酒井 郁子

Objective: The objective of this review is to explore the experiences and attitudes of physicians, nurses, and nursing assistants regarding task-shifting and task-sharing in hospitals. Introduction: Despite multiple health care professionals performing overlapping tasks, the need for effective task-shifting and task-sharing remains a concern. Understanding task-shifting and task-sharing experiences, as well as the attitudes of health care providers in hospitals, is essential for providing safe and patient-appropriate care with limited human resources. Inclusion criteria: Qualitative studies that examine the experiences and attitudes of physicians, nurses, and nursing assistants in hospitals regarding task-shifting and task-sharing will be included. The review will include physicians, advanced practice nurses who are nurse practitioners or clinical nurse specialists, registered nurses, and nursing assistants. Midwives, pharmacists, occupational therapists, physical therapists, and students will be excluded. Methods: PubMed, MEDLINE, CINAHL, PsycINFO, Cochrane Database, and Web of Science will be searched as part of a 3-step search strategy. We will search for unpublished research and gray literature using Google Scholar and ProQuest Dissertations and Theses. Inclusion criteria will be studies published in English or Japanese from the time each database was established to the present. The methodological quality of all studies will be evaluated by screening against the inclusion criteria and by at least 2 critical evaluations using the standardized JBI checklist. Synthesized results will be pooled by meta-aggregation and published as a ConQual Summary of Findings. Review registration: PROSPERO CRD42023409612

Background. Strategic leadership is key to implementing evidence-based practice (EBP). Evaluating the readiness and processes necessary to implement EBP using the Japanese version of the implementation leadership scale (ILS) may be useful to systematically promote the implementation of EBP in Japan. This study aimed to evaluate the reliability and validity of the Japanese version of the ILS for nurse managers and staff nurses. Methods. Data were collected in a cross-sectional study. The original ILS was translated into Japanese and back-translated into English. Clinical nurses reviewed it and confirmed its face validity. We distributed a web questionnaire to 119 nurse managers and 2,858 staff nurses working at three university hospitals in Japan’s metropolitan areas. Construct validity was assessed for nursing managers and staff nurses, respectively, using confirmatory factor analysis. Known-group validity for nurse managers was assessed by verifying differences in ILS scores by educational background and experience of learning EBP and working on EBP. We evaluated reliability using Cronbach’s alpha and test-retest reliability. Results. The response rates for nurse managers and staff nurses were 56.3% and 16.9%, respectively. Data from 67 nursing managers and 484 staff nurses were analyzed, excluding duplicate responses. Confirmatory factor analyses of both samples supported the four-factor structure of ILS. The ILS total score of nurse managers with experience learning EBP or experience working on EBP was statistically significantly higher than that of those with no experience, and known-group validity was supported. Across both samples, internal consistency reliability was strong (Cronbach’s alpha: 0.91–0.97) and test-retest reliability was moderate. Conclusion. This study illustrated the reliability and validity of Japanese versions of the ILS for both nurse managers and staff nurses. This study enabled international comparisons of the leadership required for EBP implementation and may support the development of intervention programs and strategies to promote EBP’s implementation in different countries. Trial Registration. UMIN Clinical Trials Registry (UMIN-CTR). This trail is registered with UMIN000045782.

本研究は,急性期病院で特定行為研修修了者の効果的な活動を支援するため,施設管理者および看護管理者の管理実践の要素を明らかにすることを目的として実施した.特定行為研修を受講した看護師がいる病院の施設管理者と看護管理者を対象にオンラインで半構造的面接法による個別インタビューを行った.インタビューは1人あたり20分程度行い,録画をもとに逐語録を作成しデータを収集した.調査期間は2021年3月である.研究協力者は施設管理者8名と看護管理者11名だった.特定行為研修修了者の活動を支援する管理者の管理実践には,「組織における修了者の活躍を期待する」「組織における修了者活用のニーズを把握する」「特定行為研修制度及び修了者に対する理解を得る」「組織の機能に応じた修了者の配置計画を立案する」「特定行為研修に看護師を送り出して受講継続を支援する」「組織の構想に応じて修了者を配置する」「組織で修了者が活動継続するための環境を整える」「修了者の活用による効果を見出す」「組織の構想に応じて修了者の活動を調整する」「修了者の活動を多様な対象に周知する」が含まれていた.これらは特定行為研修修了者を導入して複数の修了者を組織で配置・活用するための管理実践の要素として解釈でき,構想・育成・配置・活用・最適化・周知が見いだされた.(著者抄録)

本研究の目的は,特別養護老人ホーム(以下,特養)入居者のエンドオブライフにおけるケアニーズの構造を明らかにし,入居時から死亡までのケアニーズに基づくケアの体系化への示唆を得ることである.特養での看護経験があるエキスパート看護師が36人を対象にフォーカスグループインタビューを実施し,語られた118事例を質的帰納的に分析した.特養入居者のエンドオブライフのケアニーズは,【いつもと違う症状を言語で表出できない】【身体機能が低下し続け新たな健康障害が生じる】【痛みと意欲低下により動くことが難しい】【嚥下機能が低下し満足できる食事摂取が難しい】【不安で気持ちが落ち着かない】【安らかに最期までなじみの場で過ごすことが難しい】の6カテゴリーが互いに影響し合い,コンフォートな状態を目指す際のケアの必要性が拡大していく構造が示された.その根本には,避けることができない老衰がある.生活の延長線上で死を迎えるまで,急変の回避や苦痛の低減などを意図した高度な予後予測と適切な判断をもとに,長期的にケアニーズを充足する援助が必要である.(著者抄録)

AIM: To describe factors affecting critical appraisal of research articles in evidence-based practice by certified nurse specialists who were advanced practice nurses in Japan. DESIGN: A descriptive qualitative study. METHODS: Fourteen certified nurse specialists with master's degree were included by a snowball sampling to maximize the variety of specialty fields for advanced practice nurses in Japan. Individual semi-structured interviews were conducted between November 2016 and March 2017. Interview guides included the experience of evidence-based practice and learning about critical appraisal. RESULTS: The following four aspects were identified as factors affecting the critical appraisal of research articles in evidence-based practices-individual beliefs and attitude, learning status, organizational readiness and availability of research evidence. Each factor included both positive and negative aspects for critical appraisal in evidence-based practice. PATIENT OR PUBLIC CONTRIBUTION: If advanced practice nurses acquire knowledge/skills of critical appraisal, they would be able to select more appropriate care. This will increase to improve the health-related outcome for patients or populations.

本研究は,IPE(Interprofessional education)のアウトカムである専門職連携実践コンピテンシーが,IPEの教育体験や基本属性から受ける影響について,また,他職種とのコミュニケーションの実践に与えている影響を検討した.2つの特定機能病院に勤務するすべての医療専門職3,070名を対象とする自記式質問紙調査を行い,1,691名から回答が得られた(回収率:55.1%).Chiba Interprofessional Competency Scale 29によって測定した専門職連携実践コンピテンシーは,性別,学歴との関係は認められなかった.年齢は20歳代でその得点が低く,一定年数の職業経験がコンピテンシーを高めることが示唆された.現任教育のIPEはコンピテンシーを高めること,また,卒前教育のIPEは現任教育を介して間接的にコンピテンシーを高めることが示唆された.医師看護師間のモデルの検討では,コンピテンシーに関連する要因の構造に大きな違いは認められなかった.IPEの重要性が示唆されたとともに,モデルの精緻化や職種別の更なる検討等の課題が残された.(著者抄録)

Abstract Background Interprofessional collaborative practice competency (ICPC) is key to providing safe, high-quality, accessible, patient-centred care. Effective delirium management, particularly, requires a multi-component intervention, including the use of interprofessional teams at care point. This research aims to investigate the effectiveness of the flipped classroom approach for improving ICPC in simulation-based delirium case management. Method An embedded mixed-methods study was designed to investigate the effects of the flipped classroom approach on health professionals’ performance in delirium management. The study population comprised nine health professionals (three physicians, nurses, and pharmacists each). They used pre-class study materials about delirium management via a digital learning platform before a simulation case training session. A readiness assurance process test was conducted on key concepts, covered in the pre-class study material. Participants were randomly assigned to three teams, each of which included health professionals. Each team participated in a simulation case scenario. For the quantitative outcome measures, the Chiba Interprofessional Competency Scale (CICS29), a validated scale for measuring competencies of interprofessional practice, was used before, after, and three months after the educational intervention. The qualitative component consisted of a post-training questionnaire and semi-structured focused group interviews about the impact of the flipped classroom approach. Result The CICS29 measured after the intervention and three months after was noted to be significantly higher than before the intervention. Three semi-structured focused group interviews were conducted (n=9), which, upon analysis revealed that the flipped classroom approach effected on four stages of Bloom's taxonomy level. A total of nine categories and 17 subcategories were identified corresponding to four levels of the revised Bloom’s taxonomy: remember (1), understand (12), apply (23), and analyse (3). Conclusion The simulation-based skill training using flipped classroom approach can be an effective method for improving ICPC for health professionals. In this approach, an elevated level of cognitive activity is practiced in the Bloom’s taxonomy, and the participants worked on an application-based case simulation that promoted higher level learning and engagement in interprofessional collaborative practice. This approach also established a basic common language of delirium assessment and management, thus facilitating communication among health professionals and improving ICPC.

AIMS: This review aimed to determine the characteristics of a nurse-led intervention for people with dementia including mild cognitive impairment and their family in an ambulatory care setting. BACKGROUND: Enhancing the role of nurses in a multidisciplinary team of ambulatory care follow-up after a diagnosis of dementia is thought to lead to successful dementia care. DESIGN: This is a scoping review. DATA SOURCES: MEDLINE, CINAHL, EMBASE, Cochrane, JBI, Japan Medical Abstracts Society, PsycINFO and Web of Science were searched on 14 March 2019. REVIEW METHODS: This scoping review was conducted using the Joanna Briggs Institute methodology, followed the PRISMA-ScR checklist and considered studies that included interventions conducted by nurses and included outcomes regarding dementia symptoms or family care burden. RESULTS: Eleven studies were included. Of these, all interventions were multifactorial and reported effective results. Educational interventions were most common, and the content of education included the characteristics of dementia and how to interact with patients with dementia. The roles of nurses included caregiver education, assessment, care plan creation for continuous monitoring and team building. CONCLUSION: This scoping review suggested that effective nurse-led interventions in the ambulatory care of people with dementia are continuous patient and family supports, primarily caregiver education within multidisciplinary teams.

Utilizing automatic daily body weight (BW) measurements may be helpful for assessing nutritional status and detecting underlying diseases particularly in older people who require nursing care. This preliminary study aimed to verify effectiveness of eating assistance for maintaining BW in older people using a contact-free load cells under the bed (Bed Sensor System: BSS). BW was measured every night for 3 months in eight nursing home older people with severe cognitive and physical dysfunctions. Body composition of the subject's trunk and each limb was measured using a segmented multi-frequency bioelectrical impedance analyzer (BIA). A monthly BW loss was estimated as a slope of linear regression of the daily BW plot. BSS successfully measured daily BW for the study period in all participants. The 4 residents with eating assistance gained slightly more weight, while the 4 residents without eating assistance lost weight. There was a significant difference between the two groups in the monthly BW change (- 0.79 ± 0.51 kg/month versus 0.20 ± 0.49 kg/month, P = 0.030). None of the BIA-derived parameters was associated with the monthly BW change. BSS revealed effectiveness of eating assistance to maintain BW in nursing home residents with severe cognitive and physical dysfunctions.

目的:急性期病院では身体疾患の治療のための認知症高齢者の入院が急増してせん妄や身体拘束などが課題となっている.認知症高齢者の認知症医療や看護の質向上,さらには身体拘束低減をめざしたパーソン・センタード・ケアを基盤としたe-learningによる認知症看護実践能力育成プログラムを開発した.本研究の目的は7対1看護基準の急性期病院における看護師を対象に,同プログラムの有効性の検証を行うことである.方法:2020年4月から〜12月に介入プログラムを実施した.対象者病院の病棟看護師に研究を紹介して募集した.対象者には「e-learning:認知症看護実践能力育成プログラム(4週間)」の受講と介入評価アンケートでは,(1)受講前(ベースライン),(2)受講直後(1ヵ月後),(3)実践3ヵ月後,(4)実践6ヵ月後の計4回を実施した.アンケート調査では同プログラムに関する有効性の評価として,認知症看護の意識では「認知症高齢者の看護への関心」,パーソン・センタード・ケアをめざした看護実践自己評価尺度,日本語版Approaches to Dementia Questionnaireを用いて評価した.さらに臨床看護師の倫理的感受性尺度,身体拘束の低減に関する自己効力感に関して評価した.結果:本研究の対象者は71名,所属病棟は外科系・内科系など60名(85.7%),認知機能障害のある患者の入院は半数程度が最も多く30名(42.3%)であった.臨床経験は13.5±9.5年であった.「点滴・中心静脈・経管栄養などのチューブを抜かないように,ミトン型手袋をつける」を低減できる自信(self-efficacy),急性期病院の認知障害高齢者に対するパーソン・センタード・ケアをめざした看護実践自己評価尺度,日本語版Approaches to Dementia Questionnaireのそれぞれの合計点は,ベースラインと比較して介入直後,3ヵ月後,6ヵ月後と有意に増加していた.結論:本研究の介入プログラムは参加者が簡便に学習し,実践できる有効な介入であることが示唆された.(著者抄録)

Although many screening tools for delirium are available, delirium is still occasionally overlooked or misdiagnosed. One of the reasons for this is the lack of brief screening tools that do not require specialized training to use. The 4 'A's test (the 4AT) is a validated screening tool for delirium that can be administered in a very short time without specialized training. Herein, we evaluated the reliability and validity of the Japanese version of the 4AT (the 4AT-J). A total of 150 patients aged ≥ 65 years were enrolled. Their demographics and clinical characteristics were obtained within 24 hr of their hospitalization. On each patient's high-risk day of developing delirium, the 4AT-J was administered by a nurse, and the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-Ⅴ) and the Japanese version of Delirium Rating Scale-Revised-98 (DRS-98-J) were administered by a psychiatrist. Our analyses revealed that when a cut-off score of 4, the 4AT-J showed high sensitivity and specificity. The Cronbach's α-coefficient was similar to that of the original version. A receiver operating curve analysis showed sufficient power of the 4AT-J to discriminate delirium. The 4AT-J showed adequate reliability and validity for delirium screening in elderly patients.

PURPOSE: The number of hospitalizations of older patients with dementia who require medical treatment has increased and delirium or physical restriction have become problems in the acute care setting. Dementia nursing intervention ability developing program by e-learning assumed the quality improvement of dementia medical care and the nursing of older patients with dementia based on person-centered aimed at reduction of body restriction. The purpose of this study was to validate the effectiveness of the developed e-learning programs for nurses in the acute care setting of seven to one nursing standards. METHOD: This study was conducted between April and December 2020. This study was introduced to the floor nurse of the hospital for suitable application. Interested nurses were asked to attend "Developing programs for Dementia nursing intervention ability (4 weeks)" at four different time points (1) before attendance (baseline), post-attendance (1 month later), (3) practiced 3 months post-attendance, and (4) practiced 6 months post-attendance. A questionnaire to evaluate program effectiveness asked about consciousness of the dementia nursing with four items on "Interest in nursing of people with dementia and so on (four items)".In the evaluation on the person-centered dementia care, using the Self-assessment Scale of Nursing Practice for Elderly Patients with Cognitive Impairment, the Approach to Dementia Questionnaire - Japanese Edition (19 items). In the evaluation of ethics, ethical sensitivity scale for clinical nurses (19 items), self-efficacy on reduction of the physical restriction (six items). A statistical analysis was conducted using the Bonferroni test as the multiple test method to compare baseline values with the values obtained 1, 3, and 6 months later. RESULTS: A total of 70 subjects were analyzed in this study. They belonged to different wards including the surgical and internal wards from where 60 subjects (85.7%) were recruited. The average clinical experience of the nurses was 13.5±9.5 years. The degree of self-efficacy was assessed in terms of attaching mitten type gloves as a physical restraint to avoid the pulling of tubes used for intravenous feeding, central veins, normal feeding, etc. by the patients and so on. Most patients had cognitive functional disorder, including dementia [n = 30 (42.9%)]. The self-assessed scale of nursing practice for elderly people with cognitive impairment, which aimed to promote person-centered care in an acute care hospital, revealed that the total score of each of the Approaches to Dementia Questionnaire - Japanese Edition significantly increased just after intervention (1 month) in comparison to baseline, and 3 months and 6 months after intervention. CONCLUSION: This study indicated that the program developed to improve dementia nursing intervention ability significantly increased the above-mentioned evolution and consciousness of nurses after the intervention program (1 month), followed by 3 months and 6 months later. Along with ethical sensitivity, practice aimed at person-centered care was also found to improve. It was suggested that the intervention program of this study was effective and that nurses could easily learn using their respective free time and practice.

千葉大学で2020-2021年に実施したオンラインでの大規模IPEについて、4段階の段階的プログラムのうち初学年を対象とした"Step1"での協働学習と体験学習に焦点を当てて報告する。協働学習では、オンデマンド型ツールのみ使用したグループと同時双方向性ツールと併用したグループ間の比較で、学生のグループワーク自己評価得点の平均が併用グループの方が有意に高い結果であった(p<0.05)。教員評価得点には有意差はなく、オンデマンド型ツールを用いた学習では特に教員からの肯定的フィードバックが必要と思われた。体験学習に関しては、患者・サービス利用者とのメールおよび同時双方向性ツールを用いたインタビュー学習について実施上の課題を報告した。学生の各種ICTツールへのリテラシー状況のアセスメント、患者・サービス利用者の個人情報保護のさらなる徹底が課題である。(著者抄録)

千葉大学で2020-2021年に実施したオンラインでの大規模IPEについて、4段階の段階的プログラムのうち初学年を対象とした"Step1"での協働学習と体験学習に焦点を当てて報告する。協働学習では、オンデマンド型ツールのみ使用したグループと同時双方向性ツールと併用したグループ間の比較で、学生のグループワーク自己評価得点の平均が併用グループの方が有意に高い結果であった(p<0.05)。教員評価得点には有意差はなく、オンデマンド型ツールを用いた学習では特に教員からの肯定的フィードバックが必要と思われた。体験学習に関しては、患者・サービス利用者とのメールおよび同時双方向性ツールを用いたインタビュー学習について実施上の課題を報告した。学生の各種ICTツールへのリテラシー状況のアセスメント、患者・サービス利用者の個人情報保護のさらなる徹底が課題である。(著者抄録)

In the 1990s, interprofessional education (IPE) was introduced to health professionals in higher education; it has come to be regarded as a standard learning method. However, major barriers remain regarding its introduction and smooth operation. This study conducted a questionnaire survey at educational facilities for health professionals in Japan; it developed scales to measure the recognition of barriers to and benefits of IPE implementation. We surveyed chairpersons responsible for 2,690 courses in Japanese health education facilities. We used for analysis the responses related to 767 courses (valid response rate, 28.5%). In all, 216 courses (28.7%) implemented IPE. We conducted exploratory factor analysis and developed scales for measuring the recognition of barriers to IPE implementation (15 items) and its benefits (11 items). We observed a significant relationship between the state of IPE implementation and recognition of barriers to and benefits of IPE. Using information and communication technology and faculty development for faculty members would be effective in removing the barriers to IPE implementation.

【目的】本研究は、一般病棟から回復期リハビリテーション病棟へ異動した中堅看護師がリハビリテーション看護を受け入れる要因を明らかにし、要因と属性の関係を探索することで属性に応じた教育支援の示唆を得ることを目的とする。【方法】全国の回復期リハビリテーション病棟に所属する中堅看護師5,435人に自記式質問紙調査を実施し、内容分析によりリハビリテーション看護を受け入れる要因を形成した。また、要因と属性の関係はχ2検定、t検定により比較した。【結果】有効回答数は、703人(12.9%)であった。リハビリテーション看護を受け入れる要因は、【患者の回復過程を支えるやりがい】【多職種協働による看護師の役割意識の明確化】【他者からの指導やロールモデル】【治療優先から生活機能優先への視点の転換】等の7カテゴリーであった。要因につながる記述の有無により年齢、経験年数に有意差を認めた。【結論】中堅看護師の年齢や回復期リハビリテーション病棟経験年数に応じた教育支援の具体的示唆を得た。(著者抄録)

Background: Role-play (RP) and peer review (PR) are occasionally used in training and evaluating communication skills in clinical clerkship (CC). Thus, we evaluated the effect of combining RP and PR during student-oriented CC rounds.Methods: Clerkship students conducted medical interviews with and performed physical examinations on their patients, which were reviewed by five peer students who observed their performance while role-playing as senior physicians or patients' families. The peer reviewers then provided feedback to the students. The performance of the students was evaluated based on a mini-clinical evaluation exercise (Mini-CEX) and a professionalism mini-evaluation exercise (P-MEX) before and after the rounds by two attending physicians. After the CC, the students responded to questionnaires about the rounds.Results: Seventy-five students completed the rounds, and the duration of each round was 41.7 ± 7.1 min. Their communication skills and professionalism abilities on Mini-CEX and P-MEX showed significant improvement after the rounds. Improvements in medical interviewing and physical examinations were also noted. Additionally, the students recognized the importance of multiple viewpoints in patient care through experiences of the rounds.Conclusions: Combining RP and PR with CC rounds improves the students' clinical performance and professionalism and promotes their awareness of the importance of multiple viewpoints in patient care.

Aim This study aimed to explore sociodemographic factors related to evidence-based practice (EBP) competency in Japanese nurses in university hospitals. Methods In March 2016, a survey was distributed to 843 clinical nurses who directly provide nursing care at two university hospitals in Japan. Multiple regression analyses were conducted on data received from 472 nurses using the Evidence-Based Practice Questionnaire (Japanese version). Results Sociodemographic factors related to EBP competency were experience with conducting nursing research as a part of continuing education, education about EBP, advanced practice certification (certified nurse specialists/certified nurses), and years of experience in clinical nursing. These factors differed across the four subscales of the questionnaire: Practice, Attitude, Knowledge of Research and Practice, and Skills of Research and Practice. Specifically, experience with two or more nursing research activities was significantly positively associated with Attitude and Knowledge/Skills Concerning Research and Practice of EBP, but not related to the implementation of EBP itself. Advanced practice certification was significantly positively associated with Practice and Attitude of EBP. Conclusions Our study quantitatively identified sociodemographic factors including experience with conducting nursing research and advanced practice certification status that were found to be related to EBP competency and these factors were differently associated with the four subscales of the Evidence-Based Practice Questionnaire (Japanese version). EBP education should depend on nurses' levels of EBP competency, and nursing educators and managers need to be cognizant of their nurses' sociodemographic factors when providing EBP education.