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[要旨]私は2017年９月に千葉大学大学院看護学研究科とUCLAメディカルセンターが行うアメリカの看護を学ぶ研修に参加した．そこでの私の目的は，UCLAメディカルセンターでの出生前検査の在り方と職種間連携について学ぶことであった．本著では，日本での出生前検査の現状と異なる三点について論じる．まず１つめに，UCLAメディカルセンターでは妊娠初期に全妊婦がカリフォルニア州の出生前スクリーニングプログラムについて情報提供され，ほとんどの妊婦が何らかのスクリーニングや出生前診断を受けていた．２つめに，アメリカは日本より医療専門職の種類が多く，それぞれの専門性も高かった．またそれらの専門職は独立して妊婦やその家族に対する意思決定支援を行い，その情報は電子カルテで他職種に共有され，互いに連携がはかられていた．３つめに，アメリカは対象となる妊婦の人種や経済的背景，宗教などの個別性が大きかった．カリフォルニア州ではメディカルと呼ばれる公的な医療保険制度があり，それに認定された低所得世帯はこの制度を利用して，出生前スクリーニングやそれに付随する支援を無料で受けることができた．またインフォームドコンセントを得る際に，英語を話さない患者には公的な通訳サービスを用い，自律的な意思決定ができるよう配慮されていた．諸外国と比べ，日本の出生前検査の普及率はとても低い．しかし近年，妊娠中に胎児の情報を得たいというニーズは増加している．また胎児期に出生前検査によって得られる胎児の状態も増えている．そのため看護職が出生前検査の情報提供に関わることが求められている．妊婦の出生前検査に関するインフォームドコンセントや意思決定を支えるには，看護職の更なる役割の高度化や連携が必要であると考えた．

A nurse exchange program between Chiba University Graduate School of Nursing and UCLA Medical Center was conducted in September 2017. The purpose of my participation in this exchange program was to learn how prenatal screening or diagnosis is offered and how inter- professional occurs cooperation in UCLA Medical Center. There were three major differences between testing in UCLA Medical Center and Japan. First, the implementation rate of prenatal screenings in UCLA Medical Center was higher than in Japan. All pregnant women were offered the opportunity to enter the program in the California Prenatal Screening Program at the early stage of pregnancy. Secondly, the healthcare staff at UCLA Medical Center was generally more diverse and specialized professionally when compared to Japan. Each healthcare professional supported pregnant women and their families’ decision-making and shared information related to prenatal tests were shared among all involved experts by using electronic medical records. Lastly, the American population features a broad spectrum of socioeconomic and ethnic backgrounds. The California public insurance (Medi-Cal) covers the cost of prenatal screening program for registered low income patients. When giving informed consent, standardized translational service is used so that pregnant women autonomously make a decision. Although fewer prenatal screening or diagnosis is performed in Japan compared to other countries, the number of pregnant women requesting these screenings to detect fetal abnormalities in increasing. Furthermore, the range of conditions identified by genetic variants during pregnancy is expanding. Finally nurses and midwives should become more active in supporting pregnant women’s decision-making. More advanced qualification and practical cooperation among Japanese nursing professions are needed to support informed decision-making regarding prenatal testing.