新生児集中治療室（NICU）におけるEnd-of-Lifeケアの概念分析

Concept Analysis of End-of-Life Care in the Neonatal Intensive Care Unit

要旨

　目的：NICUにおけるEnd-of-Lifeケアの概念分析を行い，定義を明確にする．

　方法：計55文献を対象に，Rogersの概念分析の手法を用いた．

　結果：8つの属性【家族の愛着形成促進】【親役割獲得と家族形成の支援】【子どもの最善の利益に基づいた家族と医療者の協働意思決定】【子どもの身体的苦痛の緩和・除去】【子どもが家族とともに最期を迎える支援】【子どもを亡くした家族の悲嘆のケア】【Family-Centered-Careに基づく家族の精神的・身体的ケア】【多職種協働支援】と，5つの先行要件，4つの帰結が抽出された．

　結論：本概念は「Family-Centered-Careと多職種協働を基盤とした，愛着形成と親役割獲得・家族形成の促進，子どもの最善の利益に基づいた家族と医療者の協働意思決定，子どもが苦痛なく家族とともに最期を迎えるための支援と家族の悲嘆のケア」と定義した．

　Purpose: In this study aimed, we conduct a conceptual analysis of end-of-life care in the neonatal intensive care unit and clarify the definition.

　Methods: Fifty-five documents were analyzed using the concept analysis approach of Rogers.

　Results: Eight attributes were identified: “promotion of attachment formation,” “support for the acquisition of parental roles and family formation,” “collaborative decision-making between family and medical professionals based on the best interest of the child,” “alleviation and elimination of the child's physical pain,” “support for the child's final days with the family,” “grief care for families who have lost a child,” “family-centered-care for family mental and physical care,” and “multidisciplinary collaborative support.” Five prior requirements and four consequences were extracted.

　Conclusions: This concept was defined as “promotion of attachment, parent role acquisition, and family formation, collaborative decision-making between family and medical personnel based on the best interest of the child, support for the child to reach the end-of-life with the family without pain, and grief care for the family, based on family-centered-care and multidisciplinary collaboration.”