看護記録の開示に対する看護者の意識調査

Abstract

背景 2000年、日本看護協会は「看護記録の開示に関するガイドライン」を作成し、患者の権利擁護などにむけて積極的に開示の推進をはかっている。患者に「見せてはいけない記録」から「見せる記録」への転換は、患者・看護師関係に少なからず何らかの変化をもたらしていると推測される。目的 診療情報の開示が進展する中において、看護記録開示についての認識を明らかにし、患者・看護師関係を考察することである。方法 対象はK府内の病院、診療所、訪問看護ステーションに勤務する看護師および准看護師に独自に開発した質問紙を用いてアンケート調査を行った。実施期時は2004年8～9月であった。結果 調査に協力を得られたのは、1158名(回収率67%)の看護師、保健師、助産師、准看護師で平均年齢は36.5(SD:10.2)歳であった。看護記録の開示請求を経験した人は、5.9%と少なく、看護記録を見せることに抵抗感を持つ人は63.5%であった。40歳代以上の人や「患者は看護記録を見る権利を持っている」と認識している人のほうが、看護記録の開示によって患者との信頼関係や関係性が構築しやすいと答えていた。結論 看護記録の開示は、「信頼関係の崩れ」を危惧し、「安心感を与える・納得させる看護」が重要であると考えるパターナリズムタイプと「信頼関係の構築」につながり、「計画を一緒に考え・患者の主体性に働きかける」サポートタイプとに二極化していると推察される。今後は、形骸的な看護記録の開示ではなく、本質的なありようを市民/患者とともに創造していく取り組みが重要である。

Background The Japanese Nursing Association formed "Guidelines on the release of nursing records" in 2000 in order to promote the advocacy of patients' rights. Nurses were made aware that their records would be released to patients. The records could not be revealed to patients before; therefore it was presumed that this change could impact on the relationship between nurses and patients. Purpose This study aimed at revealing nurses' awareness and recognition of the release of nursing records, and then examining the relationship between patients and nurses. Method: Registered nurses and enrolled nurses at hospitals, clinics and the community area in K prefecture were recruited and asked to complete the original questionnaire made by researchers. This study was undertaken from August to September 2004. Result 1158 registered nurses, enrolled nurses, public health nurses and midwives agreed to participate in the study, and 67% of them answered the questionnaire. The average age of participants was 36.5 (SD:10.2). 5.9% of the participants experienced the release of their nursing records. It was found that 63.5% of the participant nurses felt reluctant to reveal their records to patients. Some nurses answered that it was easier to form a good relationship with patients if recognized that they had a right to see their nursing records. Conclusion It was presumed that there might be two opinions held by nurses in regard to the release of their records. Some nurses thought that the release of the records might destroy their paternalistic relationship with patients, and that it was important nurses reassured patients and relieved their anxiety so as not to destroy such a relationship with patients. But others thought that the release of their records might be helpful to establish a good relationship with patients, and that it was necessary to consider nursing care plans with patients and provide supportive care for them, respecting their auton omy. This study indicated that nurses should work together with patients to create not a superficial but a substantial system for the release of nursing records.