精神科病院における患者から暴力を受けた新人看護師に対するベテラン看護師の支援のプロセス

The Support Process by Experienced Nurses for Novice Nurses Who Have Experienced Violence From Patients in Psychiatric Hospitals

要旨

　目的：患者から暴力を受けた精神科新人看護師に対するベテラン看護師の支援のプロセスを明らかにする．

　方法：精神科経験10年以上・看護管理者・精神看護専門看護師のいずれかに該当する看護師12名に面接を実施し，M-GTAを用いて分析した．

　結果：ベテラン看護師は【見えにくい不適応な反応を探る】【孤立しやすさを探る】ことで支援の必要性を判断し，一方で〈言語的暴力被害に対する支援のタイミングを逃す〉ことも経験していた．さらに，【安心して相談できる土台づくり】【隠そうとする感情を受け止めコントロールする手助け】【周囲のサポートを強化する働きかけ】の心理的支援から【暴力体験を今後のケアへ繋げる内省の促し】の教育的支援へ移行していた．

　結論：心理的支援から教育的支援への移行は，感情のコントロールを支え，二次被害の予防に重きを置いたプロセスであった．また，言語的暴力被害に対する支援体制の確立も今後の課題であると考えられた．

　Objective: To elucidate the support process provided by experienced nurses to novice psychiatric nurses who have experienced violence from patients.

　Method: Interviews were conducted with 12 nurses who met at least one of the following criteria: over 10 years of experience in psychiatric nursing, nursing management position, or certified psychiatric nurse specialist. The data were analyzed using a Modified Grounded Theory Approach (M-GTA).

　Results: Experienced nurses assessed the need for support by "identifying subtle maladaptive responses" and "exploring tendencies toward isolation. " They also reported "missing the appropriate timing to provide support in cases of verbal abuse." Once the need for support was established, they transitioned from psychological support—"creating an environment where the novice nurse felt safe to consult," "helping to manage and accept suppressed emotions," and "encouraging the surrounding staff to provide further assistance"—to educational support aimed at "facilitating self-reflection to connect experiences of violence with future Care."

　Conclusion: The transition from psychological support to educational support was a process that emphasized preventing secondary harm while assisting in emotional regulation. In addition, establishing a support system for victims of verbal abuse was considered an ongoing challenge.