保健師に求められる実践能力の獲得経過を明らかにする : 学生自己評価から講義等後と実習後の到達レベル比較検討

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保健師の教育は，2010年の保健師助産師看護師法の改正に伴い大学での統合カリキュラムでの教育から新カリキュラムによる教育へと変遷しようとしている。改正の内容は教育期間を6か月から1年とし，習得単位を23単位から28単位へと変更するものである。本学でも，保健師教育を看護学生全員が卒業時に保健師の国家試験受験資格を取得する統合カリキュラムから保健師教育を選択制とし，2012年入学者から採用した。本稿は新カリキュラムでの保健師の教育課程で，「保健師に求められる実践能力と卒業時の到達目標と到達度」を学生がどのように獲得していくかを明らかにすることを試みた。 本学の保健師教育は，2年次の2月に本人の希望があり一定水準を満たした学生を履修生とし，3年次生から実施している。学生の到達度自己評価は保健師教育を開始した3年次生と4年次生とし，学生の記名自己記述式とした。調査表は「保健師に求められる実践能力と卒業時の到達目標と到達度」と保健師教育機関協議会で追加の実践能力Ⅵの表を用い，調査項目は113項目とした。調査にあたって，評価について説明を加え，評価表と保健師教育機関協議会により作成された「ミニマム・リクワイアメンツ」を配布した。調査時期は，3年次生の4・7月，4年次生の4・7・9・2月としたが，今回の研究対象は4年次生とし，①講義等での到達レベルの獲得状況を把握するために4と7月を比較，②実習での到達レベルの獲得状況を把握するために7と9月の比較，さらに，③講義等と実習での到達レベルに差があるかを分析した。113項目を1項目ごとに，到達レベルの向上に有意な差があったかどうかをウイルコクソンの符号付順位和検定で検証した。結果は，有意な差で向上した項目は①4月と7月の比較で実践能力Ⅰ・Ⅱ・Ⅵの29項目，②7月と9月の比較で実践能力Ⅰ・Ⅱ・Ⅲ・Ⅳ・Ⅴ・Ⅵの88項目であった。4月から7月の教育は，保健医療福祉行政論等の講義等が主であり，7月から9月にかけては，8月下旬から9月中旬に3週間の保健所実践・市町村保健センター実践実習を実施している。今回の結果から，実習が到達レベルを向上させることに重要な役割を担っていることが示唆された。

The education of public health nurse is going to change from the current education as the integrated curriculum to the new curriculum at colleges as a result of the Health Nurses, Midwives and Nurses Act in 2011. This revision will extend the period of education from six months to a year, and increase the number of credits students need to acquire from 23 to 28. In our college, we also revised our system since the students enrolled in 2012 from the integrated curriculum which allows all graduating nursing students to be qualified to take the national Public Health nursing exam, to the new curriculum which allows students to select the education of public health nurses. This paper tried to clarify how the students acquire "the practical capabilities which are required for a public health nurse, and levels and goals of the achievements at the time of graduation" in the new curriculum of the public health nurse education. In our collage, the public health nurse education starts from the third-year with the students who have wills and who are more than certain level of performance at the time of February in second year. We carried out a survey of student's self-evaluations about their achievement levels by using the registered self-description formula. The target was third and fourth year students who have started public health nurse education. We investigated on 113 items by using the table of the practical capabilities VI in Japan Association of Public Health Nurse Educational Institutions and added in "the practical capabilities which are required for a public health nurse, and levels and goals of the achievements at the time of graduation". Prior to the investigation, we added the explanation of the evaluation and distributed "minimum requirements" created by the results of the evaluation table and the public health nurse educational-facilities conference. We made investigations in April, July, September, and February to the forth-year students and in April and July to the third-year students. I set the fourth-year students as the target of this research, and conducted following three analyses. (1) comparison between the results of April and July to understand to what extent students achieved in the acquisition levels through lectures (2) comparison between the results of July and September to understand to what extent students achieved in the acquisition levels through trainings, and (3) Comparison between the results of lectures and trainings to see whether there are differences in acquisition levels. We examined each of 113 items by Wilcoxon rank sum test in order to find out the significant differences related to the improvement of student's acquisition levels. Significant differences were shown in (1) 29 items of practical capabilities I-II-VI when the results of April and July were compared, also in (2) 88 items of I-II-III-IV-V-VI of practical capabilities when the results of July and September were compared. The education from April to July is based mainly on lectures, such as a Social welfare and policy in Health care. In the period between July and September, the main focuses are on the health center practice and the practice trainings at local health centers for three weeks from the end of August to mid-September. From these research findings, it is suggested that trainings play important roles to raise the attainment levels.