産褥期（入院中）の褥婦の排便困難の実態調査

本研究では，正期産で経膣分娩をした褥婦の妊娠末期の排便状態と，産褥期（入院期間）における排便状態を評価し，産褥期における妊産婦の排便困難の実態を明らかにすることを目的とした．排便状態を把握する指標として，日本語版便秘評価尺度（Constipation Assessment Scale：以下CAS）と研究者が作成した質問紙を用い調査した．質問紙は自記式で留め置き法にて回収した．研究に同意が得られた対象者は１３８名（初産婦９７名，経産婦４１名）で，平均年齢は２８．５（SD＝４．９）歳であった． 分娩後の平均初回排便日は２．６（SD＝１．１）日で，産褥期の平均CAS得点は２．３～３．２（SD＝２．４～２．９）点であった．産褥１日目から５日目までの間でCAS得点５点以上の便秘の割合は，産褥３日目が２９．４％，また下剤を服用した時期も１９．１％と最も多かった．産褥期において，３日以上連続して下剤を服用した褥婦は９名いた． 本研究は，産褥期の排便困難の実態を，数値を用いて初めて明らかにした．産褥３日目に便秘の割合が多く，下剤の服用者も多かったことより，産褥早期から自然排便を促す援助の必要があると考える．The aim of this research is an actual condition survey on the difficulty in defecating for pregnant women during the puerperal period. The Japanese version of Constipation Assessment Scale（referred to as CAS）as an indicator and a questionnaire prepared by the researchers were used. The number of the subjects giving their consent for the survey was １３８ （９７ of them were pregnant for the first time and ４１ were parous）. The average days until the first defecation after delivery were ２．６ days （SD＝１．１）. The average CAS points during the puerperal period were between ２．３ （SD＝２．４） and ３．２ （SD＝２．９）. The ratio of developing constipation with ５ or more CAS points reached its highest percentage of ２９．４on the third day of the puerperal period. The ratio of laxative use reached its highest percentage of １９．１ on the third day as well. For the first time, this research has clarified actual conditions of the difficulty in defecating during a puerperal period with the use of numerical values. Natural defecation aid at an early stage of the puerperal period is considered necessary

Adequateness of Vital Signs on the Hemiplegic Side of Hemiplegic Stroke Patients

本研究では，片麻痺患者の血圧，体温，および動脈血酸素飽和度において，麻痺側と健側間で測定値に差がみられるか検討した．被験者には，脳血管障害等で片麻痺があり，研究に同意の得られた患者２７名を対象とし，そのうち男性は１５名，女性は１２名で，平均年齢は７２．８歳であった．これら患者のバイタルサインを，安静仰臥位で麻痺側と健側同時に測定した．その結果，平均収縮期血圧は，麻痺側で１２０．４４±１７．７４mmHg，健側では１２１．２８±１９．６８mmHg，また平均拡張期血圧は，麻痺側で７２．５８±９．４６mmHg，健側では７１．７２±８．８５mmHg であった．以上の血圧の測定値に麻痺側と健側間で有意差は認められなかった．一方，平均体温は，麻痺側で３６．６１±０．７℃，健側では３６．４３±０．７であり，麻痺側が有意に高値を示した．また，平均動脈血酸素飽和度は，麻痺側で９６．３１±１．８１，健側では９５．９６±１．８６であり，麻痺側が有意に高値を示した．しかし，これら平均体温および平均動脈血酸素飽和度における有意差は，正常変動と比較すると十分小さく，臨床的には意味がないと考えられた．以上から，麻痺側の測定であっても正確な値が得られることが明らかになった．The purpose of the study was to investigate if there were significant differences in vital signs （blood pressure, temperature, oxygen saturation measurements）between the hemiplegic and healthy sides of hemiplegic stroke patients. The ２７ patients with hemiplegia due to chronic-phase cerebrovascular impairments were enrolled as study subjects after they provided informed consent for participation in the study. Of the subjects，１５were men and１２were women, with the mean age of ７２．８ years. The vital signs on the hemiplegic and healthy sides of the patients were simultaneously recorded in supine position. The mean systolic arterial pressure was １２０．４４±１７．７４ and １２１．２８±１９．６８mmHg on the hemiplegic and healthy sides, respectively. The mean temperature was３６．６１±０．７and３６．４３±０．７℃ on the hemiplegic and healthy sides, respectively. The mean oxygen saturation measurements was ９６．３１±１．８１ and ９５．９６± １．８６％ on the hemiplegic and healthy sides, respectively. The statistical comparisons showed no significant differences in blood pressure between the hemiplegic and healthy sides. Although there were significant differences in temperature and oxygen saturation measurements between the hemiplegic and healthy sides. Clinical implications suggest that these differences are enough small and negligible. In conclusion, the results showed that vital signs can be accurately measured even on the hemiplegic side

ヒヤリハット体験に関する看護学生のリフレクション

本研究の目的は，ヒヤリハット・シミュレーション体験後のリフレクションの構成要素，及び「ヒヤリハット体験」がリフレクションに影響するかどうかについて明らかにすることである．「ヒヤリハット体験」は，誤薬のシミュレーションで，研究に同意の得られた５年一貫課程の最終学年の看護学生を対象に実施した．その後，体験群と対照群の両者で構成するグループによるリフレクションを行った．また，「リフレクション自己評価アンケート」を実施し，因子分析した．その結果，第１因子「事故を起こした自分の気持ちや自己の傾向への気づきと表現・分析」，第２因子「事故原因の追及と解決のためのスキルへの気づき」の２因子構造，７項目から構成されることを確認した． 第１因子の平均値の比較では体験群が対照群よりも有意に高かった（p＜０．０１）．これは，ヒヤリハットを自ら体験することがエラーを起こす可能性がある自己の傾向に気づき，振り返って熟考するリフレクションを可能にしたといえる．The purpose of this research was to clarify the effects of simulated experience of medical accidents （HIYARIHAT） and determine whether experiencing HIYARIHAT influences nursing students’ self-reflection. Participants were nursing students who agreed to participate and were in their final （fifth） year of a nursing program. In the simulated HIYARIHAT, students were required to prepare infusion solution preparations. Following the simulation, both a group HIYARIHAT group and control group met to discuss the simulation. Both groups completed the Reflection Self-Assessment Questionnaire （RSAQ） and the data were used for factor analysis. The results revealed two factors comprised of seven items. The first factor was “Expressing and analyzing the feeling and the patterns that caused the accident”. The second factor was “Identifying the cause of the accident and the skills that can prevent it”. The mean score for the first factor was compared between the self-reflection group and the control group. The mean score for the first factor was found to be significantly higher in the self-reflection group than in control group （p＜０．０１）. The present findings indicate that the self-reflection group noticed the patterns that might have cause an error by experiencing their own HIYARIHAT because they were able to look back and reflect

Development of the Reflection and Self-Assessment scale for nursing student : study of its reliability and validity

本研究の目的は，看護学生用リフレクション自己評価尺度を開発し，その信頼性と妥当性を検討することである．Gibbs のExperiential Learning CycleのReflective cycleを理論的基盤として，「リフレクション自己評価尺度」原案を作成した．看護学生１５０人を対象に，臨地実習終了後，「リフレクティブジャーナル」を使用したリフレクションを実施後，「リフレクション自己評価尺度」原案の回答を求めた．探索的因子分析で尺度原案を修正し，８項目，「意識変容・行動計画」，「評価・分析」，「記述・表現」の３因子構造であることを確認した．共分散構造分析による検証的因子分析を行った結果，探索的因子分析で得られた仮説モデルの適合度が確認された（GFI＝０．９０３，AGFI＝０．７９５，CFI＝０．８９４）．尺度の信頼性については，▯係数が０．７７であり，項目分析から内的一貫性を確認した．妥当性については，因子がGibbsのReflective cycleと類似していることから内容的妥当性を，職業的アイデンティティ尺度と批判的思考態度尺度の相関から基準関連妥当性を確認した．「リフレクション自己評価尺度」はある程度の信頼性と妥当性を備えた尺度であり，リフレクションの自己評価のための測定ツールとして，有用な尺度であることが示唆された．The purposes of this study were to develop the Reflection and Self-Assessment （RSA） scale for basic nursing education in Japan, and to examine its reliability and validity. The original RSA scale was developed based on Gibbs's “Reflective Cycle of Experiential Learning Cycle”. Participants were １５０ nursing students. They were responding to the questionnaires original RSA scale after their clinical practice at hospitals. An exploratory factor analysis was conducted on a sample of these students, and original RSA scale was revised. The following three factors were finally extracted : Alteration of consciousness/action plan, evaluation/analysis, and description/expression. Confirmatory factor analysis was conducted by analyzing covariance structures and the hypothesized statistical model was found to fit the actual data （GFI＝０．９０３, AGFI＝０．７９５, CFI＝０．８９４）. The reliability of the scale was confirmed by a Cronbach's alpha of ０．７７ and internal consistency from an item analysis. The content validity was confirmed by the factors resembled with Gibbs's reflective cycle, and the criterion-related validity was confirmed by interventions using the professional identity scale and the critical thinking disposition scale. The hypothetical model supported from above results. The final８‐item scale demonstrated both reliability and validity. It was suggested that the revised RSA scale has a certain reliability and validity. The scale was useful for reflective self-assessment

ピアエデュケーションの自己肯定意識への影響

本研究の目的は，性のピアエデュケーションにエデュケータとして参加した学生が自己肯定意識を高めるのかどうか，また，エデュケータとしての活動からどのような体験を得ているのかを明らかにすることである．５年一貫課程の看護学生１１人が，中学生に性のピアエデュケーションを実施した．前後に「自己肯定意識尺度」の回答を求め，同課程の看護学生２８人と比較した．また記述回答から，活動で得た体験の表現された記述を抽出し内容分析した．対照群は「自己肯定意識」に変化がなかった一方で，ピアメンバーは６サブスケール中４つが有意に変化した（ｐ＜０．０５）．またピアエデュケーションの体験は【エデュケータとしてのスキルと役割に気づく】【自らの性の知識・理解の増加を自覚する】【自らのセクシュアリティの捉え方の変化に気づく】に特徴付けられた．ピアエデュケーションの準備を含めた一連の過程が，エデュケータにとって自己を肯定的に捉え直すうえで有効であることが示唆された．The purpose of this study is to clarify whether the students who participated in peer sexual education as educators raised their self-positive-consciousness, and to clarify what kind of experience they obtained from activities they were involved in as educators. The participants were １１ nursing students who agreed to participate in and were in their final （fifth） year of a nursing program. They performed the peer sexual education to junior high school students. Before and after the delivery of the education, they were required to give their responses to the items in “Scale of Self-Positive-Consciousness”, and their responses were compared with those of ２８ nursing students in the control group. From the written responses of the participants, the descriptions which expressed their experience in the activities were extracted, and content analysis was performed on them. While the Self-Positive-Consciousness of the control group did not experience a change, the peer members’４ subscales changed significantly（p＜０．０５）. Also, the experience of the peer education was characterized as the following types : ［Realize the required skills and roles of an educator］, ［Aware of the enhancement in their own knowledge and understanding on gender］, and ［Realize a change in the way they grasp their own sexuality］. It was suggested that the processes involved in the preparation of peer sexual education are effective for educators to positively review their own selves

Comparison of daily activities and meals between Femoral Fracture and Control Group

The aim of this study was to clarify the actual conditions of daily activities and meals in female patients with femoral fracture and compare them with women in the same age group. Subjects were ５０ female patients with femoral fracture （a femoral fracture group） and ５０ women in the same age group （control group） whose consent had been obtained, and we investigated their daily activities and ingestion of calcium-rich foods for bone metabolism. The investigation duration was October ２００５ to March ２００７. For statistical processing, chi-square test was performed with SPSS. The study was approved by each participating institutional ethics review board. The average age of the femoral fracture group was ８０．４ years （SD ： ８．９years）, and that of the control group was ７９．０ years（SD ： ５．２ years）, showing no significant difference. The numbers of patients with a history of fracture were２５ （５０％）in the femoral fracture group and ０（０％） in the control group, with the fracture group, being significantly large in the number. For daily activities, the numbers of patients answering that they had exposure to sunshine once daily were ４０ （８０％） in the fracture group and ４７ （９４％） in the control group, with the fracture group, being significantly small in the number. Other daily activities, unbalanced diets, dietary restriction or water ingestion showed no significant difference between the groups. For foods, only yogurt intake showed a significant difference between the groups, with the intake being larger in the femoral fracture group. The intake of milk, small fishes, etc. showed no significant difference between the groups. Women with a history of fracture have higher risk to have femoral fracture. A significant difference in amount of sun exposure was confirmed between the control and inpatient groups regarding

フィリピンの看護大学および病院の視察報告

２１世紀のグローバル社会を生きる学生が国際的な視野を持つ事ができるよう，国際交流の場を提供することは看護教育における課題である．本稿の目的は，フィリピンの看護教育制度への関心を高めることにある．なぜならば，アジア地域との交流は今後ますます活発になる事が予測されるからである．そこで、フィリピン大学の看護学教育および隣接するPhilippines General Hospital の看護システムを視察した．また，University of the East Ramon Magsaysay Memorial Medical Center（UERM），College of Nursing（私学）も視察した．看護教育はすべて大学でなされ，大学の卒業生は高い実践能力を有する看護師であると考えていた．Philippines General Hospital は利用者の９０％が無収入か低所得者とのことで，１次医療から３次医療まで対応している国立の大規模な総合病院であった．病室の大半が総室で家族の付き添う姿も見られた．看護職の離職および不足においては日本と類似した問題を抱えていた．短時間の視察であったが，看護教育への示唆を得ることができた．It is an important theme in nursing education to offer an opportunity of an international exchange so that the nursing student living in global society of the 21 st century can have an international field of vision. A purpose of this report is to raise interest to a Philippine nursing education system and care system. Because we thought that the transaction with an Asian region is predicted to become more and more active in future. Therefore we inspected a nursing education of a Philippine university and a care system of Philippines General Hospital. In addition, we visited University of the East Ramon Magsaysay Memorial Medical Center（UERM）, College of Nursing（a private school）. All the nursing education in a Philippine nursing education was made at University/college, and the teacher thought that graduates of their university were nurses having ability for high practice. We had explanation that the Philippines General Hospital was the national major general hospital which provided from medical treatment to the third medical treatment and 90% of the patient who used there were no income or low-income people. Most of patient’s room was the room for the plurality of patients, and we saw that a family attended the patient there. We thought that there was a similar problem in quitting a job and a shortage of nurses. But we were able to have a suggestion to nursing education during short inspection

Challenge of psychiatric rehabilitation for patients with long-term hospitalizations using the Nirje’s normalization principles as a valuation standard: two case studies

This research investigates the current care of hospitalized, chronically mentally ill persons to determine to what extent current hospitalization supports Nirje’ s principles of normalization. We propose that care-providers try to incorporate rehabilitation programs that help the patients acquire the pattern and rhythm of living necessary for them to live in the community in their daily hospital life rather than to fit the patients into hospital rules or schedule. Therefore, care-providers must look back on their own views of the humanity, disabled people, and support and may have to change them if necessary. It is important that care-providers do not give up having psychiatric patients not give up restoration of normal social living. To develop such individual attempts into rewarding activities, it is necessary to set goals in the hospital and to let an interdisciplinary team work to achieve them. Moreover, the situation is expected to change if efficient care management is implemented to support psychiatric patients in the community. High-quality care to realize independent living of patients in the community including collection and distribution of information, management of symptoms, assistance for self-care, and psychological education is provided at hospitals that maintain the idea of, and strong belief in, providing high-quality care for returning patients to the community. The findings of this study will provide insights into how to design better hospitalization and/or community care for the mentally ill.

Illness experiences of patients with ischemic heart disease during their transitional phase from hospitalization to discharge in Japan

The purpose of this study was to explore the experience of patients with ischemic heart disease (IHD) during the transitional phase from hospitalization to discharge. Twenty-four patients who experienced IHD for the first time comprised the sample of the study. Semi-structured interviews were conducted during the transitional phase. The results of the qualitative inductive analysis showed two categories of illness experience : (i) the connection of heart attack experience with the self, and (ii) the instability of the self as a patient with heart disease. The participants were found to vacillate between the self as patient with a heart disease and the typical self before the disease onset. The transitional phase is the time when patients experience changes in their symptoms and physical conditions rather than a condition of stability signifying recovery. Patients are expected to manage the symptoms of their heart disease by themselves ; however the participants showed signs and symptoms of confusion and anxiety about facilitating their own care. These findings suggest the importance of outpatient nursing practice focusing on the support and emphasis on nursing interventions for patient anxiety and alleviation of confusion through the management of symptoms of heart disease after discharge

Illness experiences of patients with ischemic heart disease during their transitional phase from hospitalization to discharge in Japan

The purpose of this study was to explore the experience of patients with ischemic heart disease (IHD) during the transitional phase from hospitalization to discharge. Twenty-four patients who experienced IHD for the first time comprised the sample of the study. Semi-structured interviews were conducted during the transitional phase. The results of the qualitative inductive analysis showed two categories of illness experience : (i) the connection of heart attack experience with the self, and (ii) the instability of the self as a patient with heart disease. The participants were found to vacillate between the self as patient with a heart disease and the typical self before the disease onset. The transitional phase is the time when patients experience changes in their symptoms and physical conditions rather than a condition of stability signifying recovery. Patients are expected to manage the symptoms of their heart disease by themselves ; however the participants showed signs and symptoms of confusion and anxiety about facilitating their own care. These findings suggest the importance of outpatient nursing practice focusing on the support and emphasis on nursing interventions for patient anxiety and alleviation of confusion through the management of symptoms of heart disease after discharge