新生児終末期ケア教育プログラム開発のための質問紙調査 <原著>

目的: わが国の場合,新生児の終末期ケアに関する教育プログラムは,死別ケア(グリーフケア)が中心であり,意思決定のサポートや新生児の痛みや安楽のマネジメントは含まれていない.そこで本研究では,新生児終末期ケアの包括的な教育プログラムを開発するための基礎資料を得ることを目的に質問紙調査を実施した.

方法: 無記名式の構成型質問紙調査を郵送法によって行った.対象者は日本新生児看護学会員674名とし,平成23年4月と平成24年5月に実施した.質問内容は,回答者の背景,死についての捉え方,新生児終末期ケア実践の捉え方,希望する新生児終末期ケアの学習項目とした.分析は,基本統計量の算出,一元配置分散分析によって行った.

結果: 340名から有効回答を得た(51.4%).1)「新生児の死は受け入れ難い」について「思う・やや思う」のは76.5%であった.2)「両親が検討に参加する/新生児のケアをすることは,価値がある」「両親の思いを聴くことは,やりがいがある」は,意思決定期・臨死期・死別期の間で有意差を認め,意思決定期が最低値であった.3)新生児終末期ケアの学習項目の中で,希望が最も多かったのは「終末期の家族の心理的側面のケア」,次いで多かったのが「医療者の心理的ケアや対処」,最も少なかったのは「治療中止に関する倫理的意思決定」「家族とのコミュニケーション」であった.

結論: 新生児の終末期ケアや緩和ケアの理解ややりがいを促すことを目的とした学際的,かつ医療者の心理的ケアを含む教育プログラムを作成する必要があることが示唆された.

Objectives: The education program for neonatal end of life care in Japan focuses mainly on bereavement care and does not include assistance with decision-making, pain and comfort management. We therefore conducted a questionnaire survey to collect basic data to develop a comprehensive education program for neonatal end of life care.

Methods: An anonymous semi-structured questionnaire by mail was distributed to 674 members of the Japan Academy of Neonatal Nursing in April, 2011 and May, 2012. The content of the questionnaire covered the bachground of the respondent, perception of human death and neonatal end of life care practice, and what the respondent wished to learn about neonatal end of life care. Data were descriptively analyzed and then a one-way ANOVA was carried out.

Results: 340 valid responses were received (51.4%). 1) To the question "The death of neonates is difficult to accept", 76.5% of the respondents said "Yes" or "Somewhat so", with the letter totaling 40.6%. 2) The answers "There is value for parents participating in review/neonatal care" and "It is rewarding to listen to parents' feelings" showed a significant difference among three phases: pre-death (decision-making time), time of death, and after-death. The lowest score was at the time of decision-making. 3) Among the things the respondents wished to learn the most, "End of life family psychological care" came in first, followed by "Psychological care of health-care professionals". The ones that scored the least were "Ethical decision concerning treatment withdrawal" and "Communication with family".

Conclusion: The need to develop an interdisciplinary education program in order to deepen the understanding of the impotance and values of neonatal palliative end of life care including psychological care of healthcare professionals was indicated.