永嶺 仁美

PDF 本稿は、和洋女子大学看護学部の成人看護学領域で、2025年度、看護学部の3年次科目である成人看護学援助論III(看護過程・看護技術)および成人看護学実習I(急性期・回復期)において、学生の周手術期看護の技術修得に向け、段階的に取り組んだ術後シミュレーション教育に焦点を当てた演習内容の報告である。成人看護援助論IIIでは、「タスク・トレーニング」、「シチュエーション・ベースド・トレーニング」の2つの演習構造と、「ロールプレイ」、「シミュレーターモデルまたは模擬患者によるフルスケール・シミュレーション」の3つの演習形態を用いて、臨地実習開始に向けたシミュレーション教育を展開した。また、成人看護学実習I(急性期・回復期)の開始時は、フルスケール・シミュレーションでのシチュエーション・ベースド・トレーニングを復習という観点から再度実施した。事例は、いずれも胃全摘術(ルーワイ法)を受ける50代の男性とし、術直後の観察を2回、術後1日目の離床支援を1回実施した。周手術期系の演習を多様な演習構造と演習形態によって、段階的に行うことにより、学生は主体的にモデリング学習を行い、多様な形式で内省的実践の態度を養いながら、臨地実習に向けて周術期にある患者への理解を深化していった。今後は、演習における学修がさらに深まるよう、座学の教授法についてもさらなる改善を行っていくとともに、学修成果を、定性的・定量的に評価することが課題である。

成人慢性期看護実習において、学生がどのような関わりを通して慢性疾患患者や家族への理解を深め、療養生活を支えるケア実践へと発展していったのか、その学びのプロセスを明らかにすることを目的とした。A大学看護学科3年次の実習履修者による73件のケースレポートを対象に、質的記述的研究を実施した。学生の看護実践における学びの内容から、70コード、12サブカテゴリ、4カテゴリが生成された。学生の学びは、【患者・家族の苦痛を理解し、温かなケア提供により心身の苦痛を緩和する】という患者・家族理解を基盤に【、日々の状態変化を捉えたケアが、患者の主体性を引き出し、自立した生活を支える】【患者が疾病と障害を受容し、継続したセルフマネジメントを行えるように協働する】へと発展した。さらに【最善の看護を模索し、省察することで、自身の看護観を培う】段階を経て、再びケアの基盤である対象理解と苦痛緩和の重要性に立ち返る循環的プロセスを形成していた。学生は実習経験を振り返りながら、自らの行動や患者理解を省察し、次の看護実践へと活かしていた。このことから、学生の学びは経験の積み重ねの中で理解が再構築されていく循環的かつ発達的過程を示していた。看護基礎教育においては、患者理解に基づく看護実践の経験と、それを省察的に振り返る学習機会を意図的に組み込むことが、専門職としての価値観形成を支える重要な教育的要素であることが示唆された。

BACKGROUND: In occupational health, the maintenance and promotion of workers' health, especially lifestyle motivation-based interventions, have gained considerable attention and are actively implemented. Motivational theories include self-determination theory, and some studies focus on healthy lifestyles. However, the effectiveness of health promotion interventions varies depending on the health awareness and motivation of the participants. Therefore, this study aimed to clarify the processes by which workers are motivated to improve their health and to identify the need for and type of support according to their motivation. METHODS: Using a mixed-research design, an initial questionnaire survey of 94 employees (mean age = 40.97 ± 9.65) at a multicenter company in Japan, followed by semi-structured interviews with 16 employees (mean age = 40.13 ± 9.45) from the high- and low-motivation groups, were conducted. Multiple regression analysis followed by modified grounded theory-based analysis of the results of the first stage was used and the quantitative and qualitative results were integrated. RESULTS: In the first stage, autonomous motivation scores were predicted by the behavioral change stage and relatedness satisfaction/frustration. The second stage revealed that "the process of reflecting and managing one's own health while receiving support and feedback for maintaining and improving health" was the motivational process of workers. Result integration revealed that motivation increased through repeatedly escaping and adjusting to real problems and situational coping until the behavioral change. Despite interruptions during behavioral change, receiving feedback from others could increase motivation and continued behavioral change. CONCLUSION: Regardless of their level of motivation for health behaviors, workers indicated that support from others was essential. The nature of this support was found to range from providing information to offering feedback. Interventions individualized by the identified process could enable customized motivation-driven health guidance.

BACKGROUND: In the process of community building, it is important to create a place for multigenerational exchanges. To promote multigenerational exchanges in regional locations, it is essential to clarify whether such exchanges are related to government infrastructure, regional characteristics, and social capital, and how these exchanges contribute to community building. METHODS: A cross-sectional questionnaire study was conducted with representatives from 455 Chiiki no Cha-no-Ma (literal translation "community living room," and hereafter "Cha-no-Ma") in Niigata City, Japan. Responses were received from 405 representatives (response rate: 89.0 %), and 401 agreed to participate (4 declined). The survey details included basic information (e.g., date each location was established, frequency of meetings, number of caretakers and participants, qualifications of the representative), activities reflecting local culture, a social capital scale, the effects of the Cha-no-Ma implemented by the representative (12 items), challenges for management (16 items), and the implementation of multigenerational exchanges. RESULTS: Most of the age groups that participated in the Cha-no-Ma were elderly, and multigenerational exchanges took place in 125 locations (31.5 %). Items that had a significant connection to the implementation of multigenerational exchanges were "Frequency of meetings" (p < 0.001) and "Activities reflecting local culture" (p = 0.026). Binomial logistic regression analysis indicated that a high frequency of meetings was associated with the implementation of multigenerational exchanges (Odds ratio = 3.839). There was a significantly higher ratio of implementation of multigenerational exchanges when the effects were a "connection with the region" (p = 0.006) and "conversations with different generations" (p = 0.004), and when the challenge was "no support from residents" (p = 0.002). CONCLUSIONS: Cha-no-Ma participation is low among young people. The following ideas can be considered in order to increase multigenerational exchanges in regional locations. These exchanges may be promoted by increasing the frequency of meetings with qualified personnel and by adding activities that reflect local culture, such as festivals and making local foods. This community-based study clearly indicates that implementing multigenerational exchanges is an important activity for community building because it is related to connection within the community.

本研究では，全国1,815か所の学童保育を対象に，高齢者との世代間交流プログラムの現状と今後の期待について明らかにし，都市規模別に比較・検討することを目的とした． 本研究では，学童保育を「大都市」「人口10万人以上」「人口10万人未満」「郡部」の都市規模別に区分し，世代間交流活動の「実施群」「未実施群」の層化分析を行った．世代間交流プログラムの関心は，大都市では「将棋・囲碁」，人口10万人以上の都市では「昔遊び」「楽器演奏・音楽鑑賞・合唱」「体験談」「読み聞かせ・紙芝居」が高かった．人口10万人未満の都市では，「料理・おやつ作り」が高かった．今後の課題として，その地域における学童保育側から高齢者への期待，また高齢者の生活意識などの点から，お互いに参加しやすくニーズに合った世代間交流プログラムを構築する必要があることが示唆された．

AIM: To determine the effects of a primary diabetes prevention programme created for healthy young adults. DESIGN: This study was a non-randomized controlled trial. METHODS: The participants were 20-39-year-old employees of two automobile sales companies. The intervention group (N = 154) received six original educational brochures and films created specifically for young adults, while the control group (N = 157) received none. Data were collected pre-intervention and immediately after and 10 weeks after intervention. Change in knowledge about diabetes, its prevention and health management were measured. RESULTS: Overall, 129 interventions and 141 controls completed the trial. In items related to diabetes prevention, the intervention group increased their knowledge relative to controls (all p < .05). Awareness of susceptibility to diabetes also increased more in the interventions (p = .029). The interventions also improved more with items related to dietary behaviour (p < .05). This trial has been registered with UMIN-CTR clinical trial (UMIN000023749).