看護学生が捉える自己の倫理実践能力の課題と対策

　本研究は、倫理実践能力に関して看護学生が捉える自己の課題と対策について明らかにしたものである。研究対象は、3年次領域別実習を修了し「看護倫理」を受講した看護系大学4年生であり、分析対象は、対象者が「看護倫理」受講後に記載した「看護の対象となる人のために、倫理的な行動ができるか自分自身を振り返り、自己の課題とその対策について考察する」のレポート記述内容である。　研究の同意が得られ、条件を満たした71名の対象者のレポートを倫理的行動の4つの要素である「倫理的感受性」「道徳的推論」「態度決定・表明」「実施」にそって分類した結果、学生が課題として挙げた能力は、多い順に「倫理的感受性」「態度決定・表明」「実施」「道徳的推論」であった。それぞれの課題に対する対策としては、「倫理的感受性」を高める対策には、【倫理的知識を身につける】【患者の思いを汲み取り受けとめる努力をする】【倫理的な視点で臨床に臨む】他6対策、「道徳的推論」の力をつけるための対策には、【倫理的問題を自分の言葉で説明できるようにする】【倫理的知識を身につける】他3対策、「態度決定・表明」の力をつけるための対策には、【他者に相談し支援を得る】【患者のために行動する勇気を身につける】【倫理的知識を身につける】【自分の価値観を分析し修正する】他5対策、「実施」の力をつけるための対策には、【倫理的知識を身につける】【患者を第一に考え意思を尊重する】【看護師としての力量をあげる】【他者に相談し支援を得る】他3対策であった。　この4つに共通してみられた対策は、【倫理的知識を身につける】【倫理的問題を自分の言葉で説明できるようにする】【他者に相談し支援を得る】であった

Anticipatory postural adjustments in children with hemiplegia and diplegia

Anticipatory postural adjustments (APAs) play an important role in the performance of many activities requiring the maintenance of standing posture. However, little is known about how or if children with cerebral palsy (CP) generate APAs. Two groups of children with CP (hemiplegia and diplegia) and a group of children with typical motor development performed arm flexion and extension movements while standing on a force platform. Electromyographic activity of six trunk and leg muscles and displacement of center of pressure (COP) were recorded. Children with CP were able to generate anticipatory postural adjustments, produce directionally specific APAs and COP displacements similar to those described in adults and typically developing children. However, children with diplegia were unable to generate APAs of the same magnitude as children with typical development and hemiplegia and had higher baseline muscle activity prior to movement. In children with diplegia, COP was posteriorly displaced and peak acceleration was smaller during bilateral extension compared to children with hemiplegia. The outcomes of the study highlight the role of APAs in control of posture of children with CP and point out the similarities and differences in anticipatory control in children with diplegia and hemiplegia. These differences may foster ideas for treatment strategies to enhance APAs in children with CP

Early and unintentional release of planned motor actions during motor cortical preparation.

Voluntary movements are often preceded by a movement-related potential beginning as much as two seconds prior to the onset of movement. In light of evidence that motor actions can be prepared and initiated in less than 200 ms, the function of this early activity has remained enigmatic. We hypothesized that the movement-related potential reflects the state of preparation of the planned movement. This was tested by delivering a startling acoustic stimulus during the preparation phase of a load-release task. The cue to release the load was presented either 3.5 seconds after a warning cue (PREDICT condition) or randomly between 4-12 seconds (REACT condition). Electroencephalographic, electromyographic and limb and load kinematic signals were recorded. In a subset of trials, a startle stimulus was delivered at -1500, -1000, -500, -250, -100 or 0 ms before the release cue. A contingent-negative variation (CNV) waveform, with a late phase of slow-rising negativity beginning an average of 1459 ms prior to movement, was observed for the PREDICT condition but not the REACT condition. For both conditions, the startle stimulus frequently evoked the early and unintentional release of the load-release sequence. The incidence of release was significantly (p<0.001) correlated with the late phase of the CNV for the PREDICT condition but not the REACT condition. For the REACT condition, the incidence of movement release was subject-specific, constant across the preparation interval, and uncorrelated with cortical activity. The onset of movement release by the startle stimulus was significantly shorter (p<0.001) for the PREDICT compared to the REACT condition. These findings provide evidence that the late phase of the CNV reflects cortical activity mediating the progressive preparation and storage of the forthcoming movement and that during this phase an intense sensory stimulus can evoke early and unintentional release of the planned action

Movement-related oscillations were affected by the predictability of the imperative release cue.

<p>The upper plots show the grand average time-frequency spectrograms at the C3 electrode overlying the contralateral sensorimotor region for the PREDICT (A) and REACT (B) conditions. Magnitudes have been normalized to the power over the pre-warning cue interval (−5 to −4.25 s). Note the marked suppression of oscillations in the alpha band (8–12 Hz) immediately following the warning cue and in the beta-band (15–30 Hz) during the 1500 ms time period immediately preceding the onset of wrist extensor (EDC) muscle activity (0 ms) for the PREDICT task. In contrast, the suppression of MRCOs occurred immediately prior to EMG onset for the REACT task and was confined to the beta-band. Plots C and D show the results of the statistical analysis of the normalized time-frequency spectrograms at the C3 electrode for the PREDICT (C) and REACT (D) conditions. Significant (p<0.05) increases (red) and decreases (blue) in MRCOs relative to baseline activity are shown.</p

Summary of the stimulus timing conditions and muscle activation patterns.

<p>A load release task was tested using two cueing conditions: PREDICT and REACT. A. Summary of the timing of the cues and presentation of the startle stimuli. For the PREDICT condition, subjects were presented with a warning tone 3500 ms prior to an imperative cue release tone. Subjects were trained to release the load within 1 simple reaction time in 50% of trials. For the REACT condition, there was no warning cue and the release tone was presented randomly between 4–12 s. For both conditions, a 40 ms, 124 dB startling acoustic stimulus (SAS) was presented in 22% of all trials at 7 time points over the preparation interval. B. Average rectified EMG data from a single subject showing responses in the biceps brachii (BB) and extensor digitorum communis (EDC) muscles during the PREDICT and REACT conditions. EMG responses were time-locked to the onset of activity in the EDC muscle (0 ms).</p

Movement-related potentials (MRPs) were affected by the predictability of the imperative release cue.

<p>A. Grand average movement-related potentials derived from control trials at each of the nine EEG electrodes for both the PREDICT (black) and REACT (red) conditions. The cartoon to the right shows the locations of the electrodes on the scalp. B. Average integrated EEG calculated over 100 ms time bins at 8 time points centered on −4500, −2500, −1500, −1000, −500, −250, −100, 0 ms. Differences between conditions were significant (p<0.007) at all time points except at baseline (−4500 ms). C. Average slope of the movement-related potentials over three time intervals. The slopes were significantly different between conditions during movement preparation but not baseline (PRE) (p<0.007).</p

Summary of the effects of a startling acoustic stimulus (SAS) on the timing of movement release.

<p>Reaction times relative to the onset of the SAS were sorted into 20 ms bins. The histograms show the percentage of trials within each reaction time bin for both the PREDICT (open rectangles) and REACT (filled rectangles) tasks. The vertical black arrows show the timing of the imperative release tone. The vertical dashed line is drawn at reaction time of 100 ms. The percentage of trials with reaction times less than 100 ms is shown to the right of the histogram distributions. Note that fast reaction times were common for the PREDICT condition when the SAS was presented 250 ms or less before the imperative cue.</p