看護師が自己規範とチーム規範との不一致によって経験するジレンマについてのナラティヴ分析

Narrative Analysis of Dilemmas Experienced by Nurses Standing between Individual and Team Norms

要旨

　目的：看護師が自己規範とチーム規範との不一致によって経験するジレンマの内容，ジレンマ対応の様式，対応に影響を及ぼす因子を明らかにする．

　方法：ジレンマの内容と経験および対応について，看護経験2年以上の看護師21名にインタビューを行い，構造的ナラティヴ分析とテーマ的ナラティヴ分析を組み合わせた分析を行った．

　結果と考察：構造的ナラティヴ分析の結果から，ジレンマを経験した際の対応は，イ）ジレンマに対してチーム規範に則って行動した，ロ）-①ジレンマに対して個人の可能な範囲で行動した，ロ）-②ジレンマに対して小集団から同意を得られた場合に行動した，ハ）-①ジレンマに対して自己規範に則って行動したがチーム規範に変化をもたらさなかった，ハ）-②ジレンマに対して自己規範に則って行動しチーム規範に変化をもたらした，に分類できた．テーマ的ナラティヴ分析の結果から，ジレンマ対応に影響を及ぼす因子は，看護経験年数，異動経験の有無，周囲との対立回避，賛同者の獲得，役割意識に基づく行動であった．患者の多様なニーズへの対応には，看護師個人とチームの相互における継続的な検討が必要である．

　Objective: This study aimed to assess the dilemmas experienced by nurses standing between individual and team norms and the factors influencing the classification of nurses' reactions to such dilemmas.

　Methods: An interview survey was conducted on 21 nurses with more than 2 years of experience. Data were analyzed via structural and thematic narrative analyses.

　Results and Discussion: Five structural patterns in the participants' stories were evaluated via a structural narrative analysis: a), the nurse took some actions conforming to team norms, b)-1, the nurse took some actions as far as possible based on individual judgment, b)-2, the nurse took some actions when she could find a small group of supporters, c)-1, the nurse took some actions conforming to individual norms but could not change team norms, and c)-2, the nurse took some actions conforming to individual norms and succeeded in changing team norms. The thematic narrative analysis identified five factors affecting nurses' reactions: duration of experience in nursing practice, job displacement, avoiding conflict with others, acquisition of supporters, and roles assigned in the team. These results suggest the importance of cultivating organizational culture “to listen to small voices.”