小児科がない医療施設で子どもの予防接種を担う外来看護師の実践力向上のためのアクションリサーチ

Action Research to Improve the Practical Skills of Outpatient Nurses Responsible for Children's Immunizations in Hospitals Without a Pediatrics Department

要旨

　目的：小児科がない医療施設に勤務する外来看護師の子どもの予防接種に対する認識及び実践の変化を明らかにする．

　方法：本研究は外来看護師9名を研究参加者としたアクションリサーチであった．データ収集は参加観察，半構造化面接，文書収集を用い，領域分析を行って外来看護師の変化を把握した．

　結果：子どもの予防接種に対する外来看護師の認識は恐怖から自信へと変化した．実践においても親子への言葉がけは「ゴメンね」という謝罪から「大丈夫よ」と保証する言葉へと変わっていった．これらの変化に先立って固定法やディストラクションを用いた子どもの苦痛緩和に成功し，激しい啼泣や体動を回避して安全に実践できるようになった．

　結論：固定法やディストラクションの技術が向上すると子どもの予防接種に対する外来看護師の認識は変化していった．子どもの予防接種を担う外来看護師の実践力向上に繋がる支援の内容と方法が示唆された．

　Aim: Determining changes in the perception and practice of children's immunizations among outpatient nurses at hospitals without a pediatrics department.

　Methods: The present study was an action research conducted with nine outpatient nurses. Data were collected through participant observations, semi-structured interviews, and document collection. domain analysis was used to determine changes in outpatient nurses' perceptions and practices.

　Results: Outpatient nurses' perception of children's immunization changed from fear to confidence. In the practice of immunizations, nurses' words to children and their parents changed from apology ("I'm sorry") to assurance ("It'll be okay"). Before these changes, nurses succeeded in using techniques such as holding the child still in a safe manner and distracting the child to alleviate anguish and inject them safely without violent crying or movement.

　Conclusion: Improvement in techniques such as holding the child still in a safe manner and distracting them changes outpatient nurses' perception of children's immunizations. The present study suggested details and methods of support that can improve the practical skills of nurses in charge of children's immunizations.