JJAM30_312

Size: px

Start display at page:

Download "JJAM30_312"

いっけいそめや
5 years ago
Views:

1 J. Jpn. Acad. Midwif., Vol. 30, No. 2, , 2016 資料病院勤務の熟練助産師が行う臨床判断の特徴分娩第一期の分娩進行を判断していく一連のプロセス Characteristics of clinical judgement performed by hospital-based expert midwives Clinical judgment process along the first stage of labor Aya KIMURA 抄録目的対象と方法 4 結果 3 臨床判断の基盤ともに産む関係の構築結論 Japanese Red Cross Kyush International Graduate of Nursing

2 キーワード : Abstract Purpose This study aims to clarify the characteristics and sequence of processes that expert hospital-based midwives perform during the progress of the first stage of labor. Method In this study, the author defined midwives who had a prominent degree of skill and knowledge in the delivery of midwifery care to expectant and delivering mothers as expert midwives. The subjects were four expert midwives who worked in this study in the maternity ward of the general hospital. The author used participatory observation and semi-structured interviews to gather data from the four expert midwives. The 4 midwives were observed during labor care and followed with interviews upon completion of their duties. Data were analyzed by qualitative inductive analysis for the purpose of categorization of characteristics of clinical judgment performed by hospital-based expert midwives Result Using their past experience, expert midwives were able to recognize important labor progress features from the time of the first meeting with parturient women. Expert midwives had "total perspective" to link three elements of labor with parturient women's psychological background and risk factors; they controlled the general condition of parturient women while "identifying individual labor progress". In addition expert midwives "ascertained negative factors" that would negatively affect the progress of labor and "chose care measures" to control or minimize them. Furthermore, while delivering midwifery care, expert midwives "sensed a predictive turning point in the labor progress" or "created one intentionally" as needed. Expert midwives repeatedly "rebuilt the perspective of labor progress", "ascertained negative factors again", "chose new care measures" and made clinical judgments to adjust their care plans. Midwifery convictions and well-matured techniques skilled interventions were the base of the expert midwives judgment. In addition, building relations with parturient women was also one important step to obtain useful information and apply it when making clinical judgment. Conclusion Predicting the "turning point" during labor progress or creating one intentionally contributes to securing safety of the mother and child by preventing deviation of normal labor progress. This process is characteristic of the clinical judgment performed by hospital-based midwives whose main duty is to care for high-risk delivering mothers. Keywords: expert midwife, clinical judgment, first stage of labor, labor progress, turning point Ⅰ. はじめに , p , p , p J. Jpn. Acad. Midwif., Vol. 30, No. 2,

3 Ⅱ. 用語の定義 Jasper 1994, pp Ⅲ. 研究方法 1. 研究デザイン Thomas, 研究対象者 A 13 B 13 C 14 D 選出基準 1 Ericsson & Lehmann 1996, p , pp , pp , pp 表 1 対象産婦の概要産婦助産師年齢初 / 経産分娩経過 i A B A B j A k A l B m C n C o C C p D D q D

4 3. データ収集方法 Gold 1958, pp データ分析方法 , pp Ⅳ. 倫理的配慮 11-1 A 144 Ⅴ. 結果 J. Jpn. Acad. Midwif., Vol. 30, No. 2,

5 臨床判断の基盤ともに産む関係の構築 1 1. 分娩第一期の熟練助産師の臨床判断プロセス産婦の全体像の把握と個別の分娩進行の見通し i i A i A 阻害要因の抽出を示す分娩第二期図 1 分娩第 1 期の熟練助産師の臨床判断プロセス

6 A i A 3 i k k A A A k A k 3 k 3 k D p Station-2 D p D 2 D p D 3 p 阻害要因の見極めとケアの選択 i A 5 A A i i A i A i m C m m C m J. Jpn. Acad. Midwif., Vol. 30, No. 2,

7 m C C m C m C m m C ターニングポイントの予測的な察知 10 i A B i i B B B i B B ターニングポイントの意図的な生み出し o C C o C C o C C o C C 分娩進行の見通しの立て直し i A A i i i A A i A

8 3 i 阻害要因の再度の見極めと新たなケアの選択 i A i A A A i 3cm i A A i A i i i 2. 臨床判断の基盤 A i i i A i i A A i A i B i B i B B i B i B 3. ともに産む関係の構築 C o J. Jpn. Acad. Midwif., Vol. 30, No. 2,

9 C C o C o o o Ⅵ. 考察 1. 熟練助産師が分娩進行を判断していく一連のプロセスの特徴 Benner 2001/2005, pp Benner, Kyriakidis, Stannard 2011/2012, pp B C o Tanner 2000, p.70 clinical judgment 2. 病院勤務の熟練助産師に求められる臨床判断について 2010, pp

10 2010, p 助産学への示唆 B 4. 本研究の限界と今後の課題 4 Ⅶ. 結論謝辞 Herrera C. Lourdes R 28 文献 Benner, P. (2001) 2005 pp Benner, P., Kyriakidis, P.H., & Stannard, D. (2011) pp pp Ericsson, K.A., & Lehmann, A.C. (1996). Expert and exceptional performance: evidence of maximal adaptation to task constraints. Annual Review of Psychology, 47, Gold, R.L. (1958). Roles in sociological field observations. Social Forces, 36(3), Jasper, M.A. (1994). Expert: a discussion of the implications J. Jpn. Acad. Midwif., Vol. 30, No. 2,

11 of the concept as used in nursing. Journal of Advanced Nursing, 20(4), , (12), , pp Tanner, C.A.(2000) 2000 Clinical Judgment 23(4) Thomas, D.R. (2006). A general inductive approach for analyzing qualitative evaluation. American Journal of Evaluation, 27(2), (1), (1), (2), (2),

02記念論文.indd

02記念論文.indd J. Jpn. Acad. Midwif., Vol. 30, No. 1, 17-28, 2016 原著 :30 周年記念論文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 Chiaki KAMIO 1 Keiko SHIMADA 2 抄録目的 reflection