関する新卒および継続教育の充実，看護管理者や医師を含めた組織的な取り組みとスタッフへの支援が重要である．

Purpose: This study was to identify NICU nurses' benefits, promotion and barriers for family centered care (FCC) implementation in Japan.

Methods: This qualitative descriptive study used a convenience sampling of NICUs from the greater Tokyo area Japan yielding 12 NICU nurses from six of the ten perinatal medical centers approached. Three focus-group interviews with four nurses each were conducted.

Results: Seven categories were extracted as actual nurses' practices of FCC. Four categories were extracted as benefits for to implement FCC: 1) greater psychological health of parents and improvement in parental competencies; 2) strengthening family bonding and function; 3) enhancing communication and information sharing about child's care and 4) nurses' greater job satisfaction. Five categories were extracted as promoting factors for nurses' to implement FCC: 1) strength of staff education about FCC; 2) opportunities of decision-making about care policies of the unit; 3) team activities to improve care for families; 4) understanding and support from pediatricians about FCC and 5) positive responses from families to implement FCC. Five categories were extracted as barriers to implement FCC: 1) lack of knowledge and skills about FCC; 2) limited opportunities of decision-making about care policies; 3) concerns about families' abilities to perform child's care; 4) negative attitude for shifting to family-centered care policies from staff centered/task oriented care; 5) burden to implement FCC with limited staff and 6) different views on FCC among staff.

Conclusion: This study provides direction for promoting nurses' to implement FCC by strengthening staff education about FCC and providing organizational support from managers and other healthcare professionals.