The Journal of the Japan Academy of Nursing Administration and Policies Vol 12, No 1, pp 37 48, 2008 報告 看護師 医師関係における会話の特徴と協働関係形成の条件 Characteristics of Conversation in the Nurse-Physician Relation, and Conditions for the Formation of a Collaborative Relationship 中川典子 1) 林千冬 2) Noriko Nakagawa Chifuyu Hayashi Key words : nurse-physician relation, conversation, discourse, interaction, collaboration キーワード Abstract A qualitative induction study was performed with the purpose of clarifying the characteristics of how nurses and physicians interact via their mutual conversations in the patient-care setting, including the thinking that lies behind their respective discourse. Data was collected by means of participant observation at nurse-physician conversation sites and via semi-structured interviews with nine nurses and nine physicians. As results, the following were found in the nurse-physician discourse : Cues for Action, Cues for Reconsideration, Acquisition of Information and Opinions, and Provision of Information and Opinions. As for Cues for Action and Cues for Reconsideration, characteristics observed were that nurses question the opinions of physicians and use cues when intentionally offering information, thereby stimulating the development of the care process. As for Acquisition of Information and Opinions, and Provision of Information and Opinions, characteristics observed were that more information, both in terms of quantities and kinds, is provided by nurses to physicians especially observed was the provision by nurses of much information regarding changes in patients as well as concerning patient families during the course of the treatment. Also, in settings of conversations between nurses and physicians, in cases where there were differences in their respective opinions, there were not a few cases where, due to not providing verbally to the other party the thought processes supporting one s opinion, no development was seen in the mutual interaction process. From the above results, it was thought that, for the formation of a collaborative relationship between nurses and physicians, it became clear that it is required to exchange Cues for Action, Cues for Reconsideration, after a nurse and a physician share the idea which care as a patient goal, or the view and background of a plan and both sides in everyday life by exchange of Acquisition of Information and Opinions, and Provision of Information and Opinions. Also as conditions for the formation of a collaborative relationship, it was suggested that, on the side of nurses, there needs to be the ability to make clinical decisions on the basis of their specialty expertise, an understanding of patients including their families, and the ability to make clear and convincing communications, while on the side of physicians, there needs to be a deepening of their understanding of care and of the expertise of nursing, and cooperation via positive and clear expressions, including a conscious expression of information, opinions, policies, and intentions concerning care and treatment, etc. 2007 3 142008 4 14 1Kyoto Second Red Cross Hospital 2Kobe City College of Nursing Vol 12, No 1, 2008 37
要旨 9 Ⅰ. はじめに Coluccio Coluccio & Magure, 1983 1998 Feiger & Schmitt, 1979 Porter 1991 1998 2002 2006 5 1996 38 Vol 12, No 1, 2008
Ⅱ. 研究方法 1. 研究デザイン 2. 調査協力者と調査期間 9 9 2004 7 10 300 500 3 1 5 6 3. 用語の定義 4. データ収集方法 5. 分析手順と方法 1 2 183 48 3 15 4 Ⅲ. 倫理的配慮 Vol 12, No 1, 2008 39
Ⅳ. 結果 1. 発話の類型 183 295 282 15 4 表 1 2. 各カテゴリにおける特徴 1) 行動化の促し 1 D MRI A 12 MRI 2) 再考の促し 1 80C 19 ROM CPM 40 Vol 12, No 1, 2008
表 1 カテゴリとサブカテゴリおよびサブカテゴリにおける特徴的な発話 D MRI A 12 8 A27 B 43 B37 A 24 B 19 B 2 80C19 B 2 1 H2 l SO 2 OFFC 28 OP C 3 ICU A53 A 87 M B 6 27 ml 10 ml 100 mg 10 ml A 3 Vol 12, No 1, 2008 41
3) 情報 見解の供与 1 A34 4) 情報 見解の獲得 1 E C 3 FA 90 42 Vol 12, No 1, 2008
3. 看護師と医師の発話の関係 場面 1; G H I G I A 46 1 2 場面 2; 5 B 21 3 場面 3; J 1 CT B 7 4 場面 4; TK 2 Vol 12, No 1, 2008 43
1 A 37 QOL QOL 5 場面 5; L 90 1 1 L L B 18 1 1 Ⅴ. 考察 1. 行動化の促し 再考の促し における特徴 44 Vol 12, No 1, 2008
Benner Benner, 1984 MRI A 12 Stein, 1967 2. 情報 見解の供与 情報 見解の獲得 における特徴 A34 2003 2003 3. 看護師と医師との発話の関係性と協働関係の形成の条件 ( 図 1) 3 1 2 3 Vol 12, No 1, 2008 45
図 1 看護師と医師における協働関係形成の条件 3 5 4 QOL 46 Vol 12, No 1, 2008
Ⅵ. 研究の限界と課題 300 500 3 Ⅶ. 結論 謝辞 3 2005 引用文献 1998 1998 Vol 12, No 1, 2008 47
ANA141 Benner, P. 1984 1992 83 93 117 125 1996 29 159 70. Coluccio, M. & Maguire, P. 1983 Collaborative practice : Becoming a reality through primary nursing : Nursing Administration Quarterly, 7, 59 63. 2003 Quality Nursing, 9 2, 159 170. Feiger, S.M. & Schmitt, M.H. 1979 Collegiality in Interdisciplinary tealth teams : Its measurement and its effects : Social Science & Medicine, 13A, 217 229. 2003 1Nursing Today, 18 7, 44 45. Porter, S. 1991 A participant observation study of power relations between nurses and doctor in a general hospital : Journal of Advanced Nursing, 16, 728 735. Stein, L. 1967 The Doctor-nurse game : Archives of General Psychiatry, 16 6, 699 703. 1998 ET 2 165 72. 2002 22 298. 2006 9 2 22 30. 48 Vol 12, No 1, 2008