UH CNAS，RINCPC Bulletin Vol．18，2011

49

Structure of nursing care―― Analysis of the structure and process of nursing care in the
primary nurse support system ――NONAMI Youko

Abstract
Aim：The purpose of this study was to clarify the structure and process of nursing care in actual practicein the primary nurse support system a systematized nursing care resource that can be used by nurses forpatients in their charge，based on the concept ofcaring ．

Methods：This study was carried out using symbolic interaction theory，as follows．The study made use of
the grounded theory．The subjects of this study consisted of nurses in a general hospital in Tokyo．Afterthe study was explained to them，informed consent for participation in this study was obtained from all thenurses involved．Data were collected by the interview method and continuously analyzed until no new
category was obtained．Data collection was continued until the purpose of this study was realized，in
1999．A total of 34 nurses were interviewed．Their length of nursing experience ranged from 1 to 11 years（mean：3.9 years）．
Results：As a result of the evaluation of associations among the major nursing care concepts ofsituations ， creation of nursing care places（community） and the
could be structured and defined as

creation of

emergence of persons ，nursing caresymbiotic nursing care ．

Conclusion：Based on the results of this study，symbiosis could be defined asa process involving thegeneration of individuals in the space formed by the creation of situations after establishing subjects andsharing meanings between the participants and other people，and by the creation of places allowing
connections to be made with the feelings of others present ． Symbiotic nursing care can therefore be seen
as a social act involving a process of socialization that mutually creates multiple

situations

between nurses

and patients and multiple nursing care places（community） among nurses，where patients daily life patterns
gradually emerge，and nurses cooperate and become independent．

Key words：Nursing care；Caring；Primary nurse support system；Grounded Theory；
Symbolic Interaction；Symbiosis

Adult Health Nursing，College of Nursing Art & Science，University of Hyogo

50

Structure of nursing care

１．Purpose of the study

Introduction

The purpose of this study was to clarify the

The nursing situation in Japan at present is very

structure and process of nursing care in actual practiceserious，as shown by the steep rise in medical costs．

within theprim ary nurse support syste maTherefore，the health care system has been seeking

systematized nursing resource that can be used by

to increase efficiency，focusing on the provision ofnurses to care for the patients in their charge．

intensive medical care in order to achieve the early
discharge of patients．As a result，hospitals have

２．Theoretical premise of the study

been classified into special functioning hospitals which

This study was performed in accordance with aprovide highly advanced medical care and regional

series of theoretical premises based on symbolic

medical care support hospitals which provide medical

interaction theory．Symbolic interaction theory views

care，including home care．In conjunction with thissocial action as consisting of both the individual andapproach，medical care policies designed to cope withthe collective activities of people who are engaged

the steep increase in medical costs and meet thein social interaction．Thus， human beings interact

needs of the public have been adopted．However，

with one another and interpret these interactions inmodern society（comprising families，communities

the light of the situation in which they are acting

and schools）has been gradually disintegrating in（Blumer８）９），1969）．Applying this to the topic ofsome areas，causing increasing difficulties in daily

nursing care，the following assumptions can then be

life．In such a society，it has become increasingly

made：important for hospitals to provide ongoing nursing１ ） N ursing care is for m ed by a process ofcare for the elderly and those people living withinteraction with the self（indications given toillness or still in the process of recuperating from
illness．An evaluation of the value of hospitals inproviding nursing care in the form of this type ofcaringmay help clarify the role of nursing careas a social resourceas well as its social function．
In the 1980s，several nursing theories based on
１）

the idea of care were published（Leininger
２）；Watson，1980

３），1979；Benner，1989）．Subsequently，

from the 1980s to the 1990s，many studies werecarried out in order to evaluate the characteristics

the self）．
２）Nursing care is formed by a process of social
interaction．
３）Nursing care is formulated by individuals orgroups．
４）The structure and process of nursing care areintegrated．
５）The nursing care group consists of the nurses
and the patients who participate．
In the formation of nurses

ego ，which occurs

and categories of caring，caring behavior，caring

when nurses regard themselves as subjects ，become

processes （in the context of the nurse‑patientaware of their own feelings，develop their own

relationship），and the results of caring（Gaut４），1986

beliefs and communicate amongst themselves，the；Valentine

５），1989；Wolf

６），1994；Lea

７），1996；

presence of other nurses is indispensable．Nursesetc．）．However，no studies have yet been carried

becomeout on care or caring in order to clarify exactly

within nurse groups and can then form their ego

how nursing care is practiced within the complicatedand work with others in nurse‑patient interactions．

health system currently responsible for actuallyproviding such care．

social beings

through their interactions

UH CNAS，RINCPC Bulletin Vol．18，2011

３．Definitions of terms

51

primary nurse support system in a general hospital

The primary nurse support system：A systematizedin Tokyo．After explaining the purpose of the study，

nursing resource（human resource）that can be used

informed consent for participation in this study wasby the primary nurse to care for patients in their

obtained from all 34 nurses contacted．

charge（Figure １）．

３．Data collection and analysis
The study made use of the grounded theory

Methods

formulated by Strauss and Glasser10）11）．Data were１．Topics to be addressed in this study１）The contents of nurses

collected by the interview method and continuously

nurse‑patient inter‑

analyzed until no new category was obtained．

action experiences and the importance of these

Data collection was continued until the purpose

interactions for nurses in theof this study was realized（from the beginning ofprimary nurse

support system

June through to the end of September in 1999）．

２）The contents of nurses nurse‑nurse interaction

Researcher interviewed recording permission in one

experiences and the importance of these inter‑

hour．A total of 34 nurses were interviewed．Theiractions for nurses in the primary nurse support

nursing experience ranged from 1 to 11 years（meansystem：3.9 years）．

３）The contents of nurses
ences in thenursing care experi‑

primary nurse support system

and its importance in practical nursing care４）Structurization of nursing care in the primarynurse support system

Results
The importance of the nurse‑patient interaction
experience in nursing care practice was evaluated，
an d nursing care w as structured in ter m s of

２．Location of the study，and selection ofthecreation of situations ．Subsequently ，thesubjects taking part in the study

importance of the nurse‑nurse interaction experience

The subjects of this study consisted of nurses

in nursing care practice was also evaluated andin 3 nursing teams in a ward making use of the

Figure 1

structured in terms of the

The primary nurse support systemcreation of nursing care

52

Structure of nursing careplaces（community）．In addition，the importance ofnursesnursing care experience was evaluated andstructured in terms of theemergence of persons ．

existing

andcaringcharacteristic of nursing care practice．
Among the various
interactions， existing

１．Creation of situations

w ere acts that w ere

getting to know each otherandcaringwere specificto nursing care practice．The process involved in

Regarding the actual nature of patient‑nurse

the creation of situations forgetting to know eachinteractions in nursing care practice， getting tootherknow each other ， developing a bond ，and being

both nurses and patients，forming an intellect stratum

able to livein the structure described for thewere extracted as study categories．

was present at the most personal level for

creation of

The evaluation of associations among the categories

situations ．In this process， reliable and relieving

showed that nurses experienced interaction withsituations were created between nurses and patients．

patients as a process in thecreation of situations ．

The structure of this creation of situations comprised
intellect，emotion，volition and care as its various

＜From

being

thinking＞

Nurses intuitively grasp thatin the personcomponent strata（Figure ２）．

tothere is something

whenever they meet a patient andthis involves the development of their awareness．
１ ） The intellect stratum and the creation ofsituations forgetting to know each other

The interaction processes forgetting to knoweach other ranged from being to thinking ，fromfeeling to intuiting ，from staying to existing ，and from

seeingtocaring ．This interaction

facilitating

getting to know each otherformed the

For exam ple ，in one case when nurses met apatient they

that

they would like thepatient to under go treatment until the fever falls ．
In another example，when nurses
to know the patientandwanted to get

thought that there issomething special about the patient ，their desire toprovide care was raised．When patients understoodbasis of people s recognition of an object（person）

the nurses

and also a basis of nursing care．In particular，personFigure 2thought

actions oftrying to get to know theand responded，the nurses experienced a

The structure and process involved in the Creation of situations

UH CNAS，RINCPC Bulletin Vol．18，2011sense of pleasure at being trusted．Nurses experienced
instances of the53

daily cha n ges in their p atie nts b y the act ofobservingrather than by the act oflistening ．

creation of situations

betweennurses and patients in which they werefriendly ，Thus，they carried out all their daily actions byeasy to become involved with ， easy to talk to ，

intuition，taking their next action by responding toeasy to open up with ，and

subconscious clues from the patient．

easy to express

feelings to which，in turn， rapidly facilitated care ．
In this process ， nurse deter mined w hether
something waspresentorabsentin the patient

and then thought about the patient more，as a result．

This process represented

intuiting ，in which

nurses sensed the patient s own sensations in someway，such as by unconsciously observing behavioral
changes in their daily life．

By means of these acts，nurse experienced sharedfeelings and acts such as being in the mind nurses＜Fromstayingtoexisting

own feelings toward the patient and the patients

N ursesown feelings ．

talking ， speaking ，and＞staying with their patients allo w ed
listening

The nurses found that patients wereor became＜From feeling to intuiting ＞
Nurses could also intuitively sense some things
based on information obtained by simply

movingcomposedbytalking

together ．In addition，the act ofpatients talkto occur．
relieved

andstayinglistening to themeant that the nurses

physicalevery day，as part of their routine

presence and feelings were directed toward theactivities ． W hen nurses felt certain responses

patients due to their staying and their attitude offrom something they had observed，they instantly

listening ．The nurses found that their sharing

reacted，resulting in the act of

the sameand observing

sensedsensing ．They

something while carrying out their own

movements

such as observing，listening，and

placewith the patients had a slighttherapeutic effect，in itself．The ways in which thenurses carried out

staying varied：sitting at the

responding．In other words，they used their senses

bedside and making eye contact with patients bybymeasuring body

adjusting their eye level to that of the patients ，

meant that thelooking at the patients beside them ， staying

moving ．Actions such astemperatureandtaking a pulse

actions

beside the patient while talking ， staying besidethey had sensed ． The nurses intuited changes

patients while holding or stroking their hand ，and

nurses then objectively

felt

the patientsactions， which were 3‑dimensional

staying beside patients in a way that enabled themrather than 2‑dimensional，and could not otherwise

to forget the pain ．In addition，when nurses wished

be sensed by the nurses but were known by theto listenpatients themselves．In addition，while nurses did

were able to select the time and place and take thenot consciously

initiative in asking the patients about their thoughts

in patients

try to see patient s actions

they

or wereinterested in the patient ，they

unconsciously experienced these actions as theyor asking them totalk about their feelings ．When

entered their visual field when they moved about

nurses wished to make time to talk to patients，they

every day，as part of their normal routine．Whiledeliberately created something to do that required

nurses did not always actively direct their attention

them to visit patients or they created many things

to something，trying to see it，they still found thatto do so that they could repeatedly visit patients，

they could detect daily changes early by means

thereby allowing more time for talking．The nursesof their everyday observations．The nurses intuited

would then listen to patients and tried to understand54

Structure of nursing care

the appearance of a person providing nursing care ．

their feelings．
In this process，nurses

physical presence andAs a result of these processes，situations werefeelings were directed towards the patients as theygenerated in which nurses and patientsstayed beside them and the patients were more

feelings

developand become more motivated．

relieved，became more relaxed，and recovered fromT h e p r o c e ss of fo r m in g t h e in te r a ctio n ofillness faster．Both nurses and patients realized thedeveloping／revealing feelings between nurses andvalue of each other spatients comprises the core of thestaying ．

establishment of

a nurse‑patient relationship in the emotion／volition＜From

seeingtoWhen patients

caringstratum of the＞said the same thing twice ，

casually said something ，or even justactedcreation of situations ．

casually＜ Establishment of a nurse‑patient relationship ＞

in some way，the nurses would often look

In this process，situations develop in which attitudes

at their patients and w onder

w hat does thisand feelings are revealed，and information is exchanged

mean ？ ． Likewise，the nurses looked at theirbetween nurses and patients．For example，the nurses

patients

tryingmight express their respect for their patients wishes

to know or trying to see into their patients daily

by means of their attitude，or patients might try tolives based on theinfluence nurses

surroundings，they would often be

objects around themand their

positions ．

or by attracting the nurses

Nurses intuitively thought

why

What is this？

attention．

when patients

talked or complained of the same thing twice，orthought

feelings by touching，complaining，

when they saw patients＜

Further involvement by nurses＞

Once a nurse‑patient relationship was established，

saying or casually acting the same way repeatedly．

the nurses performed the interactions ofThus，nurses caught a glimpse of thetheir atte ntion to patients ， acceptin g theirpatients

daily life ofwhen patients repeated these types of

behavior．Nurses alsocared

own conflicts ，anddirectingdeveloping thoughts ．Thesepatients directly，

independent acts carried out by the nurses werethemselves，and noted changes in their feelings，

not inherently required of them but constituted

their physical well‑being，and their responses（allexploration／search processes in the establishedbased on signals given off by the patients）．

nurse‑patient relationship．Nurses experienced theIn this process，nurses were present throughout
patients

daily life and experienced their daily life

by caring theiract of further in volve m ent as the acceptanceof pressure （ stress ）． T o help o verco m e thispatients and their surroundings ．

stress，nurses needed access to nursing care places

Patients understood this and would reveal aspects of（community）where they could，for example，talktheir daily life in this situation，for the benefit ofwith other nurses involved．

patients and nurses，alike．
＜
２ ）Emotion／volition strata and the situation
leading todeveloping a bond

The processes leading to
involved theestablishment

developing a bondof a nurse‑patient

relationship ， further involvement by nurses ，and

The appearance of a person providing nursingcare＞

In this process， further involvement by nurses
induced acts such as developing feelings ， becom‑
ing motivated ，and

imagining the personality ofpatients ，and involved the persons who provided

UH CNAS，RINCPC Bulletin Vol．18，2011

nursing care appearing in front of their patients and＜Creation of situations enabling patients to live

dealing with the m directly and personally ． Inwith their illness

this process，the nurses experienced

In this process，nurses

developing

55＞
made up for those things

for their patients and reported wanting tothat patients could not do for themselves ， gave

grant their patients wishes．Since the development

patients information on their illness ， were close toof persons who provide nursing careis closely

patients while they learned to live with their illness ，involved in nursing care practice，the nurses interviewed

and overcame suffering with their patients ．Nurses

feelings

were very eager to have access to nursing care places

supplemented

and（community）．

were close to patients ， overcame suffering with
their patients ，and

３）The care stratum and the creation of situations
facilitatingwere thethings and parts，

evaluated timing

illness ，thewith regard

process of living with theirillness ，and the matter of what patients cannot dobeing able to live
being able

because of their illness ．As a result，nurses foundcreation of situations in whichthat patients could adjust by adopting their own

The interaction processes involved in
to liveto theirlinkedcreation of

specific ways of coping and became more composed

situations enablin g patients to live with theironce they were satisfied with their diet and lifestyle，illness ．To

after which they would then begin to associate withpersons can be themselves

led bylive

and theis an extremely independent act，

being able to live

interactions between theothers．

nurse and patient．
In this process，nurses who appeared as persons

２． Creation of places for nursing care（community）

providing care in front of their patients created

As regards the interactions experienced by nurses

situations in which patients can be themselves
situations enabling patients to live with theirin nursing care practice，the categories extracted from

illness ．The process for the creation of situations

the study were the unification of nurses in a small

facilitatinggroup（consisting of a primary nurse and associate

andbeing able to live

stratum in theconstituted a carecreation of situations ．

nurses），thesocialization of nursing careby thesmall group，and the organic connection of nurses＜

Creation of situations in which patients can bethemselves＞

In this process，nurses understood the patientsin the team．Evaluation of the associations among
these categories showed that nurses experienced
interactions as a process facilitating thecreation oforiginal circumstances，（i．e．，their environment，a place of nursing care（community）．The structure

what they are doing now and what they have doneofin the past ， their original lifestyle ， and their（partner） stratum and the community（everyone）

inherent problem‑solving ability ）and provided

stratum（Figure ３）．

nursing care placesconsisted of thepeernursing care that took these characteristics into
consideration and helped create situations in which

１）The peer（partner）stratum and the generationof

their patients could look after themselves．

unificationandsocialization

Nurses in each small group shared tacit knowledge
bytalking about patients ．Associate nurses who

understoodsituations between the primary nurse

56

Structure of nursing carebegan to think about patients andall members

worry about patients just as the primary nurse

connection．

and patients

did，which led to theunification

was also possible in these places of

These places of organicof associate andconnection

for all teamprimary nurses．In each small group，there was amembers were present in the social area and formedpeer（partner）stratum among nurses that allowed

a community（everyone）stratum within the structure

them to talk at ease amongst themselves，evenofnursing care places（community）．

when their ideas had not yet firmly taken shape．In
addition，the small groups in which the unificationof nurses occurred formed places offor nursing care to ensure thedaysocialization

completion of theby patients，i．e．，the result was the creationof being able to live situations between nurses and３． Emergence of persons
In terms of the nurses

experience in nursing

care practice，the extracted categories identified
in the study werecooperation／independence ，

accumulation of experience ，thedevelopmentof n urses w h o ac q uire d a n ursin g care for mpatients．

（ in d e p e n d e nt n urses ） ， th e２）The community（everyone）stratum and thecreation of places ofdaily life ，and theemergence of persons（individuals）who care about themselves ．An

connection

When the small group comprising unified nurses
socialized patientspatientse m er g e n ce ofnursing care，team members

evaluation of associations among these categories
showed that nurses experienced nursing care practicenoted the eagerness and attitude of the primary

as a process involving the

emergence of persons ，nurse and created places where nursing care for each

which consisted of thedevelopment of persons

patient could（individuals） providing nursing carespread to all members ．In addition，

independent nurses created stable places whereallmembers with their own feelings were connected ．

and theemergence of persons（individuals）who care about
themselves（Figure ４）．

Thus，the primary nurse created places where
patients could complete their day and 24‑hour
nursing care was connected in order to create
being able to live

situations between nurses andpatients．Primary nurses found that

Figure 3

observing１ ） D evelop m ent of

persons （ individuals ）providing nursing care
The nurses experienced cooperation／independence
during thecooperation of all nurses in developing

The structure and process involved in the Creation of places for nursing care（community）

UH CNAS，RINCPC Bulletin Vol．18，201157

the nursing form of each nurse ， accumulation ofrelationship with nurses and show their personality

experience ，andsharing the thinking process

in daily life ，which resulted in theamong all nurses

as processes of interaction．In

patients who care about themselves ．

addition，the personality of each nurse became more

The nurses experienced the patients

independent

noticeable and independent nurses developed theiracts ofown nursing care style，which included

processes of an interaction involving the emergenceandstaying

caring ．Independent nurses taught the othertalking ， eating ，and

emergence ofof patients

movingas thedaily life ．During this experience，

nurses their thinking process，supplementing theirpatients who acted independently talked ， moved ，own way of thinking and

and

them

demanded thinking fromwhile also experiencing the

spontaneous

ate ．

Nurses who began to evaluate patients in daily

development of acts and attitudes as humans in them．

life created situations which facilitated

In addition，independent nurses shared their thinking

independent acts

patients

and found that patients could

process with other members of the group so that

actively contribute to their relationship withthey could also become independent and serve as

nurses ．This means that each nurse，patient，and

primary nurses．Nurses developed into persons who

the other nurses could

could provide nursing care themselves，after andthat space ，i ．e ．， experience the e m ergenceaccumulating experience based on their own feelingsof individuals．In addition，the nurses found that（including any painful feelings）as part of thetheir personality is shown in daily life ，in thoseaccumulation of experience process involving self‑

situations where both the patients（individuals）

actively contribute in

who cared about themselves started to show theirinteraction．

personality，and persons（individuals）who provided
２） Emergence of persons（individuals）who caretheir nursing care gradually started to show theirpersonality and develop，also．

about themselves
In the process of interaction regardin g the
emergence of patientsso that patients could

daily life ，nurses acted

actively contribute to their

Figure 4

The structure and process involved in the

Emergence of persons

58

Structure of nursing caresocial behaviorism is concerned with the generation

Discussionof conscious subjects derived from associations

As a result of the evaluation of associations among

between the actual acts of multiple individuals，i．
e．
，

creation of situations ，

the dynamics of generated subjects and the social

creation of nursing care places（community） andprocess ， paying attention to social acts thatthe major concepts ofconstituting nursing

mutually affect multiple individuals（Ito13），1995）．

care，nursing care could be redefined and described

Nursing care is a social act，for which nurses create

as part of a new structure entitledmultiple nursing care places（community） for theirtheemergence of persons

sym biotic

nursing care ．

own use and well‑being．Thus，nursing care is aninteraction involving the creation of places where

１．Definition of nursing care

all nurses with their own feelings are connected

Nursing care is a process involving the creationof multiple

situations

between a nurse and a

due to the presence of individual patients，where
patients can complete their day，and where 24‑hourpatient who are independent of each other．Thus，

nursing care creates

situations，not relations，are created between nurses

between nurses and patients．

and patients ． Situations

are not the naturalenvironments of humans but are artificially createdbetween humans．As Blumer８）（1991，p．88）points
out

subjects are all the things that human beings

being able to live

situations

In addition，nursing care is a process involving
theemergence of persons

and consisting of thedevelopment of persons（individuals）who provide
nursing careand thee m ergence of persons

indicate or refer to，and humans beings are prepared（ in divid uals ） w ho care about the m selves ．

to act toward subjects on the basis of the meanings

However，previously published results onthat those subjects have for them ．Thus，nurses

have sometimes differed．In Lea

and patients mutually identify subjects and share

was reported to affect７）

caring，（1996）caring

both patients and nurses

２）

specific meanings in the process of presenting these（Watsonmeanings and responding to them．This allows

thealone （Gaut ４） ）．Mayeroff 14） （1993）stated that

construction of definitions for various situations andCare for another person，in the most significant

the sharing of specific meanings among the people

sense，is designed to help him grow and actualize

12）

concerned ，as Strauss described it（Hogetsu）， nurses alone （Forrest），or patients，1995，

himself．Caregivers follow the growth of cared‑forare created by the establish‑

persons，while enhancing their responsiveness toment of subjects and the sharing of meanings．Thus，

their own movements．Care is the involvement withnursing care is an interaction that creates situations

others that develops after a relatively long period

between nurses and patients in which

patients

and indicates changes in both caregivers and cared‑

p．141）． Situations

can live as they areandcan live with theirfor persons，and in their relationship that grows andillness

persons（individuals）whodevelops ．Nursing care is a process involving thesuch as those who

actdevelopment of persons（individuals）who provide

trust themselves（including their

nursing care by means of interactions such as theand also createscare about themselves
independentlyorbody）．

cooperation of all nurses in developing the nursing

Nursing care is also a process that involves theform of each nurse or sharing the thinking processcreation of multiple nursing care places（community）

among all nurses ．In addition，the personality ofamong nurses themselves．As Mead described it，nurses becomes clear over time，especially throughUH CNAS，RINCPC Bulletin Vol．18，2011

the act ofgetting to know

the patient，which inas its central focus，along with theturn leads to the creation of independent nurses．

situations

The patterns of the act of（community）（Figure ５）．

includeexisting

andgetting to know

observingpeopleinduction ofcreation ofcreation of nursing care places

The multi‑layered structure of theand show how

nursing care is directed towards theand thesituations

59

creation ofcomprises distinct intellect，emotion／and the development

volition，and care strata，all of which are involved

patients that can trust themselves（includingin the creation processes for the situations of

their body）．In addition，nursing care is a process

getting to know ， developing／revealing feelings ，independent acts by patientsofinvolving the development of persons（individuals）

and

who care about themselves．This involves an interac‑the most personal area involved in thetionsituations

between the patient and the self ，bringing

about theemergence of patients

daily life ，alongwith other interactions such as actively contributing

being able to live ．The intellect stratum iscreation ofwhile the emotion／volition stratum is at

the center of the establishment of the nurse‑patient
relationship ．
The creation of nursing care places（community）

to their relationship with nurses and showing theirpersonality in daily life ．Nursing care is an inter‑

consists of both theaction in which both nurses and patients live fully inthe community（everyone） stratum，both of which

each other s place，showing themselves how to

are involved in the processes needed to create places

live or be able to live in order to facilitate theirofunificationpeer（partner） stratum andamong nurses，thesocialization ofnursing care by the unified nurses ，and the organic

everyday life，with dignity．

connectionof all nurses．Thesenursing care

２．Structure of Symbiotic nursing careplaces（community） are organic because they only

The structure outlined above for

Symbiotic

last until the discharge of the patients． Nursing carenursing care comprises the emergence of persons

places（community） created among nurses consist

Figure 5

The structure of Symbiotic nursing care

60

Structure of nursing careof apeer（partner） stratum where paradigms aretacitly shared and a community（everyone） stratum

Japanese termkyoseias roughly equivalent tosymbiosis in terms of conviviality ．Symbiosis is thus
characteristic of closed co‑existence co‑prosperity

where paradigms are explicitly shared．
co m prises thesystems，and there is a close cooperative relationshipdevelopment of persons（individuals）who provide

between symbiotic organisms based on a stableT hee m ergence of persons

nursing careand thee m ergence of persons

community of interests （Karimata15），2000，p．
212）．

（individuals）who care about themselves ．The

Conviviality isformer process involves the development of nurses

heterogeneous group of people where different

who are cooperative and independent ， accumulate

people with different lifestyles freely take part inexperience ，and

have acquired the nursing careshared activities and make use of shared opportunities

style（independent nurses） while the latter process

to actively establish and participate in m utual

involves the emergence of patients who reveal theirrelationships （Karimata15），2000，p．
212）．

daily lifeandcare about themselves ．

a social bond pattern within a

Based on the results of the study，symbiosis could
be defined asa process involving the generation

Nursing care can be seen as a process of inter‑of individuals in the space formed by the creation

actions allowing various persons to live together ，of situations after establishing subjects and sharing

and can be structured as a process that results inmeanings between the participants and other people，

the development of persons（individuals）who careand by the creation of places allowing connections toabout themselves and nurses（individuals） who

be made with the feelings of others present ．

provide nursing care．These results are consistent
with the definition ofis

Symbiotic

nursing careis a social act andsymbiosis ，whereby there

can be seen as a process of socialization thatcooperation between two or more organisms

mutually creates multiple situations between nurses

in a large multi‑dimensional structure in order toand patients and multiple

facilitate their mutual growth and development（community） among nurses themselves，where the（Karimata15），2000，p．
212）．Therefore，the nursing

patterns of the patientscare process can be structured and described aswhere nurses cooperate and become independent．

symbiotic nursing care ．The term symbiosis

On the other hand， symbiotic nursing care can also

is frequently used in many fields，but there is abe seen as a process that results in the development

danger that the term is sometimes used withoutof nurses

nursing care places

daily life emerge，and

who provide care in individual areas
who care about themselvesasa clear definition，or that incorrect meanings arewell as patientsbysometimes attributed to the term ，as suggestedmeans of the socialization process generated andby Ozeki16）（1995，p．139）．Symbiosis was originallyexperienced by both nurses and patients．
Among the various aspects of nursing care，thea biolo gical ter m cate gorize d as b ein g either
mutualistic or commensalistic．Symbiosis is now

act ofgenerally defined as thecooperation of two or

personal．This act is intimately associated withmore organisms living together in a large multi‑

the practical knowledge acquired by nurses throughdimensional structure in order to facilitate their mutual

their accumulation of life experiences．At the center15）

growth and development （Karimata，2000，p．
212）
．

of

getting to know each otheris the most

symbiotic nursing care ，situations in which

is derived from the Greek

feelings are exchanged between nurses and patients（sum＝with，bios＝living）．Inoue classified theare generated，and the development of places where

The term

symbiosis

UH CNAS，RINCPC Bulletin Vol．18，2011

th e

fe elin g s of all n u rses are co n n e cte distogetherofpersons61

and the e m ergence ofthen facilitated by these situations．Thus，nursing

individuals who areable to live ， nurses andcare can be described as consisting of various

patients also need to be able to interact with theinteractions such as the development offeelings

community and others（individuals）involved in

between persons or the connection offeelings

nursing care practice．
Sy m biotic nursing careamong nurses．The most sociable area of symbiotic

is a process thatconsists of the care stratum andfacilitates the expression of personality and thethe community stratum where nurses connect withexchange of feelings between nurses and patients，

everyone．Therefore，in order to createa n d a m o n g n u r s e s t h e m s e l v e s ， w h il e a ls onursing careallowing

emergence of individuals

and the（community） are needed where everyone lives

creation of situations where everyone

can live

together and their feelings are all interconnected．

together ．

persons to live

situations， nursing care places

As a result ，in order to achieve theencouraging thelivingReferences

１）Leininger，M．
M．
（1980）．Caring：A central focus of nursing and health care services．Nursing and HealthCare，１，135‑143．
２）Watson，J．（1979）．Nursing：A Philosophy and Science of Caring．Boston：Little，Brown．
３）Benner，P．Wrubel，J．（1989）．The Primacy of Caring：Stress and Coping in Health and Illness．Menlo
Park，California：Addision‑Wesley Publishing Company．
４）Gaut，D．A．
（1986）．Evaluation caring competencies in nursing practice．Topics in Clinical Nursing，８盪，
77‑83．
５）Valentine，K．（1989）．Caring is more than kindness：modeling its complexities．Journal of Nursing
Administration，19眥，28‑34．
６）Wolf，Z．R，Giardino，E．R，Osborne，P．A，Ambrose，M．S．（1994）．Dimensions of Nurse Caring．Image：Journal of Nursing Scholarship，26盪，107‑111．
７）Lea，A，Watson，R．（1996）．Caring research and concepts：a selected review of the literature．Journalof Clinical Nursing，５，71‑77．
８）Blumer，H．（1969）／Gotou，M．（1991）．Symbolic interactionism−Perspective and Method．Keisou Press（in Japanese）．
９）Blumer，H．
（1969）．Symbolic interactionism−Perspective and Method．Berkeley and Los Angeles，California：University of California Press．
10）Strauss，A．
L，Glaser，B．
G．
（1967）／Gotou，T．
Oyama，H．
Mizuno，S．
（1996）．The Discovery of Grounded
Theory．Sinyou Press（in Japanese）．
11）Strauss，A．L．Corbin，J．（1990）／Minami，H（1999）．Basics of Qualitative Research−Grounded Theory
Procedures and Techniques．Igaku shoin（in Japanese）．
12）Hougetu，M．（1995）．Methodological Foundation of Symbolic interactionism．（pp．135‑144）．Kouseisya‑
Kouseikaku．

62

Structure of nursing care13）Itou，I（1995）．The Roots of Symbolic Interactionism−Chicago School．
（pp．
14‑24）．Kouseisya‑Kouseikaku．
14）Mayeroff，M．（1971）／Makoto Tamura／Noriyuki Mukano（1993）．On Caring．Yumiru publishing（inJapanese）．
15）Karimata，M．（2000）．Symbiosis Society Support System．Chuo keizai‑sha（in Japanese）．
16）Ozeki，S．（1995）．Modern communication and symbiosis and joint．Aoki Bookstore（in Japanese）．

UH CNAS，RINCPC Bulletin Vol．18，201163

看護ケアの構造化―― プライマリーナース・サポートシステムにおける看護ケアの構造とプロセスの分析 ――
野並 葉子

要

旨

〔研究の目的〕
本研究では、ケアリングとしての看護ケアを基軸として、看護師が担当患者の看護実践に使うことができる看護資源を組織化した「プライマリナース・サポートシステム」において、どのように看護ケアが行われているのか、その看護ケアの実践のグラウンドで看護ケアの構造とプロセスを明らかにすることを目的とした。
〔研究方法〕
本研究は、シンボリック相互作用論の考え方を理論的前提とし、グラウンデッドセオリー法を用いた。データ収集
は、インタビュー法を用い、継続的な比較分析を行い、新しいカテゴリーが出なくなるまで行った。データ収集は、
1999年６月上旬から９月下旬にかけて研究の目的が達するまで行った。本研究は、研究への参加に同意を得た、東京
都内の総合病院の看護師を対象とした。インタビューを実施した看護師は、34人で、看護の経験年数は平均3.9年、１年目から11年目までと幅があった。
〔結果〕「プライマリナース・サポートシステム」における看護ケアの構造とプロセスを検討した。その結果、「状況の生成」、「看護ケアの場（コミュニィティ）の生成」、「人の生成」の主要な概念が抽出された。その主要な概念の関連を検討した結果、看護ケアは、「『共生』の看護ケア」というように構造化できた。
〔結論〕
本研究の結果から共生は、「人が他者との間に対象の形成と意味の共有によって生成する状況と、人の存在によって他者間に気持ちが繋がる場の生成によってつくられる空間に個人が生成されるプロセスである」として定義することができた。『共生』の看護ケアは、看護師と患者の間に相互に多重な「状況」を生成し、看護師間に多重な「看護ケアの場（コミュニティ）」を生成し、その空間に患者が日常生活を現し、看護師が共同・自律するという社会的行為であり、社会化のプロセスであった。

キーワード：看護ケア、プライマリーナース・サポートシステム、グラウンデッドセオリー、シンボリック相互作用論、共生兵庫県立大学看護学部

成人看護学