精神科看護師における境界の調整技術の獲得過程

Abstract

精神科看護において看護師がかかわりの中で境界を調整する技術をどのように獲得してきたのかを明らかにすることを目的として、精神科看護師15名を対象に、半構成面接を行い、逐語録を質的帰納的に分析し、カテゴリーを抽出した。その結果【環境により境界の調整を意識しない】【看護師役割より個性が前面に表出される】【境界の調整に対する制約を受ける】【境界の調整が困難である】【周囲を活用して境界の調整を発達させる】 【自分自身で境界の調整を発達させる】 【意図的に境界を調整する】の7カテゴリーが抽出された。 境界の調整を含めたかかわりの技術を磨けばエキスパートになれるという視点が共有できれば, 境界の調整に関するかかわりの主体的な振り返りやその技術を発展させられるようなチームのサポートの可能性が広がる。さらに, チームと受持ち看護師との関係も対立する可能性が軽減し, 患者との相性に敏感になり過ぎることも軽減できると考えられる。

To identify how nurses working in psychiatric wards acquire the skills necessary for negotiating boundaries during the course of their interactions with patients, semi-structured interviews were conducted with 15 psychiatric nurses. Interviews were transcribed verbatim and data were qualitatively and inductively analyzed in order to extract categories from the transcript contents. The following seven categories were extracted: [those who are not conscious of the negotiation of boundaries due to environmental factors], [those whose individual personality is expressed foremost and more prominently than that of their role as a nurse], [those who feel restricted by the negotiation of boundaries], [those who feel it is difficult to negotiate boundaries], [those who proactively try to develop boundary negotiation skills using their surroundings], [those who proactively try to develop boundary negotiation skills on their own], and [those who consciously try to negotiate boundaries]. Nurses can be considered 'experts' if they are highly skilled in interacting with patients, including negotiating boundaries . Such expert nurses have the potential to expand support in a team setting by proactively utilizing and developing their boundary negotiating skills. Moreover, when such nurses are primary care nurses, they encounter fewer conflicting relationships within the nursing team by acting to reduce the tendency of nurses to becoming overly sensitive about their compatibility with patients.