セイジン カンゴガク リンチ ジッシュウ ニ オイテ シュウトク サレタ コンピテンシー ノ ジコ ヒョウカ

　成人看護学臨地実習を行う事で学生がどのように変化しているかを明らかとするため，実習前 の目標達成度とコンピテンシーの自己評価を調査・検討した．対象者として，A 大学3 年生170 名（回答138 名，有効回答率81％）に対し，まず実習前説明時に集合調査を行い，ついで，実習後調査を成人看護学実習（6 週間）終了毎に逐次実施した．調査内容は，成人看護学実習目標の20 項目について各々4 段階評価とし，コンピテンシー項目では吉本（2001）らが開発した調査用紙を参考として看護師向けに作成した37 項目に対し，獲得能力と職業上必要な能力について各々5 段階の自己評価を行った．　その結果，実習目標達成度における学生の自己評価は，実習後に上昇しており有意差も認められた．ところが，コンピテンシーの37 項目では獲得能力はすべて低下を示していた．しかしながら，職務上の必要能力においては「外国語の使用」以外のすべての項目が有意に上昇していた．　すなわち，臨地実習では，成人看護学実習目標こそ達成してはいたものの，コンピテンシーの獲得能力に関する全37 項目が低下していた．この結果から推測されることとして，学生は机上学習のみの時点では自己評価が高まり、あたかも全てができるように感じていたのであろうが．いざ実際に臨地実習を行った際には，不十分なレベルの看護実践しか行えず、いわゆる第一段階のリアリティショックを感じていたのではなかろうか．これらのことを臨地実習指導者は十分に理解したうえで，指導において，学生自身が自己の現時点での能力をしっかりと見据えながらも、看護者として働く自己の姿を客観的に見つめる機会をも与えるような教育姿勢が必要であろう．To clarify how nursing students have changed through adult nursing practice training, self-assessment exercises regarding practice training goals and their competencies before and after training were conducted and analyzed. These were undertaken with 138 nursing students of A University before and after six week training (81% response rate). The self-assessment chart consists of 20-item scale representing adult nursing practice training goals with a four-point scale and 37-item scale of competencies featuring acquired abilities and required professional abilities that were modified from competency frameworks that Keiichi Yoshimoto and others haddeveloped with a five-point scale. Results; the self-assessed scores on practice training goals indicated higher levels after training and showed significant differences. In 37-item scale of competencies, averaged scores on acquired abilities didn\u27t show any improvement. However, all required professional abilities except communication in foreign languages were improved through practice training. After the theoretical learning, nursing students might feel as if they could take all required abilities on the job for adult nursing due to their better self-assessment. However, students seem to have experienced a kind of reality shock through practice training. Therefore, nursing practice training has to be taken on this respect as well

カンゴケイ ダイガクセイ ニオケル ジソン カンジョウ ノ ジッタイ : SOBA SET オ モチイテ

　本研究の目的は，看護系大学に入学した学生の自尊感情の実態を調査し，看護を担う社会人としての責務を理解し成長するための学習支援を提言することである．研究方法は自尊感情測定尺度（以下SOBA SET：18 項目を4 段階評定）を用いた調査研究．看護大学生にSOBA SET 用紙を配布，回収した．　SOBA SET 配布総数は388 部で174 名の回答を得た（有効回答率44.8％）．分析対象内訳は，1 年生74 名（42.5％），2 年生24 名（13.8％），3 年生26 名（14.9％），4 年生50 名（28.7％）であった．SBタイプは4 年生が43.0％，2・3 年生は60％台，1 年生は70.3％であった．失敗や叱咤の体験があっても，自らの力で立ち直ると推察される．Sb タイプは，2 年生が8.3％を呈した．周囲に「この学生なら大丈夫」と捉えさせてしまい，学生が「孤独感」に苛まされていることを見落とす可能性がある．　今後は自尊感情の発達・成長を縦断的に追跡し，教育方法の検討をしていく必要性が示唆された．The objective of this study is to investigate issues related to self-esteem among nursing collegestudents， and contribute to understanding what support arrangements would be of help for students to develop and understand the responsibilities they are expected to fulfill as members of society who are in charge of nursing. The study design is a questionnaire survey using a social and basic self-esteem test （SOBA-SET）， which rates 18 items on four scales. The SOBA-SET questionnaire forms were distributed to and collected directly from the nursing college students. In total， we distributed 388 forms and collected 174 responses （44.8 ％）. The analysis was conducted with 74 first year（ 42.5 ％）， 24 second year（ 13.8 ％）， 26 third year（ 14.9 ％）， and 50 fourth year （28.7 ％） students. The responses were classified into SB and Sb types， and 70.3％ of the first year， about 60％ of second and third years and 43.0 ％ of fourth year students were included in the SB type. This suggests that students can overcome difficulties by themselves even if they make mistakes and are scolded. However， a total of 8.3 ％ of the second year students were evaluated as the Sb type. This suggests that teachers may be overlooking distress arising from“ feelings of isolation” felt by these students by assuming that“ there is no need to worry about these students”. The findings suggest the necessity to follow up the development and growth of the selfesteem of these students and also to examine educational methods

ザイタク コウレイシャ ノ ショウジョウ ニ タイスル オモイ : ショウジョウ オ ウッタエ ツヅケテイタ 1 ジレイ ノ ケントウ

　本研究の目的は、在宅高齢者の1 事例がもった症状に対する思いから、症状を訴え続けた意味を明らかにし、看護的示唆を得ることである。協力者は80 歳代の女性で、うつ病や認知症の既往はなかった。データ収集は非構造化面接法で、データ分析は質的記述的方法を用いて行った。この結果、本事例の症状に対する思いから、《自分のことがわかってもらえないいらだち》《自分のことがわかってもらえる安心感》《症状が改善しづらい》《人に頼らず生活したい》《症状が悪化し、人に迷惑をかけるのではないかという恐怖》《老人同士のつながりがある安心感》の6 つのテーマ群が抽出された。このことから本事例にとっての症状は、人に頼らず生活できるかどうかの指標となることを意味していた。また、本事例が症状を訴え続けた意味は、わかってもらえる安心感を持つこと、そして症状が増悪し人に迷惑をかけることを予防しようとする対処行動であることが示唆された。よって、看護師は高齢者が訴える症状の意味を理解し、高齢者の希望がかなえられるように援助する必要がある。　The objective of this study is to describe the thoughts an at-home elderly felt about her symptoms qualitatively, and obtain suggestions to help in nursing. The person under study is a woman in her 80’s. Data were collected through an unstructured interview and the data were analyzed by a qualitative descriptive method. As a result, six theme categories concerning how the person under study felt about her symptoms were obtained:“frustration that no one can understand her feeling,” “a sense of ease which comes from the thought that someone can understand her feeling,”“ the fact that the symptoms have not been easily alleviated,”“ the desire to live independently,”“ fear about the thought that her condition will worsen and trouble others,” and“ a sense of ease feeling she has a good relationship with other elderly people.” Thus, the symptoms in this study work as an indicator that shows whether or not the patient can live independently. Also, it was suggested that the behavior of the patient’s complaining about her symptoms can be a coping behavior in order to gain a sense of ease by having someone know how she feels and to prevent her from troubling others when her symptoms worsen

ボシ ホケン ソウダンイン カラ ミタ ゲンダイ カゾク ノ イクジ ヨウソウ

　本研究は、母子保健相談員がみている現代家族の育児の様相から、家族の育児支援への示唆を得ることを目的とした。母子保健相談を行っている相談員3 名に半構成的面接をおこなった。その結果、現代の家族の心配・困りごとは【過度にアトピーを心配する】、【離乳食の悩み】、【母親の資格に関わる母乳の出方】【体重増加は関心の的】【健診は合否判定の場】が抽出された。育児中の家族については【育児を知らない・子どもと関われないママ】、【ママの代わりができるパパ】、【介入し過ぎる祖母・しない祖母】に、育児支援については【安心を与える育児支援】、【親が育ち合える場の必要性】が抽出された。現代家族の育児様相は、父親は協力的に育児参加しているが、祖母は介入し過ぎる・しないの両極化であること、母親は子どもの関わり方が分からない、自分への育児評価が気になっていることが明らかになった。今後の育児支援については、母親に安心を与える育児支援、世代を超えて親子が集まり、親同士が育ち合う身近な場が必要であることが示唆された。　This study sought to obtain suggestions for parenting support for families based on aspects of parenting by modern families as noted by maternal and child health counselors. Semi-structured interviews were conducted with 3 counselors who provide advice on maternal and child health. Based on the results, concerns of or troubles facing modern families were “excessive concern about atopy,” “worry about the introduction of solid foods,” “expression of breast milk as it relates to a woman’s fitness as a mother,” “focusing on weight gain,” and“ passing or failing a health checkup.” Thoughts about families parenting a child were“ a mother who lacks knowledge of parenting and who is not involved with her child,” “a father who can take the place of the mother,” and“ a grandmother who meddles and one who does not.” Views on parenting support were“ parenting support that provides peace of mind” and “the need for parenting by both parents.” Aspects of parenting by modern families were found to be a father helping to parent with a mother, a strict dichotomy of a grandmother who meddles versus one who does not, a mother’s involvement with her child at an undetermined level, a selfcentered parenting approach, and concern about how one’s parenting is assessed. Results suggested that future parenting support requires parenting support that puts the mother at ease and intimate settings in which multiplegenerations of the family are assembled and both parents parent together

セイジン カンゴ ガクシュウ ニオケル インシデント ノ ジッタイ ト キョウイクジョウ ノ カダイ

　本研究の目的は，成人看護学実習において看護学生が体験したインシデントの実態を明らかにし，本学の成人看護教育の中で医療安全についての教育方法を考察することである．本学の成人看護学実習において学生より提出されたインシデント・アクシデント報告書を集計し，項目別に「発生時間」「実習開始日数」「発生場所」「事例レベル」「対象者の概要」「発生状況」「原因分類」に沿って内容分析を行った．学生には同意書および口頭で研究参加への説明をおこない，同意書により承諾が得られた者のインシデント・アクシデント報告書のみ集計した．結果，インシデント・アクシデントレポートの総計は21 件であり，そのうち研究参加の同意を得ることができたのは18 件であった．インシデント・アクシデントの内容では，転倒・転落が10 件と圧倒的に多く，次いで薬剤，チューブ抜去，報告，その他が各2件であった．学生のインシデント・アクシデントの結果から成人看護学実習における指導方法として，学生と患者の安全確保のために教員と臨床指導者が常に学生が行動レベルにおいて見守ること，安全な看護技術を思考し実践できるようかかわる必要性が示唆された．This study aims at understanding the reality of incidents that nursing students experience in adult nursing practice and at examining methods for medical safety education and training in adult nursing education at our university. Reports on incidents and accidents that nursing students experienced in their adult nursing practice were collected for analysis. These incidents and accidents were analyzed according to the time of the day when each took place, the numberof days elapsed from the start of the nursing practice to the day of the incident/accident, the place of the incident/accident, the severity of the incident/accident, the people affected by the incident/accident, the circumstances of the incident/accident, and the cause of the　 incident/accident. Nursing students were given an oral and written explanation of this study to obtain their informed consent, and reports from those who gave consent in writing to their participation in the study were used for analysis. Of the 21 reports on incidents and accidents, 18 reports were available for this study with the consent of students who prepared these reports. The majority of the reported incidents/accidents were falls (10 cases) followed by 2 cases each of incidents/accidents related to medication, extubation, reporting, and other. The results suggestthat it is necessary for teachers and clinical instructors to watch out for the safety of patients and students while students are engaging with patients, and to help students to think about and put into practice safe nursing skills

カンゴ ガッカ ニオケル カリキュラム ノ サイコウチク ト ソノ ガイヨウ

　本学科は，平成24 年度より新カリキュラムによる教育を開始した．平成21 年，教員間から現行カリキュラムについて，教育理念と教育内容の整合性，科目間における教授内容の重複や実習進度などの問題等が提起され，完成年度に向けて根本的にカリキュラムを再構築することになった．　再構築におけるカリキュラム特徴は，本学の教育理念に則り，加えて看護系大学の社会からの要請に応え①人間の生命の尊厳，倫理感を備えている，②ヒューマンケアリングの視点に立った看護実践能力，③他職種と連携，協働できる基礎的能力，④地域社会，国際社会に貢献できる能力，それらを有する人材の育成である．その構築過程は，看護の主要概念，内容の諸要素，教育理念，教育目標，学年目標，理論的枠組みに基づくカリキュラム軸，レベル目標と科目原案の段階を経て進められた．　再構築する過程で，保健師助産師看護師学校養成指定規則の一部改正に伴い，本学はそれまでの保健師看護師の統合カリキュラムから看護師教育の一本化に変更して，新カリキュラムを完成させた．今後，組織全体で議論を重ね，段階的に評価しながら，看護教育の更なる質の向上をめざしていく．The Nursing Department of our university instituted a new curriculum in April of 2012. In 2009, some faculty members raised questions about the existing curriculum, concerning consistency between the educational philosophy and the content of the education, duplication of content among curriculum courses, and the degree of progress of practical training. With this background, it was decided to restructure the curriculum drastically by 2012. The curriculum was reconstructed to fill the needs that society seeks from nursing colleges, in accordance with the educational philosophy of the university. Characteristics of the curriculum are placing greater importance on fostering human resources equipped with (1) a sense of ethics and appreciation of the dignity of human life, (2)an ability to practice nursing from a viewpoint of human caring, (3) fundamental abilities which allow one to cooperate and collaborate with other occupations, and (4) an ability to contribute to both local and international society. Curriculum reconstruction proceeded through these phases: main concept of nursing, various aspects of the contents, educational philosophy, educational targets, target for each grade, curriculum axis based on a theoretical framework, target levels, and draft proposal for curriculum courses. In the process of the reconstruction, we changed the existing curriculum that integrated education for both public health nurses and regular nurses into that for regular nurses following a partial revision of the regulation specific for vocational schools for public health nurses, midwives and sick nurses. As a future perspective, we will strive to improve the quality of nursing education further while having discussion and evaluating the curriculum in stagesthroughout the whole organization

セイジン カンゴガク ジッシュウ ゼンゴ ノ ガクセイ ノ ヘンカ ニ カンスル ケンキュウ : フアン カンゴ カテイ テンカイ コンピテンシー オ チュウシン ニ

　効果的な臨地実習指導を検討することを目的として、新設看護系大学の3 年生78 名を対象に臨地実習（以下実習）における「不安」、「看護過程展開」および「コンピテンシー」の自己評価に基づくアンケート調査を行ったところ、学生は実習前よりも実習後に不安や実習中の記録物への負担を感じており、対象の理解が不足しているために看護計画の立案に困難さを感じていることが分かった。また、実習を通して、誠実さや批判的能力、言語的能力、リーダーシップ、自分とは異なる考えを理解し受容する力量、リーダーシップ、書き言葉によるコミュニケーションを獲得する必要があることに気づいていることが分かった。実習に携わる教員は、学生が新たな知識や学習の必要性に気づけるように関わる必要がある。　With the aim of studying effective on-site laboratory work, a self-evaluation-based questionnairesurvey on “anxiety,” “development of the nursing process,” and “competency” during practical laboratory training (practical training, below) was conducted on 78 third year students at a new nursing university. Compared with before training, the students experienced increased anxiety after practical training; moreover, they experienced stress with regard to the maintenance of records during training. We discovered that difficulty was experienced in drawing up a nursing care plan because of insufficient subject understanding. Furthermore, throughout practical training, we noticed a need to improve written communication, reliability and critical skills,linguistic skills, ability to understand and accept ideas different from one’s own, and leadership. The teaching staff participating in practical training needs to be aware of students’ need for new knowledge and training

コウトウ ヨウゴ ガッコウ ニ オケル セイキョウイク ニ タイスル キョウユ ノ ニンシキ

　本研究は，高等養護学校における性教育の実態と課題を明らかにする目的で，性教育を担当する教諭に半構成的面接を行い意味内容を分析した質的記述的研究である．その結果【性被害を危惧】【反復・継続の教育】【性教育への熱い信念】【実態と時間数との狭間のジレンマ】の4 つのカテゴリーが抽出された．教諭は生徒の身に起こる性被害を危惧し，性教育への熱い信念を持ち，生徒に反復・継続の教育を行っていた．しかし，生徒の実態と性教育の時間の狭間でジレンマが生じていた．限られた時間の中で，生徒一人ひとりの実態に合わせ，生徒の行動変容につながるような教育方法，教諭間の共通理解と寄宿舎との連携が課題とされた．The objective of this study is to understand the situation and problems related to sex education in high schools for disabled students by conducting semi structured interviews with teachers in charge of sex education at such a school. The data obtained in the interviews were analyzed into the following four categories: "apprehensions about sexual violence", "repeated and continuing education", "strong beliefs in the value of sex education", and "dilemmas arising from perceived student needs and the number of class hours". Teachers conducted sex education repeatedly and continuously to the students with a strong belief in the necessity for sex education and with apprehension about the danger of sexual violence inflicted on students by others, or other students. However, teachers felt a dilemma between the situation surrounding the students and the time available for sex education. The findings suggest the necessity of establishing a method of sex education that helps respond to the behavioral changes experienced by students based on the specific condition of each student in the limited time available, sharing understanding and insights among teachers, and ensuring cooperation with the staff of dormitories

臨地実習における看護学生の感染予防管理の実態

　近年の予防接種法の度重なる改変は，青年期を中心とした麻疹などの流行がみられ問題となっている．今回医療系の高等教育機関における感染予防に対する現状を明らかにし，その感染予防対策の枠組みの方向性を示唆することを目的に調査研究をおこなった．　対象は，A 大学看護学科1 － 4 年生全員（377 名）．調査内容は，感染症の認知度などを質問紙で実施し，学年間の分析は，Kruskal Wallis 検定をおこなった．　学生の予防接種は，麻疹で学年間の有意差を認め（ｐ＜ 0.05），認知度は，全項目で学年が上がるにつれ上昇した（ｐ＜ 0.001）．また，抗体価検査費用は，2,000 － 5,000 円/ 項目，予防接種費用は，5,000円/ 項目/ 回となった．注目すべきことは，4 年生の麻疹の抗体検査結果，陰性者がいることであった．　感染症に対する認知度の上昇は教育効果の現れであろう．感染症抗体価検査，予防接種ともに高額の費用であり経済的な負担となっていることより，医療者となる学生の感染に対する意識が高められる教育が求められている．また，費用が高額であることより保護者へは感染予防対策に関する充分な説明が必要性である．最後に，麻疹の抗体価の自然低下を視野に入れた対応の必要性が示唆された．　感染予防対策は，臨地実習のみを見据えたものではなく教育機関自体の対策も重要であるため，事務職と教員とが連携をとり大学としての一括管理体制の構築が必要であることが明らかとなった．Repeated amendments to the Preventive Vaccination Act in recent years has been an issue of concern amid the proliferation of diseases such as measles mostly among adolescents. This study aimed to identify the current state of infection prevention at higher education institutions offering medical degrees, and consider a framework to facilitate infection prevention strategies. The subjects were all (first- to fourth-year) students at the Department of Nursing of A University (n=377). Questionnaires were used to investigate items including their awareness of infectious diseases. The Kruskal-Wallis test was used to analyze data according to grade level. Regarding vaccination, significant differences were noted among the grade levels for measles (p<0.05). The level of awareness increased for all items as the students advanced to the next grade (p<0.001). Antibody test costs varied from 2,000 to 5,000 yen/item, and the vaccination cost was 5,000 yen/item/dose. Of note, some fourth-year students had negative measles antibody titers. A heightened awareness of infectious diseases was likely to be the effect of education. Given the financial burden of infection antibody titer tests and vaccinations, it is imperative to raise students’ awareness of infection to a level appropriate for healthcare professionals, through education. It is also necessary to provide students’ parents andguardians with sufficient explanations regarding infection prevention strategies in light of the high costs of such tests. The findings also suggest the need to develop and implement strategies for the natural decline of measles antibody titers. Infection prevention strategies should not only be considered in terms of the clinical practicum, but also in terms of strategies that concern the educational institution as a whole. It is, thus, necessary to develop auniform management system by facilitating collaboration among teaching and administrative staff of a university

カンゴ ガクセイ ガ キジュツ シタ コウレイシャ トノ エピソード ノ トクチョウ : バメン セッテイ ト チュウシン テーマ ノ シテン カラ

　本研究の目的は、看護学生が記述した高齢者とのエピソードを「場面設定」と「中心テーマ」の視点から特徴を明らかにし、老年看護学教育の基礎資料とすることを目的とする。研究協力者は４年生大学看護学科２年生175 名であった。データ収集は“最も良く覚えている高齢者との体験を100 字程度”の自由記述で実施した。データ分析は、記述された文章の「場面設定」と「中心テーマ」を明らかにし、研究者間で内容を検討した。　記述されたエピソードは「９場面」で＜生き生きとした高齢者とのふれあい＞＜現在の日常の出来事＞＜高齢者との別れ＞＜納得のいかない出来事＞＜子どもの頃の思い出＞＜仕事や学習の場での出会い＞＜知らない人との出会い＞＜病気の高齢者とのかかわり＞＜ボランティアでのふれあい＞が場面設定として抽出され、この中で２－９の「中心テーマ」が抽出された。　看護者が持つ対象者のイメージは、看護に対する姿勢を形成する基となる。そのイメージ形成は、関心の強いエピソードから印象づけられることも多い。対象者のイメージが看護活動に影響する事を考えると、学生との間で印象づけられたエピソードや高齢者の言動の意味を討議し、高齢者を看る視点が養われるよう教育的にかかわる必要性が示唆された。　The objective of this study is to gain a new insight into characteristics of episodes which nursing students described in terms of“ the scene setting” and“ the main theme”， in hopes of using the findings as a basic resource for geriatric nursing education. The participants in the study were 175 second year students in the nursing department of a four-year college. Data were collected and analyzed by asking the participants to write about “the most memorable experience they had with elderly people in about 100 Japanese characters”. Data analysis clarified the terms "the scene setting" and "the main theme" in the description， and the contents were examined among the researchers.Regarding the scene setting， the following nine scenes were yielded: “relationship with lively elderly people”，“present daily events”， “separation from an elderly person”， “childhood memory”， “meeting through work or study opportunities”， “meeting with strangers”， “involvement with sick elderly people”， and “meeting through volunteer activities” . Among these two to nine“ main themes” were extracted.An impression is formed from the episode， and from there the participants form images about nursing. Assuming that the participants\u27 image about nursing may affect care， it can be suggested that teachers need to show direction and have students discuss the meaning of elderly people\u27s traits in order to provide students with opportunities where they can cultivate the ability to see elderly people from various points of view