看護学生の「生と死」に対しての考え方の推移

P(論文)

「生と死」に関する講義・実習の前後の4回(1回目は「死生学」講義開始時,2回目は「緩和ケア学」講義開始時,3回目は「緩和ケア学」講義終了時,4回目は「緩和ケア実践(以下実習とする)」終了時)で学生の考え方の推移を知り,教育上の示唆を得ることを目的に質問紙による縦断的調査を実施した。対象は,看護系大学生2年次から3年次にかけて45名であり,期間は平成18年10月から20年3月であった。 　その結果,以下のことが明らかになった。 １．　対象者の死に関する体験は,祖父母が多かった。次に,自分の死に対する考えの頻度は,講義・実習を通して徐々に増加した。死について語り合う頻度は,「死生学」講義開始前から「緩和ケア学」講義終了後は変化がないが,「実習」終了後は増加した。 ２．　死生観尺度は4回の調査で有意差はなかった。しかし,死生観尺度Ⅱは徐々に不安が軽減され,Ⅴは徐々に人生における目的意識が高くなった。これらは,講義・実習によるものが大きいと考えられる。 ３．　死のイメージでは, 4回の調査で全ての項目が肯定的に推移し,8項目で実習終了後に有意な差がみられた。これは,講義・実習によるものが大きいと考えられ,実習終了後の有意な推移は,実習での体験による影響が大きいと考えられる。 ４．　1～3において講義・実習の成果がある程度得られた。しかし,学生の死に関する体験は少なく,青年期の発達段階を踏まえた死の準備教育としての教育活動の充実がさらに必要である。

Four vertically integrated comprehensive surveys, using questionnaires, were conducted before and after lecture/practicum courses that focused on issues involving death and dealing with death. The purpose of the surveys was to document changes in students' notions, which would in turn provide hints on education. The first survey was conducted at the start of the lecture series on thanatology. The second was conducted at the start of the series on palliative care, and the third was conducted at the end of that series. The fourth survey was conducted at the end of the palliative care practicum. Forty-five university nursing students were targeted from their second through third years. The survey period was from October, 2006 to March, 2008. 　　The surveys yielded the following results: 1．Many of the informants’initial experiences with death were with their grandparents. As they progressed through the lectures and practicum, the frequency with which they thought about their own death gradually increased. As for the frequency with which they talked with each other about death, there were no changes from the start of the thanatology lectures to the end of the palliative care series; however, the frequency increased after the practicum. 2．No significant difference was seen among the four survey indexes for the informants’view on death. However, for“Index II”regarding their view on death, their worries over death gradually diminished; and for“Index V”their awareness of their sense of purpose in living gradually increased. Those changes were mainly attributed to the lectures and practicum. 3．There was a positive shift in the informants’perception of death for all items in the four surveys. After the practicum, there were significant differences in eight items. Those were mainly attributed to the lectures and practicum, but the most significant changes after the practicum seem to have been influenced mainly by what they experienced during the practicum. 4．As evidenced in items 1 through 3 above, the lectures and practicum produced good results. The students however, have had little experience with death, and there is a need for better developed educational activities that deal with death issues - taking into account the students’adolescent development.