Competencies required of hospital nurses in Nagano Prefecture: Based on group interviews with nursing administrators

本研究は，長野県の病院に勤務する看護師に求められるコンピテンシーを明らかにすることを目的とした．研究方法は，長野県内の看護管理者にグループインタビューを実施した．その結果，病院看護師のコンピテンシーとして，【患者にとっての最善を考慮するアセスメント力】，【患者を生活者として捉え強みをいかす力】，【患者や家族の意思決定を支える力】，【退院を見据えて自組織および地域の関係機関・職種と協働する力】，【組織の問題解決を図る力】，【組織の中で主体的に活動できる力】の6つが生成された．病院看護師には，社会の変化に合わせ，施設問わず地域をより深く知ったうえで，患者が安心して生活できるよう看護を提供することが求 められていた．医療中心の看護から入院から在宅まで切れ目のない支援の必要性が示唆された．This study aims to clarify the competencies required of nurses in Nagano Prefecture. Group interviews were conducted with nursing managers, from which six abilities were identified as competencies for hospital nurses. The six competencies comprised the abilities to “assess to make consider what is best for patients,” “capitalize on patients’ strengths by viewing them as community-dwelling individuals,” “support the decision-making of patients and their families,” “collaborate with related organizations and professions in the community with a view to discharge,” “solve problems in the organization,” and “take the initiative in working within the organization.” As society changes, hospital nurses will need a deep understanding of the community regardless of the facility and the ability to support patients to live with peace of mind. Furthermore, hospital nurses will need to be able to provide seamless nursing care from hospital admission to home, rather than medical-centered nursing care.departmental bulletin pape

Collaboration between visiting nurses and visiting caregivers in the support of terminally ill clients at home

本研究の目的は，訪問看護師と訪問介護員の終末期療養者支援における連携について，訪問看護師の 視点から明らかにすることである．B県A地域の訪問看護師7名を対象に，半構造化面接を実施し，終末期療養者 に対して訪問介護員と連携した内容と課題を聞き取りカテゴリー化した．その結果，連携として【徐々にできな くなる日常生活を維持するためのケアの役割分担】，【急激な状態悪化を防ぐための観察と援助の依頼】，【臨死期 の状態変化の共有と速やかな対応】，【療養者の意思を踏まえた関わりをともに検討】，【療養者を看取る家族の介 護負担と不安の軽減】，【常時連絡がとれる体制と関係の構築】の6カテゴリーが抽出された．また，連携におけ る課題として【療養者の状態の変化や思いの迅速で詳細な共有の困難】，【看取りに向かう療養者・家族に対する ケア方針のずれ】，【訪問介護員に認められている医療行為が増えない現状】，【療養者・家族に対する看護と介護 の役割の周知不足】の4カテゴリーが抽出された．今後，訪問看護師は，訪問介護員との迅速できめ細やかな情 報共有と具体的な協働に向けて検討する必要がある．This study aims to identify the collaboration activities of visiting nurses and visiting caregivers in the support of terminally ill clients, and the issues related to the collaboration from the perspectives of visiting nurses. Semistructured interviews were conducted with seven visiting nurses in Region A of Prefecture B in Japan. The interview data about the collaboration and its issues among these two professions in supporting terminally ill clients were categorized. For collaboration activities the following six categories were identified: “Sharing roles of care to maintain a daily routine that they are gradually becoming unable to have,” “Request observation and assistance to prevent condition from rapid worsening,” “Sharing and prompt response to changes in near-death conditions,” “Considering support together based on the client's wishes,” “Reduce the burden of care and anxiety of families who provide the end-of-life care,” and “Building a contact framework and relationship enabling making contact at any time.” For the issues, the following four categories were identified: “Difficulties in promptly and in-depth sharing of changes in the condition and thoughts of the clients,” “Differences in care policy for the clients and families facing end-of-life care,” “Current situation with no increase in the number of approved medical procedures allowed for visiting caregivers,” “Lack of understanding of nursing and caregiving roles for the clients and families.” The findings suggest visiting nurses need to be considered these issues to share information promptly and in-depth with visiting caregivers and to specific collaboration for the future.departmental bulletin pape

A conceptual analysis of shared decision making： Potential for use in the critical care

本研究は，Shared Decision Making(SDM)の概念分析をし，属性と構成要素を明らかにし，クリティカルケア領域での活用の可能性の検討を目的とした．Walker&Avantの概念分析方法を用いて分析した結果，SDMの属性には【相互作用で生まれるプロセス】，【いざとなった時の拠り所】，【患者の尊厳を中心とした価値観のバランス】の3つが含まれた．先行要件には，【進歩するテクノロジーの過剰使用と不確実性】，【繰り返される代理意思決定の課題】，【家族の心理的負担の症状】，【患者尊重の困難さ】，【異なる文化的状況】の5つが含まれ，帰結には，【家族の負担軽減と満足度の向上】，【患者を尊重したケア提供】，【家族の絆の再形成】，【医療費の削減の効果】の4つが含まれた．今回の研究で明らかになった属性である【患者の尊厳を中心とした価値観のバランス】からは，SDMとして家族間での話し合いの重要性が明らかとなった．クリティカルケア領域では，医療者は代理意思決定をする家族のためにいざとなった時の拠り所として，家族と共に患者の尊厳を保つための話し合いを意図的に繰り返すことが重要であり，そのことで家族の絆を再形成し，患者を尊重したケア提供へとつながることが示唆された．The purpose of this study was to analyze the concept of Shared Decision Making (SDM), identify its attributes and components, and then examine its potential for use in the critical care domain. The results of the analysis using Walker&Avant's conceptual analysis method showed that the attributes of SDM included [process created by interaction], [a stronghold in times of emergency], and [balance of values centered on the dignity of the patient]. The antecedents included [overuse and uncertainty of advancing technology], [repeated proxy decision-making challenges], [symptoms of family psychological burden], [difficulties in respecting patients], and [different cultural situations], and the consequences included [reduced family burden and increased satisfaction], [provision of care with respect for patients], [reformation of family ties], and [effectiveness in reducing healthcare costs]. The attributes identified in this study, [balance of values centered on the patient's dignity], revealed the importance of family discussions as SDM. In the critical care domain, it was suggested that it is important for healthcare providers to deliberately repeat discussions with family members to maintain the patient's dignity, as a source of support in times of crisis for family members who make proxy decisions, which can lead to the reformation of family bonds and the provision of care that respects the patient.departmental bulletin pape

Effects of natural environmental sounds on cognition of peculiar noises in hospital wards

病棟で発生する騒音に対する自然環境音の効果を調べた．被験者は大学生40名であった．音刺激は， 4種類の病棟で聞こえる特徴的な騒音と10種類の自然環境音を用いた．被験者は，各騒音及び各自然環境音の他， 騒音と自然環境音を組み合わせた音を提示され，うるささと不快さの程度の評価を求められた．その結果，各騒音に対して，うるささは特に強くは感じられないが，ある程度不快に感じることが示された．自然環境音に関しては，うるささは感じられず，不快さも高くはなかった．しかし，騒音と自然環境音を同時に提示した時には， 不快さの程度は騒音のみを提示した場合と同程度に高かった．本研究では，病棟で起こる騒音による不快感の低減に対して，自然環境音は効果的には作用しない場合があることが示唆された．これについては，本研究で使用した騒音が何らかの望ましくない状況や身体状態を意味する音であったという違いに帰因すると考えられた．This study attempted to examine the effects of natural environmental sounds on human cognition of noises to explore the methods for improving the sound environments in hospital wards. Since the natural environmental sounds used in a previous study reduced uncomfortableness of some noises in hospital wards, we expected a similar effect of natural sounds on peculiar noises. Participants were 25 female and 15 male college students. Four peculiar noises characteristics to hospital wards (nurse call, sucking, footsteps, and ambulance siren) and ten natural sounds constituting a typical natural environmental sound in Japan [sounds of stream, water-filled bamboo tube striking a stone, Japanese Tit (Parus minor ), Japanese Bush Warbler (Horornis diphone ), Large Brown Cicada (Graptopsaltria nigrofuscata ), Higurashi Cicada (Tanna japonensis ), Cricket (Teleogryllus emma ), Bell-ringing Cricket (Homoeogryllus japonicus ), iron wind bell, and glass wind bell] were presented both separately and in combination. The participants were asked to evaluate the degrees of annoyance and uncomfortableness created by hearing them. They rated the separate noises, not so much annoying but somewhat uncomfortable while they rated both the annoyance and uncomfortableness of the natural environmental sounds low. However, combining the peculiar noises with the natural sounds did not lower the ratings of uncomfortableness of the peculiar noises although our previous study showed that it could reduce the uncomfortableness of noises produced by provision of daily patient care in hospital wards. This seems to be attributable to the difference that the noises in the present study convey some messages arousing some sort of undesirable conditions while those in the previous study had no specific message. Therefore, to improve the subjective sound environment of the hospital wards, staffs should provide their patients with information about noises in an early stage of admission.departmental bulletin pape

Development of “Scale on Competency of Multitasking Performance for Nurses in Internal Medicine/Surgical Ward”

長野県看護大学博士令和５年度thesi

Nursing practice that outpatient nurses working at a hospital in prefecture A perceived a patient in need of support

本研究は，A県内の複数診療科を持つ病院の外来看護職が，支援を要する外来通院患者を察知した看護実践を明らかにすることを目的として，質問紙調査を実施した．A県内16施設の外来所属看護職 395名のうち， 134名（33.9％）より回答を得た． 支援を要する患者を察知した情報は，【在宅介護の継続が難しい患者・家族】，【知覚可能な患者の認知機能低下】などの９カテゴリーであった．察知した情報のアセスメントは，【セルフケア能力と介護力の見極め】，【患者の病状変化に伴う介護の行き先の見当付け】など6カテゴリーであった．察知した情報のアセスメント後の対応は，【他部門・多職種との患者情報の共有】，【さらなる情報収集】など7カテゴリーであった．外来看護職は， 支援を要する患者を察知し，その時その場で看護職自身が行う在宅療養支援の実践とともに，同職種や多職種協働により外来通院患者の在宅療養継続支援を行っていると考えられる．しかし，他職種との連携や院内の看護職との連携はされているものの，患者のかかりつけ医療機関の看護職との連携はされておらず，情報の共有が在宅 療養継続支援上の課題であることが示唆された．The purpose of this study was to clarify the nursing practices of outpatient nurses at a hospital with multiple departments in prefecture A who perceived outpatients in need of support. A questionnaire survey was conducted, and responses were obtained from 134 (33.9%) of 395 outpatient nurses at 16 facilities in A prefecture. Based on the responses provided by the outpatient nurses, nine categories of information that nurses perceived outpatients in need of support were identified. The categories included the following: the patients/families who have difficulty continuing being cared for at home, noticeable decline in the patient's cognitive function, etc. Furthermore, six categories were identified to impact the nurses' assessments of the perceived information: assessment of self-care and caregiving capabilities, assessment of where the care should be provided as the patient's medical condition changes, etc. The following seven categories of measures taken following the assessment of the perceived information were identified: sharing patient information with other departments and various health professionals; sharing further patient information; etc. The survey responses indicated that outpatient nurses identify patients in need of support for continued home care and provide assistance on the spot. Additionally, the nurses are considered to collaborate with other nurses and various other healthcare professionals to provide support for continued home care to such patients. However, although collaboration is built with other professions and with nurses in the hospital, there is no collaboration with nurses at the patient's own medical institution, suggesting that sharing of information is an issue in providing support for continued home care.departmental bulletin pape

“Good nursing” in nursing practice recognized by ICU nurses： A consideration of changes accompanying the transition of the times

本研究は，2008年のデータを基に，ICU看護師が看護実践において「よい看護」をどのように認識していたのか明らかにし，それは今の時代ではどのように変わったのかという視点で考察することを目的とした． 質的記述的研究デザインを用いて，4施設のICU看護師9名を対象とし，参与観察および半構成的面接を行った． 得られたデータを分析した結果，【先を見越し危険を回避する】【重症患者に対処できる知識と技術をもつ】【一人の人間として患者に接する】【生活するための場を整える】【早期回復のためチームで関わる】等の7カテゴリー が抽出された．ICU看護師は，患者の重症化を防ぎ回復に向かえるよう先見性と知識・技術を持つこと，患者その人を看ること，今後を見据えて生活の場を整えることを「よい看護」と認識していた．これらは現在に通じる 「よい看護」であった．一方で，チーム医療に関する「よい看護」は，今日では多職種で関わるという広義の意味に変化していることが示唆された．Based on data from 2008, this study clarified how intensive care unit (ICU) nurses perceived the idea of “good nursing” in their nursing practice, and examined how this perception has changed over time to become what it is today. Using a qualitative descriptive research design that comprised participant observation and semi-structured interviews, nine ICU nurses from four facilities were included in the study. The data obtained were analyzed and seven categories were extracted: “anticipating risk factors and avoiding,” “accumulating knowledge and skills to care for seriously ill patients,” “respecting patients as a human,” “preparing the patient’s daily life,” and “strengthening the team approach to promote the patient’s early recovery.” ICU nurses recognized that “good nursing” involved having the foresight, knowledge, and skills needed to prevent patients from becoming seriously ill and help them recover, caring for the patient as a person, and preparing a place for the individual to live for the future. These “good nursing” techniques are relevant to the present. On the other hand, it was suggested that the meaning of “good nursing”, which relates to team medical care, has changed to a broader meaning that involves multidisciplinary care today.departmental bulletin pape

Nursing practices to support self-management of older diabetic patients with mild cognitive impairment : Literature review

軽度認知機能障害（MCI）を有する高齢糖尿病患者のセルフマネジメントを支える看護実践を明らかにする目的で文献レビューをおこなった. 【患者の言動と療養生活の現状から認知機能の変化を捉える】【患者の保持している力を捉える】【患者の療養生活への意向を尊重する】【環境を整え療養行動を支える】，等９つの看護実践のカテゴリーが抽出された．これら実践から＜アセスメント＞＜患者の意思の尊重＞＜患者と家族への個別支援＞＜多職種協働で行う支援＞といった実践の側面が見出された． MCIを有する高齢糖尿病患者の特徴を踏まえたアセスメントに基づき，患者と家族双方を多職種協働で支えるというものであり，糖尿病セルフマネジメ ント支援と同時に高齢者看護としても重要な実践である．This study conducted a literature review to describe nursing practices that support the self-management by older diabetic patients with mild cognitive impairment (MCI), and identified nine categories including “perceiving changes in cognitive function based on the current behaviors and daily life of patients,” “understanding the retained abilities of patients,” “respecting the patient wishes for daily life,” and “assisting in the self-care behaviors by adjusting the environment.” From these practices, the following elements of the practices were identified: “assessment,” “respect for patient wishes,” “individualized support of patients and their families,” and “support provided through interprofessional collaboration.” These are important practices to support both patients and their families through interprofessional collaboration based on an assessment that pays attention to the characteristics of older diabetic patients with MCI, and are also important practices as nursing care for the older adults as well as nursing support for diabetes self-management.departmental bulletin pape

Literature review on the characteristics and instructional issues for subjects in specific health guidance

本研究は特定保健指導の対象者についての文献検討を行い，対象者の背景・属性・支援状態と明らかになっていた点を捉え，指導上の課題を検討することを目的とした．医学中央雑誌Web版，PubMedにて文献を抽出し，目的に合わせ情報を整理した．その結果，支援終了者の研究が多く，未利用者の研究は少なかった．また途中終了者の研究はなかった．結果から明らかになっていたことは，「行動変容の要因」，「減量の成功・非成 功要因」，「未利用の理由」，「食習慣・運動習慣・行動変容ステージ」，「特定保健指導に対する認識」，「ヘルスリテラシー」の６つが抽出された．共通して見られた記述として，特定保健指導に対する否定的な認識や自身の価値観を優先的に捉える傾向が示唆された．特定保健指導の課題として，未利用・途中終了者の研究が少ないこと， 対象者の認識そのものを把握し支援する学習援助の枠組みの検討に取り組む必要があると考えられた．The purpose of this literature review on the subject of specific health guidance, was to capture the background, attributes, extent of support for the subject and what has been clarified, and to discuss instructional issues. We searched the bibliographic online databases, Japan Medical Abstracts Society and PubMed, and organized the information on the extracted articles according to the specific health guidance purpose. We found many completed studies on the successful use and a few studies on non-use, but no specific studies on discontinuation of specific health guidance. The studies were classified into six categories: factors concerning behavior change, factors related to successful/unsuccessful weight loss, reasons for non-utilization, the relationship between eating/exercise habits and stages of behavior change, perceptions of specific health guidance, and health literacy. The common descriptions suggested a negative perception of specific health guidance and a tendency to prioritize one's own views. Further research is needed to address the problems of non-use and discontinuation. Moreover, it is necessary to examine a learning assistance framework that supports the subjectivity of the subject, including negative cognitions.departmental bulletin pape

Satoyama nursing, Zen Buddhism, Japanese vernacular mentality, Misuzu Kaneko

departmental bulletin pape