NICUにおける子どもの最善の利益と生命維持治療に対する看護師の認識 <原著>

本研究の目的は, 重篤な新生児の治療をめぐる意思決定に関する看護師の体験事例を通して, 生命維持治療のおける子どもにとっての最善の利益について看護師がどのように捉えているかを探索することとした. 対象はNICUの看護師20名とし, 非構成的面接を実施した. 分析は内容分析の方法を用いた.

結果は次の通りであった:

1. 看護師にとっての子どもの最善の利益は, その子どもをみている人に〈子どもが幸せそうに生きていると映る〉ことであった. 決定されたことが最善であったか否かは, 親がよかったと〈納得しながら生きられる〉こととした.

2. 幸せそうに生きていると映るのは, 親子関係が形成され, 親が治療に納得し, 子どもが家族の中で意味ある存在として受け入れられている状況であり, 生命維持治療は親の意向に合わせ肯定的であった.

3. 幸せそうに生きていると映らないのは, 親子関係が形成されず, 治療に納得せず, 親が子どもを見放してしまっている状況であり, 生命維持治療は親の意向にあわせ否定的であった.

これらの結果から, 親の意向を尊重し, 死亡率や重篤な障害が非常に高い場合緩和ケアを選択肢に入れることの重要性が示唆された.

The purpose of this study was to explore NICU Nurses' Perception of the Best Interests of the Infant and Life-Support Treatments. The research was conducted through unstructured interviews with 20 NICU nurses. The subjects were asked about the ethical decision making they experienced in NICU and their thoughts on the best interests of the infants in those cases. The results are summarized as follows:

1. Nurses perceive what makes the infant "appear to be living happily" for in his/her best interests. If a decision is made according to this perception and parents are satisfied with the results, then nurses consider it a right decision.

2. The state where "the infant appears to be living happily" is materialized when the bonding between the parents and the infant is established, the parents are satisfied with the treatments for the infant, and the infant is accepted as a meaningful member of the family. In such cases, nurses are positive about life support treatment for the infant in accordance with the parents' wishes.

3. The state where "the infant does not appear to be living happily" is found when the bonding between the parents and the infant fails to be established, the parents are not satisfied with the treatments for the infant, and the parents give up on the infant. In such cases, nurses are negative about life support treatment for the infant in accordance with the parents' intention.

These results indicate the importance of parents' wishes and palliative care when the infant is severely impaired and his/her mortality is considered very high.