Departmental Bulletin Paper 看護師経験のある助産師学生の助産学実習における困難と教育的配慮

須貝, 麻由美  ,  小林, 由希子

Description
目的本研究は,看護師としての臨床経験がある助産師学生の助産学実習場面での学習困難について,その状況を明らかにし,臨床看護経験が助産学実習にどのように活用できるのか,そのために必要な教育的配慮について検討することを目的とする。
対象と方法看護師としての臨床経験を経てT大学大学院助産研究科に入学した学生3 名を対象に,1 年次に経験した助産学実習について,インタビューガイドを用いた半構造的面接を行った。そこで得られた主観的な経験の語りの内容,教員や臨床指導者による教育的示唆,具体的な実習状況を併せてデータとし,質的分析を行った。
結果臨床看護経験を持つ助産師学生は,目的意識が明確であり,学業への意欲も非常に高かった。しかし,助産学実習においては達成感や充実感よりも自尊心や自己効力感の低下を感じる場面が多くあった。看護師経験が活用できた内容は,「コミュニケーション力」,「一般的な看護技術」,「臨床スタッフの状況を判断して行動する」等であった。これに対し,経験が活用できなかった内容は,「健康な方へのウエルネス志向の助産過程を考えることが難しかった」,「実習で求められる到達度が現役学生より高いと感じた」,「経験を活かせないことへの苛立ち」等であった。また,現役学生に比較して学習に時間を要する,体力の低下,経験が活用できないことへの心理的ストレスがあり,臨床看護経験をもつことが学習困難に影響している可能性が考えられた。
結論助産学実習において,臨床看護経験を持つ学生が,その経験を効果的に活用できないことによる学習困難の現状があった。その背景には,助産過程において問題志向型からウエルネス志向型への発想転換をする際,これまでの経験との間で思考の混乱が起こり,経験が活用できないことによる自己効力感の低下があった。そのため,これまでの個人の経験を考察し,客観的思考をサポートする学習を取り入れた教育的配慮が必要である。
PurposesMidwifery students with clinical nursing experience frequently have difficulties in midwifery practicum although they aspire to pursue the study with clear purposes. Considering this situation, this study attempts to determine problems involved, understand how clinical nursing experience is utilized in midwifery training, and consider educational measures necessary in the training.
Participants and methodsWe conducted semi-structured interviews, based on an interview guide, with three students enrolled in a midwifery course of T College. The students were asked about the midwifery practicum they had experienced in the first year. Data from the interviews were classified into details of the subjective experience, educational advice given by faculty and clinical instructors, and details of the training, and these were qualitatively analyzed.
Results practicumMidwifery students with clinical nursing experience had clear purposes and motivation to pursue the study. However, there were many situations where self-esteem and self-efficacy were lower than any sense of achievement or satisfaction in the midwifery training. We found that students felt their clinical nursing experience useful include "communication skills", "general nursing skills", and "attitude towards the work by evaluating the situation of clinical staff". On the other hand, we also found that the students did not feel the clinical nursing experience useful include "difficulty in thinking about wellness-oriented midwifery process for healthy pregnant women", "feeling that the goals required in the training were more demanding than for midwifery students who have no nursing experience", and "irritation at the inability to make use of their experience". It may be inferred that the clinical experience caused difficulties in the learning because they need more time to study than the midwifery students without nursing experience, are physically less able to keep up, and suffer from mental stress due to the inability to make use of their experience.
ConclusionsIt became clear that students with clinical nursing experience have difficulties in the midwifery practicum because it was not possible to incorporate it effectively into their clinical experience. This may be ascribed to feelings of poor self-efficacy due to the inability to make use of the clinical experience as they experience conflicts between their prior experience and ideas, this occurs while trying to change a problem-oriented approach into the wellness-oriented midwifery process. The results suggest that it is necessary to consider educational measures that introduce reflective learning by examining the previous clinical nursing experience of the students.
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