看護とケアのジャーナル

Learning how to work effectively on inter-professional teams has been identified as an outcome competency in nursing education as specified by the Quality and Safety Education in Nursing Teamwork and Collaboration Competency [1] and in medical education as specified in the Liaison Committee on Medical Education [2]. How to teach teamwork skills, and where to place this content in the curriculum, is an ongoing problem for both medicine and nursing. The purpose of this paper is to describe the development and evaluation of a community work-place learning activity that evolved from a nursing student experience to an interprofessional experience.

Background: Nursing students from a large midwestern research university had been participating in a health screening research project of school children supported by the Elisabeth Severance Prentiss Foundation of their community health courses. Learning objectives for each course were broad with very little differentiation between levels. Using concept-based curriculum principles, and content from the Team STEPPS in 2006 national program, the courses were restructured and an interprofessional teamwork experience for nursing and medical students was implemented. All students participated in an extensive orientation that required each one to pass skills tests for taking an accurate blood pressure and performing accurate height and weight measurements. Nursing students were educated at two different levels: junior nursing students lead the activity while sophomore students focused on health screenings data collection and assessment. Previous to the restructuring, the team leader role was assumed by faculty. With role clarification, faculty shifted their function to the role of a team coach. Medical students were trained much like sophomore nursing students with the role of carrying out clinical tasks. Following each interprofessional teamwork experience, students completed the Interprofessional Collaborative Competencies Attainment Survey (ICCAS). IRB determined this to be exempt from review.

Results: An Independent sample t-test was used to compare mean score differences. Mean score differences on the ICCAS between inter-professional collaborative competencies before and after the experience for 122 participants showed a significant improvement between Total pre-mean score (M=116.5, SD=19.1) and Total post mean score (M=127.6, SD=15.2); t=8.5, p<0.001. Additionally, all ICCAS subcategories (Communication, Collaboration, Roles and Responsibilities, Collaborative Patient/Family Centered Approach, Conflict Management, Team Functioning) showed a significant difference between pre and post mean score differences.

Conclusion: The public health screening project funded by the Prentis grant was effective in learning interprofessional collaborative competencies while meeting nursing and medical student course learning objectives. Faculty creatively working together can overcome the obstacles to inter-professional education to promote learning teamwork and collaboration.

Aim of the study: To identify the attitudes of undergraduate Saudi nursing students towards studying nursing profession.

Background: Nursing profession is the backbone of the healthcare services and nurses in the workplace should be accountable to deliver high-quality of care. The Saudi Society, cultural forces and values influence nursing profession and its development. Assessment of undergraduate attitudes towards nursing profession is vital as it can help to identify the potential barriers, deficits and challenges to conquer them.

Methods: A descriptive cross-sectional survey was administered. The survey design was intended to identify the undergraduate Saudi nursing students’ attitudes towards studying nursing profession. Questionnaires were randomly distributed to 250 nursing students. Descriptive statistics were employed to identify the students’ attitudes towards the profession.

Results: A total of 141 students completed the survey questionnaires giving a response rate of 56.4%. The participating students 70 (52%) indicated that the most commonly reason to choose studying nursing was their own interest. Most of the students (48.90%) agreed that their English language proficiency is the hardest in the nursing program. The results showed that students favor to work on direct patient care rather than holding managerial or educational tasks. Generally speaking, the students’ families and friends had positive attitudes towards nursing profession.

Conclusion: The nursing students and families in Saudi Arabia had strong positive attitudes towards studying nursing profession. Universities in Saudi Arabia are to increase enrolling students to study nursing and should commit to graduate highly competent nurses to compensate the nursing shortage. Lack of students’ awareness of workplace literacy requirements might lead to difficulty in designing appropriate curriculum.

Purpose: The purposes of this study were to investigate the factors related to illness representations and their influence on self-management behaviors in hypertensive patients, based on Leventhal’s common-sense model.

Method: A cross-sectional study was conducted with a convenience sample of 149 patients with hypertension. Illness representations were assessed with the Illness Perception Questionnaire-Revised (IPQ-R) and data were analyzed using t-test, ANOVA, Pearson’s correlations, and hierarchical regression analysis.

Results: There were differences in patients’ illness representations depending on their demographic and healthrelated characteristics including medication adherence and the amount of time since hypertension diagnosis. Two dimensions of illness representations, in terms of predictability (β=-0.226, p=0.036) and coherence (β=0.246, p=0.029), were significant factors predicting self-management behaviors, indicating that patients who believed hypertension was more predictable and who were more confident of their awareness about hypertension engaged more actively in selfmanagement behaviors.

Conclusion: This study demonstrates the critical role of illness representations, leading to self-management behaviors of hypertensive patients. The findings highlight that a concrete assessment of illness representations is an essential task when developing nursing interventions to facilitate active self-management of hypertension.

The review focuses on qualitative literature describing the experiences of immigrant women with postpartum depression. Initial electronic searching was done by using Medline and CINAHL database. The references lists of related articles are also reviewed. Three articles were chosen for the review with careful consideration. The findings can be organized into three themes: differences of meanings of childbearing and postpartum practice among immigrant women, factors contributing to immigrant women’s postpartum depression, and factors aiding recovery. The results of the review can lead to instrumental and conceptual utilization. The review indicates that some further research, including research from the perspectives of health care givers, and research on immigrant cultures, is needed

Every year, approximately 1.38 million people are diagnosed with breast cancer, worldwide. Previous studies have shown that religiosity is crucial for the health and quality of life of cancer patients. This study explored religious faith associated with the recovery experience of women who survived breast cancer for more than five years without recurrence. A qualitative methodology was used and in-depth semi structured interviews were conducted. The interviews were audio-taped. Data were transcribed and analyzed using content analysis. Data were saturated after interviewing 10 breast cancer survivors, mostly Buddhists. Four common themes were developed: peace of mind, obey God’s will, religious social support, and being grateful. The findings of this study revealed crucial suggestions for healthcare professionals and providers of follow-up care in services for breast cancer survivors.

Background: New methods are needed in continuing professional development of emergency staff. The article describes simulation-based teaching in continuing professional development of emergency care staff, who wants to revise and update their advanced resuscitation skills and practise inter-professional team work to better manage critical incidents.

Methods: The focus is on the factors that need to be considered when planning simulation pedagogy for mature learners. The manuscript is a case report. A case presentation from Finland is provided.

Conclusion: Simulation-based learning is found to suitable for experienced participants as they are prepared to go profoundly and holistically into a subject area and to combine action-based learning, critical enquiry and reflection. Participants can safely practise rare and critical events, learning from other experienced professionals. They can even become co-developers of education, as their experience and tacit knowledge can be incorporated into training programmes.

Many hospitals worldwide have recently experienced a rise in turnover rates among their healthcare professionals. For example, in the United States, the turnover rate of healthcare professionals has dramatically increased from 13.5% in 2011 to 17.2% in 2015. Almost 40% of newly employed nurses in the United States intend to quit their jobs and search for new positions within the first year of their employment. The existing literature has documented many factors that can contribute to high turnover rates such as stress, feelings of inadequacy, lack of professional development and training, limited opportunities, and lack of the required skills and knowledge. However, a new factor that can lead to turnover has recently been discussed in the literature and is gaining greater attention: the conflict that exists between work and family demands. In this paper, we discuss the concept of workfamily conflict, its consequences, and a promising strategy to effectively tackle this issue and address its consequences. Helping healthcare providers to maintain the balance between work and family demands can reduce stress and increase job satisfaction among nurses, which can eventually lead to their retention in the workplace.

Background: Although urinary incontinence is not life threatening, the condition is one of ‘inconvenience’ and is associated with widespread adverse physical and psychological consequences. For many women, there is a general consensus to ‘accept’ the condition, bear the problem and not seek health care to manage the physiological leakage until the problem becomes unbearable and distressing to their daily lives.

Objective: To identify health care-seeking behaviors of women with urinary incontinence (UI).

Method: A retrospective descriptive exploratory design was utilized in this study. A convenience sample of 249 women who had UI, recruited from the outpatient clinics of three hospitals. Two tools were validated and used to collect data: Tool I: biological and socio-demographic and reproductive history interview schedule; and Tool II: health care-seeking behaviors of women with UI.

Results: The results clarified that the study subjects’ health-seeking behavior for UI was poor. The majority (89.2%) did not seek medical consultation for UI; they attended urologic or gynecologic outpatient clinics to treat other health problems .They followed self-care practices such as use of protective pads and decrease fluid intake. A highly statistically significant correlation between help-seeking behaviors and frequency of UI, amount of urine leakage, severity of incontinence and suffering from terrible disturbances UI was revealed. Furthermore, women believed that UI is a natural part of aging and a consequence of vaginal childbirth, and that there is no effective cure or treatment. It is recommended to empower primary care providers in frontline care delivery with the necessary skills, knowledge base and tools to educate women in healthy behaviors, and UI prevention modalities.

Introduction: OPTIMA is a multi-professional quality management and research project, conducted at the Cantonal Hospital of Aarau (KSA), Switzerland in cooperation with post-acute care institutions from November 2009 until December 2012.

Objective: The goal of this study was to optimize patient care pathways and to provide patient-centered, costeffective care that is conform with the introduction of the Diagnosis Related Groups (DRG) in 2012.

Methods: The “Post-Acute Care Discharge Scores” (PACD) was applied to assess the risk for transfer to postacute care facilities in 240 patients suffering from lower respiratory tract infections during the first phase of the study (OPTIMA I) from October 2009 until April 2010. In order to assess the patients’ self-care ability, the “Self-Care Index” (SPI) tool was applied on admission and during the course of inpatient treatment.

Results: The PACD predicted that 55% of patients (N=202) were at medium to high risk of requiring post-acute care. According to the SPI, 38% of patients (N=217) showed reduced ability to care for themselves. The discharge of 69% of medically stable patients (N=43) was postponed due to shortage of beds in post-acute care facilities. Correspondingly, 62% of the medically stable patients (N=141) could imagine receiving post-acute care in a “Nurseled Unit” (NLU). Despite being medically stable, one third of the patients (N=124) was not ready to return to their homes because they felt too weak or insecure to cope with everyday life.

Conclusion: Using standardized tools to predict patients at risk for transfer to post-acute care facilities and reduced self-care abilities and the continuous evaluation of medical stability are all methods that could be applied to enhance interdisciplinary care and optimize discharge management. Furthermore, setting up NLU is expected to unburden the occupancy of acute care beds by a considerable amount of patients who are in need of post-acute care.

Communication skills are essential for all categories of health care workers. The Calgary Cambridge Model of communication is accepted as a doctor patient communication model in Europe and Canada. It has world-wide recognition and is now used as a model for teaching communication in disciplines like nursing and veterinary science. Since the value of an interdisciplinary approach in continuous professional development has been recognised and all categories of health care professionals face similar challenges with regards to communication with patients an educational activity was developed to facilitate the learning of communication skills as a multidisciplinary team. Feedback on this program was accessed by means of observations, questionnaire and focus group discussions. Results revealed that there was positive feedback on this approach as a means of communications skills training.

Objective: The process of changing student nurses attitudes, values, and behaviours so that they become congruent with the profession are neither easy nor successful in all cases. This paper will clearly highlight to the reader the conditions necessary in order to both optimise teaching activities and measure the degree of change in the affective domain of student nurses.

Method: The aim of the meta-ethnography was to analyse and synthesize literature on the impact of four undergraduate pre-registration programme enrichment activities (Inter-professional learning, International placements, simulation, and blended learning) on the affective domain development of student nurses. A systematic search of the literature identified qualitative studies using explicit criteria. Key concepts were identified and translated across the studies, by using a recognised framework that measured changes in values and attitudes: compliance, identification, and internalisation, from the collective views of the participants. The findings created a line of argument synthesis from the developed tables and mind maps.

Results: Data were synthesised from twenty nine papers, across seven countries, with more than 755 student nurse participants. Reciprocal translation highlighted teaching activities that created significant modification in affective domain development, resulting in the internalisation of learning, were those that introduced the nursing students to a new patient, personal or professional culture via an international placement or an inter-professional training programme.

Conclusion: The final synthesis presents conclusions not evident in the primary studies. To develop students so they have attitudes and values congruent with the profession, academics and registered practitioners need to focus on creating enrichment activities alongside the regular curriculum that are: based on cultural issues that challenge beliefs and assumptions, either immersive or repeated for more than 6 weeks, based around or in clinical practice, and provide regular opportunities for premise reflection with experienced staff.

Worldwide, 30% of all men, (665 million), are circumcised for various reasons including cultural, religious and medical reasons. This figure is too low, considering that it is projected that by the end of 2015 80% of all males should have been circumcised in order to reduce sexual transmission of HIV infection by 50% by 2025. Though prevalence of male circumcision is high in Jewish, Islamic and Muslim countries where it is about 98%, in some parts of the world, it is less than 5%. The purpose of this study was to assess the level of knowledge of medical benefits of male circumcision among pregnant women aged 18-35 years at Parirenyatwa Antenatal Clinic in Harare, Zimbabwe. The study was conducted with a convenience sample of 30 pregnant women. Data was collected from February to March 2013 using structured questionnaires. The health belief model was the guiding framework for the study. Permission to carry out the study was granted by the respective institutional review boards and all participants gave written consent. Data was analyzed using Microsoft Excel. Results indicated that 66.7% knew that male circumcision is a preventive method of HIV. Twenty five (83.3%) were aware that it was easier to be infected with HIV if he is not circumcised that when he is circumcised. Ten percent of the respondents demonstrated low knowledge of Voluntary Medical Male Circumcision while 53.3% had moderate knowledge and 36.7% had high levels of knowledge about VMMC. It follows from the study that women need to be actively involved in the VMMC programme.

Determining the clinical competency of nursing students before graduation involves many challenges. Recently in Taiwan, objective structure clinical examinations have been promoted for evaluating the clinical competence of nursing graduates. Objective structure clinical examination remained controversial, despite many studies having demonstrated the benefits of such examinations and their extensive use in nursing education. In this commentary, we discuss the benefits and drawbacks of using objective structure clinical examination in the nursing education to provide reference for their application.