doi:10.15065/jjsnr.20170525014 - 研究報告 - Reality Shock in Nurses in their Second Year after Graduation Yoko Suzuki Yoshiko Kawatsu Key Words nurse, reality shock, workplace はじめに 2 2014 2 2010school to work transition 2004 1986 198619861986 Kramer 1974 2004 20062007 20052008 2006 2006 2008 2003 2009 2010 1 20132 2014 Schein 1978/1991 2004 2006 2004 2005 2012 2012 2 2006 Department of Nursing, Faculty of Nursing, Mejiro University Vol. 41 No. 1 2018 47
2 2004 3 2010 2015 1981Partners in Changes Dana Gaines Robinnson Robinnson & Robinnson 2008/2010 Performance Consulting 2 2 2007 Robinnson & Robinnson 2008/2010 2011 2 2 Ⅰ. 目的 Ⅱ. 研究方法 1. 用語の定義 2 2012 1986 2. 対象 2002 3. 期間 2015 5 11 2015 7 31 4. 収集方法 176 5. 内容 就職後 3ヶ月時の新卒看護師のリアリティショック構成因子 ( 平賀 布施,2007) 17 14 11 5 6 2 4 3 5 1 5 48 Vol. 41 No. 1 2018
職場環境要因 2011 2 4 3 基本属性 離職意向 6. 分析方法 2 3 Mann-Whitney Kruskal-Wallis Steel- Dwass 表 1 対象者の基本属性 n 270 20 231 85.6 30 24 8.9 40 11 4.1 50 1 0.4 3 1.0 4 85 31.5 3 9 3.3 3 140 51.9 2 16 5.9 19 7.0 1 0.4 66 24.4 5 1.9 187 69.3 3 1.1 8 3.0 1 0.2 11 4.1 19 7.0 182 67.4 ICU 36 13.3 22 8.2 201 74.4 57 21.1 12 4.5 238 88.1 6 2.2 20 7.4 1 0.4 5 1.9 Ⅲ. 倫理的配慮 15010 Ⅳ. 結果 872272 31.2 2 270 31.0% 1. 対象者の基本属性 表 120 23185.6%3 14051.9%18769.3% 18267.4% 20174.4% 23888.1% 2. 卒後 2 年目看護師のリアリティショック因子分析 3 2007.4 286KMO.87Cronbach α.91 1.882.853.774.835.736.79 表 2 1 9 2 Vol. 41 No. 1 2018 49
6 3 4 4 3 5 3 1 6 3 5 12 表 3 表 2 卒後 2 年目看護師のリアリティショック構成因子 n 270 Cronbach 1 2 3 4 5 6 1.88 11.867 -.118.142 -.076.022 -.018 12.832 -.041.021.051.002.026 53.712 -.026 -.067.147.035 -.091 25.639.062.032.030.086 -.130 35.548.211 -.065.026 -.043.099 46.545.292 -.034 -.033 -.041.050 39.519.284 -.062 -.006 -.084.022 1.501 -.205.001 -.129 -.023.153 16.499 -.101.090 -.024.094.218 2.85 37.112.806.054 -.088 -.087 -.121 27 -.037.766.058 -.082.153.045 23 -.138.733.162 -.010 -.014.068 28 -.063.707.077 -.010.074.016 34 -.002.437 -.068.220.019.142 55.049.436 -.184.220 -.011.076 3.77 10.052.003.853.004 -.001 -.072 14 -.026.043.673.058 -.030.055 9 -.046.069.631 -.032 -.060.066 19.105.081.542.034 -.010 -.121 4.83 51 -.017.085.053.835.030 -.088 6.019 -.121.033.798 -.069.019 18 -.020.021 -.020.786.020.003 51.73 20.060.041 -.155 -.092.980 -.111 52 -.007.117.044 -.036.575.006 60 -.037 -.131.121.230.518.167 6.79 29.012.046.045 -.048.106.842 61.156.016.029 -.005 -.012.666 4.128.101 -.164.009 -.172.496 Kaiser a.6 1 表 3 卒後 2 年目看護師リアリティショックの各因子平均得点 2 3 4 5 1 6 MSD 2.43 0.80 3.32 0.85 2.25 1.05 3.28 1.16 3.66 0.96 2.81 0.89 50 Vol. 41 No. 1 2018
3. 卒後 2 年目看護師リアリティショック構成因子と職場環境要因の関連 2 Mann- Whitney Kruskal-Wallis 2 3 表 4 教育体制 78 7 職場役割 物理的状況 1 1 1 勤務体制 787 151616 1 1 処遇 Steel-Dwass 1 50% 51% 1 Steel-Dwass 50% 51%50% 1 50% 50% 1 51% Vol. 41 No. 1 2018 51
表 4 卒後 2 年目看護師リアリティショック構成因子と職場環境要因 n 270 n 174n 198 1 2 3 4 5 1 6 118 21.0 129.1 20.0 131.3 9.0 136.8 10.0 128.7 11.0 121.1 9.0 127.5 141 21.5 136.8 20.0 133.8 8.0 129.7 10.0 135.3 12.0 144.3 8.5 136.6 11 27.0 157.1 22.5 177.3 11.0 169.8 11.0 156.8 11.5 143.2 11.0 184.8 94 21.0 141.6 21.0 149.6 * 9.5 142.2 10.0 140.5 11.0 136.2 9.0 148.4 * 174 21.0 132.3 19.5 128.0 8.0 131.9 10.0 131.3 11.0 135.1 8.0 128.6 2 60 21.0 48.9 21.0 48.3 8.0 46.4 9.0 49.7 11.0 50.6 8.0 50.8 2 34 21.5 45.0 21.0 46.0 8.0 49.5 8.5 42.3 11.0 42.1 6.5 41.7 80 7 66 22.0 51.1 19.0 53.2 9.0 50.6 11.0 51.2 12.0 53.0 9.0 54.9 * 8 34 19.5 49.3 18.0 45.2 8.0 50.4 10.5 47.6 11.0 45.6 8.0 42.1 70 72 22.0 144.1 21.0 147.8 9.0 132.1 10.0 130.5 11.0 139.2 9.0 153.2 * 198 21.0 132.4 20.0 131.0 8.0 136.7 10.0 136.0 11.0 134.2 8.0 129.1 1 94 21.0 70.0 20.0 67.2 8.0 67.6 10.0 69.1 12.0 71.6 8.0 72.2 2 45 21.0 70.0 21.0 75.8 8.5 75.0 10.0 70.3 11.0 66.7 7.5 65.4 59 8 42 22.0 38.6 21.0 41.3 8.0 36.8 10.5 40.6 11.5 39.9 9.0 41.6 9 38 23.5 42.6 19.0 39.7 10.0 44.6 10.5 40.4 11.0 41.1 9.0 39.2 118 222 20.0 122.1 20.0 127.2 8.0 129.5 10.0 131.4 11.0 131.9 8.0 125.3 48 28.0 194.3 *** 22.0 170.8 *** 10.0 160.6 * 10.0 146.4 11.0 149.2 10.0 179.5 *** 7 24.0 156.3 19.0 114.6 11.0 185.6 11.0 157.3 12.0 148.0 8.0 120.2 261 21.0 133.9 21.0 135.0 8.0 133.1 10.0 132.9 11.0 134.1 9.0 134.9 2 11 16.0 93.2 19.0 114.0 10.0 163.0 10.0 144.8 11.0 144.0 6.0 90.3 257 21.0 136.3 21.0 135.4 8.0 133.3 10.0 133.0 11.0 134.1 9.0 136.4 2 83 21.0 133.2 21.0 137.7 8.0 135.9 10.0 137.1 12.0 146.3 9.0 141.2 185 21.0 135.1 20.0 133.1 9.0 133.9 10.0 131.9 11.0 129.2 9.0 131.5 2 17 18.0 133.0 22.0 147.9 8.0 149.4 10.0 134.9 12.0 135.2 9.0 135.5 252 21.0 135.1 20.0 134.1 9.0 134.0 10.0 133.9 11.0 135.0 9.0 135.0 1 191 20.0 122.8 20.0 126.8 8.0 126.9 10.0 135.1 11.0 133.4 8.0 124.7 78 25.0 164.9 *** 22.0 155.0 ** 10.0 154.9 ** 10.0 131.4 12.0 139.0 9.0 160.3 ** 1 179 20.0 125.0 20.0 129.3 8.0 129.0 10.0 136.0 11.0 130.5 8.0 126.1 90 23.0 155.0 * 21.0 146.3 9.0 146.9 10.0 130.1 12.0 144.0 9.0 152.8 * 1 170 19.0 123.0 19.0 125.2 8.0 128.2 10.0 134.6 11.0 126.3 8.0 128.0 100 23.0 156.7 ** 22.0 153.1 ** 10.0 148.0 * 10.0 134.3 12.0 151.2 * 9.0 148.3 * 180 20.0 123.8 19.0 123.9 8.0 127.5 10.0 130.1 11.0 122.8 8.0 128.2 69 23.0 157.7 ** 22.0 157.4 ** 10.0 150.1 * 10.0 141.9 12.0 159.8 *** 9.0 148.7 * 1 188 20.0 121.4 20.0 125.2 8.0 128.5 10.0 126.5 11.0 119.4 8.0 124.3 72 24.5 154.3 ** 21.0 144.3 9.5 135.9 10.0 139.0 12.0 159.5 *** 9.0 146.8 * 10 2 207 22.0 137.5 20.0 132.8 8.0 133.8 10.0 131.2 11.5 136.2 9.0 135.5 3 47 20.0 130.0 22.0 146.5 8.0 128.0 11.0 144.7 11.0 136.3 8.0 130.0 4 21.5 147.4 20.0 129.5 11.0 167.4 12.0 166.4 11.0 112.0 9.5 144.1 11 16.5 104.1 18.5 129.0 11.0 176.0 10.0 129.2 9.5 115.1 8.0 143.0 7 147 21.0 126.4 20.0 123.6 8.0 117.9 11.0 134.7 ** 11.0 120.3 9.0 126.8 8 101 21.0 121.7 21.0 125.8 10.0 134.1 9.0 108.2 12.0 130.6 9.0 121.1 22 15 131 21.0 118.2 19.0 111.9 8.0 106.2 10.0 119.3 11.0 110.2 8.0 112.9 16 98 20.0 110.8 21.0 119.2 10.0 126.8 * 9.0 108.1 12.0 121.4 9.0 117.9 41 113 21.5 121.9 20.0 113.7 8.0 113.4 10.5 125.0 11.0 104.1 8.0 112.0 129 20.5 121.2 21.0 128.3 9.0 128.6 10.0 116.6 12.0 136.7 *** 9.0 129.8 * 28 74 19.0 122.4 19.0 122.2 8.0 126.2 10.0 130.4 9.0 75.7 8.0 119.3 193 22.0 138.5 21.0 138.5 9.0 137.0 10.0 134.0 12.0 156.3 *** 9.0 139.7 3 84 20.0 122.6 *** 20.0 128.3 ** 7.0 116.9 ** 10.0 119.4 * 10.0 106.2 ** ** 7.0 117.1 150 20.5 129.3 *** 20.0 133.1 9.0 137.2 * 10.0 136.2 11.0 136.5 ** 9.0 135.8 * 33 25.0 184.2 22.0 152.9 11.0 163.0 12.0 153.3 14.0 193.4 9.0 168.7 3 0-50 102 22.0 142.3 * 21.0 136.4 10.0 149.8 * ** 10.0 128.4 12.0 152.0 ** ** 9.0 145.0 51-100 68 21.5 133.3 20.0 128.5 8.0 124.2 10.0 134.5 10.5 114.9 8.0 124.8 94 19.0 121.3 19.5 131.2 8.0 119.8 10.0 132.8 11.0 124.0 8.0 124.5 4 9 18.0 107.4 ** 22.0 144.2 8.0 115.9 7.0 88.8 * 9.0 97.2 * 7.0 90.7 * 118 20.0 123.8 * 19.0 126.2 9.0 137.7 10.0 131.4 11.0 119.3 ** 8.0 126.5 140 24.0 144.3 21.0 139.9 8.0 132.1 10.0 137.2 12.0 148.8 9.0 143.1 3 Mann-Whitney Kruskal-Wallis Steel-Dwassp.05p.01 p.001 ** 52 Vol. 41 No. 1 2018
1 表 5 卒後 2 年目看護師リアリティショック構成因子と離職意向 2 * 3 4 5 1 * n 270 6 129 19.5 120.2 *** ** 19.0 125.2 * 08.0 122.1 *** ** 10.0 134.2 * 11.0 123.5 ** 08.0 117.9 *** ** 96 25.0 158.6 21.0 148.7 * 10.0 156.9 09.5 128.6 * 12.0 150.5 10.0 162.8 42 25.0 160.8 23.0 185.8 07.0 101.3 14.0 201.5 14.0 222.7 09.0 157.3 3 Mann-Whitney Kruskal-Wallis Steel-Dwassp.05p.01 p.001 1 Steel-Dwass 1 1 4. 卒後 2 年目看護師のリアリティショック構成因子と離職意向との関連 Kruskal-Wallis 表 5 Steel-Dwass Ⅴ. 考察 1. 卒後 2 年目看護師のリアリティショック 2 1 2005 2006 20072003 20042 2003 20082007 2000 2011 2 2 2011 2014 OJT 2 1 1 2 2 3 2 Vol. 41 No. 1 2018 53
2012 2. 卒後 2 年目看護師の職場環境 2011 OJT OJT2009 OJT 3 2009 2003 2 2011 1 5 20102011 2 7 1 2 2010 QOL 2 2007 2 Phillips, C., Esterman, A., & Kenny 2015 2 3. 卒後 2 年目看護師のリアリティショックと離職 2 54 Vol. 41 No. 1 2018
2013 20072010 2010 2010 2012 2010 20082009 2011 2010 2 2 2012 結論 1 12 34 5 1 6628 2 利益相反の開示 著者貢献度 要 旨 目的 : 方法 : 2 270 2007 結果 :212 34 5 16 結論 :2 2 Vol. 41 No. 1 2018 55
Abstract Purpose: The purpose of this study was to explore the association between reality shock and workplace environmental factors in nurses in their second year after graduation. Method: Participants included 270 randomly extracted, second-year nurses working in facilities in the Kanto, Kansai, and Chukyo regions of Japan. Participants completed a self-administered questionnaire on constituent factors of reality shock and workplace environment developed by Hiraga & Fuse 2007. The questionnaires were returned via mail by individual participants, and the results were statistically analyzed. Result: Reality shock in second-year nurses was caused by six factors: 1 lack of support from senior nurses, 2 psychological burden, 3 physical burden, 4 caring for patients close to death, 5 workload per person, and 6 reduced motivation. Nurses who had a more negative perception of their workplace environment experienced greater reality shock. Conclusion: The suggestion that reality shock in second-year nurses is associated with the workplace environment indicates that review and improvement of the workplace environment of second-year nurses could help reduce or avoid reality shock. 文献,, 2010.., 14 1, 42-50.,,,,,,,,,, 2006.., 22, 1-11., 2007. 3., 30 1, 97-107. 2010.., 23 1, 27-36., 1986.., 11 6, 568-573.,,, 2010.. 38,., 2008.., 7 1, 18-25.,,,,, 2009.. 21.,,,, 2009. 3., 11 1, 1-11., 2010. 4., 5, 19-28.,, 2005.., 9 1, 30-37. 2015.. http://www.mhlw.go.jp/stf/seisakunitsuite/bunya/kenkou_iryou/ iryou/quality/2016 8 8 Kramer, M. 1974. Reality shock: Why nurses leave nursing. St Louis: Mosby. 2014.., 39, 133-139.,,,,,,,, 2014. 4., 35, 9-23., 2011.., 41, 17-24. 2014. 2., 39, 147-152.,, 2010.., 12 4, 211-220. 2003.., 23 4, 41-50. 2004.., 27 1, 91-99.,,,, 2006.., 16 1, 43-52., 1986.., 11 6, 562-567.,, 1986.., 11 6, 583-588. 2012...,,, 2009.., 12 1, 16-24. 2013. 2012. http://www.nurse.or.jp/up_pdf/20130307163239_f.pdf 2016 11 20,,,, 2011.., 34 4, 73-82.,, 2010.., 30 3, 51-60. 56 Vol. 41 No. 1 2018
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