我々は,クリティカルケアで看護師が活用する臨床倫理分析･調整ツールACTce-CCMを開発した.作成過程は,構成概念の設定とプロトタイプ版の作成,プロトタイプ版による架空事例への適用,フォーカスグループインタビューに基づく構成概念の明確化,倫理的問題と倫理調整等に関する実態調査の4段階で実施した.完成したACTce-CCMは,情報整理とアセスメントの枠組み,問題の分析と統合,問題リスト,目標,ケアの実践と倫理調整で構成される.情報整理とアセスメントの枠組みは,病態と治療,QOLとQOD,患者の意思,家族の心理･社会的状況,医療チームの状況,周囲の状況の6つの枠組みがある.問題リストは,患者の問題,家族の問題,医療者の問題の3つがある.目標は,医療チームの目標,患者/家族にとって期待される成果の2である.ケアの実践と倫理調整は,患者への直接的ケア,家族への直接的ケア,医療チーム調整の3側面で構成される.We have developed ACTce‑CCM̶ Analysis and Coordination Tools of Clinical Ethics in Critical Care Medicine. The preparation process was carried out in four stages:construct setting and prototype creation, application of prototype version to fictitious cases, clarification of the construct based on focus group interviews, and a fact-finding survey on ethical issues and ethical adjustment. The completed version of ACTce-CCM consists of information organization and assessment frameworks, problem analysis and integration, problem lists, goals, care practices, and ethical adjustment. There are six frameworks for information organization and assessment:pathology and treatment, QOL and QOD, patient intention, family psychosocial situation, medical team situation, and the surrounding situation. The problem lists include those related to the patient, the family, and the medical staff. Goals include those of the medical team and the expected outcomes for the patient/family. Care practices and ethical adjustment consist of three aspects: direct patient care, direct family care, and medical team adjustment
