看護学生が臨床場面を観察する時のアセスメント力を視覚情報から可視化する試み

Objective：To investigate whether the assessment capabilities of nursing students can be clarified from the observation contents of a questionnaire-based survey and the descriptive contents of thought processes using visual information to visualize the trajectories of their cognitive processes for patient observation.　Methods：Still images of model dummies receiving oxygen therapy and fluid therapy were shown to five third-year nursing college students who had taken all courses prior to practical training in different areas of nursing，and gaze measurements and a questionnaire-based survey were conducted.　Results：The students fixed their gazes the longest and the most frequently on intravenous（ IV）infusions，followed by oxygen inhalation and aspiration. Gaze trajectories followed a pattern of first looking at the face，perfunctorily checking all areas，and then carefully looking at each area considered necessary for observation，such as IV infusions，oxygen inhalation and aspiration. Four of the five students began by looking at the face and all of the students stopped to observe IVinfusions，oxygen inhalation，and aspiration for 2 seconds or longer.　In the studentsʼ descriptions of IV infusions，on which students fixated the longest and the most frequently，four students described noticing that “an IV infusion was attached” and thought that “drugs and other fluids were being fed into the body,” “a risk of IV infusion-related complications existed,” and “they would check for loosening of the needle or any bleeding.” Furthermore，“infusion management” and “ensuring reliable IV infusion management and an IV route” were described by the students as necessary support.　Discussion：The students surveyed in this study appeared to recognize that oxygen inhalation and IV infusions are areas that must be observed. Current practical training in nursing is aprocess of acquiring knowledge and experience; however，the findings of this study suggest that “the ability to anticipate,” “the ability to estimate safety and pain,” and “the ability to predict risks” are also being nurtured in students. These abilities allow students to use observations to recognize problems，such as the possibility that an IV needle may have come loose or that a patient may be receiving insufficient oxygen.The assessment capabilities of nursing students could conceivably be understood by visualizing the gazes fixed on focused images　and analyzing in conjunction with the observation contents of a questionnaire-based survey and the descriptive contents of thought processes. 　Increasing opportunities for students to observe nursing care through clinical images and increasing experiences that confirm knowledge，skills，and coping strategies that are necessary together with teachers could enhance studentsʼ assessment capabilities.目　的：本研究の目的は，動作を伴う視線計測に関する先行研究から，視線の測定方法，分析方法，対象者数の妥当性を明らかにすることである。方　法：文献の選定には，CiNii Articles，医学中央雑誌Web 版（Ver.5），Medical Online を用い，キーワードは「視線計測」「アイマークレコーダ」「注視」とした。得られた文献のうち，選定基準に合致した文献23 件を分析対象とした。帰納的に内容を分析し，機器の条件設定，対象者数，分析指標等をマトリックスシートに整理し，視線の測定方法や分析方法の妥当性を検討した。結　果：視線計測機器の条件設定において，眼球運動の測定には瞳孔角膜反射法が多く用いられており，視野カメラレンズには水平角92°のレンズが最も多く用いられていた。対象者と分析処理方法について，対象者5 名以下では視線パターンを把握することを目的としており，統計的検定は行われていなかった。一方で，11 名以上を対象とした文献では，若齢者と比較した高齢者の視線，非熟練者と比較した熟練者の視線の特徴を統計学的検定から明らかにしていた。分析指標としては「注視時間」「注視回数」「注視項目変化表」「視線軌跡」が多く用いられていた。考　察：動作を伴う視線計測から熟練者の技の可視化，新人看護師や看護学生の技術習得，患者教育に繋げるためには，モバイル型視線計測機器を用い，動作環境に合わせた視野カメラレンズ，キャリブレーション方法を選択する必要がある。また，10 名以上を対象とした注視時間や注視回数の比較，注視項目変化表の分析より，動作中の思考や認知のプロセスを推定することが可能になると示された原

2020 年におけるCOVID-19 の状況と看護学部の臨地実習への対応

教育活動報

Estimation of the Lethality Rate, Recovery Rate, and Case Fatality Ratio of Classical Swine Fever in Japanese Wild Boar: An Analysis of the Epidemics From September 2018 to March 2019

Understanding the morbidity and lethality of diseases is necessary to evaluate the effectiveness of countermeasure against the epidemics (e.g., vaccination). To estimate them, detailed data on host population dynamics are required; however, estimating the population size for wildlife is often difficult. We aimed to elucidate the morbidity and lethality of classical swine fever (CSF) currently highly prevalent in the wild boar population in Japan. To this end, we estimated lethality rate, recovery rate, and case fatality ratio (CFR) of CSF without detailed data on the population estimates of wild boar. A mathematical model was constructed to describe the CSF dynamics and population dynamics of wild boar. We fitted the model to the (i) results of the reverse transcription polymerase chain reaction (RT-PCR) test for the CSFV gene and the (ii) results of the enzyme-linked immunosorbent assay (ELISA) test for the antibody against CSFV in sampled wild boar. In the 280 wild boar sampled from September 2018 to March 2019 in the major CSF-affected area in Japan, the lethality rate and recovery rate of CSF per week were estimated as 0.165 (95% confidence interval: 0.081-0.250) and 0.004 (0-0.009), respectively. While the estimate of lethality rate of CSF was similar with the estimates in previous studies, the recovery rate was lower than those reported previously. CFR was estimated as 0.959 (0.904-0.981) using our estimate of recovery rate. This study is the first to estimate lethality rate of CSF from the dynamics of CSF epidemics in the wild boar population. Since the value of CFR is sensitive to the value of recovery rate, the accuracy in the estimate of recovery rate is a key for the accurate estimation of CFR. A long-term transmission experiment of moderately virulent strains may lead to more accurate estimation of the recovery rate and CFR of CSF

Measuring impact of vaccination among wildlife: The case of bait vaccine campaigns for classical swine fever epidemic among wild boar in Japan

Understanding the impact of vaccination in a host population is essential to control infectious diseases. However, the impact of bait vaccination against wildlife diseases is difficult to evaluate. The vaccination history of host animals is generally not observable in wildlife, and it is difficult to distinguish immunity by vaccination from that caused by disease infection. For these reasons, the impact of bait vaccination against classical swine fever (CSF) in wild boar inhabiting Japan has not been evaluated accurately. In this study, we aimed to estimate the impact of the bait vaccination campaign by modelling the dynamics of CSF and the vaccination process among a Japanese wild boar population. The model was designed to estimate the impact of bait vaccination despite lack of data regarding the demography and movement of wild boar. Using our model, we solved the theoretical relationship between the impact of vaccination, the time-series change in the proportion of infected wild boar, and that of immunised wild boar. Using this derived relationship, the increase in antibody prevalence against CSF because of vaccine campaigns in 2019 was estimated to be 12.1 percentage points (95% confidence interval: 7.8-16.5). Referring to previous reports on the basic reproduction number (R-0) of CSF in wild boar living outside Japan, the amount of vaccine distribution required for CSF elimination by reducing the effective reproduction number under unity was also estimated. An approximate 1.6 (when R-0 = 1.5, target vaccination coverage is 33.3% of total population) to 2.9 (when R-0 = 2.5, target vaccination coverage is 60.0% of total population) times larger amount of vaccine distribution would be required than the total amount of vaccine distribution in four vaccination campaigns in 2019