小児がんの子どもの死を契機とした看護師の態度変容過程

Process of Attitude Changes in Nurses Who are Witness to the Deaths of Children with Cancer

要旨

　本研究の目的は，小児がんの子どもの死を契機とした看護師の態度変容過程を明らかにすることである．

　参加者は，小児がんの子どもの死を体験した看護師13名である．データ収集は，半構成的面接を行い，修正版グラウンデッド・セオリー・アプローチ（M-GTA）を用いて質的帰納的に分析した．

　本プロセスは，【喪失の悲しみを抱える】【関わりの中での慰めを感じる】【揺らぎつつ変えていく】【生きられる時間を意識して技を尽くす】【生の限界を了解する】という過程を辿ると考えられた．そしてその過程には，【闘病支援とターミナルケアの板ばさみに悩む】という看護師の葛藤が表出された．すなわちそれは，子どもの死を契機として，看護師が，初期には関係性の中に身を置くことで悲嘆からの回復過程を辿りながら変わり，闘病支援に葛藤しながら技を駆使して，最終的には死をも承認する態度へと変容し，成長していく過程として捉えられた．

　本結果は，新人看護師も含めて，子どものターミナルケアに関わり，最期の時まで受持つことの重要性と，そのための精神的支援，および技術的・教育的支援の必要性を示唆するものであった．

　The purpose of this study is to clarify the process of attitude changes in nurses who are witness to the deaths of children with cancer.

　The subjects were 13 nurses with experience in witnessing the deaths in witnessing children with cancer. Data was analyzed with the Modified Grounded Theory Approach.

　The process goes from feeling the sadness of loss, experiencing solace in relationships, making changes even with fluctuating feelings and demonstrating the art of nursing by being aware of the time that the child has left and accepting the limits of the patient's life. This process also revealed the nurses' conflict in worrying about the dilemma between providing support to fight the illness, and terminal care. With the initial experience of the death of a child, nurses make changes, while going through the recovery process from grieving, by being involved in other relationships with the people around them. Nurses then feel conflict in providing support to fight the illness while making use of the art of nursing, and transitions to a phase of finally accepting the death. This process was regarded as a growth process for nurses.

　These results suggested the importance of nurses including those who had newly graduated in terminal care for children and continuing to care for patients right until the end, and the necessity of mental support and technical and educational support for nurses involved in terminal care.