緩和ケア病棟における患者・家族にとっての意味深いケア環境の創出過程の可視化—ミューチュアル・アクションリサーチの手法を用いて

Visualizing a Process for Creating a Meaningful Care Environment for Patients and Families in the Palliative Care Unit: Utilizing Mutual Action Research Methodology

要旨

　研究目的は，がん終末期にある患者の最期が，“患者とその家族にとって意味深い体験”となることを目指して，研究者と緩和ケア病棟に所属する看護師の協働のもとで，看護師が“患者・家族にとっての意味深いケア環境”として自らを創出していく過程を探求し，その過程を可視化することと，その過程に潜む推進力を明らかにすることであった．

　方法は，全体論の見方に立つM. Newmanの健康の理論に準拠したミューチュアル・アクションリサーチ（MAR）の手法を用い，実践事例をもとに参加者の内省と自己のケアパターン認識を奨励する「対話の会」を繰り返した．データは，会の逐語録，研究者と参加者のジャーナル，研究者のフィールドノートであった．分析方法は，Newmanの健康の理論を踏まえ，研究目的に即して関連する部分の意味を抽出し，過程として眺め，意味づけた．当該大学と医療施設で倫理的側面の審査・承認を受けた．

　参加者は，緩和ケア病棟における看護師17名であった．会は20回開催され，参加者の延べ数は126名，取り上げられた事例は18事例であった．

　本MARを通して，参加者らの集合的な変化は6局面を経ながら，らせん状に進化する過程として可視化され，そこに潜む推進力として7つの要素が明らかとなった．

　本研究結果から，看護師らが全体性のパラダイムに準拠したNewman理論と看護実践のつながりに関心を持ち，ケアの事例について対話を重ね，そこでの学びを実践につなげていくならばMARは可能であり，類似したらせん状の過程をたどりながら，変化・成長を遂げていくであろうことが示唆された．

　The purpose of this research was to investigate a process for nurses to create themselves as a meaningful care environment for patients and their families in the palliative care unit in collaboration with a researcher, to visualize this process, and to figure out motivation factors during this process.

　Using the unitary-based mutual action research methodology (MAR) based on M. Newman's theory of health, “dialogue meetings” about the participants' nursing case were held repeatedly, in which both self-introspection and care pattern self-recognition were encouraged among participants. Data included transcriptions of dialogue meetings, the journals of participants and researcher and field-notes. The data analysis was conducted by extracting meaningful parts by paying attention to patterns, and by comparing them from the perspective of Newman's theory of health. Approvals of Ethical Committees were obtained from the relevant university and hospital.

　Seventeen palliative care nurses participated. Twenty dialogue meetings were held, and a total of 126 nurses joined. Eighteen cases were presented through all meetings.

　The collective pattern of participants was visualized as an evolving process spirally from Phase 1 to 6, and the motivations during MAR were extracted as 7 factors.

　When nurses in any kind of clinical nursing unit are interested in the connection of Newman's theory in the unitary paradigm and their nursing practice, and when they have dialogue about their own nursing cases and learn from them by using the MAR process, it is suggested that they will develop as nurses in a similar, spiral evolving process.