看護基礎教育に求められる政策コンピテンシー ―「学士課程教育における公共政策学分野の参照基準」との比較から―

【要旨】超高齢社会に対応するための制度改革が頻回に行われ，制度設計にアドボケーターとして看護職の関わりが求められていることから，看護基礎教育において政策の基本を体系的に学ぶことが必要と考え，政策教育プログラム開発に関する研究を行った。 1 年目の研究では看護に関連した政策に現に取り組んでいる 政策企画者等を対象に面接調査を行い，政策教育において獲得すべきコンピテンシー77 項目を抽出し，これを日本公共政策学会の参照基準をもとに 8 つのカテゴリーに分類した。この結果を参照基準と比較すると，参照基準の「政策の働きに関する基本的理解」などの項目は少なかったが，「政策問題を主体的に考える力」の項目は非常に豊富であった。このことは対象者が政策の実践者であったことが影響しており，また，看護教育に対して政策決定に関する“知識”に力点を置くよりも，看護現場の課題を解決するための能力獲得に期待がされていることが明らかとなった。Abstract: With frequent revisions in the medical-care system in response to the aging society, nurses are required to be involved in system design as advocators. This suggests the necessity for nursing students to systematically learn the basics of policy studies in basic nursing education. Given this background, we conducted research into the development of a nursing education program related to policy studies. In the first year of the research, we conducted an interview survey with policy planners who worked on policies related to nursing. From the interview data, we extracted 77 items of competencies to be acquired through the education program, and classified the items into 8 categories based on the academic standards of the Public Policy Studies Association, Japan (PPSAJ). Comparing the results in this study with the items of the academic standards, there were fewer items related to the “Basic understanding of the functions of policy” than those in the standards, but there were many items related to the “Competencies to think independently about policy issues”. These results may be because the participants in the interviews were policy practitioners. The findings suggest that it is important for nursing education to place more emphasis on competencies needed to solve problems in nursing settings than on knowledge about policy making

Degenerative changes in the appendicular joints of ancient human populations from the Japan Islands

Degenerative changes in six major limb joints were investigated to compare their prevalence among five ancient skeletal populations from the Japan Islands. The populations assessed in this study consisted of the farmers in the northern Kyushu/Yamaguchi area and the foragers from the northwestern Kyushu area from the Yayoi period (5th century BC to 3rd century AD); the Okhotsk (5th to 12th centuries AD) foragers from Hokkaido and Sakhalin; the common people from medieval Kamakura (12th to 14th centuries AD) in Kanto, central Japan; and the early-modern farmers (17th to 19th centuries AD) from Kumejima, in the southernmost island chain (Ryukyu Islands). Crude prevalence comparisons showed that the shoulder and hip joints were principally affected in early-modern Kumejima and medieval Kamakura, which contrasted with the high prevalence of elbow and knee joint changes in the Okhotsk people. The heavy dependence on marine mammals and fish for dietary protein intake probably required flexion and extension movements of the most severely degenerated joints in the Okhotsk people. The northern Kyushu/Yamaguchi and northwestern Kyushu Yayoi peoples were more affected by degeneration in the wrist joints than others, possibly due to their use of innovative tools such as stone or shell knives and harpoons. A multivariate logistic regression analysis, adjusted for age, region, and sex as the predictor variables for degenerative changes in joints, was applied to only the two samples from Kumejima and Kamakura (including previously reported spine data) because of their better preservation. This revealed differences in the prevalence of changes in some joints; for example, age-related changes were recognized. The Kumejima people were more commonly affected by hip and knee joint changes, whereas the Kamakura people were more commonly affected by changes to apophyseal joints. Because a stable isotope analysis indicated that the trophic levels of the two populations were almost the same, the pattern of degenerative changes would have reflected differences in their specific workloads, such as wet rice cultivation using a peculiar hoe by the Kumejima people. This study, combining multivariate logistic regression analysis of degenerative joint changes and stable isotope analyses, uses large skeletal populations to add clarity to the actual rigors of ancient life. © 2015 Elsevier Ltd and INQUA

Effectiveness of a facilitation programme using a mobile application for initiating advance care planning discussions between patients with advanced cancer and healthcare providers: protocol for a randomised controlled trial (J-SUPPORT 2104)

Introduction Timely implementation of the discussion process of advance care planning (ACP) is recommended. The communication attitude of healthcare providers is critical in ACP facilitation; thus, improving their communication attitudes may reduce patient distress and unnecessary aggressive treatment while enhancing care satisfaction. Digital mobile devices are being developed for behavioural interventions owing to their low space and time restrictions and ease of information sharing. This study aims to evaluate the effectiveness of an intervention programme using an application intended to facilitate patient questioning behaviour on improving communication related to ACP between patients with advanced cancer and healthcare providers.Methods and analysis This study uses a parallel-group, evaluator-blind, randomised controlled trial design. We plan to recruit 264 adult patients with incurable advanced cancer at the National Cancer Centre in Tokyo, Japan. Intervention group participants use a mobile application ACP programme and undergo a 30 min interview with a trained intervention provider for discussions with the oncologist at the next patient visit, while control group participants continue their usual treatment. The primary outcome is the oncologist’s communication behaviour score assessed using audiorecordings of the consultation. Secondary outcomes include communication between patients and oncologists and the patients’ distress, quality of life, care goals and preferences, and medical care utilisation. We will use a full analysis set including the registered participant population who receive at least a part of the intervention.Ethics and dissemination The study protocol was reviewed and approved by the Scientific Advisory Board of the Japan Supportive, Palliative and Psychosocial Oncology Group (Registration No. 2104) and the Institutional Review Board of the National Cancer Centre Hospital (registration No. 2020-500). Written informed consent is obtained from the patients. The results of the trial will be published in peer-reviewed scientific journals and presented at scientific meetings.Trial registration numbers UMIN000045305, NCT05045040