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5 2007年度 吉 本 圭 一 立 石 和 子 227 出している 2) 看護職のコンピテンシー研究 管理的なキャリア以外の看護職に直接関わるキャリア発達モデルを描こうとすると その職業的 な能力形成 発達に着目しなければならない ここで看護におけるコンピテンシー研究が登場する ことになる 経営学から展開したコンピテンシー研究は 看護管理の中で活用され 人事考課を中 心に展開されている 看護職として必要なコンピテンシーとして 問題解決 チームワーク ネットワーク 部下育成 リーダーシップ が提示し コンピテンシーの定義づけとして 業 績の高い成果を達成できる能力 特性をいくつか選んで基準とする そして 優れた行動能力を定 性的でなく定量的にとらえるために 年功要素はなく 客観的で納得性がある としている 渡 邉 2003 看護においてはコンピテンシーをクリニカル ラダー 3) と関連させている研究もある 朝倉 2005 すなわち 配属部署や経験に応じて必要とされるコンピテンシーとその育成 形成メカニズムが 異なっていることが注目されている While 1996 は 看護基礎教育でcompetenceの基礎を習得 すると仮定すると 臨床現場では competenceの洗練とperformanceの方法論を学ぶことと考えるこ とができ 臨床現場の持つ教育的機能は極めて大きい 井部 2002 といっている また Ritta Meretoja 2004 が72項目のスケールを用いて コンピテンシーの自己評価のためのスケールを開 発するに至っている 3) チーム医療の一員としての看護師のコンピテンシー こうした看護職のコンピテンシーとキャリア形成にとって 現代的な職への要求の変化にも注目 しておく必要がある 現代医療は 一般的に高度化するというだけでなく チーム医療という分 業 協業のコンセプトの新たな展開がある 全人的チーム医療が求められており ケアといえども 看護師だけのマンパワーでは不充分である 他方 医療の現実としては 例えば山崎豊子氏著作 白い巨塔 に描かれるように 現場は序列化された 縦の社会 であり 従来新人看護師の実務 表1 病院 総数 の100床当たり常勤換算従事者数 2005年10月
6 228 大 学 論 集 第39集 経験は 見習い 的感覚を注入するものであったが 現在のチーム医療確立のためには そうした 見習い 感覚は大きな足枷となる キャリア形成の基礎段階の教育において チーム医療を主体 的に担う一員としてのコンピテンシーの育成が鍵となるのである 日本看護協会 ス ニュースリリー 2006 チーム医療の検討のために ここでは 一般的な病院における 医療施設の実態調査 による構成員を表1に示す 尾形 2007 病院は 看護師の占めている割合は大きいが 看護師も 含む他部門の業種との連携の中で日々の業務が成り立っていることが読みとれる 4 調査研究の概要 1) 調査の対象と実査期間 大卒の新人看護師に必要なコンピテンシーを確認するために以下の対象を選定して調査を実施し た 対象1 チーム医療として看護師の成長過程に関わる人々 表2 2002年7月 11月 対象2 私立大学卒業した新人看護師 表3 2004年9年8月 2005年2月 表2 インタビュー対象者 属性
7 2007年度 吉 本 圭 一 立 石 和 229 子 インタビュー対象 大卒新人看護師 㩷 表3 㪊㩷 䉟䊮䉺䊎䊠䊷ኻ 䋨ᄢතᣂ Ꮷ䋩 㪥㫆㩷 䋱㩷 䋲㩷 䋳㩷 䋴㩷 䋵㩷 䋶㩷 䋷㩷 䋸㩷 䋹㩷 㪈㪇㩷 㪈㪈㩷 㪈㪉㩷 㪈㪊㩷 2) 㩷 㪸㩷 㪹㩷 㪺㩷 㪻㩷 㪼㩷 㪽㩷 㪾㩷 㪿㩷 㫀㩷 㫁㩷 㫂㩷 㫃㩷 㫄㩷 ᐕ㦂㩷 㪉㪌㩷 㪉㪋㩷 㪉㪋㩷 㪉㪋㩷 㪉㪋㩷 㪉㪋㩷 㪉㪊㩷 㪉㪊㩷 㪉㪊㩷 㪉㪊㩷 㪉㪊㩷 㪉㪊㩷 㪉㪊㩷 ᕈ 㩷 㩷 㩷 㜞 㩷 තᓟᐕᢙ㩷 䋳ᐕ 㩷 䋲ᐕ 㩷 䋲ᐕ 㩷 䋲ᐕ 㩷 䋲ᐕ 㩷 䋱ᐕ 㩷 䋱ᐕ 㩷 䋱ᐕ 㩷 䋱ᐕ 㩷 䋱ᐕ 㩷 䋱ᐕ 㩷 䋱ᐕ 㩷 䋱ᐕ 㩷 㩷 ੩䋨 ว 㒮䋩㩷 ජ 䋨ᄢቇ 㒮䋩㩷 ጟ㩷 䋨ᄢቇ 㒮䋩㩷 ጟ䋨 ว 㒮䋩㩷 ᄢಽ䋨 ว 㒮䋩㩷 ᄢಽ㩷 ੩䋨 䉶䊮䉺䊷䋩㩷 ᄢಽ䋨ᄢቇ 㒮䋩㩷 ጟ䋨 ว 㒮䋩㩷 ᄢಽ㩷 㐳ፒ䋨 ว 㒮䋩㩷 ੩䋨ᄢቇ 㒮䋩㩷 インタビューの内容 方法 および倫理的配慮 対象1 看護師像に関するものとして 看護師と職能について あるべき姿と現状 教育歴に よる違い 5 10年前の看護師との比較 理論の重要性 看護技術 以前と比べどうであるか コ ミュニケーション能力 他の部門との連携について 看護養成課程や教養 特に急激な大学化のイ ンパクトについて 看護師の学歴への現状での期待 昇階制度 専門看護師 5年後の看護師に期 待すること 看護師の採用をするときの基準や期待すること 採用時に学歴を考えるか否か 看護 師に必要な教養とは などの項目をあらかじめ準備し 半構造化面接をおこなった 対象2 大卒新人看護師 卒後1 3年目 に対しては 学生時代に学び役立ったこと 学生時 代に学習しておけばよかったこと 看護師に必要な能力 学生時代と看護師として勤務した後との ギャップ 看護師として勤務してうれしかったこと 辛かったこと 努力したこと 他の看護養成 課程との違いなどの項目による半構造化面接を行った インタビュー調査の面接時間は1人に対し60 180分実施した なお インタビュー内容は すべ て同意のもとにICレコーダに録音し 各面接終了後逐次録を作成し 内容の解釈から文脈ごとにコ ーディングを行い分析した 分析時には 看護専門職者としてのコンピテンシーに注目して内容を 分類した また インタビューに対しては 対象者へあらかじめ研究目的を説明し同意を得た上で実施した インタビューの際に 研究の目的 守秘義務 インタビューを録音すること 中断の権利 利益と 損失 協力の意志選択の権利について書面および口頭で説明の上 対象者の理解を得たあと 対象 者の署名をもって同意を得た 5 大卒看護師をめぐるインタビュー結果 医療チームの中で求められている看護師の能力と大卒新人看護師が考える看護師の能力について インタビュー結果を分析し 看護師の高学歴化に関する価値とキャリアの関連性 医療チーム
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18 240 Initial Career and Competency Development of University-Educated Nurses: Analysis of the Interview Results Regarding Initial Career Development Keiichi YOSHIMOTO Kazuko TATEISHI Nursing education faces changes and problems, especially those of shifting its training toward universities and the increasing early turnover and decreasing practical competence of beginning nurses. In the light of these issues, this study aimed to elucidate the educational challenges regarding career preparation of nurses and the competency required for nurses and the problems these create. To this end, interviews were conducted with members of medical teams and with beginning nurses holding a university degree. The results were analyzed and examined in four categories: the advantages from higher education of nurses and its relation to their careers; nursing skills required as part of a medical team; the contents of professional education in higher education; and discussion about career improvement at work. Both nurses and other members of medical teams expected university-educated beginning nurses to show a rich humanity and social skills as members of a medical team. At the same time, however, mere humanity is not enough to satisfy all the skills required professionally. In this context, nursing professionals with a university degree should acquire qualities such as basic knowledge, technical knowledge, and communication skills during higher education. Training was expected to explore how to nurture a rich humanity, rather than simply to upgrade the nursing curriculum. New nurses who had just graduated from a university realized how immature they were. Despite their willingness to remedy their lack of skills and experience, the university-educated nurses particularly were expected to become a substantial part of the workforce immediately, due to the overwhelming clinical workload and a large numbers of nurses leaving their jobs. Examining the interview results revealed an issue of legislating for nurse training in a way similar to that of compulsory training of doctors. In addition, the survey indicated a necessity to discuss issues arising from the new education/training methods for nurses in order to advance their careers from the initial stage. Associate Professor, Department of Education, Faculty of Human-Environment Studies, Kyusyu University Lecturer, Division of Nursing, School of Medicine, Kurume University
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