集中治療室看護師のMoral Distressの様相と対処プロセス

The Nature and Coping Processes of Moral Distress Among ICU Nurses

要旨

　目的：集中治療室（ICU）看護師のMoral Distress（道徳的苦悩）の様相と対処プロセスを明らかにすること．

　方法：道徳的苦悩の経験を有するICU看護師11名に半構造化面接を行い，修正版グラウンデッド・セオリー・アプローチを用いて分析した．

　結果：ICU看護師は，内的価値観と外的要因との対立から《苛まれる心残りなケア》という苦悩を経験していた．その対処は，現状を受容する【組織順応型】，内省や対話を通じて成長を目指す【専門的成長型】，職場から距離をおく【離職意向型】に大別された．これらの類型は固定的ではなく，相互に移行しうる動的なプロセスであった．

　結論：道徳的苦悩は，離職のリスクと専門的成長の契機の両義性を持つことが示唆された．【組織順応型】から【専門的成長型】への移行を促すためには，個人の内省に加え，対話の場の設定や意思決定への参画を促す組織的支援が重要であることが示唆された．

　Purpose: This study aimed to elucidate the nature of Moral Distress experienced by intensive care unit (ICU) nurses and their coping processes.

　Methods: Semi-structured interviews were conducted with 11 ICU nurses with experience of Moral Distress, and the data were analyzed using the modified Grounded Theory approach.

　Results: ICU nurses experienced profound distress, described as 《lingering regret over compromised care》, arising from the conflict between their internal values and external constraints. Their coping processes were broadly categorized into three types: the Organizational Compliance Type, characterized by accepting the status quo; the Professional Growth Type, characterized by aiming for growth through introspection and dialogue; and the Withdrawal Intention Type, who intended to leave their positions. Furthermore, these types were not static, but part of a dynamic process wherein nurses could transition between them.

　Conclusion: The experience of Moral Distress was revealed to be ambivalent, presenting both a risk of nurse turnover and an opportunity for professional growth. To facilitate the transition from the Organizational Compliance Type to the Professional Growth Type, organizational support—such as providing spaces for dialogue and promoting participation in decision-making—is crucial, in addition to individual introspection.