NICUで受けた看護実践に対する家族の認識 : ファミリーセンタードケアとエンパワーメントに焦点をあてて <原著>

目的: NICUに入院する子どもがいる家族がもつ看護実践への認識とエンパワーメントの程度, およびそれらに関連する家族ならびに環境要因を明らかにすることを目的とした.

方法: 全国の総合・地域周産期母子医療センターのうち32施設, 239名の母親に自記式質問紙を用いた量的記述的研究を実施した. ファミリーセンタードケア(Family-centered Care, 以下FCCとする)の枠組みで看護実践を測定するMPOC-20(Measure of Process of Care-20)およびエンパワーメントの程度を測定するEPS(Enabling Practice Scale)をそれぞれ翻訳・修正して使用した.

結果: 119名(回収率49.8%)の母親から回答があり, 有効回答は101名(有効回答率42.3%)であった. 看護実践得点に関して, 退院後にも利用できる情報提供に関する得点が特に低く, 母親の最終学歴(F=3.545, p=.017)や母親の就業形態(t=-2.030, p=.045)といった家族の属性によって差がみられた. 一方で, エンパワーメント実践得点は全般的に高く, 両親への厳格な面会制限の有無(t=-2.118, p=.037)やカンガルーケアに対する意思の反映度(t=-2.502, p=.014)といった環境要因によって差がみられた.

結論: NICUに入院する子どもをもつ母親は, NICU退院後にも利用できる情報提供を得ることができていないと認識していた. また, 家族中心の看護実践への認識やエンパワーメントの程度は, 家族背景や環境要因が影響していた. よって, 看護師は母親の思いを明らかにし, 個別の支援を提案・実施していける体制づくりをすることが重要である.

Purpose: The purpose of this study was to clarify how families in Japan with a child in NICU perceive nursing practices, degree of empowerment, the family members involved, and environmental factors.

Methods: A quantitative, descriptive study was conducted using a self-administered questionnaire filled out by 239 mothers whose babies were hospitalized in a NICU certified by the Ministry of Health, Labor and Welfare as an advanced treatment facility. Neonatal intensive nursing was assessed using the Measure of Processes of Care (MPOC-20), which focuses on family-centered care (FCC), and the Enabling Practice Scale (EPS) was used to assess degree of empowerment. Both questionnaires were translated into Japanese and modified.

Results: 119 mothers returned the questionnaire for a 49.8% response rate, with 101 valid responses (42.3%). The MPOC-20 score regarding useful information that could be utilized after hospitalization was particularly low, and a statistical difference was seen in family attributes, such as the mother's level of education (F=3.545, p=.017) and employment (t=-2.030, p=.045). The EPS scores were high overall, and a statistical difference was seen in environmental factors that reflect the extent of feelings toward the existence or nonexistence of an explicit parental visitation system (t=-2.118, p=.037) and kangaroo care (t=-2.502, p=.014).

Conclusion: Mothers with children in the NICU do not believe there is information available to them that they can utilize following discharge from the NICU, and perceptions about family-centered nursing care and degree of empowerment are impacted by family background and environmental factors. Therefore, it is important to design a system where nurses recognize family concerns so that individual support can be offered and implemented.