NICUにおけるファミリーセンタードケアを促進する個人的・組織的要因：マルチレベル分析を用いて

Individual and Organizational Factors to Promote Family-Centered Care in the Neonatal Intensive Care Unit: Multi-level Analysis

要旨

目的：新生児集中治療室（Neonatal Intensive Care Unit; NICU）における看護師のファミリーセンタードケア（Family-Centered Care; FCC）の実践の影響要因について仮説を検証する．

方法：43カ所のNICUの看護管理者43名およびスタッフ1,700名を対象に質問紙調査を実施した．FCC実践の影響要因はマルチレベル分析および重回帰分析により探索した．

結果：有効回答数（回答率）は，管理者40名（93.0％），スタッフ764名（44.9％）であった．FCC実践の個人的要因は，FCC信念（t = 9.11），個人レベルの組織風土（t = 4.79），臨床経験年数（t = 3.35）であり，組織的要因は集団レベルの組織風土（t = 3.33），両親の24時間面会可の方針（t = 2.62）であった．また，管理者の教育・管理行動の一部の項目と集団レベルの組織風土は有意な関連があり，FCC実践に間接的に影響していた．

結論：良好な組織風土や家族の自由な面会方針は看護師のFCC実践を促進することが示唆された．

Purpose: To examine the individual and organizational factors that predict nurses' family-centered care (FCC) behaviors in neonatal intensive care units (NICUs) in Japan.

Methods: A nested cross-sectional survey (nursing staff within units) was conducted using a mailed self-reported questionnaire to 43 nurse managers and 1,700 staff nurses from 43 NICUs in Japan. Nurse-managers responded to an organizational-level questionnaire including items about visiting policy, staff education and management behaviors. Staff-nurses responded to an individual-level questionnaire including items about FCC behaviors, FCC beliefs, unit's organizational climate and demographic data. The data were analyzed with a multi-level analysis and a multiple linear regression analysis.

Results: The response rates for nurse managers and staff nurses were 40 (93.0%) and 764 (44.9%), respectively. Greater beliefs about FCC (t = 9.11), better individual-level organizational climate (t = 4.79), and clinical experience (t = 3.35) were significant individual-factor predictors of FCC behaviors. Better unit-level organizational climate (t = 3.33), and open access 24-hour parental visiting (t = 2.62) were significant organizational-factors predictors of FCC behaviors. The unit-level organizational climate mediated the relationship between the nurse-managers' management behaviors and staff-nurses' FCC behaviors.

Conclusion: Better NICU individual and unit-level organizational climate and open access visiting policies for families and were significant predictors of FCC behaviors. Nurse-managers' management behaviors toward staff, enhanced organizational climate and organizational commitment to an open access visiting policy for families are key components in implementing FCC.