患者−看護師関係における看護師の専心のプロセス

The Process of Nurse Dedication in Patient-Nurse Relationships

要旨

　目的：患者−看護師関係における看護師の専心のプロセスを明らかにする．

　方法：総合病院に勤務する看護師12名に半構成インタビューを実施し，M-GTAを用いて分析した．

　結果：臨床の看護師は《生活者との関係構築》に集中し，《患者の思いへの配慮》に心を注ぎ，《患者の思いへの対応》に専念していた．その過程で《看護師の感情的反応》も経験していたが，《患者−看護師関係の維持》を行い《個別的なケア》に集中していた．以上のように，臨床の看護師は基本的に《患者を中心とすること》に専心しようとしていた．このプロセスを【流動的専心】としてとらえた．

　結論：《看護師の感情的反応》をケアではないと個人の問題として抑圧したり，切り捨てたりするのではなく専心に内包し，患者−看護師関係のインボルブメントの概念枠組みでとらえることで，看護師は患者に起こっていることをアセスメントし，自身の感情の中で起こっていることと患者−看護師関係の中で起こっていることを振り返り，再度専心を患者に向け看護ケアを行うことが可能となると考える．

　Objective: This study was conducted to clarify the process of nurse dedication in nurse-patient relationships.

　Methods: Semi-structured interviews were conducted with 12 nurses working in a general hospital and the results of the interviews were analyzed using the modified grounded theory approach.

　Results: Nurses concentrated on “building relationships with patients living in the community,” focused on “showing consideration for patients' feelings,” and were devoted to “responding to patients' feelings.” In this process, nurses also experienced “nurses' own emotional response,” but concentrated on “personalized care” through “maintaining a nurse-patient relationship.” Accordingly, nurses tried to dedicate themselves to fundamentally “focusing on the patient.” This process was perceived as ‘fluid dedication.’

　Conclusions: Nurses should be capable of assessing what is happening to patients, reflect on what is happening in their own emotional response and in the patient-nurse relationship, and rededicate themselves to patients by providing nursing care that incorporates the “nurse's own emotional response” instead of suppressing or discarding it as a personal problem that is not related to care, and by perceiving the “nurse's own emotional response” within the conceptual framework of involvement in the patient-nurse relationship.