看護師養成課程の多様化と卒業後のキャリア志向の展開 : 総合病院勤務看護師へのアンケート調査より

日本教育社会学会第58回大会, 2006年9月(大阪教育大学), Ⅳ-7部会 職業と教

臨地実習における看護学生の感染予防管理の実態

　近年の予防接種法の度重なる改変は，青年期を中心とした麻疹などの流行がみられ問題となっている．今回医療系の高等教育機関における感染予防に対する現状を明らかにし，その感染予防対策の枠組みの方向性を示唆することを目的に調査研究をおこなった．　対象は，A 大学看護学科1 － 4 年生全員（377 名）．調査内容は，感染症の認知度などを質問紙で実施し，学年間の分析は，Kruskal Wallis 検定をおこなった．　学生の予防接種は，麻疹で学年間の有意差を認め（ｐ＜ 0.05），認知度は，全項目で学年が上がるにつれ上昇した（ｐ＜ 0.001）．また，抗体価検査費用は，2,000 － 5,000 円/ 項目，予防接種費用は，5,000円/ 項目/ 回となった．注目すべきことは，4 年生の麻疹の抗体検査結果，陰性者がいることであった．　感染症に対する認知度の上昇は教育効果の現れであろう．感染症抗体価検査，予防接種ともに高額の費用であり経済的な負担となっていることより，医療者となる学生の感染に対する意識が高められる教育が求められている．また，費用が高額であることより保護者へは感染予防対策に関する充分な説明が必要性である．最後に，麻疹の抗体価の自然低下を視野に入れた対応の必要性が示唆された．　感染予防対策は，臨地実習のみを見据えたものではなく教育機関自体の対策も重要であるため，事務職と教員とが連携をとり大学としての一括管理体制の構築が必要であることが明らかとなった．Repeated amendments to the Preventive Vaccination Act in recent years has been an issue of concern amid the proliferation of diseases such as measles mostly among adolescents. This study aimed to identify the current state of infection prevention at higher education institutions offering medical degrees, and consider a framework to facilitate infection prevention strategies. The subjects were all (first- to fourth-year) students at the Department of Nursing of A University (n=377). Questionnaires were used to investigate items including their awareness of infectious diseases. The Kruskal-Wallis test was used to analyze data according to grade level. Regarding vaccination, significant differences were noted among the grade levels for measles (p<0.05). The level of awareness increased for all items as the students advanced to the next grade (p<0.001). Antibody test costs varied from 2,000 to 5,000 yen/item, and the vaccination cost was 5,000 yen/item/dose. Of note, some fourth-year students had negative measles antibody titers. A heightened awareness of infectious diseases was likely to be the effect of education. Given the financial burden of infection antibody titer tests and vaccinations, it is imperative to raise students’ awareness of infection to a level appropriate for healthcare professionals, through education. It is also necessary to provide students’ parents andguardians with sufficient explanations regarding infection prevention strategies in light of the high costs of such tests. The findings also suggest the need to develop and implement strategies for the natural decline of measles antibody titers. Infection prevention strategies should not only be considered in terms of the clinical practicum, but also in terms of strategies that concern the educational institution as a whole. It is, thus, necessary to develop auniform management system by facilitating collaboration among teaching and administrative staff of a university

セイジン カンゴガク ジッシュウ ゼンゴ ノ ガクセイ ノ ヘンカ ニ カンスル ケンキュウ : フアン カンゴ カテイ テンカイ コンピテンシー オ チュウシン ニ

　効果的な臨地実習指導を検討することを目的として、新設看護系大学の3 年生78 名を対象に臨地実習（以下実習）における「不安」、「看護過程展開」および「コンピテンシー」の自己評価に基づくアンケート調査を行ったところ、学生は実習前よりも実習後に不安や実習中の記録物への負担を感じており、対象の理解が不足しているために看護計画の立案に困難さを感じていることが分かった。また、実習を通して、誠実さや批判的能力、言語的能力、リーダーシップ、自分とは異なる考えを理解し受容する力量、リーダーシップ、書き言葉によるコミュニケーションを獲得する必要があることに気づいていることが分かった。実習に携わる教員は、学生が新たな知識や学習の必要性に気づけるように関わる必要がある。　With the aim of studying effective on-site laboratory work, a self-evaluation-based questionnairesurvey on “anxiety,” “development of the nursing process,” and “competency” during practical laboratory training (practical training, below) was conducted on 78 third year students at a new nursing university. Compared with before training, the students experienced increased anxiety after practical training; moreover, they experienced stress with regard to the maintenance of records during training. We discovered that difficulty was experienced in drawing up a nursing care plan because of insufficient subject understanding. Furthermore, throughout practical training, we noticed a need to improve written communication, reliability and critical skills,linguistic skills, ability to understand and accept ideas different from one’s own, and leadership. The teaching staff participating in practical training needs to be aware of students’ need for new knowledge and training

セイジン カンゴガク リンチ ジッシュウ ニ オイテ シュウトク サレタ コンピテンシー ノ ジコ ヒョウカ

　成人看護学臨地実習を行う事で学生がどのように変化しているかを明らかとするため，実習前 の目標達成度とコンピテンシーの自己評価を調査・検討した．対象者として，A 大学3 年生170 名（回答138 名，有効回答率81％）に対し，まず実習前説明時に集合調査を行い，ついで，実習後調査を成人看護学実習（6 週間）終了毎に逐次実施した．調査内容は，成人看護学実習目標の20 項目について各々4 段階評価とし，コンピテンシー項目では吉本（2001）らが開発した調査用紙を参考として看護師向けに作成した37 項目に対し，獲得能力と職業上必要な能力について各々5 段階の自己評価を行った．　その結果，実習目標達成度における学生の自己評価は，実習後に上昇しており有意差も認められた．ところが，コンピテンシーの37 項目では獲得能力はすべて低下を示していた．しかしながら，職務上の必要能力においては「外国語の使用」以外のすべての項目が有意に上昇していた．　すなわち，臨地実習では，成人看護学実習目標こそ達成してはいたものの，コンピテンシーの獲得能力に関する全37 項目が低下していた．この結果から推測されることとして，学生は机上学習のみの時点では自己評価が高まり、あたかも全てができるように感じていたのであろうが．いざ実際に臨地実習を行った際には，不十分なレベルの看護実践しか行えず、いわゆる第一段階のリアリティショックを感じていたのではなかろうか．これらのことを臨地実習指導者は十分に理解したうえで，指導において，学生自身が自己の現時点での能力をしっかりと見据えながらも、看護者として働く自己の姿を客観的に見つめる機会をも与えるような教育姿勢が必要であろう．To clarify how nursing students have changed through adult nursing practice training, self-assessment exercises regarding practice training goals and their competencies before and after training were conducted and analyzed. These were undertaken with 138 nursing students of A University before and after six week training (81% response rate). The self-assessment chart consists of 20-item scale representing adult nursing practice training goals with a four-point scale and 37-item scale of competencies featuring acquired abilities and required professional abilities that were modified from competency frameworks that Keiichi Yoshimoto and others haddeveloped with a five-point scale. Results; the self-assessed scores on practice training goals indicated higher levels after training and showed significant differences. In 37-item scale of competencies, averaged scores on acquired abilities didn\u27t show any improvement. However, all required professional abilities except communication in foreign languages were improved through practice training. After the theoretical learning, nursing students might feel as if they could take all required abilities on the job for adult nursing due to their better self-assessment. However, students seem to have experienced a kind of reality shock through practice training. Therefore, nursing practice training has to be taken on this respect as well

大卒看護職の初期キャリアとコンピテンシー形成 : 看護師・関係者インタビューの分析

Nursing education faces changes and problems, especially those of shifting its training toward universities and the increasing early turnover and decreasing practical competence of beginning nurses. In the light of these issues, this study aimed to elucidate the educational challenges regarding career preparation of nurses and the competency required for nurses and the problems these create. To this end, interviews were conducted with members of medical teams and with beginning nurses holding a university degree. The results were analyzed and examined in four categories: the advantages from higher education of nurses and its relation to their careers; nursing skills required as part of a medical team; the contents of professional education in higher education; and discussion about career improvement at work. Both nurses and other members of medical teams expected university-educated beginning nurses to show a rich humanity and social skills as members of a medical team. At the same time, however, mere humanity is not enough to satisfy all the skills required professionally. In this context, nursing professionals with a university degree should acquire qualities such as basic knowledge, technical knowledge, and communication skills during higher education. Training was expected to explore how to nurture a rich humanity, rather than simply to upgrade the nursing curriculum. New nurses who had just graduated from a university realized how immature they were. Despite their willingness to remedy their lack of skills and experience, the university-educated nurses particularly were expected to become a substantial part of the workforce immediately, due to the overwhelming clinical workload and a large numbers of nurses leaving their jobs. Examining the interview results revealed an issue of legislating for nurse training in a way similar to that of compulsory training of doctors. In addition, the survey indicated a necessity to discuss issues arising from the new education/training methods for nurses in order to advance their careers from the initial stage

看護師養成課程の多様化と卒業後のキャリア志向の展開 : 総合病院勤務看護師へのアンケート調査より

日本教育社会学会第58回大会, 2006年9月(大阪教育大学), Ⅳ-7部会 職業と教