臨床場面における看護ケアの効果に関する研究 : 理論的サンプリングによるケア場面における患者行動の分析

本研究は,看護ケア場面における患者行動を看護問題に対応させて分析し,概念化することにより看護ケアの現状とその効果について記述検討することを目的としている。研究方法にはgrounded theory approachを参考にした質的帰納的方法を用い,ケア場面における患者行動を理論的サンプリングにより,持続比較分析した。清潔ケア場面における看護婦と患者の相互行為を参加観察によりデータとして収集し,患者行動を看護問題に対応させ分析した結果,353の患者行動-看護問題対応コードを抽出し,これらのコードから93のサブカテゴリ,16のカテゴリが形成され,さらに【1・問題発生と依存】【2・問題への対処と調整】【3・ケアと自己対処による問題の自覚・好転・解決】【4・ケアと自己対処による充足感獲得と心理的解放】【5・問題解決状況によるケア提供者との関係性の発展と変化】という5つのコアカテゴリを発見した。これらの結果は,ケアの多様な効果を説明するとともに,看護婦が質の高いケアを提供する上で重要な対象理解の視点をもたらした。

The study was intended to describe the current status and the effect of nursing care, by conceptualizing patient behavior through analyzing patient behavior under nursing care corresponding to nursing problem. Using a qualitative and inductive method with reference to the grounded theory approach, patient behavior in clinical setting was analyzed by a constant comparative method achieved through theoretical sampling. Data were collected by participant observation without intervention while patients were receiving hygienic care and patient behavior corresponding to nursing problem were analyzed. As a result, 353codes were found out of patient behavior classified into 93 subcategories, then formed into 16 categories. These categories were, then, developed into 5 core-categories. These were as follows: 1) arising of problems and resulting dependence; 2) taking self countermeasure and adjustment; 3) awareness, improvement and/or solution of problem through taking self countermeasure and acceptance of care; 4) attainment of satisfaction and mental release through taking self countermeasure and acceptance of care; and 5) development and evolution of patient-caregiver relationship based on approach to overcoming problems. These results provided not only an explanation of the diverse effects of care but also a perspective for understanding patients, an important factor in the provision of high-quality care.

source:Journal of Chiba Academy of Nursing Science