片麻痺擬似体験後の看護学生のイメージの変化

看護学生の片麻痺疑似体験前後の片麻痺患者に対するイメージの変化を明らかにするため，学生が記載したレポートについて質的に内容分析を行い，比較した．対象は３年次看護学生のうち研究協力が得られた６５名であった．片麻痺擬似体験は，片麻痺患者を約２０分間体験した．片麻痺の設定は利き手側の上下肢とし，片麻痺患者役は日常生活動作を実施した． その結果，擬似体験後の片麻痺患者に対するイメージの記述数は増加し，イメージの内容がより具体的となった．体験後は「片麻痺患者は想像しにくい」の記述がなくなり，カテゴリーとして抽出されなかった．カテゴリーやサブカテゴリーは，体験前の否定的なイメージから，麻痺があっても可能なことはあるなど肯定的なイメージが増えた．また，学生は片麻痺患者の体験するストレスを実感することで，心理面に対する共感的イメージをもつことにつながった．さらに，擬似体験は，机上の学習では気づくことができない患者を想像する貴重な機会となっていた．In order to show the changes in the image that nursing students have regarding hemiplegic patients before and after simulated experiences of hemiplegia, a content analysis of the reports made by the students was qualitatively conducted, and comparisons were performed. The subjects were６５students in Junior year, all participants signed an informed consent. During the implementation of the simulated hemiplegic experiences, the students experienced becoming hemiplegic patients for approximately ２０ minutes. Hemiplegia was set for the upper and lower limbs on the side of the dominant hand, and students who took the part of hemiplegic patients experienced various activities associated with daily living. As a result, the number of descriptions of their image of hemiplegic patients after the simulated experiences increased, and the descriptions of such images were also more specific. After the experience, as their response “it is not easy to imagine what it is like for hemiplegic patients” was no longer observed, and thus it was not included as a category. The details of the image of the categories and the subcategories showed a more positive image, such as things that they can do in spite of their paralysis, compared to negative details before the experience. In addition, the students felt the stress that hemiplegic patients have, which resulted in them having a more empathetic image regarding psychological aspects. Furthermore, the simulated experiences provided a good opportunity todevelop an image of the patients, which cannot be obtained from reading books or articles

THE UTILIZATION OF THE DIOHAT©

Aim：To evaluate the utilization of the Diabetes Oral Health Assessment Tool （DiOHAT©） for Nurses by Diabetes Nurse Specialists（DNSs）in the clinical settings. Methods ： A survey was done using self-administered questionnaire distributed to １３８ DNSs who signified continuing collaboration during the authors’ previous study. The DNSs answered the questionnaire after utilization of the DiOHAT© in the clinical settings. Results ： Forty-seven DNSs responded（３４．１％）. The data revealed that items on cooperation with dental professionals（e.g., “regular dental visits” （８８％）, etc.）were frequently utilized, but those about oral function and self-care（e.g.,“checking one’s mouth with a mirror” （４０％）and “use of supplementary tools” （４４％）, etc.）were rarely utilized. However, over ６０％ of DNSs evaluated the DiOHAT© utilization version on the “nursing-process” and “collecting-information” as “possible” or “possible if revised”. Non-utilization of the DiOHAT© were due to insufficient time, and insufficient knowledge and skill. Conclusion ： The results of the study revealed the need for DNSs to increase their knowledge and skill about the content and use of the DiOHAT© e.g. oral function, and self-care, and to examine the coordination and division of roles between DNSs and dental specialists to support the oral health care of patients with diabetes

Assessing the oral health

Aims : To compare assessment of the oral health conditions and behaviors of in-patients with diabetes using a clinical version of the Diabetes Oral Health Assessment Tool (C-DiOHAT©) with dental examinations. Methods : A cross-sectional design was used. A nurse assessed 60 in-patients using the C-DiOHAT© (a formatted questionnaire to assess four factors of patients’ oral health conditions and behaviors : oral health conditions, oral hygiene behaviors, sharing health information among patients and dental/medical professionals, and perception and knowledge of oral health) while a dentist examined their oral health conditions. Results : “Use of supplementary tools (e.g., interdental brush, dental floss)” in the item of C-DiOHAT© was significantly associated with dental examination of “the number of present teeth” and “no recommendation of further dental visit”. “Symptoms of gingival swelling” in the item of C-DiOHAT© was also significantly associated with “recommendation of dental visit”. “Knowledge of a relationship between periodontal disease and systemic disease including diabetes” was significantly associated with Community Periodontal Index. Conclusions : These results suggest that nurses should prioritize these assessment items to most quickly acquire useful information about patients’ oral health. It is important to encourage nurses to be interested in patients’ oral health by such small pile of clue

Diabetes Oral Nursing Intervention

Purpose : This study aimed to evaluate the effectiveness of a diabetes oral nursing intervention program for individuals with diabetes. Methods : Fifty-six participants with diabetes underwent a diabetes oral nursing intervention program. The program’s effect was evaluated through questionnaires and small interviews. The modified diabetes oral health assessment tool (M-DiOHAT©) was used to assess and educate four factors ; oral conditions, behaviors, perceptions and knowledge about diabetes and periodontal disease, and health information-sharing, among participants at baseline, 3, 6, and 12 months later. Primary outcomes included changes in the M-DiOHAT© total scores. Secondary outcomes included scores on the motivation stage of changes in oral health behaviors’ scales, dental visits, number of present teeth, hemoglobin A1c (HbA1c), and participants’ comments. Results : The M-DiOHAT© total score and the motivation stage score significantly improved with the narrative comment of “being motivated to practice oral health behaviors” between the baseline and 12 months later. Eight participants visited the dentist, whereas no differences were observed in the number of present teeth or HbA1c. Conclusions : This program improved participants’ M-DiOHAT© total score, motivation stage score, and dental visits. These results suggest the program improved oral health perceptions and behaviors among individuals with diabetes

Self-evaluation study of nursing students’ recognition of their degree of achievement of educational goals in clinical practice

臨地実習指導における教育的な介入への示唆を得ることを目的に，３年課程短期大学３年次学生を対象に，臨地実習開始前・中期・終了後に，国立大学医療技術短期大学部看護学科協議会臨地実習委員会A グループが作成した「臨地実習固有の学習内容」を用いて，学生の臨地実習固有の学習内容に対する到達度の認識に対する調査を行った．その結果，以下の結果が得られた． ①自己評価得点は，実習開始前と比べて終了時に自己評価が有意に上昇したもの（以下上昇群）と，上昇しなかったもの（非上昇群）の２群に大きく分類できた． ②上昇群のうち，段階的に評価が上昇した項目は７項目であった． ③学生は，認知領域は高く自己評価し，学習内容に到達したと認識していた． ④学生は１４項目は終了時に至っても，到達レベルに達していないと自己評価しており，それらの項目は，コミュニケーションや看護過程，理論との照合など看護を深める取り組みに関する内容であった． 以上のことから，教育的な介入として，学生がコミュニケーション技術を有効に用いながら，看護過程を展開し，看護実践を深めることができるように，カンファレンスを有効に活用し，場面を捉えて，学生の学習状況にあわせて，丁寧に指導を行うことが必要であると考えられた．学年進行に伴う到達レベルの詳細な明示など，学生の成長を長期的な視点に立って支援することの必要性が示唆された．Objectives : The purpose of this study was to : assess the nursing students’ recognition of their achievement of their educational goals in clinical practice ; and discuss the clinical teaching interventions of nursing education by means of self-evaluation for the students at a 3-year nursing junior college. Methods : We used the self-evaluation questionnaire (62 questions). Self-evaluation was performed three times : the first was before clinical practice (hereinafter first evaluation), at the middle point of clinical practice (middle evaluation) and after the clinical practice (final evaluation). Results : １．There ware 2 patterns in self-evaluation scores. One was rise, and the other was not rise by comparison between first evaluation and final evaluation. ２．Only 7 scores were improved among 62 questions. They were classified cognitive domain, and they were recognized by the nursing students to be achieved of their educational goals. ３．In the final evaluation there were 14 items for which they had not achieved their educational goals. They were the following items : comparing their clinical practice experience with nursing theory, performing clinical practice while thinking about the nature of nursing and using communication skills, and the process of nursing diagnosis. Conclusions : Nursing students need educational intervention. That is, they need teachers to teach them, or to think with them, how to use the nursing process to overcome patients’ problems in each clinical situation by means of communication skills. It is also important to make effective use of conferences at school to so that student’s can shore experiences

Study on the difference in observation points between students before and after experiencing related nursing practice : on the observations of vital signs and oxygen inhalation by use of an acute stage dummy

本研究は術後急性期の状況を設定したモデル人形を用い，実習開始前と実習終了後の学生が行なった術後患者に対する観察のちがいを分析し，今後の実習指導に生かすことを目的に行った． 対象は成人看護実習（急性期患者の看護）の実習開始前の学生７２名と実習終了後の学生４５名であった． 方法は実習室でモデル人形を用いて，１０分間学生に自由に観察させた．この時の観察用紙に記入された記入項目を分析対象とした．分析方法は「ドレーン・チューブについて」「輸液について」「バイタルサインについて」を自由に記載してもらい，筆者らが『観察できた』『誤認』『記入なし』の３つに分類した． その結果，「モニター上に表示：心拍数」は実習終了後の学生の方が観察できていなかった．「酸素流量」は，『誤認』がどちらの学生も他の項目より多く，酸素流量計の見方を正確に把握していないことがわかった．「モニター上に表示：深部体温」，「酸素濃度」に関してはどちらの学生も『記入なし』であった．今後は学生の術後患者に対する観察能力が，より向上するように指導を行なっていく必要性が示唆された．そのためには急性期モデル人形を活用することで観察の機会を多くして練習を重ねるとともに，演習時および実習時において観察が的確になされているかを教員が確認する必要が示唆された．The difference in observation points for postoperative patients between two groups of nursing students was analyzed in terms of the students’ experience of related training for the purpose of improving the training tutorial. The object was 72 students before starting adult nursing training (nursing of the acute stage patient) and 45 students after the training termination. The students were allowed to observe an acute stage dummy for 10 minutes and to write down the observation results of the ‘drains and tubes’, ‘fluid therapy’, and ‘vital signs’. The descriptions about these three items were analyzed by classifying them into ‘correct’, ‘mistaken’, and ‘no description’. The main results are as follows. The percentage of nursing students who correctly reported the ‘heart rate on the monitor’ was lower in the group after training termination comparing to the other group. As for the ‘oxygen flow rate’, many mistakes were found in the both groups, indicating the technical problem on the monitoring of the oxygen flow meter. In the both groups, no student described ‘core temperature on the monitor’ and ‘oxygen concentration’. These results suggest the necessity of developing tutorial method to improve the students’ observation ability for postoperative patients. The use of an acute stage dummy would be helpful for the practice of observations. It is also necessary for the teachers to check the observation behaviors of students during the exercises and practices in order to make the observations correct

The learning in the practices of the students who care the disturbance of consciousness patients from the analysis of their process

意識障害患者を学生に受け持たせ，看護過程の展開の実習を行った．実習終了後の学生の学びを内容分析した結果，看護基礎教育で必須に学ばなければならない清潔などの基本的技術項目や合併症の予防や，意識障害患者に必要な観察や回復支援方法やその大切さを学んでいた．さらに，モデリングとしての看護師の実施するケアの気づきや，学習後の充実感や達成感，患者が回復する事の喜びなどがあった．また，コミュニケーションや状態把握の難しさも学びとして表現していた．このように，意識障害患者を受け持つことで，多くの学習内容を学べることが明らかとなった．We make my students care the disturbance of consciousness patients. This study examines their practice developments by watching their process and analyzing their reports. They learned the followings : （１）The basic technical items（ex. the importance of the cleaning）and the prevention of the complication. （２）How to observe and support the disturbance of consciousness patient. （３）The existence of the nurses as modeling. （４）the emotional reactions such as the fulfillment, the accomplishment and the pleasure after caring and learning. （５）The difficulty to communicate with the patients and to grasp the situations. This result shows how necessary the students care the disturbance of consciousness patients because they learn many points

Analysis of cases applying shiatsu massage for nursing care

東洋医学の１つの手法である指圧を看護ケアに取り入れた論文の検討を行ない，その効果と問題点を明らかにすることを目的に，『医学中央雑誌』（WEB版ver．３）を使用して１９９３年から２００３年まで１０年間に，看護師による指圧の影響が明らかにできた論文を抽出した．その結果１０論文が得られた．１０論文の内訳は排便障害（便秘）の軽減および排ガスの促進５件，癌化学療法実施時の副作用（嘔気・嘔吐等）の軽減３件，癌性疼痛の軽減１件，リンパ節郭清後に発生した浮腫の軽減１件であった．それぞれの論文に共通して言えることは，患者が指圧について肯定的に捉える場合は，その効果が非常に大きいことであった．さらに指圧の圧迫部位，圧迫の強さ，頻度など，まだ一定の手技と効果が得られていないため，追試験を重ねる必要性が示唆された．Shiatsu massage is one of the common therapeutic methods in oriental medicine, and is considered to be useful for supporting conventional medicine. However, there has been little evidence for its effects. In this report, papers dealing with the application of shiatsu massage to nursing care are extracted from literature, in order to clarify the effects and problems of this method as a nursing care. Papers containing studies of shiatsu massage by nurses as a nursing care were extracted from literature by using the Japan Centra Revuo Medicina (WEB issue, version 3), and those published during 10 years from 1993 to 2003 were analyzed. It was found that the relaxation effects by shiatsu massage were reported for various symptoms. Among these, 10 papers were analyzed in detail, which described the effects on relief of the following symptoms ; dysphasia (constipation) (5 papers), nausea and vomiting at cancer chemotherapy (3 papers), pain from cancer (1 paper), and edema generated after lymphadenectomy (1 paper). It was found from these papers that shiatsu massage is effective for patients who have positive thinking to this therapy. On the other hand, the necessity of further experiments was indicated because of the lack of common methods and effects in this therapy ; for example, position, force, frequency, etc., should be optimized

臨地実習で糖尿病患者を受け持った学生の学び

学士課程３年次での成人看護学実習で，糖尿病患者を受け持った看護学生（以下，学生）３４名の学びの内容について検討することを目的に，学生の記述したレポート内容を質的帰納的に分析した．その結果，４カテゴリー（「療養行動が主体的に実践できるための具体的な支援方法」「学生が感じた困難感や達成感」「療養生活支援のために必要な看護技術」「療養生活を送る対象の理解」）と１７サブカテゴリーが抽出された．学生は糖尿病患者を理解し，療養生活行動が主体的に行えるための支援方法を考えていた．そして，患者の行動変容を目指した介入の難しさを実感しながら，患者が主体的に療養行動を実践できるように支援することの大切さについて考え，学生としての立場での看護実践の喜びを感じていた．今後は，学生の学びについて，個々の事例ごとの確認を丁寧に行いながら，学びの内容を卒業時の到達目標と照らし合わせて確認する方法を考案することの必要性が示唆された．Purpose : To clarify what nursing students（hereafter referred to as students）learned during their clinical practice experiences with individuals with diabetes mellitus. Methods : Subjects were 34 nursing students enrolled in a bachelor program. Following clinical practice in adult nursing, data were obtained from students’ written reports on what they learned during nursing interventions for individuals with diabetes mellitus. Data were analyzed inductively. Results : Four categories and 17 sub-categories were extracted. The 4 categories were : “concrete nursing interventions for helping individuals with diabetes mellitus carry out their daily regimen”, “students’ feelings of difficulty and satisfied after the clinical practices”, “the necessity of nursing arts for facilitating a daily regimen”, and “knowledge about individuals with diabetes mellitus.” Conclusions : Through nursing practices, the students learned about individuals with diabetes mellitus and nursing interventions for individuals with diabetes mellitus. These findings suggest that teachers should carefully confirm what students learned in terms of both quality and quantity. Such confirmation ensures that students learn nursing interventions that are suitable for individuals with diabetes mellitus, and how to practically apply such nursing interventions. These findings will contribute to the improvement of nursing practices and education

糖尿病患者に対する看護介入の効果と評価 : 文献検討

医学中央雑誌Web版（Ver．３）を用いて，１９９４年から２００４年の過去１０年間に，糖尿病を有する人を対象に，看護師が行った教育や指導などの看護介入行為のうち，その効果が患者の持つ問題の解決に有効であると報告されている研究論文の分析を行い，以下の結果が得られた． １．対象となった論文は１６編あった． ２．介入内容は食に関連するものが１１編あった．看護師は，患者の持つ問題の明確化，その具体的な対応，到達目標の設定に対して，患者が主体的に取り組むことができるように，患者の情緒面も含めて援助していた． ３．介入内容の評価を看護師が行っていたものは１３編あった．評価項目は糖尿病の血糖コントロール指標としてのHbA１cがすべての文献で用いられていた． 以上のことより，今後は，患者の自己管理を支援するために，患者が一貫して主体的に取り組めるような介入方法を開発することが必要である．また，介入結果の評価においては，血糖コントロール指標に加えて，患者の行動や心理の変化を適切に評価できる評価方法や評価指標を開発する必要があると考えられた．Objective : The purpose of this study was to review published studies focusing on nursing interventions, which were effective in solving problems for persons with diabetes mellitus（hereinafter persons） in Japan. Method : We used the Ichushi-Web（Ver．３）to search from １９９４ through to ２００４. Results : １．We finally selected １６ primary studies. ２．Eight nursing interventions were related to diet and eating. Nurses supported that persons independently decide their own clinical goals, persons understood what were their problems and what they should do. Nursing involved emotional supports in this situation. ３．Thirteen evaluations were conducted by nurses, and all of evaluations used HbA１c as their control indexes for diabetes mellitus. Conclusion : To be able to support self controlled persons we have to develop ways to intervene, so persons can decide their clinical goals. Allowing them to learn to face their problems independently. It is necessary to evaluate not only HbA１c as diabetes control but also the changes of persons' activities and emotions in order to assess the effects of interventions suitably