病院で子どもたちに行われる検査や処置に対する心理的準備としてのプレパレーションが欧米を中心に広く行われてきているが,日本ではまだ十分とは言えない状況である。本研究では,膀胱尿管逆流症の手術のために入院した4歳女児に対して,看護師がキワニス人形と木製模型等を用いたプレパレーションを実施し,実施する上での効果的な要素と普及の可能性を検討した。実施後に担当看護師を中心とした入院から退院までの経過についての検討会を行い,その内容から作成した逐語録と退院後に返送された調査用紙の内容分析を行った。その結果,【子どもが自分で描いた人形を説明に用いること】が,【説明への参加の導入】となり,【親も子どもの説明に参加すること】によって理解が促され【医療者との関係性を促進する要素】となっていた。また【看護師の主体性をさらに磨く方法】として普及していくために【子どもに説明することの根本的な意義を浸透させていくこと】や事例を重ねて【病棟の状況に応じた方法】を検討していくことの必要性が示唆された。

The concept of psychological preparation for children undergoing a medical procedure or a physical examination in Japanese hospitals is being adopted from Western countries. However, it remains poorly developed. This study therefore investigated the factors effective in the preparation and the possibility of expanding this concept. We report a case of a 4-year-old girl scheduled to undergo surgery for vesicoureteral reflux. Preparation was undertaken by a nurse using a Kiwanis doll and a wooden model of the medical procedure. Thereafter, the nurse and researchers discussed the case from admission to discharge, and records of this meeting and a questionnaire completed by the patient's parents after discharge were analyzed qualitatively. It became clear that the use of the Kiwanis doll drawn by the girl acted as an introduction to preparation. Involvement in preparation using the doll and the wooden model also aided parents in their understanding of the operation. This was also an important factor in strengthening the relationship between the child, parents and nurse. Preparation is a subjective area of nursing. In order to cultivate subjectivity in nurses and expand preparation in many hospitals, it is necessary to establish the basic significance of explanations of surgery to children and to investigate suitable methods of giving such explanations. This can be done by accumulating the experience of many cases to investigate appropriate methods in each hospital.

症例報告

Clinical Report

国立情報学研究所で電子化