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  • 第30号No.3

An Exploration of the Effects of Peer Coaching on the Professional Autonomy and Identity of Nurses during Initial Career Development: A Cross-sectional Study

冨田亮三 1、細田泰子 2
Ryozo Tomita 1, Yasuko Hosoda 2
1 武蔵野大学看護学部、2 大阪府立大学大学院看護学研究科
1 Musashino University Faculty of Nursing, 2 Osaka Prefecture University Graduate School of Nursing)


Aim: Autonomy and professional identity are significant concepts in the nursing profession needing educational methods for development. Peer coaching is a collaborative activity between two or more colleagues through which nurses can experience transition into more spontaneous behaviors. This study explored the effects of peer coaching on nurses' professional autonomy and professional identity during their initial career development. It was hypothesized that peer coaching would affect both professional autonomy and professional identity.
Methods: This study surveyed a total of 328 nurses at 95 facilities across Japan. All participants were in their second or third year since graduation and affiliated with hospitals. Anonymous, self-administered questionnaires were distributed to approximately
10 nurses per facility. Nurses answered questions on their personal characteristics as well as on the Peer Coaching Scale for Nurses during the Initial Career-Development Period, the Scale for Professional Autonomy in Nursing, and the Nursing Professional Identity Scale. Multiple-index models were developed to explore the effects and analyzed using covariance structure analysis.
Results: The analysis revealed that the path coefficient from "peer coaching" to "professional identity" was non-significant. Thus, a multiple-index model for "peer coaching"and"professional autonomy" was created and another analysis was conducted after referencing modification indices and degrees of improvement. The results revealed that all paths were significant.
Conclusions: The effect of peer coaching on professional autonomy was demonstrated, suggesting that peer coaching can possibly be used as a developmental tool for professional autonomy among nurses.


peer coaching, professional autonomy, covariance structure analysis, initial career, nurses

Thought Process of the Expert Nurses for Supporting Decision Making of COPD Patients in the End-of-Life Stage

Rika Hamano, Asami Tsuji
Postgraduate School of Health and Nursing Science, Wakayama Medical University


結論:COPD 患者の終末期に移行する予測が困難である。そのため熟練看護師は、患者の意思を探索しながら意思決定支援の介入時期を見極め、看護師としての役割を自覚しながら自己との内省によってジレンマを乗り越え支援の実践に繋げる思考プロセスを辿っていた。

[Objectives] This study clarified the thinking process of expert nurses to support decision-making of COPD patients at the end-of-life stage and obtained suggestions for better nursing practices.
Method Semi-structured interviews were conducted from eight subjects, analyzed using SCAT, and a storyline was created.
[Results] The subjects were 8 expert nurses. 9 categories were generated from the analysis results: (1) understanding patients at the end of life, seeing it as an extension of their lives. (2) Recognition of difficulty in determining the timing of intervention for decision support. (3) Recognition of the possibility of reaching the terminal stage of each acute exacerbation. (4) Every time a patient recovered from acute exacerbations, the nurse provided support to give the patient an opportunity to think about how he/she would like to spend time in the future. (5) Continuous search for intention. (6) The patient's intention is reflected in the family's intention. (7) The role of the patient as an advocate for his/her own intention. (8) Unification and sharing of the direction of treatment/nursing. (9) Psychological dilemmas of nurses affected by patients and suppression of behavior.
[Conclusion] It is difficult to predict the transition to end-of-life in COPD patients. Therefore, expert nurses identify the timing of decision support intervention while exploring the patient's intentions, and while being aware of their role as a nurse, follow a thinking process that overcomes the dilemma and leads to the practice of support through self-reflection.


COPD(慢性閉塞性肺疾患)、人生の最終段階の過ごし方、意思決定支援、熟練看護師、 SCAT
COPD (chronic obstructive pulmonary disease), End-of-Life Stage, decision making, expert nurse, SCAT

Clinical Reasoning Process of Expert Nurses in General Wards

岡田純子 1、森嶋道子 2、梶谷佳子 1、中橋苗代 1
Junko Okada 1, Michiko Morishima 2, Yoshiko Kajitani 1, Mitsuyo Nakahashi 1
1 京都橘大学看護学部看護学科、2 天理医療大学医療学部看護学科
1 Faculty of Nursing, Kyoto Tachibana University, 2 Faculty of Health Care Department of Nursing Science, Tenri Health Care University


結果:エキスパートナースは【対象者を理解するための視点】を持ち、【積極的な関与】によって患者やその家 族への理解を深める。また、【心の動きに添う】ことに よって看護の対象者がどのように生きたいと願って いるのかを知り、【その人らしい生を支える】ことを 志向する。そして、患者にとって最適な看護を導くために【広い視野での推論】を行う。また【協力体制整備 のための工夫】について考えることによって、エキスパートナースの推論の幅は広がり、エキスパートナー スは、患者や家族への自身の理解、他の専門職者の見 解等をもとに、【看護の方向性の定まり】を得ていた。


Clinical Reasoning, Expert Nurses, Clinical Judgement

The relationship between Educational Needs, affiliation and years of experience of Public Health Nurses who work in prefecture A

戸谷紗嘉 1、吾郷美奈恵 2、伊藤智子 3
Suzuka Toya 1, Minae Ago 2, Tomoko Ito 3
1 知夫村役場村民福祉課、2 島根県立大学大学院看護学研究科、3 島根大学医学部看護学科
1 Welfare section, Chibu village office, 2 Graduate School of Nursing Science, The University of Shimane, 3 School of Nursing, Faculty of Medicine Shimane University


【結果】アンケートは176部を回収でき(回収率55.5%)、教育ニード未記入分を除き167部を分析対象とした(有効回答率94.9%)。所属は、県40名(24.0%)、市町村127名(76.0%)で、保健師経験年数16.9 ± 11.2年、看護師経験を有する者49名(29.3%)であった。教育ニード総得点は保健師の経験年数が短いほど高く(p<0.1)、看護師経験の有無による差は認めなかった。また、教育ニード得点は県・市町村ともに【対象者・家族の意思を尊重し自律的な問題解決を継続的に支援する】が最も低く、【専門的技能を発揮し、迅速・的確に問題に対処する】が最も高かった。


Public Health Nurses, Assessment tool of Educational Needs-For Public Health Nurses-, Years of experience, Career level


Support Available from Public Health Nurses for Preschool-children in Need of Medical Care

戸谷紗嘉 1、吾郷美奈恵 2、伊藤智子 3
Suzuka Toya 1, Minae Ago 2, Tomoko Ito 3
1 知夫村役場村民福祉課、2 島根県立大学大学院看護学研究科、3 島根大学医学部看護学科
1 Welfare section, Chibu village office, 2 Graduate School of Nursing Science, The University of Shimane, 3 School of Nursing, Faculty of Medicine Shimane University


【結果】医療的ケア児に対する支援内容として「平素の体制整備」14項目、「入院期」8項目、「在宅移行期」 15項目、「在宅療養期」13項目の計50項目が抽出できた。アンケートは317名に配布し176部の回答を得(回収率55.5%)、167部を分析対象とした(有効回答率 94.9%)。県・市町村ともに全ての支援内容が実施されており、5項目で県と市町村の実施割合に有意差を認めた。
【考察】医療的ケア児に対する支援は、児の状態や家族の状況などを踏まえて、必要に応じて実施されており、 50項目の支援は全て必要と考えられた。また、県と市町村の役割により実施割合は異なっていたが、所属機関に関係なく習得する必要がある。医療資源が十分でない地域においては、医療的ケア児の支援を経験する機会が少ない。そのため、医療的ケア児が地域で生活するために、事例検討や報告の場などの研修会等で行政保健師の実践能力を強化する必要がある。


Need of Medical Care, Public Health Nurses, Livelihood support, Preschool-children

Relationship between types of social activities and cognitive function among elderly people living in remote island

Kazuko Hashimoto, Kazuya Yamashita, Sayaka Fujita
The University of Shimane


方法:島根県の離島在住高齢者59名を対象者として、基本属性、社会活動、認知機能について質問紙調査を実施した。解析にはSPSSを用い、社会活動の総合点と認知機能との関連及び下位項目【1. 個人活動】【2. 社会参加・奉仕活動】【3. 学習活動】【4. 仕事】と認知機能との関連を、年齢、性別、教育歴を制御変数とした偏相関係数にて検討した。
結果:社会活動の総合点と認知機能及び下位項目【2. 社会参加・奉仕活動】と認知機能の間に有意の正相関がみられた。社会活動の下位項目【1. 個人活動】【3. 学習活動】【4. 仕事】と認知機能の間には相関がみられなかった。
結論:離島在住高齢者の社会活動の総合点と認知機能及び下位項目【2. 社会参加・奉仕活動】と認知機能には関連があることが示された。本結果を踏まえた社会活動の種類を計画立案し参加を促すことは、離島在住高齢者の認知症予防や健康の維持増進に繋がることが示唆された。

[Objectivess] As the community-based comprehensive care system is being developed in each region, participation in social activities has been emphasized as a means of preventing dementia and promoting health among the elderly. In this study, we aimed to clarify the relationship between the types of social activities and cognitive function among elderly people living in remote island.
[Methodss] A questionnaire survey on basic attributes, social activities, and cognitive function was conducted on 59 elderly people living on a remote island in Shimane Prefecture. SPSS was used to analyze the relationship between the total score of social activities and cognitive function, and the relationship between the sub-items [1. personal activitiess], [2. social participation and service activitiess], [3. learning activitiess], and [4. works] and cognitive function, using partial correlation coefficients with age, gender, and educational background as control variables.
[Resultss] There were significant positive correlations between the total score of social activities and cognitive function, and between the sub-items [2. social participation and service activitiess] and cognitive function. No correlation was found between the sub-items of social activities [1. personal activitiess], [3. learning activitiess], and [4. works] and cognitive function.
[Conclusions] The results showed that there was a relationship between the total score of social activities and cognitive function and between the sub-items [2. social participation and service activities] and cognitive function of elderly people living in remote island. The results suggest that planning and encouraging participation in social activities based on the results of this study will lead to the prevention of dementia and the maintenance and promotion of health among elderly people living in remote island.


social activities, cognitive function, remote island, elderly people

Care of Intensive Care Unit Nurses Leading to Acceptance for Ostomy Patients Undergone Emergency Operation

Chie Furukawa
School of Nursing Himeji University


本研究の目的は、緊急でストーマ造設術を受けた患者のストーマ受容に繋がるICU看護師の援助を明らかにすることである。患者12名に半構造化面接を行い、 Krippendorffの内容分析の手法を用いて質的記述的に分析した。分析の結果、【状況を説明しながら必死にケアする看護師の態度】、【手際のよいケアによる信頼感・安心感】、【苛立ちや不安に時間をかけてくれる看護師の存在】、【回復できれば何でもできると思わせる生命力への称賛】など6大表題が生成された。緊急でストーマ造設術を受けた患者は、ICUで意識が回復し医師からの説明を受けた後、現状を受け止めきれない【苛立ちや不安に時間をかけてくれる看護師の存在】を通して、ストーマとなったショックを徐々に落ち着かせ、実際に【手際のよいケアによる信頼感・安心感】を感じることで、ICU看護師からストーマの受容に繋がる援助を受けていることが示唆された。

The purpose of this study was to clarify how the support provided by ICU nurses helped patients who had undergone an emergency ostomy accept their ostomy. Qualitative inductive analysis was performed on semi- structured interviews conducted with 12 patients using Krippendorff's Content Analysis method. The analysis resulted in six major categories, including"an attitude among nurses to provide earnest care while explaining the situation," "trust and peace of mind through skillful care," "presence of nurses who spend time dealing with irritation and anxiety," and "admiration for their efforts to make us believe we can do anything if we recover." These results suggest that after patients who have undergone an emergency ostomy regain consciousness in the ICU and receive an explanation from the surgeon, they go through a stage in which the"presence of nurses who spend time dealing with irritation and anxiety, "unable to accept their current situation, gradually eases their shock over having a ostomy, and ICU nurses are able to help patients accept their ostomy by giving them "trust and peace of mind through skillful care."


Ostomy, Acceptance, Emergency operation, Intensive Care Unit nurse

Effective education in chronic phase of adult nursing and geriatric nursing practices-An analysis of learning contents of students in charge of the elderly in both practices-

堤雅恵 1、清永麻子 1、永田千鶴 1、齊田菜穂子 2、江藤亜矢子 2、渡邉則子 3、野垣宏 1
Masae Tsutsumi 1, Asako Kiyonaga 1, Chizuru Nagata 1, Nahoko Saita 2, Ayako Eto 2, Noriko Watanabe 3, Hiroshi Nogaki 1
1 山口大学大学院医学系研究科保健学専攻地域・老年看護学講座、2 山口大学大学院医学系研究科保健学専攻臨床看護学講座、3 九州大学病院看護部<
1 Division of Community/Gerontological Nursing, Faculty of Health Sciences, Yamaguchi University Graduate School of Medicine, 2 Division of Clinical Nursing, Faculty of Health Sciences, Yamaguchi University Graduate School of Medicine, 3 Kyushu University Hospital Nursing Departmen



This study aims to analyze the students' learning in the chronic phase of adult nursing and the geriatric nursing practices for effective educational values using the two practices. Eighty-four nursing students at A University received an adult nursing practice II (chronic stage) in their third year, and geriatric nursing practice in their fourth year. Fifty-seven students (67.9%) had taken charge of elderly patients aged 65 years old and above in both practices. Each learning contents sheet presented by 52 students was analyzed. The results showed that the age of the patients in the adult nursing practice was 76.6±6.7 years old and 83.5±8.3 years old in the geriatric practice, with significance (p<0.01). Three categories were extracted from the adult nursing practice contents: attitude of nursing, nursing to support proactive establishment of life, and team approach. Five categories were extracted from geriatric nursing practice: attitude of nursing, nursing to protect dignity, maintenance and improvement of life functions, team approach, and nursing conscious of the final stage of life. The results of this study indicate the close relationship of the two practices, but the students need to be aware of learning contents in each practice. It is important for students to learn the characteristics of perceptive functions and communication techniques of the elderly before the adult nursing practice in order to educate them. In geriatric nursing practice, it would be effective to encourage students to recall what they learned in adult nursing practice.


adult chronic nursing practice, geriatric

Student learnings through linkage between class in which teachers act as simulated patients and clinical practicum in fundamental nursing

Tomoko Ishimaru,Satoko Shin,Keiko Tanaka
Oita University of Nursing and Health Sciences


本研究の目的は「対象を理解する」ための基盤づくりを目的とした模擬患者参加型授業と基礎看護学実習の連繋を行うことによる学生の学びを、授業後・実習後のアンケートと基礎看護学実習の実習記録から明らかにすることである。A大学看護学部に在籍する1年次生81名を対象とし、授業後・実習後アンケートの分析は質的帰納的に分析を行い、実習記録はテキストマイニングを使用し量的に分析を行った。分析の結果、授業後アンケートでは『患者理解に必要な情報収集の視点』『患者理解と専門知識の重要性の理解』『意図的な情報収集方法』『記録の重要性と記載方法の理解』のカテゴリーが抽出され、実習後アンケートでは『対象理解のために必要な情報収集の視点』『生活者としての対象理解』『実習記録の書き方の理解』のカテゴリーが抽出された。また、実習記録の学びからは、実習中に経験し、観察した患者の姿や、それに対する看護師の看護実践が多く記述されていた。学生は基礎看護学実習前に、模擬患者の教員に対し情報収集を繰り返すことで「1. 主体的に情報を収集する技術力と姿勢の必要性」「2. 患者を生活者としてとらえ、健康上の問題を提示する重要性」「3. 自分の経験や考えを伝えるための実習記録の書き方の理解」を得ていることが明らかとなった。


Simulated Patient, Nursing Education, Clinical Practicum in Fundamental Nursing, Communication, Information gathering