NICU入院期間中の超低出生体重児の両親の家族形成過程 <研究報告>

本研究の目的は, 超低出生体重児の両親が出生直後から退院間際までに, 子どもにどのな思いを持ち, どの様に子どもの問題を共有し, どの様な過程を経て親そして家族となって行くかという家族形成過程を明らかにし, その際の看護の示唆を得ることとした.

NICUに入院中の超低出生体重児の両親3組から, 半構成的面接を行い, 分析は内容分析の手法を参考にしながら質的帰納的に行った. その結果, 超低出生体重児の両親の思いを語った内容から, 母親の思いは27カテゴリー抽出され, 父親の思いは23カテゴリー抽出され, 第1期を『家族が危機的状況を乗り越えるまでの時期』, 第2期を『子どもと家族の相互作用が促進されるまでの時期』, 第3期を『家族として子どもを迎え入れる時期』と名づけた. 第1期は, 両親が喪失体験を経験しながらも子どもに出来ることを精一杯しようとしていた. 第2期は子どもとのスキンシップから親と子どもの相互作用が芽生え, 第3期には, 子どもの世話から得られる安心と子どもの予後への不安というアンビバレントな感情を抱きながらも, 子どもを受け入れて新たな家族を形成しようとしていた.

超低出生体重児が出生し退院するまでに家族は, 親と子どもの相互作用を促進させるための関わりを持ち, その場面から考えられる看護の方向性について, 危機を家族で乗り越えられるような支援をしていき, 家族がエンパワメント出来る様な環境作りを行い, 家族の関係性を深める関わりの重要性が示唆された.

The objective of the present study was to elucidate the family formation process of parents of extremely low birth weight infants from childbirth to discharge. Specifically, we investigated the parents' feelings toward the child, the ways in which they shared problems related to the child, and the process by which they established themselves as parents and formed families, and determined appropriate nursing methods during this process.

Semi-structured interviews were conducted for three pairs of parents of extremely low birth weight infants who were hospitalized in NICU. Analysis was performed using a qualitative and inductive approach based on content analysis. A total of 27 categories of maternal feelings and 23 categories of paternal feelings were extracted from the contents of feelings expressed by the parents of extremely low birth weight infants. In addition, the family formation process was divided into the following three stages: first stage, "the period up to the point at which the family overcomes the critical situation"; second stage, "the period up to the point at which interactions between the child and parents are promoted"; and third stage, "the period during which the child is welcomed into the family". During the first stage, parents made every effort to help the child while experiencing a sense of loss. During the second stage, interactions between the child and parents arose from physical contact, while during the third period, parents strived to accept the child and form a new family while having ambivalent feelings of comfort derived from childcare and concerns regarding the child's prognosis.

These findings indicate that between the birth and discharge of extremely low birth weight infants, important processes in family formation include the promotion of interactions between the child and parents, provision of support that enables the family to overcome crises with respect to nursing approaches that consider each situation, establishment of environments that promote empowerment in the family, and deepening of family relationships.