新人看護師に対するソーシャルサポートが医療事故の認知的評価および報告の迷いに及ぼす影響

The Influence of Social Support on Novice Nurses' Cognitive Appraisal of Medical Error and Hesitation to Report the Error

要旨

　目的：新人看護師にとって「支持的な対人関係」や「医療事故のサポート認識」が，医療事故の「認知的評価」や「迷いのない報告」にどのように関連するかを明らかにする．

　方法：全国から無作為抽出した病院の新人看護師597名に自記式質問調査紙調査を実施した．

　結果：305名（51.1％）が回答し272名（89.2％）の有効回答を得た．パス解析から，新人看護師への「支持的な対人関係」は「医療事故後のサポート認識」に影響し，この認識が医療事故の認知的評価の「影響性」と「コミットメント」にさらに影響することで報告の迷いが減じられるモデル（χ²値＝70.321（p＝.001），RMSEA＝.058，SRMR＝.0345，TLI＝.970，CFI＝.980）が示された．

　結論：新人看護師は「支持的な対人関係」を基に得られる「医療事故後のサポート認識」によって，医療事故の認知的評価のうち「影響性」と「コミットメント」を高く評価できることが関連し，迷いのない報告に繋がると考えられる．

　Aim: To clarify how “supportive relationships” and “perceived availability of post-error support” effect “cognitive appraisal of error” and “hesitation-free reporting of error” among novice nurses.

　Method: Questionnaires were distributed to 597 novice nurses working in hospitals chosen by random sampling.

　Results: Three hundred and five surveys (51.1%) were returned, with 272 (89.2%) valid responses. Path analysis showed good model fit for a model in which “supportive relationships” influence the “perceived availability of post-error support,” and where this perceived availability affects the cognitive appraisal of error in terms of the appraisal of “effect” and “commitment,” in turn reducing hesitation to report the error (χ² = 70.321 (p = .001), RMSEA = .058, SRMR = .0345, TLI = .970, CFI = .980).

　Conclusion: The results suggest that novice nurses report errors without hesitation when they are better able to appraise “effect” and “commitment.” This is enabled by the “perceived availability of post-error support,” which novice nurses predict from “supportive relationships.”