精神科看護師の自己教育力と看護実践および学習ニードの関連

　本研究の目的は，精神科看護師の自己教育力と看護実践および学習ニードの関連，それらに影響する要因を明らかにすることで，主体的に取り組める精神科看護継続教育プログラム作成の資料とすることである．Ａ県の精神科単科の8 病院に勤務する看護師450 名を対象に，自記式質問紙調査を実施した．質問紙の内容は梶田が作成し西村が追加した自己教育力40 項目，日本精神科看護技術協会の看護技術チェックリストをもとに作成した学習ニードと同項目の看護実践40 項目，影響要因としての看護師の背景等である．回収率95.3％であった．自己教育力を数量化した平均点は高い方から側面Ⅰ「成長・発達への志向」，側面Ⅱ「自己の対象化と統制」，側面Ⅲ「学習の技能と基盤」，側面Ⅳ「自信・プライド・安定性」の順で，一般看護師を対象としたデータと同様であった．自己教育力と看護実践の関連は，側面Ⅲの項目に多かった．自己教育力総得点に対しても側面Ⅲは最も高い相関を示し，精神科看護師の自己教育力を高め看護実践を向上させるためには「学習の技能と基盤」を高めることが必要といえる．特に疑問を文献検索や研究的視点で検討し，文章にまとめるなどの学習技能の支援が必要である．自己教育力と学習ニードの関連は側面Ⅰに多く，「成長・発展への志向」の高い看護師は学習ニードも高い．自己教育力と看護師の背景では性別，尊敬する看護師の有無，継続意志，年齢の数項目に関連があった．年齢では年齢が上がるとともに肯定的回答が少なかった．中堅看護師の自己教育力を高める対策が必要である．自己教育力と学生指導経験，研修会参加，研究発表経験との関連はなく，自己教育力を高め主体的参加に導く体制が必要といえる．The purpose of this research was to elucidate the relationships between the self-education ability of psychiatric nurses and their nursing practice and learning needs, as well as related factor. A self-report questionnaire survey was conducted on 450 nurses working at eight psychiatric hospitals in Prefecture A. Questionnaire items included 40 items on self-education ability by Nishimura, 40 items on learning needs and nursing practice based on the nursing technique checklist developed by the Japanese Psychiatric Nurses Association, and the background of nurses. The response rate was 95.3%. Mean scores for self-education ability was the order of Aspect I“ orientation toward growth and development”, Aspect Ⅱ“objectivization and control of self”, Aspect Ⅲ “learning skills and　foundation”, and Aspect Ⅳ “confidence, pride, and stability”. These results were similar to data obtained for general nurses. A relationship between self-education ability and nursing practice was seen for many items in Aspect Ⅲ. Enhancement of the “learning skills and foundation” can therefore be considered essential for improving the nursing practice of psychiatric nurses. A relationship between self-education ability and learning needs was observed for many items in Aspect I, indicating that nurses with a strong “orientation toward growth and development” have more learning needs. Support for learning skills for investigating questions from a research perspective and through literature searches as well as writing skills is particularly important. The number of positive responses decreased as age increased, indicating the need for measures for enhancing the self-education ability of expert nurses. Self-education ability was not related to experience in student guidance, participation in workshops, or experience in research presentation, and a system for improving self-education ability and promoting independent participation was considered necessary in the future

妊娠・産褥期における描画によるリラクセーション効果の検討 － POMS・筋硬度・口頭データを用いた心理・生理的評価－

　本研究の目的は，生理的指標と心理的指標を用いて，妊娠・産褥期における描画によるリラクセーション効果を検討することである．妊婦および褥婦5名を対象に，パステルによる描画前後に, POMS (Profile of Mood States) および肩部の筋硬度の測定を実施し，描画後に感想を求めた．描画前後のPOMSの6尺度の各得点および筋硬度比較を行った．また，描画した内容についてのテーマ毎の説明・感想，および全テーマの描画終了後の感想を記録し，質的に分析を実施した．描画前後のPOMSは，全員が緊張- 不安などのネガティブな気分の5尺度（T-A･D･A-H･F･C）の得点が下がり，活気得点（V）は上昇した．筋硬度は描画途中で授乳をした褥婦1名を除き描画後に低下した．テーマ毎の描画内容に関する説明・感想として，「自分」のテーマでは，「風に色がついている感じ」で「やわらかく柔軟になりたい」，「ピンクとかオレンジ」よりも「緑が欲しい」気分などが聞かれた．描画後の感想では，「力が抜ける」，「リラックスできる」，「あったかい」，「発汗」などがあった．今回の調査対象者は，描画後に，生理的指標である筋硬度及び心理的指標であるPOMSの測定でリラクセーション傾向を示した．全体終了後の感想でもリラックス感が表出された．また，描画の説明・感想より，色のイメージと気持ちの一致や色で自分を表現させていることが認められ，気持ちの表現に色などのパステル素材の効果があり，妊婦と褥婦にとっては描画が自己表出の機会となっていることが考えられた．パステルによる描画は心身両面に変化を与え，出産前後の女性の心身のリラクセーションに効果があることが示唆された．The purpose of this study was to examine the effects of relaxation evoked by drawing during pregnancy and the puerperal period by using a physiological index and a psychological index. Muscular tension of the shoulder and the Profile of Mood States (POMS) were assessed before and after drawing with pastels in 5 pregnant or puerperal women. After drawing, subjects gave their impressions of the experience, and POMS scores and muscular hardness measurements before and after drawing were compared. The impressions of drawing were qualitatively analyzed. After drawing, scores on 5 POMS scales for negative feelings had decreased, while the vigor score had increased. Muscular hardness also decreased after drawing, except in one puerperal participant who had suckled while drawing. The impressions of drawing with the theme of“ Myself” included feelings of“ I used the color of the wind”,“ I want to become flexible gently”, and“ I want to use green from pink and the orange”. Impressions of the entire drawing experience included “The tension in my body was relieved”, “I became relaxed”, “It became warm”, and “I started sweating”. After drawing, muscular hardness measurements and POMS scores indicated a tendency toward relaxation. The participants then matched the colors in images to feelings and expressed this connection with colors from their impressions of the drawing experience. The pastel material was effective for the expression of feelings. Drawing provided an opportunity for self-expression in the pregnant and puerperal women. The results suggest that drawing with pastels elicits a change in mind and body that can effectively help women to relax before and after birth

精神看護学実習についての病棟看護スタッフの意識に関する研究

　本研究の目的は，精神看護学実習における病棟看護スタッフの学生を指導することに対する意識を明らかにし，教員と病棟看護スタッフの連携のあり方を検討することである．A大学が精神看護学実習をした4施設の病棟看護スタッフ190名を対象に，自記式質問紙調査を実施した．質問紙の内容は独自に作成した実習に対する抵抗感，負担感，実習に対する意識に関する質問と抵抗感や負担感への影響要因としての対象者の背景である．回収率73.7％であった．実習前の抵抗感は38人（27.5％）にあり，内容は指導への不安，業務量の増加による多忙が多かった．抵抗感は資格により差があり准看護師に高かった．指導の負担感はあり群47人（34.1％），なし群86人（62.3％）であった．負担感の内容は業務優先の葛藤，業務量の増加が多かった．負担感は指導者の経験，現在指導者か否か，講習会受講の有無，役職の有無に差があった．実習指導によりスタッフの意識は向上心，患者対応の見直し，言葉づかい等で変化した．看護スタッフが感じる実習の患者への影響では，「学生を楽しみにしている」「良い刺激になり良い反応を示している」等の肯定的な捉えと，「負担感，疲労感による症状悪化へのつながり」という否定的な捉えがあった．実習指導での困難は，「関わりの程度がわからない」「複数の学校が実習する戸惑い」「大学の方針が分からない」「指導が困難な学生の態度」であった．抵抗感や負担感を軽減するためには，教員は病棟看護スタッフ全体への働き掛けや実習中の連携，指導に対する支援体制が重要である．実習が負担だけでなく看護師の成長やケアの質の向上につながることを意識できる教員の働きかけが必要である．患者への影響では，患者との距離の取り方に対する指導が重要であるといえる

精神科看護継続教育に関する研究の動向

　本研究の目的は，１９９８年から２００７年の間に発表された，精神科看護継続教育に焦点を当てた研究を分析することにより，精神科看護継続教育研究の動向を明らかにし，精神科看護継続教育の発展に必要な研究内容や今後の研究遂行上の課題を検討することである．４７の文献を分析した結果，研究の出版年は最近５年間に集中していた．研究対象は，全国の看護師を対象としたもの１，県内の看護師を対象としたもの８，一病院の看護師を対象としたもの１５，一病棟の看護師を対象としたもの１０，認定看護師・専門看護師を対象としたもの２，事例８，その他３であった．論文の中で「取上げられている問題」を抽出し分析した結果【ニーズに合わない教育プログラム】【専門性の高い教育プログラムの不足】【中堅看護師の研修の不足】【継続性のない教育プログラム】【研修参加の障害】の５つのカテゴリーが明らかになった．改善のための「方法の提案」を抽出し分析した結果【個人のニーズを尊重した研修の企画】【専門性を高める教育プログラムの企画】【学ぶことを支援する体制】【現場で活かせる研修内容】【継続的な研修の企画】【中堅看護師の教育体制の充実】【新人教育の体系化】【地域教育ネットワークの充実】【看護基礎教育と継続教育とのつながりの明確化】の９つのカテゴリーが明らかになった．分析結果から個人のニーズを尊重し，個別性に対応した中堅看護師の継続教育とその支援が求められていた．対象とした研究には精神科継続教育のシステム開発に向けた研究はなかった．精神科看護継続教育のシステム開発に向け，精神科看護師の学習ニード，学習継続の要因についての研究が必要であることが示唆された．The purpose of this research is to analyze studies published between 1998 and 2007 that focused on continuing education for psychiatric nurses. In order to elucidate trends in research on continuing education for psychiatric nurses and examine future issues in research, we analyzed 47 articles. Those articles were mostly published within the last five years. The most common subjects were nurses at a single hospital (n=15), followed by nurses at a single ward (n=10), nurses within a prefecture (n=8), Certified Nurses and Certified Nurse Specialists (n=2), nurses nationwide( n=1), case studies( n=8), and other( n=3). Analysis of problems covered in research revealed the following five categories: "educational programs not meeting needs", "lack of educational programs with high expertise", "lack of training for mid-level nurses", "lack of continuity in educational programs", and "impediments to participation in training". Analysis of proposed methods revealed the following nine categories: "plans for training that onsiders individual needs", "plans for educational programs aimed at enhancing expertise", "systems for supporting learning", "training contents that can be applied in work settings", "plans for continuous training", "development of education systems for mid-level nurses", "systematization of education for new nurses", "development of regional education networks", and "clarification of the connection between basic nursing education and continuing education". No studies focused on development of a system for continuing education in psychiatric nursing. These findings suggest that more research is needed to determine the learning needs and factors among psychiatric nurses in order to develop the system for continuing education in psychiatric nursing

急性期病院における看護学生への実習指導に対する看護師の思い

　本研究は，看護学生への実習指導に対して看護師が抱いている思いを明らかにし，学生および指導する看護師にとってもよい環境を作るための示唆を得ることを目的とした．2つの急性期病院に勤務する看護師18名を対象に半構成面接を行い，グランデット・セオリー・アプローチで分析した．　結果，『「学生の置かれた状況の気づき」と対応改善の過程』『「満足のいく指導ができない不全感」と課題』の2つのコアカテゴリーを見出した．看護師は，看護学生の実習指導について，「知識不足による自信のなさ」や「多忙な業務の中での学生指導の負担」を感じ，同時に「学生への高い期待」を持ち，それが実際の学生の状況と解離があることで「学生の実習姿勢への不満と危惧」となる．その状況が「学生に対するきつい態度」となる．しかし，自分が学生の時の思いの想起や自分が学生だったらと学生の立場にたつことで「学生の置かれた状況の気づき」となる．その結果，学生の実習環境としての「病棟の雰囲気づくり」と学生一人一人を尊重した「指導方法の改善」をした．それは就職の希望などの「優しい対応の良い評価」になった．同時に「厳しさも必要という思い」もあり，優しさと厳しさという葛藤が生じている．　「学生の実習姿勢への不満と危惧」や教育機関の「教育方針・指導体制への不満」，「スタッフ間の意識の差」がある状況が「多忙な業務の中での学生指導の負担感」とも結びつき，「満足のいく指導ができない不全感」になっている．その解決として「指導者とスタッフの連携の必要性」「教員との連携の必要性」を感じており，それらが課題となっている．「厳しさも必要という思い」が「指導方法の改善」に向かい，「満足のいく指導ができない不全感」が解決できるよう臨床及び教育側で取り組んでいくことが課題といえる．　The aim of the present study was to elucidate nurses’opinions regarding practice instruction for trainee nursing students. Semi-structured interviews were conducted on 18 nurses, and interview data were analyzed using a grounded theory approach.　The following two core categories of nurses’ opinions were identified: “\u27attention to the situation students are in\u27 and the process of improving support” and “\u27feeling of insufficiency at not being able to provide the best guidance possible\u27 and related issues”. The first core category was constructed as follows. Nurses felt a “lack of confidence caused by a lack of knowledge” and “the burden of guiding students amid all the other demands of work”, but had“ high expectations for the students”. These feelings led to“ dissatisfaction and misgivings regarding students’attitudes during practice”. This situation in turn led to“ a strict attitude vis-à-vis students”. However, recalling their own thoughts when they were students led to paying “attention to the situation students are in”. Consequently, they “created a ward environment” and “improved guidance methods”. While this fulfilled the need for“ positive evaluation through kind interaction”, there was also“ the idea that it is necessary to be strict”.　The second core category was constructed as follows. The situation of “dissatisfaction and misgivings regarding students’ attitudes during practice”, “dissatisfaction with the educational policies and guidance systems” and “gaps in understanding between staff” was linked to “the burden of guiding students amid all the other demands of work”, and led to a “feeling of insufficiency at not being able to provide the best guidance possible”. Nurses felt that the solution to this issue lies in “the need for coordination between supervisors and staff ” and “the need for coordination with faculty members”

Hair-Follicle-Associated Pluripotent (HAP) Stem Cells Can Extensively Differentiate to Tyrosine-Hydroxylase-Expressing Dopamine-Secreting Neurons

Hair-follicle-associated pluripotent (HAP) stem cells are located in the bulge area of hair follicles from mice and humans and have been shown to differentiate to neurons, glia, keratinocytes, smooth muscle cells, melanocytes and beating cardiac muscle cells in vitro. Subsequently, we demonstrated that HAP stem cells could effect nerve and spinal-cord regeneration in mouse models, differentiating to Schwann cells and neurons in this process. HAP stem cells can be banked by cryopreservation and preserve their ability to differentiate. In the present study, we demonstrated that mouse HAP stem cells cultured in neural-induction medium can extensively differentiate to dopaminergic neurons, which express tyrosine hydroxylase and secrete dopamine. These results indicate that the dopaminergic neurons differentiated from HAP stem cells may be useful in the future to improve the symptoms of Parkinson’s disease in the clinic

The Influence of Education on Preference : A Natural Experiment by the School Grouping Policy

We reveal the effect of education on academic performance and preferences by analyzing a special selection system for high school entrance examinations in Japan, the “school grouping policy.” Owing to the random assignment of students, the difference in performance between the schools in a group was due to their educational features. Education affected both academic performance and hometown loyalty, and the instruction on how to choose a college to apply to strongly influenced students’ choices. While there is significant selection bias in most empirical studies, our findings are free from such bias and are important when considering educational policies

Analysis of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis in Japan from 2000 to 2006

ABSTRACTBackgroundStevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe adverse drug reactions with high mortality.MethodsTo present the current clinical characteristics and treatment of SJS and TEN in Japan, we retrospectively analyzed reports of SJS and TEN published in medical journals from 2000 to 2006.ResultsFifty-two cases of SJS (19 males and 33 females; mean age, 45.2 years) and 65 cases of TEN (31 males and 34 females; mean age, 45.7 years) were reported. Thirty-six cases of SJS (69.2%) and all cases of TEN were caused by drugs, such as nonsteroidal anti-inflammatory drugs (NSAIDs), antibiotics, and anticonvulsant drugs. Hepatitis was the most common organ involvement in both SJS and TEN. Renal dysfunction and respiratory disorders were also involved in some cases. The major complication was sepsis, but in only 1.9% of SJS and 10.8% of TEN. Most cases were treated systemically with corticosteroids, and 42 cases (80.8%) of SJS and 39 cases (60.0%) of TEN were treated with corticosteroids alone. Plasmapheresis and/or immunoglobulin therapy was combined with corticosteroid therapy in some cases. The mortality rates for patients with SJS and TEN were 1.9% and 6.2%, respectively. The mortality in TEN decreased remarkably from 21.6% (58/ 269) during the previous 17 years (1981 to 1997).ConclusionsImprovement of treatment may be one of the reasons for the decrease in mortalities of both SJS and TEN