喫煙者に対する看護学生の態度に防煙・禁煙教育が及ぼす影響とその構造

２００４年に日本看護協会が看護学生の防煙・禁煙教育の推進という方針を打ち出して以降，多くの看護師養成所で看護学生の防煙・禁煙教育が実施されている．本研究では，喫煙者に対する看護学生の態度を明らかにすることを目的とし，防煙・禁煙教育の効果と，防煙・禁煙教育を受けた経験が喫煙者に対する態度にどのように影響したかを構造化した．研究の対象者は最終学年に在籍する３３名の看護学生で，年齢は２１歳から２３歳で，煙草を吸った経験のある者が７名，喫煙者が２名含まれていた．分析の対象は，防煙・禁煙プログラムについての自由記述方式の感想である．質的統合法（KJ法）を用いて分析した結果，看護学生たちは喫煙者に対して，最初は，幻滅，嫌悪などの否定的感情を抱いていたことがわかった．そして，家族や友人など身近な人に禁煙を進めたが成功しなかった体験から，禁煙指導を難しいと感じ，無駄だと諦めていた．また，喫煙は本人の自由で，健康を害してもその責任は喫煙者自身にあり，他人に害が及ばなければよいと考えていた．一方で，喫煙者に対して可哀想など同情の感情も持っていた．しかし，禁煙指導方法の学習が進むにつれて，看護学生たちの考え方は変化し，喫煙者を否定するのではなく，共感し，禁煙の方法を一緒に考える姿勢が必要だと感じ始めた．そして，禁煙指導は困難なことではあるが，看護師には禁煙を推進する責務があり，喫煙者を見放さず，根気強く，取り組む必要があるとの考えに到達していた．看護学生の，喫煙者への態度や禁煙指導に対する考え方は，学習の到達度によって変化していた．入学から卒業までの段階を追った防煙・禁煙教育プログラムは有効であり，入学時の教育に留まるのではなく，継続的に学習を進めていく必要があることが示唆された．

Many nursing schools have been providing smoking prevention and cessation education since the Japanese Nursing Association announced a policy to promote such education for nursing students in２００４. We assessed the effects of such education and its influence on the attitude of nursing students toward smokers. The subjects were ３３ final-year nursing students（seven former smokers and two current smokers）aged between ２１ and ２３ years. We investigated the respondents’ impressions of a smoking prevention and cessation program. Data were analyzed by the qualitative synthesis method（KJ method）. We found that the respondents initially had negative emotions toward smokers, such as disillusion, contempt, and aversion. After advising people around them, including family members or friends, to stop smoking and finding it failed, they felt that smoking cessation guidance was difficult. They concluded that smoking was an individual decision, that smokers were responsible for their health damage, and that smoking was acceptable if it did not harm others. They also had sympathy（a feeling of pity）for smokers. However, as the respondents learned to provide guidance about smoking cessation, they no longer viewed smokers negatively and developed empathy, feeling that they should consider how to stop smoking together. The respondents further thought that nurses were obliged to promote smoking cessation and to try patiently without abandoning smokers, although providing guidance for smoking cessation was difficult. The attitude toward smokers and smoking cessation guidance varied according to their level of learning. In the initial stage, the respondents had negative emotions and a cold attitude toward smokers. In the last stage, however, they showed understanding of smokers and realized their role of promoting smoking cessation as nurses. This study suggested the effectiveness of implementing a stepwise education program for smoking prevention and cessation from admission to graduation and the necessity for continued education.