短 報 A narrative analysis of nurses uncomfortable feelings and dilemmas experienced in teamwork 1 1 Megumi TAGUCHI Michio MIYASAKA キーワード : 違和感 ジレンマ チーム

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1 短 報 A narrative analysis of nurses uncomfortable feelings and dilemmas experienced in teamwork 1 1 Megumi TAGUCHI Michio MIYASAKA キーワード : 違和感 ジレンマ チームワーク 看護経験 規範 ナラティヴ Key words :uncomfortable feelings, dilemma, teamwork, nursing experience, norm, narrative 看護師が看護実践の中でどのような違和感 ジレンマを経験し その状況にどのように対応しているのか また その対応に対する看護チームの反応を明らかにするために看護師 10 名にインタビューを行い テーマ分析と構造分析を組み合わせたナラティヴ分析を行った 構造分析から 1) 違和感 ジレンマを経験したが対応できなかったというナラティヴ19 例 2) 違和感 ジレンマに対応したが効果が得られなかったというナラティヴ10 例 3) 違和感 ジレンマに対応し効果が得られたというナラティヴ2 例が見いだされた 効果が得られた2 例は 成功体験や良いモデルに出会った経験があるケースだった テーマ分析の結果 違和感 ジレンマは X. 看護チームの習慣 ルール 看護システムに対するもの Y. 看護経験の多少に基づくもの Z. 看護師 医師の関係に基づくもの に分類された 倫理的ジレンマへの対応 行動のあり方を組織的に検討し 看護師が倫理的実践能力を発揮しやすいチーム 集団の環境を整えることが不可欠であることが示唆された This study s objective is to examine the uncomfortable feelings and dilemmas experienced by nurses in their teamwork, as well as to clarify their common structures. An interview survey was conducted with 10 nurses, and a narrative analysis was performed in regard to the structures of the nurses stories of incongruities. As a result, the findings of the structural narrative analysis suggested three structural patterns in the reported episodes: 1)the nurse did not take any action(19 episodes); 2)the nurse took some actions, but they had no effect(10 episodes); and 3)the nurse took some actions and they had some effect(2 episodes). Regarding the latter two episodes, one nurse noted that her colleagues were a good model while another referred to her previous successful experiences when dealing with the current incongruity. In addition, the reported causes for such incongruities were categorized into three themes: (X)owing to the conventional habits in their nursing teams, (Y)owing to the length of clinical experience, and(z)owing to nurse doctor relationships. 1 1Department of Nursing, Graduate School of Health Sciences, Niigata University VOL.7 NO

2 VOL.7 NO

3 表 1 研究参加者の背景病院 病棟研究参加者年齢看護経験年数異動経験の有無看護師 A 20 歳代 3 年目なし看護師 B 20 歳代 3 年目病院移動経験有り看護師 C 20 歳代 4 年目なし看護師 D 20 歳代 5 年目病棟移動経験有り看護師 E 20 歳代 6 年目なし看護師 F 20 歳代 7 年目なし看護師 G 20 歳代 7 年目病院移動経験有り看護師 H 20 歳代 8 年目病院移動経験有り看護師 I 30 歳代 10 年目病院移動経験有り看護師 J 30 歳代 10 年目病院移動経験有り X YZ 3 1)違和感 ジレンマを経験したが対応できなかった というナラティヴ 19 X Y Z 3 X VOL.7 NO

4 48 VOL.7 NO A A C Y 199 G

5 49 VOL.7 NO B B Z 191 D 2)違和感 ジレンマに対応したが効果が得られなかった というナラティヴ 10 X Y Z 3 Z X 107 A A

6 50 VOL.7 NO I Y 103 E 3)違和感やジレンマに対応し効果が得られた というナラティヴ 2 X Y Z 32X J

7 51 VOL.7 NO p.xi xii

8 J H 2 J H wellbeing VOL.7 NO

9 http:// s html Goethals S, Gastmans C, Dierckx de Casterlé B. Nurses ethical reasoning and behavior: a literature review. International Journal of Nursing Studies. 2010; 47: Ulrich CM, Taylor C, Soeken K et al. Everyday ethics: ethical issues and stress in nursing practice. Journal of Advanced Nursing. 2010; Riessman CK. Narrative methods for the human science. California: SAGE publications. 2008; Labov W, Waletzky J. Narrative analysis: oral versions of personal experience. In: Helm J ed. Essays on the verbal and visual arts. Seattle: American Ethnological Society/University of Washington Press; 1967; ICN http:// rinri/pdf/icncodejapanese.pdf Dierckx de Casterlé B, Izumi S, Godfrey NS, Denhaerynck K. Nurses responses to ethical dilemma in nursing practice: meta-analysis. Journal of Advanced Nursing. 2008; 63 3 : Gallagher A. 16 In: Davis AJ, Tschudin V, de Raeve L eds. 2006/ VOL.7 NO

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