看護師の自律的な臨床判断が磨かれるプロセス

The Process of Enhancing Autonomous Clinical Judgment among Japanese Nurses

要旨

目的：看護師は専門職として，自律性を発揮することが必要である．看護師が自律性を発揮する様相として，看護業務における自律的な臨床判断がある．本研究の目的は，看護師の自律的な臨床判断がどのように磨かれるのか，そのプロセスを明らかにすることである．

方法：臨床経験8年以上の看護師14名に半構成的面接を行った．研究方法論は修正版グラウンデッド・セオリー・アプローチを採用した．

結果：15個の概念から5個のカテゴリーが生成された．看護師の自律的な臨床判断が磨かれるプロセスは，【知識を深める土台を築く】ことから始まっていた．看護師の自律的な臨床判断は，【育んだ技能を活用する】【自分以外の知識・技能を消化する】【判断の中身を振り返る】【知識と実践が深化する】の4つのカテゴリーを循環し磨かれていた．

結論：看護師の自律的な臨床判断は，看護師が自ら知識を蓄え，看護実践を省察することによって磨かれていた．

Purpose: It is crucial that nurses in Japan exert autonomy as professionals. One of the ways in which they exert autonomy in nursing practice is through autonomous clinical judgment. The aim of this study was to describe the process of how to enhance autonomous clinical judgment among Japanese nurses.

Method: We conducted semi-structured interviews of 14 nurses who had more than 8 years of clinical experience. The modified grounded theory approach was used for data collection and analysis.

Results: Five categories were extracted from 15 concepts. First, the process of autonomous clinical judgment of the nurses started from [building foundation to deepen their knowledge]. Nurse's autonomous clinical judgment was enhanced constant repetition of the four categories of [using acquired knowledge and skills], [understanding knowledge and skills of others], [reviewing contents of judgment], and [increasing their knowledge and skills].

Conclusion: Autonomous clinical judgment of nurses was enhanced by accumulating knowledge and by reflecting on their nursing practices.