Journal Article 熟練助産師の分娩介助におけるReflectionの探究
Reflection of the care for childbirth made by expert midwives

紙尾, 千晶  ,  島田, 啓子

30 ( 1 )  , pp.17 - 28 , 2016-01-01 , 日本助産学会 = Japan Academy of Midwifery
目 的  熟練助産師が分娩介助の経験を積みながら,どのようなreflectionをしているのかを明らかにする。 対象と方法  解釈学的現象学を理論的背景として14名の熟練助産師に対して,参加観察及び面接調査を行った。 結 果  助産師のreflectionは,分娩介助しているプロセスの中で行われるreflectionと,介助の終了後に行われるreflectionに大別された。  そして介助のプロセスの中で行われるreflectionは,予測外の展開や不確かな状況を気がかりとして感知するかどうかによって違いがみられた。まず,気がかりを感知した状況では,助産師は過去の経験知から様々な手段を携えて試行していく【様態1:試行を生み出すreflection】を行っていた。一方,正常に経過,進行していく想定内の状況においては,気がかりを感知せず,自身の経験知や身体感覚を復元させて瞬間的に介助行為に取り入れる【様態2:状況との融合を生み出すreflection】を行っていた。そして介助行為の後には【様態3:鏡映的に自己を客観視して洞察するreflection】を行っていた。  【試行を生み出すreflection】は2つのテーマ,〈成功する確信がない中で反応を探りながら試行する〉〈過去の経験で身に着けた豊富な手段を引き出す〉に整理された。  【状況との融合を生み出すreflection】は2つのテーマ,〈身体感覚を復元させて状況の意味を瞬時に見抜く〉〈正常性を見通して自然な行動を導く〉に整理された。  【鏡映的に自己を客観視して洞察するreflection】は5つのテーマ,〈気がかりが引っかかり心を揺さぶられながら取り組みを見直す〉〈その人にとっての出産の意味付けを共に考える〉〈経験した学びをパターン付けして塗り替える〉〈助産師として関わる自分の姿勢を見つめ直す〉〈他者との関わりの中で自分の経験知を磨き究める〉に整理された。 結 論  熟練助産師のreflectionは3つの様態,【試行を生み出すreflection】【状況との融合を生み出すreflection】【鏡映的に自己を客観視して洞察するreflection】に大別できた。 Purpose This study aims to clarify the reflections made by expert midwives during their care for childbirth. Methods 14 expert midwives were observed during their practice and interviewed. Interpretative phenomenological analysis of the interview was made. Results The reflection made by midwives were classified into two categories, a reflection made during and after their care for childbirth. Whether the midwife was aware of unpredictable or uncertain situations as a concern was the difference seen in the reflection made during the care for childbirth. When a midwife was aware of concerning situation, [State 1: reflection that creates trials] was made where midwives reflect on their past experiences and took various trials to prepare themselves for the event that they assumed to follow. On the other hand, when childbirth was progressing normally and as predicted, [State 2: reflection that fuse with the situation] was made where midwives were not aware of any concerns and instantaneously restored their empirical knowledge and their somatic sensation into their care. After their care, [State 3: reflection by mirroring and seeing themselves objectively] was being made. The [reflection that creates trials] was sorted out into 2 themes, <making trials while uncertain of its success> and <drawing out means from ones' rich past experience>. The [reflection that fused with the situation] was sorted out into 2 themes, <recognize the situation instantly through restoring their somatic sensation> and <leading natural action foreseeing the normality of the process>. The [reflection by mirroring and seeing themselves objectively] was sorted into 5 themes, <reconsidering their action due to their awareness of concern>, <sharing the process parturient can find the significance of their own chirdbirth>, <patterning and rewriting the learning from their experience>, <reconsidering the attitude as a midwife> and <polishing the empirical knowledge thoroughly by involving with others>. Conclusion The reflection made by midwives were classified into three states, [reflection that creates trial] [reflection that fused with the situation][reflection by mirroring and seeing themselves objectively].

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