看護婦国家試験における疾患別出題頻度の変遷

看護婦国家試験に出題された臨床医学的選択肢について,1974年度から2000年度までの疾患別出題数を集計し,旧カリキュラムであった1992年度までと新カリキュラムになった1993年度からの2期に分けて,選択肢の増減から疾患の変遷を検討した。両群を比較して選択肢数が増加傾向にある疾患および手術は,増加の大きい順に糖尿病,肺結核,後天性免疫不全症候群,痴呆・アルツハイマー病,人工関節置換術であり,国家試験1回当たり2.0肢以上の増加がみられた。同様に両群を比較して選択肢数が減少傾向にある疾患および手術は,減少の大きい順に精神分裂病,胃切除術,乳癌手術であり,国家試験1回当たり少なくとも1.6肢以上の減少がみられた。両群を通して常に出題選択肢数が多い疾患は,多い順から糖尿病,精神分裂病,躁鬱病,気管支喘息,心筋梗塞,急性白血病であり,いずれも国家試験1回当たり2.2肢以上の出題があった。The national licensing examinations for nurses are annually performed by multiple choice method. The total number of questions consisted of four legs each is 210 ; 150 questions for all subjects and 60 questions about clinical cases. Since 1975 to 2001 total multiple choice legs concerning clinical medicine were divided in two stages : an old curriculum stage until 1992, the first stage, and a new curriculum stage since 1993, the second stage. This survey revealed transition of the importance of diseases in the national examinations. The results are as follows. Comparing the two stages the main diseases and operations increasing in the number of multiple choice legs were diabetes mellitus, pulmonary tuberculosis, acquired immunodeficiency syndrome, dementia including senile dementia of Alzheimer type and replacement of the hip joint with artificial joint. In these diseases and operations multiple choice legs of the second stage increased more than 2.0 legs on the average of an examination comparing with the legs of the first stage. On the other hand the main diseases and operations decreasing in the number of the multiple choice legs were schizophrenia, gastrectomy and mammary operation. In all of them the legs of the second stage decreased more than 1.6 legs on the average comparing to the first stage. Some of the urogenital and gynecological diseases showed a decrease in the number of legs but less than 1.6 legs on the average. Through the two stages the number of multiple choice legs were numerous in diabetes mellitus, schizophrenia, depression, bronchial asthma, myocardial infarction and acute leukemia in order of total number of legs. The tendency of questions in the national licensing examinations for nurses reflects rather well the importance of diseases at each time

N式実力反映型多肢選択試験の結果からみた看護学生の特徴 : YG性格検査を用いて

我々は確信度を加味し,学力をより反映するN式実力反映型多肢選択試験(以下N式と略す)を考案し,現在その有用性を検討している。147名の看護学生にN式とYG性格検査を実施した。その結果,慎重考慮群の学生に対しては,試験勉強をする際には学習に自信が持てるまで繰り返し同じ内容を学習するように指導するなど,彼らの性格傾向を考慮することの重要性が示唆された。また,自信過剰群の学生に対しては,自分の勉強方法が適切か否かを熟考させる方策が考えられた。We developed a new method for answering multiple-choice questions, named the N system, in order to assess the degree of confidence in answers. We analyzed the responses of 147 nursing students to the N system and Y-G character test. The results indicated that teachers should advise nursing students to pay careful attention to details and to emphasize the benefits of repetitive study in accordance with the student\u27s individual character. We also suggest teachers attempt to encourage overconfident students to give careful thought to their answers

学力を反映させた多肢選択試験の検討

我々は多肢選択試験のうち四肢択一方式のテストにおいて,自らの解答に対する確信度を考慮した方式を考案し,実施してきた。今回は1998・1999年度に実施したT短大の分について報告した。自信があるときは解答を一つだけ,迷うときは二つの解答を可能性の高いと思う方からA,Bと順位をつけて記入させた。そしてそれぞれに配点上の差を明示した。その結果,延べ922名,36,880問のうち,正答率は「自信あり」で66.2%,「迷うA」で40.7%,「迷うB」で28.1%であった。自信があって答えるほど正答率が高い結果が得られたので,個々の学生について,「自信あり」「迷う」の選択数と正答率を知ることによって,通常の四肢択一方式の解答よりも学生の学力をよく推測できることが分かった。「自信あり」を選択した数とその正答率から,(1)学力確実群,(2)自信過剰群,(3)慎重考慮群,(4)学力不足群,(5)中間境界群に分けると,学習上の指導に役立てることができる。We have originated a new method to decrease the rate of random guessing and to reflect the learning of examinees in multiple-choice questions (MCQ) of one or two out of four choices. According to the degree of confidence to answer to each question examinees can choose one answer if they have confidence enough to the answer (first rank) and they can select two answers (second and third rank) with grading by possibility of correct answer if they are less confident of the answer. Allocation of points in each question was three, two or one in order of the confidence. The examinees were 922 in total on fourteen examinations of pathophysiology and symptomatology during two years in T nursing college. Each examination consisted of forty MCQ. Then total questions were 36,880. The correct answers were 13,337 of 20,133 (66.2%) in first rank, 6,809 of 16,747 (40.7%) in second rank and 4,701 of 16,747 (28.1%) in third rank. The rate of correct answers was proportional to the degree of confidence to questions even though the percentage of correct answers was not so high. We can estimate learning of the students more precisely than ordinary method of answer in MCQ by our method. From the number of choice in enough confidence and the rate of correct answer the examinees were divided into five groups : 1) certain learning group, 2) modest thinking group, 3) overconfidence group, 4) insufficient learning group, 5) middle or boundary group. This classification may be useful to give instruction to each student

N式実力反映型多肢選択試験に対する受験者側の評価

我々は解答に対する確信度を加えた新しい解答方法(N式)を考案し,実施してきた。N式では受験者が解答に自信があるときは答えを一つ,自信がなく迷うときは正しいと思う方から順位をつけて二つの答えを記入させた。その際,正答の場合,配点に差をつけることを明記した。2004年2月の定期試験期間中にA短大看護学科の1年生85名,2年生77名に無記名で,N式についてのアンケート調査を行なった。回収率は100%であった。解答に迷ったとき二つの答えを選べることには91.3%が賛成であった。解答を-つにするか二つにするか決断しにくいのが46.9%,二つの答えを選ぶときの所要時間は短くて済むのが43.5%であった。N式は知識の確実性を自己評価する機会になると答えたのが64.6%であったのに対し,実力が反映される方式であると認めているのは,予測に反して37.0%であった。そのほか配点などについては基本的には現行の方法が支持された。We developed a new method for answering multiple-choice questions which we have named the \u27N system\u27, in order to evaluate the degree of confidence in answers. Namely, when examinees are confident in their answers, they are requested to select one answer, and when they are less confident, to select two answers, one they consider the most probable and another they consider less probable. Examinees are informed in advance that the allocation of marks for a correct answer differs according to the examinee\u27s degree of confidence. The survey by unsigned questionnaire was performed on 85 first-year students and 77 sophomore students during the final examination at A College in February 2004. The questionnaire sheets were immediately submitted by all students. Most students (91.3%) approved of the N system because they are able to select two answers when they are less confident in their answer. 46.9% remarked that they had difficulty in deciding whether to select a single answer or two. 43.5% reported that the consumption of time to select two answers was short. The opinion that N system provides a useful self-assessment of confidence on examinee\u27s knowledge was supported by 64.6% of students, while 37.0% of students thought that N system reflected the knowledge of each student and were supportive of its use as a method of evaluation. The allocation of marks was generally approved by examinees

痴呆性高齢者の問題行動と介護者の負担と支援 : よりよいQOLをめざして

わが国の人口の高齢化は急速に進み,2000年では全人口の6人に1人であった高齢者(65歳以上)が,2025年には3人に1人になると予測されている。それに伴い,痴呆性高齢者の数も確実に増加し,在宅で痴呆性高齢者を介護する家族も増加することが考えられる。今回著者らは,介護者だけでなく介護を受けている痴呆性高齢者に対しても家庭訪問による聞き取り調査を行い現状を把握した。調査の結果,痴呆性高齢者の問題行動は徘徊が最も多く,そのため介護者は自分の時間が持てないことが一番の悩みであった。しかし訪問したうち多くの家庭では,それぞれ介護負担はあるが,介護サービスを利用して介護状況は安定していた。保健師は専門職として介入する役割が求められていることが明らかになった。As the population of Japan increases, the population of aged people (more than 65 years of age) increases, from one in six in 2000 to probably one in three in 2025. As a result, it is assumed that the number of family who take care of aged demented people at home also increases. We thus made a survey on care-givers and demented people by visiting their homes and found their present situation. The most serious problem the families suffered from was that care-givers are not able to have their own time due to the roam of the demented. Nevertheless, as far as we have visited, the present condition of the care-givers in the family who take care of demented seems stable by using nursing services. In conclusion, public health nurses are expected to play an important role in supporting not only aged demented people but also care-givers in the family

2校間の比較によるN式確信度反映型多肢選択試験の検討

我々は4肢択一式多肢選択試験において,解答に対する確信度を知るための新しい解答方式(N式)を考案した。すなわち,受験者が解答に自信があるときは1つ,自信がなくて迷うときは可能性の高い方から2つの答えを選択させた。その場合,正答に対する配点は自信があって正答するほど高くなることを明記しておいた。看護系の2短大(グループI,グループIIとする)において,同一教員が担当した専門基礎科目(医学関連科目)の試験でこの方法を実施した。対象者はグループIでは延べ924名,グループIIでは延べ1,192名であった。確信度に応じた解答の分布を両グループにおいて比較し,本方式の有用性を検討した。その結果は次の通りであった。1)両グループの地域および実施時期は異なっていたが,自信の有無に関しての解答傾向およびそれらの正答率は類似していた。このことから本方式が両グループにおいて同じように理解されており,様々なグループで実施,比較ができ,有用であることが示唆された。2)自信をもって解答した問題数とその正答率によって5群に分類すると,両グループの学生の解答傾向を知ることができた。In the present research we have developed a new method of answering questions (N method), which enables examiners to estimate the degree of examinees\u27 confidence in giving correct answers, in multiple-choice tests of choosing one of four options in principle. Examinees are requested to select just one answer only if confident enough. When they are not so confident they are allowed to select two answers considered to be the most and the second most likely. Examinees are informed in advance that different marks are to be given for a correct answer according to the degree of confidence. This method has been implemented in two nursing colleges (Groups I and II), during the tests in fundamental health science (medical) subjects administered by the same teacher. The total numbers of examinees are 924 and 1,192 respectively. We compared the two groups in terms of the distribution of answers and the degree of confidence in order to investigate the usefulness of this method. The results are as follows:1) Performances of both groups are rather similar in terms of the degree of confidence and the rate of giving correct answers, though the two colleges are located in different regions and the tests were implemented at different times. This suggests that the two groups\u27 comprehension of the method is almost the same and that the method may be useful enough because it can be applied to various groups and the results can be compared. 2) By dividing examinees into five groups based on the number of answers given with confidence and the rate of their correctness, answering patterns of students will show

地域における子育てサロンの有効性 : 参加者と運営者へのアンケート調査を通して

少子化,核家族化,地域連帯感の希薄化などの社会環境が,育児中の母子に与える影響は大きい。M市においても育児に自信がもてない母親からの相談が多く,その解決方法の一つとして地域内交流に重点をおき,民生委員児童委員が中心となって子育てサロンを立ち上げた。今回,私たちは子育てサロンに参加している母親と運営している民生委員児童委員およびボランティア(以下運営者とする)に対し,アンケート調査を行った。アンケート結果から母親は子育てをサポートしてくれる仲間が地域にいると感じることで,地域への関心が高まっていると考えられた。一方,運営者は子育て中の母親に対するイメージが,子育てサロンの運営に携わる前に比べて良くなっていると考えていた。これらは,地域内交流につながるものであり,子育てサロンはその役割を果たしていると考えられる。Recent changes of social circumstances, such as decrease in the number of children and family members and lessening of a sense of community have remarkably influenced mothers in bringing up their children. In M city, the Civil Service Section has been frequently consulted by low-confidence mothers regarding the proper care of children. To solve such problems, community child-care salons have been held informally at several areas in the city since 2002 by administrators, social workers and volunteers. One of the important purposes of this activity is to focus on the development of human relationships within the community through taking care of children. We have examined opinions about this activity by means of questionnaire to the mothers and administrators. The results are as follows. The mothers may take more interest in community affairs because of the support received from participants in the child-care salon, while administrators would gain a better understanding of these mothers than they had previously. It is expected that the community child-care salon will play an important role in the improvement in human relationships within the community

双生児を育てる母親の生活実態の検討

本研究では,双生児を出産してから現在に至るまでの母親の生活の実態を明らかにし,双生児を育てる母親の育児支援に対するニーズを明らかにすべく,双生児を育てる母親38組にアンケート調査を実施した。その結果は,(1)双生児の育児は日常生活で身体的な面での負担も大きい一方,ストレスにより,精神的な面に関しても負担が重なっていく,(2)育児情報が氾濫しているにも関わらず,双生児の子育てに関する情報・支援は少ない,(3)双生児の母親は夫以外に父母の援助も受けられ,睡眠に関する問題点は少ない,(4)友達づくりで得られた友達は育児に影響を与え,その役割は大きい,(5)日常生活上,多くの家庭において,双生児の育児に対する経済的な負担が大きい,であった。In order to reveal the actual conditions of mothers after giving birth to twins and find what support in rearing twins they need, we conducted a questionnaire survey on 38 mothers who are raising twins. This survey shows the following facts. 1. In addition to the considerable physical burden, raising twins imposes a stress-related mental burden on them. 2. Despite an abundance of information about child-rearing, little information and support as to raising twins is given. 3. In addition to assistance from husbands, their parents\u27 often provide assistance in rearing children. 4. They tend to experience difficulty in sleeping. 5. Their friends often have an influence on their raising children and play a large part in it. 6. Raising twins puts a great strain on family finances in many families

National trends in the outcomes of subarachnoid haemorrhage and the prognostic influence of stroke centre capability in Japan: retrospective cohort study

Objectives To examine the national, 6-year trends in in-hospital clinical outcomes of patients with subarachnoid haemorrhage (SAH) who underwent clipping or coiling and the prognostic influence of temporal trends in the Comprehensive Stroke Center (CSC) capabilities on patient outcomes in Japan.Design Retrospective study.Setting Six hundred and thirty-one primary care institutions in Japan.Participants Forty-five thousand and eleven patients with SAH who were urgently hospitalised, identified using the J-ASPECT Diagnosis Procedure Combination database.Primary and secondary outcome measures Annual number of patients with SAH who remained untreated, or who received clipping or coiling, in-hospital mortality and poor functional outcomes (modified Rankin Scale: 3–6) at discharge. Each CSC was assessed using a validated scoring system (CSC score: 1–25 points).Results In the overall cohort, in-hospital mortality decreased (year for trend, OR (95% CI): 0.97 (0.96 to 0.99)), while the proportion of poor functional outcomes remained unchanged (1.00 (0.98 to 1.02)). The proportion of patients who underwent clipping gradually decreased from 46.6% to 38.5%, while that of those who received coiling and those left untreated gradually increased from 16.9% to 22.6% and 35.4% to 38%, respectively. In-hospital mortality of coiled (0.94 (0.89 to 0.98)) and untreated (0.93 (0.90 to 0.96)) patients decreased, whereas that of clipped patients remained stable. CSC score improvement was associated with increased use of coiling (per 1-point increase, 1.14 (1.08 to 1.20)) but not with short-term patient outcomes regardless of treatment modality.Conclusions The 6-year trends indicated lower in-hospital mortality for patients with SAH (attributable to better outcomes), increased use of coiling and multidisciplinary care for untreated patients. Further increasing CSC capabilities may improve overall outcomes, mainly by increasing the use of coiling. Additional studies are necessary to determine the effect of confounders such as aneurysm complexity on outcomes of clipped patients in the modern endovascular era