原 著 * 小児がんの子どもの死を契機とした看護師の態度変容過程 要 旨 13 M-GTA. Key words はじめに 2, QOL 連絡先

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1 原 著 * 小児がんの子どもの死を契機とした看護師の態度変容過程 要 旨 13 M-GTA. Key words はじめに 2, QOL 連絡先 Phone FAX ohkubo@niigata-cn.ac.jp

2 表 研究参加者の概要 A B 40 9 C D 20 6 E F G H 20 4 I 20 5 J K 20 5 L 30 7 M 研究目的 用語の定義 看護師の態度 子どものターミナルケア 研究方法 参加者 3 13 表 データ収集方法

3 IC 分析方法 Modified Grounded Theory Approach M-GTA 14 M-GTA M-GTA 2 倫理的配慮 70 結果 表 結果図とストーリーライン 図 カテゴリーの説明 喪失の悲しみを抱える A

4 表 カテゴリー 概念 定義一覧 1 1 1

5 表 カテゴリー 概念 定義一覧 ( つづき ) 関わりの中での慰めを感じる 揺らぎつつ変えていく 生きられる時間を意識して技を尽くす

6 生の限界を了解する もう助けられないと思う 苦しみからの解放に安堵する 私が送り出してあげると思う : 出来事 : カテゴリー : サブカテゴリー : 概念 : 変容の方向 : 対立 : 影響 喪失を実感する あってはならないことと思う 空しくなる 気持ちをしまい込む 親の悲しみを思う 喪失の悲しみを抱える 闘病治療に葛藤する 闘病治療に無力感を抱く 悲しみに沈む後悔する 申し訳なく思う 足を向けられなかったことを悔いる 心を通じ合えなかったことを悔いる 思いに沿えなかったことを悔いる 闘病支援とターミナルケアの板ばさみに悩む 闘病治療に葛藤する時を逃すことに悩む 希望を叶えられる時を逃す現実に悩む 子どもの不安に応えられない葛藤がある 家族を傷つけない言葉選びに悩む 子どもと心の距離を縮める 子どもの思いをケアにつなぐ 親との信頼を築く 悲しんでばかりいられない 守りたい思いが湧き上がる 手助けしたい 遺されたメッセージに応えたい 経験を活かしたい 不完全さを埋めたい できるようになりたい 関わりの中での慰めを感じる 心の距離を縮めてケアにつなぐ 母親による手当をケアに組み込む 揺らぎつつ変えていく 悲しんでばかりいられない 生きられる時間を意識して技を尽くす 親子が共に過ごせる場所をつくる 最期の過ごし方を共に考える きょうだいが抱く気持ちにも配慮する 気持ちを切りかえよう 場を整えて親子の時間を大切に育む 新人の辛さを気遣い共にケアする子よく分からない感覚をもつ よく分からない感覚をもつ 悲しむ余裕もない 子どもの笑顔に救われる 看護することで気持ちが落ち着く つながっていると思う 死が終わりではないと感じる 親の姿に励まされる 感謝の言葉を嬉しく思う 気遣いを感じる 図 小児がんの子どもの死を契機とした看護師の態度の変容過程 どもの死

7 闘病支援とターミナルケアの板ばさみに悩む.. 生の限界を了解する 考察 子どもの死と看護師の態度変容過程

8 Conte Wengström 19 Wengström

9 板ばさみが意味すること bad news 25 悲嘆からの回復と看護師としての成長への示唆 結論

10 謝辞 36 利益相反 文献 http://ganjoho.jp/child/dia_tre/ about_childhood/about_childhood.html , html , html Knapp C,Woodworth L, Wright M,et al. Pediatric palliative care provision around the worlda systematic review. Pediatric Blood & Cancer , , , Rickerson EM, Somers C, Allen CM, et al. How well are we caring for caregivers? Prevalence of grief-related symptoms and need for bereavement support among long-term care staff. Journal of Pain and Symptom Management Conte TM. The Lived Experience of Work-Related Loss and Grief Among Pediatric Oncology Nurses. Journal of Hospice & Palliative Nursing Wengström Y, Ekedahl M.The art of professional development and caring in cancer nursing. Nursing & Health Sciences , , End-of-Life ,

11 Abstract Process of Attitude Changes in Nurses Who are Witness to the Deaths of Children with Cancer by Akiko Ohkubo 1 2 Tikayo Koyama from 1 Niigata College of Nursing 2 Graduate School of Health Sciences Niigata University The purpose of this study is to clarify the process of attitude changes in nurses who are witness to the deaths of children with cancer. The subjects were 13 nurses with experience in witnessing the deaths in witnessing children with cancer. Data was analyzed with the Modified Grounded Theory Approach. The process goes from feeling the sadness of loss, experiencing solace in relationships, making changes even with fluctuating feelings and demonstrating the art of nursing by being aware of the time that the child has left and accepting the limits of the patients life. This process also revealed the nurses conflict in worrying about the dilemma between providing support to fight the illness, and terminal care. With the initial experience of the death of a child, nurses make changes, while going through the recovery process from grieving, by being involved in other relationships with the people around them. Nurses then feel conflict in providing support to fight the illness while making use of the art of nursing, and transitions to a phase of finally accepting the death. This process was regarded as a growth process for nurses. These results suggested the importance of nurses including those who had newly graduated in terminal care for children and continuing to care for patients right until the end, and the necessity of mental support and technical and educational support for nurses involved in terminal care. Key words childhood cancer, death, nurse, attitude change Address reprint requests to : Akiko Ohkubo. Niigata College of Nursing 240 Shinnancho, Joetsushi, Niigata , JAPAN Phone FAX ohkubo@niigata-cn.ac.jp

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