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論文
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坂上, 章 ; 相上, 律子 ; グェン, ティ トゥ フォン ; 片山, 美穂 ; 長田, 恭子 ; 北岡, 和代
概要:
This study was performed to examine the effects of emotional labor and work-related stressors along with the relation be
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tween emotional labor and burnout in psychiatric nurses in Japan. A self-administered questionnaire survey was sent to the director of nursing at a mental hospital, who then sent the surveys to all 169 nurses at the hospital. From among existing measures, we chose the Japanese version of the Maslach Burnout Inventory-General Survey （MBI-GS）, to measure burnout; the emotional labor scale to measure emotional labor; and the Japanese version of the Areas of Worklife Survey （AWS） to measure work-related stressors. Multiple regression analysis was applied to the data, with three subscales （exhaustion , cynicism , and professional efficacy ） of the Japanese MBI-GS as dependent variables. The significant predictors of exhaustion were reward and workload （from the Japanese AWS） and display of negative emotions to patients （from the emotional labor scale）. Significant predictors for cynicism were reward , workload , and values （Japanese AWS） and display of negative emotions to patients （the emotional labor scale）. For professional efficacy, only marital status and reward （from the Japanese AWS） were found to have significant effects. The present study revealed some effects of emotional labor, particularly negative emotional labor. However, work-related stressors, notably reward, workload, and values, had greater effects on worker burnout. Some forms of emotional labor, such as empathy for patients and display of positive emotion , emotional dissonance, and emotional sensitivity requirements , were found to have no effect on worker burnout. In clinical practice, it is necessary to ensure that psychiatric nurses do not take on a disproportionate number of patients whose care would require negative emotional labor. It is also important that new nurses are trained by experienced nurses who demonstrate good awareness when engaging in negative emotional labor and know how to persuade patients. Furthermore, instead of simply assuming that emotional labor degrades mental health, we should actively pursue ways to allow professionals to exhibit empathy for patients and to handle emotional dissonance and sensitivity as needed. To prevent burnout among psychiatric nurses, organizations need to evaluate the nursesʼ performance, prevent individual nurses from becoming overworked, and reflect the nursesʼ sense of value in work. In this way, we can prevent burnout among psychiatric nurses and thereby provide better quality care to the patients.<br />日本の精神科看護師を対象として、感情労働と職場ストレッサーの双方がバーンアウトにおよぼす影響を検討し、精神科看護師の感情労働とバーンアウトとの関係を明らかにすることを目的とした。1 単科精神科病院に勤務する看護師 169 名を対象に自己記入式質問紙調査を実施した。バーンアウトは日本版MBI-GS （Maslach Burnout Inventory-General Survey）を、感情労働は感情労働尺度を、職場ストレッサーは日本版 AWS （Areas of Worklife Survey）を採用し、測定した。 日本版 MBI-GS の 3 下位尺度を被説明変数とした重回帰分析を行った結果、‘ 疲弊感 ’ では日本版 AWS の ‘ 報酬 ’ と ‘ 仕事の負担 ’、感情労働尺度の ‘ 患者へのネガティブな感情表出 ’ が有意な説明変数となった。‘シニシズム’では日本版AWS の ‘ 報酬 ’、‘仕事の負担’、‘ 価値観 ’、感情労働尺度の ‘ 患者へのネガティブな感情表出 ’ が有意な説明変数となった。‘ 職務効力感 ’ では ‘ 婚姻状況 ’ と日本版 AWS の ‘ 報酬 ’ のみが有意な説明変数となった。 感情労働の中でも、ネガティブな感情労働のバーンアウトへの影響を認めることができたが、職場ストレッサーがおよぼす影響の方がより大きいと考えられた。精神科看護師のバーンアウトを予防してより質の高い看護を提示していくためには、組織全体で看護師の仕事の成果等を正しく評価すること、看護師個々に仕事の負担がかかりすぎないように配慮すること、看護師の価値観を仕事に反映させることを重要視し、取組んでいく必要がある。
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| 2.
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論文
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長田, 恭子 ; 北岡, 和代
概要:
This study was performed to examine changes after talking to alleviate suicidal ideation in people with depression or bi
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polar disorder that have attempted suicide, and to clarify the role of the researcher in this process. Data were collected through unstructured interviews with participants suffering from depression or bipolar disorder that were hospitalized because of attempted suicide. The interview began when they emerged from the crisis situation, and continued after discharge from hospital. From the contents of the interview, we analyzed the parts where emotions and thoughts before and after suicide were expressed and the remarks of the researcher. The participants were five women, and the interview number ranged from three to eight times. We extracted six categories based on analysis of participantsʼ narratives. There were four categories regarding strong obsession with death and great anxiety and loneliness: “Obsession with death,” “Loneliness the same as before suicide attempt,” “Anxiety about an uncertain future,” and “Losing self-confidence by confronting reality.” In addition, there were two categories regarding alleviation of suicidal ideation and newfound affirmation of life: “Feeling inclined to live” and “Developing motivation for life.” Throughout the interview process, the researcher strove to “wait patiently for participants to express their feelings and thoughts,” never hurrying them or interrupting their remarks. In the second half of the interview, to address participantsʼ everyday problems “the researcherʼs ideas were shared so that participants could change their behavior.” When attendees made an effort and experienced behavioral changes, the researcher focused on the positive by “urging participants to be aware that they are changing and to notice what they are doing.” The results of this study clearly showed that after a suicide attempt patients with depression were moving forward but still vacillating between life and death. Even those that were hopeless and desperate enough to choose their own death had taken definite steps toward the future. Nurses need to recognize this, come close to their wavering emotions, and provide support to help them think positively and find hope for the long term.<br />本研究は、自殺企図を行ったうつ病あるいは双極性障害をもつ者の希死念慮を緩和していく過程における語りの変化と研究者の関わりを明らかにすることを目的とした。自殺未遂が原因で入院となったうつ病あるいは双極性障害をもつ者を対象に、ナラティヴ・アプローチの原則に基づいた非構造化面接を行った。面接内容より、自殺に至るまでや自殺企図後の感情や思考が表現されている部分とその前後の研究者の発言を分析対象とした。 参加者は女性 5 名、面接回数は 3 ～ 8 回であった。参加者の語りを分析した結果、1）死への執着があり不安や孤独感が強い時期には【死への執着】【自殺前と変わらない孤独感】【先がみえない不安】【現実に直面することによる自信喪失】の 4 つのカテゴリー、2）自殺念慮が緩和し生きることを肯定し始めた時期には【生きることに気持ちが向く】【生への意欲の芽生え】の 2 つのカテゴリーが抽出された。研究者は、参加者が考えや気持ちを表現できるようにゆっくり待つ姿勢を示した。面接の2回目以降は、参加者が多面的な見方ができるよう、また変化を自覚できるよう問いかけた。参加者は生と死の間を揺れ動きながらも前に進んでいること、一度は自ら死を選ぶほどの絶望の淵に立たされた人であっても、わずかながらの希望をもち将来に向かって歩き始めていることが明らかになった。看護師は、自殺企図に至ったうつ病者の揺れ動く気持ちに寄り添い、肯定的に思考を変化させて希望を見出せるよう長期的にサポートしていくことが重要だと考えられる。
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論文
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大江, 真吾 ; 北岡, 和代 ; 長田, 恭子
概要:
This study was performed to determine the views and expectations of patients with pervasive developmental disorders（PDD）
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regarding nurses. Semi-structured interviews were conducted with 10 patients with PDD. Five categories were extracted based on quantitative descriptive analysis of the data: people whose presence is insignificant; people who do not understand me; people who bring a sense of relief; people who provide support; and an expectation of understanding. While patients had negative thoughts regarding nurses as insignificant and as people who did not understand them, they also associated nurses positively with relief and support, revealing their ambivalent views regarding nurses. Furthermore, patients had an expectation of being understood by nurses. These findings suggest that it is important for nurses to understand the hardships experienced by PDD patients and build relationships with them through communication and nursing care. Using these newly built relationships taking their characteristics into account, nurses should provide advice to patients, thereby encouraging them to express their needs and hopes for the future. As PDD patients may make few expressions, it is necessary to convey what the patients would like to say and what they are thinking to family members and physicians.
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