Japanese

Title	NICUにおける子ども虐待予防に向けた新生児集中ケア認定看護師の臨床判断
Subtitle	研究報告
Authors	岩崎美輝1), 松浦和代2)
Authors (kana)
Organization	1)釧路赤十字病院, 2)札幌市立大学看護学部
Journal	日本新生児看護学会誌
Volume	26
Number
Page	32-40
Year/Month	2020 / 5
Article	報告
Publisher	日本新生児看護学会
Abstract	【目的】本研究の目的は, NICUに入院した新生児の親に対して子ども虐待を予防するために行っている看護実践における臨床判断のプロセスを明らかにすることである. 【方法】質的記述的研究デザインとし, 対象は新生児集中ケア認定看護師とした. データ収集方法は, 半構造化インタビューであった. 分析方法はBerelson, B. の内容分析の手法を用いた. 抽出したカテゴリとサブカテゴリを, Tanner, C. の臨床判断モデルの構成要素; I コンテクスト・背景・関係性, II 予期, III 初期把握, IV 推論パターン, V 行為, VI 結果, VII 行為中の省察, VIII 行為後の省察, をフレームとして類型化した. 【結果】対象者数は6名であり, 12事例を得た. NICU退院後の帰結から, 子ども虐待回避群(n=7)と子ども虐待群(n=5)に大別した. 臨床判断は, 子ども虐待回避群ではI〜VIとVIIIの7構成要素が見出された. Vで個別性を重視したディベロップメンタルケアや育児指導を実践し, VIでは親が育児の担い手になることができた. 子ども虐待群では8構成要素が見出された. IIでは入院した当日や翌日に親の過剰にへつらう行動や威圧的な態度などに対して違和感を覚えIIIを開始したが, VIでは子ども虐待を回避できなかった. 【考察及び結論】対象者が子ども虐待予防のために行う臨床判断は, Tanner, C. の臨床判断モデルを踏襲していた. 子ども虐待回避群では親の特徴や問題に合わせた個別的な対応を実践し, 一連の看護が子ども虐待の予防に役立つプロセスとして機能していた. 一方, 子ども虐待群において, 入院した極早期に子ども虐待を予兆し臨床判断を開始するきっかけとなったIIの内容は, 子ども虐待の予兆を発見するために, 今後, 活用すべき重要な項目になり得る.
Practice	看護学
Keywords	NICU, 子ども虐待, 新生児集中ケア認定看護師, 臨床判断, Child abuse, Certified nurse in neonatal intensive care, Clinical judgment

English

Title	Clinical judgment on prevention of child abuse in NICU by certified nurses in neonatal intensive care
Subtitle	Study Report
Authors	Miki Iwasaki1), Kazuyo Matsuura2)
Authors (kana)
Organization	1)Kushiro Red Cross Hospital, 2)Sapporo City University
Journal	Journal of Japan Academy of Neonatal Nursing
Volume	26
Number
Page	32-40
Year/Month	2020 / 5
Article	Report
Publisher	Japan Academy of Neonatal Nursing
Abstract	Objective: The purpose of this study is to clarify the process of clinical judgments made by nurses concerning the provision of nursing care for the prevention of child abuse for parents of neonates hospitalized in the Neonatal Intensive Care Unit (NICU). Methods: This study employed a qualitative, descriptive design with certified neonatal intensive care nurses. Data were collected using a semi-structured interview. The method of content analysis was used. The extracted categories and sub-categories were classified as frames based on the components of the Clinical Judgment Model proposed by Tanner, C.: I) context/background/relationship, II) expectations, III) initial grasp, IV) reasoning patterns, V) action, VI) outcomes, VII) reflection-in-action, and VIII) reflection-on-action. Results: Twelve cases were identified among six participants. The cases were broadly divided into a child abuse avoidance group (n = 7) and a child abuse group (n = 5) based on the consequences after discharge from the NICU. In the child abuse avoidance group, seven components of I - VI and VIII were identified for clinical judgment. In V, developmental care and childcare guidance were provided, which emphasized individuality, and in VI, parents were able to become involved in childcare. In the child abuse group, eight components were identified. On the day of hospitalization or the day after, an uncomfortable feeling toward to flatter with excessively of parents and to assume a coercive attitude, etc., was perceived and thus component III was initiated. However, in VI, child abuse could not be avoided. Discussion and conclusion: The clinical judgment of the participants concerning the prevention of child abuse was based on Tanner's clinical judgment model. The child abuse avoidance group practiced individual nursing tailored to parental characteristics and issues, while a series of nursing care procedures functioned as a useful process for avoiding child abuse. In contrast, in the child abuse group, the content of II, which triggered the early start of clinical judgment by predicting child abuse early in hospitalization, can be an important item that should be used to detect signs of child abuse in the future.
Practice	Nursing
Keywords	NICU, Child abuse, Certified nurse in neonatal intensive care, Clinical judgment

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