看護実践の語り合いによる看護師の気づきと行動—看護実践を語る会を用いたアクションリサーチ

Nurses' Awareness in Meetings to Discuss and Develop Nursing Practices: Action Research Using a Group that Talks about Nursing Practice

要旨

　目的：看護師が看護実践を語る会に参加し，語り合いからどのような気づきを得て実践で行動するのか，看護師間や周囲の看護師にどのような変化をもたらすか記述する．

　方法：語る会を用いたアクションリサーチである．参加者は急性期病院1病棟の看護師5名と師長1名であり，データは語る会の内容，インタビュー等を用いて質的記述的に分析した．

　結果：〈ケアを受けたくない患者の思いをキャッチした〉語り合いから気づきを得た看護師は，患者の理由を聴く新たな行動をとり症状が改善する変化が生じた．その行動を次の語る会で〈患者が食事をしない原因を捉えた〉と語り合い，「後輩は困りごとを発信していない」とさらなる気づきを得て実践に役立てた．2年後，困りごとを語り合う取り組みとなった．

　結論：看護師は語る会で気づきを得て，これまでの実践とは違う新たな行動を行った．病棟で自発的に語り合いが生起し，語る会は学習の機会であることが示唆された．

　Objective: This study aimed to outline the findings from nursing practice narratives and action plans for nurses working in acute care hospitals, describing potential changes that may occur between participants and other nurses.

　Methods: This was an action study using meetings to discuss nursing practices. The participants included five female nurses and head nurses in one ward of the acute care hospital. During the meetings, the nurses shared their practical stories and other participants were asked to put the knowledge they gained from the stories into practice. We conducted a qualitative analysis using four semi-structured interviews before and after the meetings.

　Results: A nurse who heard of a story about wound cleaning applied a new method after a meeting, and successfully treated her patient. At another meeting, a story about finding the cause of symptoms was mentioned. Another nurse who heard this story noticed that she “caught the thoughts of patients who do not want to receive care” and took a new action “Caught the cause of the patient not eating”. Two years later, she found mechanisms to talk about her problems.

　Conclusion: Participants gained new perspectives and ideas at the meetings, taking new actions that were different from the ones practiced so far. Participants suggested that the meetings take place in the hospital ward going forward, in order to create a culture of participation and encourage communication.