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Title: 米国ハワイ州における「成人患者の利益・権利を守るアドボカシー」に関する看護師の意識 : 日本とハワイの看護師の意識の比較を試みて
Other Titles: Awareness among nurses in Hawaii toward advocacy for benefits and rights of adult patients : A comparison of nurses' awareness between Japan and Hawaii
Authors: 竹村, 節子
Keywords: ハワイ州の看護師
Nurses in Hawaii
nurses' awareness and reality
patients' rights
comparison between Japan and the US (Hawaii)
Issue Date: 31-Mar-2008
Publisher: 滋賀県立大学人間看護学部
Abstract: 背景 現在の医療現場において、真に患者の意思決定に基づく医療サービスが提供されているのかという問題意識から、患者の身近にいる看護師の役割は何かを探求するために、看護師が患者の権利や人権をどのように認識し実際に係わっているか、アドボカシー実践を促進する要因は何か、アドボカシーの用語について、その用語の持つ意味や構成概念をどのように理解しているかを明らかにしていく必要がある。近畿圏内の300床以上の病院で働く看護師を対象に調査をした結果とアドボカシーの概念化については既に報告したが、アドボカシーの概念が共通の普遍的な概念になり得るかについては検証されていない。目的 権利意識が醸成されている米国において、看護が行うアドボカシーの概念を実践看護師の視点から検討し、アドボカシー概念の構成している要素を明確にし、日本と比較することである。そしてアドボカシー概念が普遍的なものになり得るかを検証していく手がかりにすることである。方法 日本の調査で使用した質問票を用いてアンケート調査を行った。対象者はハワイ州の施設で働いている臨地経験5年以上の看護師(48名)である。結果 アドボカシーの実践内容は、日本は医師との調整役であるが、ハワイは医師への進言・苦言を呈し患者の意思を尊重するもので、患者側の立場に立った積極的な支援を行っている。アドボカシー実践を促進する職場環境の欠如は、日本は「ゆとりある業務」「医師はあくまで同僚」「民主的な環境」に対し、ハワイは「ゆとりある業務」である。患者の権利に対する看護師の現実の係わりにおいて、「代理人に意向を託す権利」、「尊厳死の権利」、「リビング・ウイルを実行してもらう権利」、「治療をやめる・拒否する権利」、「自分のカルテや看護記録を見る権利」、「看護・治療計画に参加する権利」、「臨床試験の参加、不参加の権利」、「信仰・宗教儀式を行う権利」に有意差があった。アドボカシーの構成要素に影響を及ぼす属性の要因は、日本は[情報の提供(権)]とアドボカシー・権利擁護の学びが正の関係、「主体的参加(権)」は修得した学位と負の関係である。ハワイは[主体的参加(権)]と臨床経験が負の関係である。ハワイでは9割の人がアドボカシーについて学んでいることから、アドボカシー実践を促進する大きな要因は、アドボカシーについて学んだかが大きく影響を及ぼす。結論 ハワイでの結果はサンプル数が十分ではないので精度として問題はあるが、医療制度・体制が違うハワイと日本では、看護師の権利やアドボカシーについての考え方に少なからず差異が見られた。ハワイは患者を権利から守る法律・法規に裏付けされた肯定的な認識が伺われる。
Background Do patients receive medical care services based on their own decision in current clinical settings? To clarify the roles of nurses, we need to understand how they perceive human rights, particularly patients' rights, and address relevant issues; what factors may promote the practice of advocacy. While I have reported the result from my survey in Japan in nurses working at hospitals with 300 or more beds in the Kinki region and offered a conceptualization of the term "advocacy," whether the concept of advocacy can be universally applicable has not yet been studied. Objective To study the concept of nursing advocacy from the standpoint of practice nurses in the USA, where people have a high awareness of rights, in order to clarify the values and elements that compose the concept of advocacy; and to compare the result with the result obtained from the survey in Japan. It is hoped that this study will help assess whether the concept of advocacy can be universally applicable. Method A questionnaire survey was conducted in 48 nurses with five or more years of clinical experience at medical facilities in Hawaii, using the questionnaire form used for the survey in Japan. Results While nurses in Japan play a role as a coordinator between patients and doctors, nurses in Hawaii play a more active role from the patient's point of view: They offer their opinions and advice to doctors in a way to respect patients' wishes. While factors that interfere with advocacy efforts in Japan were "stressful working schedule," " dominant-subordinate doctornurse relationship" and "less democratic environment," those in Hawaii was "stressful working schedule." As for the involvement of nurses in advocating for patients' rights, significant differences were observed in rights for patients to "delegate decisions to their representative," "die with dignity," "have their living will be followed," "discontinue and/or refuse treatment," "access their own medical and nursing records," "participate in nursing and treatment planning," "decide whether or not to participate in a clinical study" and "perform a religious ceremony." As for factors affecting the elements of advocacy, "information provision (right)" was positively correlated with the learning of advocacy and "subjective participation (right)" was negatively correlated with an earned academic degree in Japan. In Hawaii, "subjective participation (right)" was negatively correlated with clinical experience. In the survey result, 90% of the respondents had learned about advocacy, indicating that a major factor to encourage nurses to engage in advocacy is whether or not they have learned about advocacy. Conclusion While the accuracy may not be very high due to the limited number of samples in the survey in Hawaii, there was more than a little difference in understanding of nurses' rights and advocacy between nurses in Hawaii and those in Japan due to different medical systems. The survey result indicates the positive attitude toward advocacy supported by laws and regulations to protect patients' rights in the USA.
NII JaLC DOI: info:doi/10.24795/nk006_001-015
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