ファミリーセンタードケアに基づいた看護実践に関するNICU看護師の認識 <原著>

目的 : わが国では，1970年代終わりに新生児看護実践にfamily-centered careが取り入れられ始め，その後，family-centered developmental careの普及とともに，family-centeredであることに関心が向けられるようになった．しかし今日，NICU看護師が，自分自身のFCCに基づいた実践をどのように捉え，かつ，実践を困難にさせる理由をどのように捉えているかは十分明らかにされていない．そこで本研究では，FCCに基づいた看護実践に関するNICU看護師の認識を調査し，FCCを推進するための課題を考察することとした．
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,FCCに基づいた看護実践，FCCに基づいた看護実践が困難な理由とした．分析は，基本統計量の算出，t検定，一元配置分散分析によって行った．
結果 : 340名から回答を得た(51.4%)．1)各基本概念の平均得点は，「心がけている」「実践している」とも，有意に「参加」が高く，「協働」が低かった．2)基本概念のいずれにおいても，「実践している」より「心がけている」の得点が有意に高かった．3)FCCに基づいた看護実践が困難な理由は，知識や実務の側面が上位を占め，最も多かったのは「医師，看護スタッフ・師長が，FCCの理念を実践化する方法を知らない」であった．4)FCCに基づいた看護実践が困難な理由は，年齢，総臨床経験年数NICU経験年数，他領域経験年数と関連した．
結論 : FCCの推進には，ガイドラインの作成および教育・訓練が重要な課題であることが考えられた．

Objectives: Family-centered care was introduced into neonatal nursing practice in Japan at the end of the 1970s. It attracted much interest with the spread of family-centered development care. Today, however, what NICU nurses think about their practice based on FCC, and the reasons it is difficult to practice are not clearly understood. We therefore surveyed the perceptions of NICU nurses on nursing practice based on FCC, and discussed ways of promoting FCC.
Methods: An anonymous structured question survey was sent by mail to 674 members of the Japan Academy of Neonatal Nursing in April 2011 and May 2012. Questions asked were on the respondents' background, nursing practice based on family-centered care, and reasons why practicing FCC was difficult. Data were descriptively analyzed and then a t - test and a one- way ANOVA were carried out.
Results: 340 valid responses were received (51.4%).
1) Concerning practicing or being mindful of the basic concept of FCC, "participation" scored significantly highly, while the score for "collaboration" was low.
2) For all the basic concepts, the response "mindful" scored significantly higher than "practice".
3) As for the reasons why nursing practice based on FCC is difficult, most issues were related to knowledge and practice. The most frequent response was "doctors, nursing staff, and head nurses do not know how to practice the concept of FCC".
4) The difficulty of nursing practice based on FCC correlated with age and years of total clinical experience, NICU experience, and experience in other areas.
Conclusion: Developing the Guidelines and providing education and training are considered necessary to promote nursing practice based on FCC.