患者とのズレ(不一致)に繋がる看護師の思考・感情・行動の特徴 : 看護場面の再構成による自己との対峙から

本研究の目的は、研究者自らの看護実践場面から看護師としての思考・感情・行動の特徴を抽出し、看護の目的を達成するための看護師の思考・感情・行動のあり方を考察することである。患者とのズレを感じた15場面を再構成し、各場面における患者-看護師間のコミュニケーション過程を、E.ウィーデンバックの自己評価項目に照らし、第三者と振り返った。その結果、ズレに繋がる看護師の思考・感情・行動の特徴として【看護師の思いを先行させること】が抽出された。しかし同時に看護師の思考や感情は看護師としての内的な限界にもなり得る一方、患者の援助へのニードと、時間・場・他職種との意見の相違といった【ケアの場の制約】として存在する外的な限界との間に生じる葛藤を打破する資源にもなり得ることも確認された。これらのことから、看護師は、現在の力を自覚し、臨床の場で生じる矛盾を調和的に解消していくための訓練が必要であり、その方法として自身の実践場面を再構成し第三者と振り返る過程そのものの有効性が示唆された。The purpose of the point book study extracts the characteristic of though

コウセイテキ グループ エンカウンター ヲ カツヨウ シタ カンゴ キソ キョウイク ニオケル タイジン カンケイ ノウリョク ノ イクセイ : フカイ ノ カンジョウ ヲ モツ タシャ リカイ

「援助的人間関係論」の授業において、「不快の感情を持つ他者理解」で構成的グループエンカウンターを実施した。その結果(1)学生は、自己覚知、感情表現、自己主張ができており、他者受容、役割遂行へと学びを発展できていた。(2)話し手側学生に「自己表現の抑制」、聴き手側学生に「自己理解の深化」があり、相互関係へと発展ができない学生がいた。(3)社会的スキルKiSS−18の「コミュニケーション因子」やオープナー・スケールの「なごませ因子・共感因子」は授業前後に有意に上昇し、対人関係能力が育成されることが示唆された。A structured group encounter was applied in a session aimed at "Understanding others who held negative feelings" in a "Helping Relationships" course. The results are as follows: 1) Students were able to recognize, express, assert themselves and further develop the skills required for acceptance during role‑playing. 2) The "speaker" student had "deepened their self‑understanding" by "controlling their self‑expression." The "listener" student which included an immature student, helped to develop the inter‑personal relationship. 3)The "communication factor" of the Opener Scale increased significantly and consistently throughout the entire session. It could be concluded that the students\u27 inter‑personal relationship abilities were improving

タイジン カンケイ ノウリョク ノ イクセイ ニ コウセイテキ グループ エンカウンター ヲ ジッシ シタ ジュギョウ ノ コウカ : カンゴガクセイ ノ カンジョウ ニ チャクモク シテ

対人関係能力の育成を目的にB看護短大1年生を対象に、SGEの体験学習を2回授業展開した。授業中のワークシートおよび実施後の振り返り用紙を「感情」に着目して分析した結果、以下のことが明らかになった。1.学生は自己の感情を基盤に「自己理解」「他者への関心」を高めるとともに、他者を意識した自身の行動の振り返りが行えていた。2.学生は自己の快・不快の感情を意識することを出発点に、聞き方が話し手に及ぼす影響を自覚し自分から相手へと立場を変換させていた。3.目的を明らかにしたエクササイズの選択により自己理解・他者理解を基盤にした対人間との相互作用へ発展させる効果が示唆された。I conducted a work‑study class of SGE for freshmen students of B Junior College of Nursing twice, aiming at developing better their interpersonal relationship skills. The following was clarified when I analyzed a worksheet given during their classes and a reviewing form focusing on "Emotion" after implementation. 1. As well as being able to review their own actions with awareness of others, the students could better enhance "self‑understanding" and "interests in others" based on their own emotions. 2. Starting from being aware of their own comfortable and uncomfortable emotions, the students changed their stance from self‑awareness to awareness of others by the effects of the way of listening on the speaker. 3. It suggested the effects of development towards interpersonal interaction based on self‑understanding and a greater understanding of others through a selection of exercises aimed to clarified that purpose

ニッポン セキジュウジシャ ダイイチ ブロック シブ ゴウドウ サイガイ キュウゴ クンレン ニオケル A ダイガク オヨビ A タンキ ダイガク ノ トリクミ

平成26年度の日本赤十字社第一ブロック支部合同災害救護訓練に、A大学およびA短期大学の学生が被災者役とボランティア役として参加し、その他の学生は医療救護訓練を中心に見学した。訓練を振り返り、参加した学生の経験を共有し、全体としての学びにしていくことが重要であると感じた。また、災害時の不安を想起させられる状況下での、学生への支援のあり方を考えていく必要があると示唆された。Students of university A and junior college A participated in the 2014 joint disaster relief drill for block 1 branches of the Japanese Red Cross Society. Some of the students acted as disaster victims and disaster-relief volunteers in the drill while others observed the medical relief drill. Reflecting on the drill, the importance of sharing the experiences of the participating students helped provide insights for other students, was confirmed. The necessity to review the support system for students under uneasy situations after a disaster was also suggested

Intratumoral heterogeneity of programmed cell death ligand-1 expression is common in lung cancer

Programmed cell death ligand-1 (PD-L1) expression may predict the response to both programmed cell death-1 and PD-L1 inhibitors in lung cancer. However, the extent of intratumoral heterogeneity of PD-L1 expression, which may cause false negative results, is largely unexplored. We aimed to assess the intratumoral heterogeneity of PD-L1 expression in surgically resected lung cancer specimens by applying a novel method of tissue microarray, namely Spiral Arrays, which enables us to observe the heterogeneity in spiral-shaped tissue cores. Adenocarcinoma and squamous cell carcinoma specimens were obtained from consecutive patients with lung cancer who had undergone surgical resection at Nagasaki University Hospital (Nagasaki, Japan) since 2009. Small cell lung cancer and large cell carcinoma specimens were selected from patients in the same archive who had undergone resection since 1998. Spiral Arrays were constructed of spiral-shaped cores, prepared from representative blocks of each case, which were subjected to immunohistochemistry using an anti-PD-L1 antibody. Each core was divided into 8 segments and each segment was classified as either PD-L1-positive or PD-L1-negative using thresholds of 1.0%, 5.0%, 10.0%, and 50.0%, respectively. In total, 138 specimens were selected, including 60 adenocarcinomas, 59 squamous cell carcinomas, 12 small cell lung cancers, and 7 large cell carcinomas. The majority of specimens with PD-L1-positive segments exhibited heterogeneous expression (i.e., had a mixture of PD-L1-positive and PD-L1-negative segments within a core) irrespective of the threshold (1.0%, 66.7%; 5.0%, 74.4%; 10.0%, 75.8%; and 50.0%, 85.7%]. Large variations in the ratios of PD-L1-positive segments were observed. At least 50.0% of the segments within a core were negative in no fewer than 50.0% (range, 50.0?76.0%) of cases with heterogeneous PD-L1 expression. In conclusion, intratumoral heterogeneity of PD-L1 expression was frequently observed in cases of lung cancer. Thus, multiple tumor biopsy specimens may be needed to accurately determine the PD-L1 expression status

カンゴ キソ キョウイク カテイ ニオケル コモン スキル トレーニング ドウニュウ ノ トリクミ

看護学部初年次生のコモンスキル向上を図る取り組みとして、コモンスキルに関する無記名自記式質問紙調査と並行して、松澤らが開発したトレーニングプログラムを希望者に実施した。質問紙調査では、トレーニングを"受けたい"または"必要だ"と思う者は全体の3割であることがわかった。また、トレーニングの受講に消極的な学生は日々の生活において自分の属する社会に適した行動をとるという意識が希薄であり、トレーニングを積極的に必要としない学生は大学に入学する以前と入学後一年とで対人関係のとり方が変わっていないと認識していることが示唆された。松澤らのプログラムを実施した12名は、自身の省察と他者への関心・共感を軸に、他者との相互作用や集団の変化を感受しており、プログラム実施中に得られた知識を行動化したり、看護者としてのあり方を考えたりと、自ら成長発展しようとする姿勢がみられた。In an attempt to improve the common skills of nursing students in the first year, a survey was conducted on awareness in regards to common skills. In addition, a common skills training program developed by Matuzawa et al. was implemented for interested students, after which its effects were verified. The results of this awareness survey revealed that those who needed common skills training amounted to 30% of the total and that there was a group of students who felt that they were "not aware of socially appropriate attitude in their ordinary life." On the other hand, it was found that students who have just completed their on‑site clinical practicum had significantly changed the ways of daily living and attitudes toward interpersonal relationships and that they strongly felt a lack of knowledge about common‑sense manners and interpersonal relationships as well as had difficulties acting on this knowledge. As for the 12 students who completed the program developed by Matuzawa et al, it was found that they perceived the changes in the group caused by individuals\u27 interaction with others based on self‑reflection, care and empathy towards others. In addition, they showed an attitude to try and willfully grow by acting on the knowledge acquired during the program and thinking about how nurses should behave. In consideration of the fact that maturity as a person is not irrelevant to growth as a nurse, this study suggested the usefulness of common skills training at an appropriate time

レイメイキ ノ カンゴ キョウイクシャ ガ カンガエル カンゴ ノ ダイガク キョウイク ノ アリカタ ニ カンスル ケンキュウ

わが国では1990年代、一気に看護系大学が急増し、大学教育は学士課程教育の一環でありかつ専門職業人として位置づけられた。このような中、実際の教育現場で大学としての教育がどのように教員に認識・理解され教育方法はどのように変化してきたのか。本研究では看護大学教育黎明期に活躍した教育者へのインタビューにより、参加者が当時大切にしていたことや専修学校教育と何を意識的に変えたのか、また何を行ったのかを明らかにし、今の看護の大学教育の課題を探るとともに看護の大学教育を担う教員たちへの示唆を得る目的で行った。その結果、【看護学の存在を確信していた】【学部教育は大学院を含む構造の一部という認識があった】【大学の看護教育としての教育環境を整えた】の3大カテゴリーが抽出された。看護大学教育の黎明期に教育を担った参加者が当時から大切にしていたことは看護学という独自の学問の存在の確信であった。看護学を体系化し、看護を科学として伝えられるように努力をしてきた参加者たちは看護学を教えるのに学校の種類は関係ないという認識を持っていた。看護の大学教育は大学院までを含んで完成されるものであるが、学部教育は専門職業人教育であり、良き実践者の養成という視点が最も重要である。参加者の姿勢から、看護の本質を常に追求する姿勢を看護教員こそが持ち続ける必要があるのだということを今回の研究で改めて示されたと考える。The establishment of nursing colleges in Japan increased rapidly in the 1990s\u27. Universityeducation forms a part of the bachelor degree education program and nursing fell under the rubric of a profession. Under such circumstances, it is important to understand how a university education was perceived/understood by faculties in a real university setting and to ask how methods of education have changed. Based on interviews with nursing educators who took an active part in the dawning era of university education of nursing, this research clarifies the participantsc\u27ontemporary values and what they deliberately changed in order to distinguish themselves from standard vocational technical schools. This research was conducted in order to obtain helpful suggestions for faculties who bear the burden of a university education of nursing, while investigating the challenges associated with current nursing education programs at universities themselves. Three major categories were extracted from the results:[Confidence in Nursing Science Exists], [There is a Perception that the Undergraduate Program is Part of a Larger Structure that Includes Graduate School], and [A University Nursing Education Environment was Established]. The participants, who were nursing educators during the dawning era of university education of nursing, valued the conviction that there was an independent Nursing Science from the very beginning. These participants, who systemized Nursing Science and made efforts to convey nursing as a science, understood that the type of school is not relevant to teaching Nursing Science. The structure of a university education of nursing as a whole should include graduate school. However, it is the undergraduate program that is considered to be the primary education for nursing professionals and is seen as most important in the training of good practitioners. This research formally points out that it is necessary for nursing educators to continuously adopt a standard of exploration in further developing the nature of nursing