Journal Article 精神科病院における電子カルテ導入過程での看護部長の意思決定場面と問題認識の特徴
The Characteristics of Problem Recognition in the Process of Decision-making Performed by Directors of Nursing During the Introduction of an Electronic Health Record System at a Psychiatric Hospital

松下, 直美  ,  小林, 洋子  ,  村瀬, 智子

 本研究の目的は、精神科病院で電子カルテを導入する過程で看護部長が行った意思決定場面における問題認識の特徴を明らかにすることである。協力が得られた3 県内で、電子カルテ導入時に看護部長職にある4 名を研究参加者として質的記述的研究を行った。 その結果、電子カルテ導入過程での看護部長の意思決定場面として7 場面が抽出された。これらは、組織の一員として機種決定に参画、機会を活かした調整、電子カルテに向けたシステム作り、看護記録の様式選定、専門に対応する人員整備、職員の不安への配慮、医師の足並みを揃えるための対応の場面であった。 これらの意思決定場面における看護部長の問題認識の特徴は、看護部長の経験年数や電子カルテの導入の経験の有無により相違を認めた。この相違はメタ判断の関与が推察された。いずれの看護部長にも共通していたのは、病院の組織全体を見据えた問題認識をしていたことである。また、予算、経験、時間、人材が不足しているという多くの問題を認識している状況の中でも≪電子カルテ導入というチャンスを戦略的に生かしたいという認識≫をし、問題と認識している状況を逆にチャンスと捉え、看護記録の質向上や、業務改善、人間関係の調整を行おうとする看護部長の問題認識の特徴が明らかになった。
 The purpose of this study is to clarify characteristics of problem recognition in the process of decision-making, performed by Directors of Nursing during the introduction of an Electronic Health Record System at a Psychiatric Hospital. In the three participating prefectures, qualitative and descriptive research was conducted on four people who were in the position of Director of Nursing as research participants. As a result of this, 7 scenes were extracted as specific scenes in the decision-making process during the introduction of the Electronic Health Record System.These scenes are; participating in the decision about the model as a member of the organization, making adjustment by taking advantage of the opportunity, establishing a system for the Electronic Health Record System, selecting a model type for the nursing record, allocation of the staff who can act professionally, paying attention to the concerns of the staff, and alignment with doctors. We recognized that the characteristics of problem recognition in these scenes differ depending on the years of experience as the Director of Nursing as well as whether they had experience with the Electronic Health Record System introduction or not. The involvement of meta-decision was assumed in this difference. Also, all the Directors of Nursing had problem recognition which was based on the entire organization. In addition to this, even if they were in the situation where they recognized many issues such as the budget, length of experience, time span and lack of human resource, they had the intention of ≪ making use of this opportunity strategically ≫ by taking the situation of problem recognition as a chance in reverse, and improving both the nursing record quality and the tasks, and adjusting human relationships. These characteristics of problem recognition of Directors of Nursing were clarified.

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