Departmental Bulletin Paper 大学院教育と学部教育の妊婦健康診査実習前後の助産実践能力に対する自己評価の比較
Comparison of Self-Evaluations of Midwifery Practical Skills by Students in Graduate and Undergraduate Midwifery Programs

山田, 貴代  ,  松岡, 惠  ,  西川, 浩昭  ,  Yamada, Takayo  ,  Matsuoka, Megumi  ,  Nishikawa, Hiroaki

41 ( 2 )  , pp.139 - 150 , 2018-01-31 , Wellness and Health Care Society , ウェルネス・ヘルスケア学会
本研究の目的は、助産師養成課程で学んだ大学院生と大学生の妊婦健康診査実習前後の助産実践能力の到達レベルの違いを自己評価とその理由から明らかにすることである。 研究方法は、助産師養成課程の大学院生 10 名と大学 4 年生 9 名を対象に、妊婦健康診査での助産実践能力に対する自己評価と自己評価の理由について、実習前後に調査した。分析は、時期(実習前と実習後)と教育課程(大学院と学部)を二要因とし、自己評価項目を従属変数として二元配置分散分析と行った。また、自己評価の理由は最小単位に細分化し共通内容をまとめた。 結果として、妊婦健康診査実習前後の実践能力に対する自己評価得点で、教育課程で有意差が見られたのは「妊娠の経過予測」と「親準備」、実習前と実習後で有意差が見られたのは「胎位」「胎児の健康上状態」「胎児の成長」「妊娠経過の診断」「妊婦の訴えに対する助言」と健康教育ケアプランの「分娩準備」の 6 項目で実習後に自己評価得点は高くなっていた。交互作用で有意差が見られた「胎向」は、実習前に比べ実習後の自己評価得点が高いことに教育課程が関連していた。自己評価の理由から大学院生と学部生に共通のカテゴリー<診察技術能力評価の根拠>、<妊娠経過の診断能力評価の根拠>、<ケア計画・実践評価の根拠>、<妊婦とのコミュニケーション能力評価の根拠>、<学びを深めた背景>の 5 つが抽出されたが、コードは 1 つを除き異なっていた。 学部生の自己評価得点とその理由からは、助産師教育卒業時の「少しの助言で自立してできる」の到達レベルまで至っていなかったが、大学院生からは、助産診察技術の基本となる「胎向」は実習後に有意に高くなっており、自己評価の理由からも「少しの助言で自立してできる」の到達レベルにあったと示唆された。しかし、アセスメント能力、コミュニケーション能力と助産師としての専門性を得るためには、さらなる実習が必要であるという示唆が得られた。
In this study, we surveyed graduate and undergraduate students in midwifery programs before and after undergoing antenatal examination clinical practice training. Students were asked for their own evaluations of how much the clinic had benefited their practical competence, and their reasons for their self-evaluations.Questionnaires were given to ten graduate students and nine undergraduates in 4-year university programs before and after their clinical practice. The two parameters independent variables were the timing of the survey (before and after clinical practice) and curriculum (graduate school and undergraduate). The dependent variables were the 52 self-assessment items in the questionnaire. The variables were examined along the two dimensions by analysis of variance. The reasons the respondents gave for their ratings were arranged by minimum units and categorized. With regard to self-evaluation of practical skills before and after antenatal examination clinical practice, when only the main effect of group was examined, “prediction of course of pregnancy” and “preparation to be a parent” were significant. When only the main effect of time was examined, the following six items were significant: “fetal presentation,” “fetal health status,” “fetal growth,” “diagnosis of pregnancy course,” “advice for pregnant womenʼs appeal,” and “health plan to prepare for delivery.” When only interaction was examined, only “fetal position” was significant. The responses regarding the subjectsʼ reasons for their ratings were arranged into the following five categories: (1) basis for evaluation of examination skills; (2) basis for evaluation of ability to diagnose pregnancy progress; (3) basis for evaluation of ability to make and implement care plans; (4) basis for evaluation of ability to communicate with clients; and (5) factors contributing to deepening of the learning experience. Among these five categories, only one involved a criterion that was cited by both classes of students. In all other cases, the respective classes of students cited different criteria as reasons for their evaluations. The self-evaluations by undergraduate students suggested that upon completion of their midwifery course they felt that they were not quite at the level where they could handle the work on their own, but still required further advice from seniors. Graduate students tended to show more confidence in their own competencies in examination, gained from the practical experience of ongoing antenatal examinations of a number of women. However, this study suggested that further practical experience is necessary to obtain assessment and connection with their clients as midwives.

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