NICUにおける看護師のファミリーセンタードケアに関する実践と信念 <原著>

【目的】新生児集中治療室(以下, NICU)の看護師のファミリーセンタードケア(Family-Centered Care: 以下, FCC)の概念に基づいた看護実践とFCCに関する信念, および関連要因を明らかにすることを目的とした.

【方法】関東圏内のNICU30施設を対象とし, 各施設の看護師長30名に「病棟の理念・方針・環境に関する質問紙」, 看護師計900名に「FCCの実践と信念に関する質問紙」を配布し, 量的横断的調査を実施した. FCCの実践と信念の測定には, Rosenbaumらが開発したFCC実践尺度(MPOC-SP)とFCC信念尺度(MBP-FCS)を翻訳し, 使用した.

【結果】看護師長対象の質問紙は30部すべて回収できた. 看護師対象の質問紙の回収率は81.6%, 有効回答数N=710, 看護師の平均年齢は30.3±6.8歳, 平均臨床経験年数は8.9±6.6年, NICUでの平均臨床経験年数は4.8±3.7年であった. FCC実践得点の看護師全体の傾向としては, 対人関係に関する行動の得点は高かったが, 情報提供に関連した行動の得点は低かった. また, 一元配置分散分析およびt検定の結果, FCCの実践および信念は, 対象者の年齢・臨床経験年数・教育背景・役職の有無に有意な関連があった.

【結論】FCCの理念に基づく看護を実践するためには, 看護師の情報提供者としての役割認識を強化し, FCC実践に対する自己効力を高めるような教育, FCCの実践の組織的な方向づけや支援, 環境づくりが重要である.

Purpose: The purpose of this study was to clarify nurses' practices and beliefs about family-centered care(FCC) in the neonatal intensive care unit (NICU) in relationship to several factors in Japan.

Methods: A quantitative cross-sectional survey was conducted by self-reported questionnaire in 900 nurses working in the NICU of 30 hospitals and nurse managers of each Unit in the Kanto region in Japan. Two questionnaires were used; the questionnaire of philosophy, policy and environment of the NICU for nurse managers and the questionnaire of the nurses' practices and beliefs about FCC for staff nurses in the NICU. Practices about FCC were assessed by the Measure of Processes of Care for Service Providers (MPOC-SP) and beliefs about FCC was assessed by the Measure of Beliefs about Participation in Family-Centered Service (MBP-FCS) which developed by Rosenbaum in Canada.

Results: The response rate was 81.6%. In order to conduct statistical analysis, appropriate data from 710 respondents were used. The subjects' mean age was 30.3±6.8 years. The mean of their clinical experience was 8.9±6.6 years. The mean of their neonatal care experience was 4.8±3.7years.

As the tendency to the entire MPOC-SP score, the score of the practice which related to providing information was low though the score of the practice which related to interpersonal relationship was high. Age, clinical experience, neonatal care experience, educational background and managerial position had significant relationship to both the score of MPOC-SP scale and the score of MBP-FCS scale.

Conclusion: It was revealed that the nurses' practice of FCC was related to each nurses' self-efficacy to implementing FCC. These results suggested that it is necessary to strengthen the recognition of nurses as the role of the providing information, educate and build environment for improving the nurses' self efficacy to implementing FCC.