子どもの急変に先立つ過程における看護師の経験

The Series of Processes Undergone by Nurses before A Child's Condition Deteriorates

要旨

　目的：子どもが急変を起こす以前に看護師がどのような経験をしているのか，一連の過程を把握すること．

　方法：子どもの急変経験がある看護師9名に非構造化面接調査を行い，グラウンデッド・セオリーを用いて分析した．

　結果：看護師は何が起こるかわからない《不確かな状況》において，危機を回避するために《子どもの声を届ける》という過程がある一方，回避するための思うような対応が得られず《引っかかりを残す》という，異なる帰結に至る過程が把握された．これら帰結を導くプロセスは，《アンテナを張る》《何かが起こる予感》《医師との共有化のハードル》《声にならない声を届ける使命感》《周囲を巻き込む》で構成され，子どもの状態を医師と共有できるかが道筋を分ける分岐点となった．

　結論：子どもの急変においてはこの共有化のハードルをいかに下げ，一人の看護師の感覚を医療チーム全体の問題意識にしていくことの重要性が示唆された．

　Objective: To ascertain the series of processes that nurses have undergone before a child's condition deteriorates.

　Methods: Unstructured interviews were conducted with nine nurses who experienced the deterioration of a child's condition, and their responses were analyzed using a grounded theory approach.

　Results: In an “Uncertain situation” in which a nurse is unsure what happens, nurses undergo a process of “Conveying the child's thoughts and feelings” to avoid a crisis, but the process of “Having doubts,” i.e. the doctor has not responded to the nurse's concerns as expected, leads to different consequences. The process that leads to those consequences consists of the following steps: “Put out an antenna,” “A sense that something will happen,” “Overcoming the hurdle of sharing the child's plight with the doctor,” “Commitment to giving a voice to patients without one [children],” and “Involving others.” The outcome diverges depending on whether or not a nurse was able to share a child's condition with the doctor.

　Conclusion: Results suggested the importance of lowering the hurdle of sharing a child's condition with the doctor and the importance of making the entire medical team aware of the nurse's expert perceptions.