HIRO Mutsuo Graduate School of Integrated Science & Art, U.of East Asia Professor, 総合学術研究, 教授 (80033504)
ARAKAWA Yasuko Kobe City College of Nursing, Nursing Professor, 看護学部, 教授 (50167996)
SHIJIKI Yasuko Tokyo Metropolitan College of Allied Medical Sciences, Nursing Asso.Professor, 看護学科, 助教授 (60259140)
TSURU Satoko University of Hiroshima, Medical Asso.Professor, 医学部, 助教授 (80177328)
YOKOO Kyoko University of Hiroshima, Medical Asso.Professor, 医学部, 助教授 (80230639)
片田 範子 兵庫県立看護大学, 看護学部, 教授 (80152677)
南 裕子 兵庫県立看護大学, 看護学部, 教授 (70094753)
|Budget Amount *help
¥4,300,000 (Direct Cost: ¥4,300,000)
Fiscal Year 1996: ¥1,600,000 (Direct Cost: ¥1,600,000)
Fiscal Year 1995: ¥2,700,000 (Direct Cost: ¥2,700,000)
Regarding Informed Consent (IC), 66 articles in MEDLINE,Igakuchuozasshi, etc. since 1980 were selected and reviewed considering the following four points : 1) concepts and principles, 2) the difference between formal practice and actuality, 3) sway of the decision and 4) nurse's roles. Then, interview information from 6 groups of 18 people (6 physicians, clients and nurses each) were analyzed, and the factors in a sway of the decision were identified from the medical teams'and the clients'points of view. Five factors from the medical teams such as "quality of information" were identified. Four client's factors such as "characteristic of the illness and life events" were identified. Especially, how the client's family participates in the decision-making process, what the client's life-events were, and how the client's physical conditions were, were related to swaying the decision. A factor in the final decision to agree to the IC was "support client coping" from the medical team. Particularly, nurse's responses : showing interest ; listening sincerely ; guaranteeing validity of the client's decision ; approaching the physician, appeared the be effective support of the client. On the other hand, "the ability to deal with a dilemma" and "a proper extension of time of the agreement" were factors in the final decision of clients.
The findings above led to the next two steps. First, construction of a rough conceptual framework derived from relationships among the factors above. Second, surveyed the sway of the clients to gather quantitative information. Based on questionnaires, answered by 164 people out of 261, about 20% recognized sway. The results indicated the following basic roles of nurses in the process of IC : 1) a coordinator in the medical team, 2 )a facilitator for a client to support the right to know and to participate in the medical decision-making process, and 3) a mental and emotional supporter of the client and their families.