臨地実習指導者の役割遂行下における看護実践

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[要旨] 目的：臨地実習指導者の役割遂行下における看護実践の実態を解明し，看護のロールモデルとしての役割遂行を支援するための基礎資料を得ることである 。方法：データ収集には参加観察法（非参加型）を用い，指導者と学生の２者間および指導者と学生，患者の３者間の相互行為場面をデータ収集し，質的帰納的に分析した。結果：収集した32現象は，指導者６名，学生７名などによる79相互行為場面で構成された。分析の結果は，指導者の役割遂行下における看護実践10コアカテゴリを明らかにした。それは，【データと観察の徹底に基づく客観的判断と経験的判断による回復支援】【アセスメント伝達反復による患者への回復過程認知支援】【学生を巻き込んだ標準化された看護行為の遂行】【遂行機能査定による自立支援の進行と判断不十分による回復の妨げ】【異変感知による援助再考の機会を逃した援助継続】等である。考察：指導者の役割遂行下における看護実践10コアカテゴリは，「学生のロールモデルとなる患者の回復過程を支援する看護実践」と「学生の学習を妨げ患者の回復過程を脅かす看護実践」の２つの特徴を持つことを示した。指導者は，指導することに重点を置くのではなく，看護実践者として自己の看護を学生に見せることが，看護のロールモデルとしての機能を発揮する。そのため，役割遂行支援に向け，指導者の看護実践能力向上に資する支援方法を検討する必要性が示唆された。

[SUMMARY] Objective: To clarify the reality of clinical instructors’ nursing practices while they execute their teaching role and obtain basic materials to support their job as role models for the nurses. Method: Non-participant observation was used to collect data. Data based on two-way interactions between the instructor and student and three-way interactions between the instructor, student, and patient were collected and analyzed qualitatively and inductively. Results: The 32 phenomena collected comprised 79 interactive scenes that involved six instructors, seven students, and others. Results revealed ten core categories of nursing practices while executing the role of an instructor, that is, the instructor provided recovery support through objective and empirical judgment based on thorough utilization of data and observations, assisted patients’ understanding of the recovery process through communicating and reiterating assessments, involved students in the execution of standardized nursing practices, made progress in supporting independence through performance appraisals and the obstruction of recovery due to poor judgments, and continued support that failed to detect changes which should have been an opportunity to reconsider the form of assistance suited to the patient. Discussion: The ten core categories of nursing practices while executing the teaching role could be categorized into two types of characteristic practices: 1) the type of nursing practices that were supportive of the patient recovery process and acted as a role model for the students and 2) those that hindered the students’ learning and threatened the recovery process of the patients. Demonstrating one’s nursing practice as a nurse practitioner to the students fulfilled the function of a nursing role model better than when the instructor emphasized the act of instruction. For this reason, the findings suggest that it is necessary to consider ways to contribute to improving the instructor’s capabilities concerning their nursing practice so they may better execute their teaching role.