大江 理英

Intensive care unit (ICU) nurses' professional autonomy is a critical factor affecting their ability to sustainably provide high-quality care to patients who are critically ill and to their families. However, in the absence of a systematic or scoping review of ICU nurses' professional autonomy, limited information and evidence are available on this topic. The aim of this scoping review was to clarify the extent and type of evidence on ICU nurses' professional autonomy. This scoping review was conducted in accordance with the Joanna Briggs Institute methodology for scoping reviews. The following research questions were addressed: (1) Which areas of interest and trends regarding ICU nurses' professional autonomy have been explored in studies published in scientific journals? And (2) What is known about ICU nurses' professional autonomy? The data sources included MEDLINE, CINAHL Ultimate, PsycINFO, Cochrane Library, and Ichushi-Web of the Japan Medical Abstracts Society databases. Identified studies were mapped based on their aim, design, methodology, and key findings and categorized according to their focus areas. Of the 734 identified studies, 16 were analyzed. The identified categories were as follows: "relationship between professional autonomy and mental issues," "experiences and processes of exercising professional autonomy," "relationship between professional autonomy and nurse-physician collaboration," "relationship between professional autonomy and demographic characteristics," "concept of professional autonomy," "barriers to professional autonomy," and "team approach to improve professional autonomy." Most studies have focused on the relationship between professional autonomy and mental health issues and nurse-physician collaboration and few included interventions to enable or promote the exercise of professional autonomy, highlighting a research gap. Future research should identify factors that inhibit the professional autonomy of ICU nurses and that can be changed through interventions and should develop educational and organizational change-based interventions to modify the factors.

災害拠点病院は事業継続計画（BCP）の策定が必要である．本研究はICUにおけるBCPの策定，運用，点検に関する状況から集中治療室の災害に対する備えに関する実態を明らかにすることを目的とした．全国153のICUから回答を得た．BCPを策定しているのは119施設（77.8％）であり，そのうちICUの内容を記載しているのは69施設（58.0％）であった．BCPを策定する特定のチームがあるのは101施設（84.9％）であり，策定チームには治療室所属の看護師や災害有識者が半数以上を占めていた．BCPの運用経験を有しているのは実災害で7施設（6.0％），訓練で68施設（58.7％）であり，BCPを点検しているのは94施設（81.7％）であった．BCPを策定している施設は多いが，ICUに関する記載がある施設は半数程度であった．災害に対する備えとしては，策定したBCPの運用，点検も含めた管理が重要である．