特別支援学校の学校看護師が医療的ケアを要する子どもの急変に備えるプロセス

Process of Nurses' Preparing for Sudden Health Deterioration in Children with Medical Technology Dependence in Special Needs Schools

要旨

　目的：特別支援学校の看護師（以下，学校看護師）が，医療的ケアを要する子どもの急変に備えるプロセスを明らかにする．

　方法：学校看護師18名に半構造化面接を実施し，修正版グラウンデッド・セオリー・アプローチを用いて分析した．

　結果：学校看護師は，急変対応を経験し，重責を伴う急変対応の判断に迷い，急変にチームで対応する必要性を感じる中で，急変時に関わる人たちと信頼関係を築き，その子を知るように努めていた．そして，その子に起こりうる体調の変化や急変を予測し，教諭と共に，急変時に動けるように備え，急変に至らないよう先手を打っていた．その際，学校看護師は，親や教諭の思いや学校のルールにそわなければいけないことで葛藤を抱くと，教諭や親の思いと折り合いをつけていた．学校看護師は，教諭と共に急変に備えながら教諭の急変対応力を高めていた．

　結論：急変に備えるため，学校看護師と教諭が経験を共有し学ぶ場の必要性が示唆された．

　Purpose: This study aimed to describe the process of nurses' preparing for sudden health deterioration in children with medical technology dependence in special needs schools.

　Method: Semi-structured interviews were conducted with 18 nurses with work experience of more than 3 years at special needs schools, and obtained data were analyzed using the modified grounded theory approach.

　Results: Nurses felt a strong sense of responsibility and expressed difficulty in assessing and responding to children's sudden health deterioration; therefore, they tried to know each child individually. After getting to know the children, nurses could predict how a child's health could change, including sudden health deterioration. Nurses were prepared to work together with teachers when sudden health deterioration occurred, and they made plans to prevent it. While preparing for sudden health deterioration, nurses faced conflicts because of accepting requests of parents and teachers and school rules. In such situations, nurses reconciled these requests while maintaining children's health and safety. Nurses expressed the necessity of working with school staff as a team to address sudden health deterioration. Therefore, nurses built mutual relationships with school staff and parents, improved skills of teachers in caring for the children, and prepared to work together with teachers.

　Conclusion: To prepare for sudden deterioration in a child's health, it is necessary for nurses and teachers to learn by sharing their experiences.