NICU新人看護師の医療事故防止関連の知識習得過程に関する前向き調査 <原著>

本研究の目的は,新人看護師の就職後1年間における「医療事故防止上習得しておくべき知識」について,新人看護師の自己評価と臨床教育担当者による第3者評価をもとに,その習得状況の1年間の推移と,双方で「知っている」認識の一致状況を明らかにすることである.対象は2002年度,当施設新生児病棟に配属となった新人看護師5名とした.医療事故防止の観点から検討し独自に作成した「医療事故防止上重要な52項目」を用いて,就職時・4ヶ月後・8ヶ月後・12ヶ月後の計4回構成面接を行い,知識の習得状況を調査した.その結果は次のとおりである.1.「知っている」と判断された項目数は,個人別では就職時と比し,12ケ月後は有意に増加した.また質問52項目中,全新人看護師が「知っている」と面接者が評価した項目の割合は,就職時の12項目(23.0%)から12ヶ月後には35項目(67.3%)に上昇した.2.新人看護師と面接者の「知っている」の一致率は,就職時52%,4ヶ月後86%,8ヶ月後74%,12ヶ月後81%で,就職時と比べ12ヶ月後には高くなる傾向が認められた.3.質問52項目を4ヶ月後・8ヶ月後・12ヶ月後でそれぞれ「知っているべき」項目に分類し,全新人看護師が「知っている」と面接者が評価した割合は,4ヶ月後66%,8ヶ月後68%,12ヶ月78%であり,12ヶ月後新人看護師と面接者の「知っている」の一致率は84%だった.これらの結果から,新人看護師の教育担当者謹師は新人看護師が理解している内容を具体的に把握し,双方の「知っている・いない」の認識は一致しないことを意識して関わることが医療事故防止上の観点から重要である.

Purpose: To demonstrate the tendency of knowledge acquisition for first-year nurses to practice clinical nursing by observing them for 1 year. Subjects and Methods: Five first-year nurses assigned to the neonatal ward in 2002 were interviewed at the beginning of the year and 4, 8 and 12 months after in order to assess the process of the acquisition of knowledge. We developed The Questionnaire called "Fifty-two Items of Important knowledge for Malpractice Precaution". It was used for data collection. Results: (1) The number of items judged I1known" to each 5 nurses had significantly increased at 12 months, compared with the number at the beginning. Out of the 52 items, the proportion judged "known" to all 5 nurses also rose from 23% at the beginning to 69% at 12 months. (2)The items judged "known" to all 5 nurses by themselves were objectively confirmed by the interviewer. The proportion of confirmed items in all "known" items were 71%, 88%, 72%, and 86%, at the 4, 8 and 12 month. (3) Minimal essential items of knowledge at 4, 8 and 12 months were respectively selected out of the 52 items. Those items, the proportion judged "known" to all 5 nurses resulted in 66,68% and 78%, at 4, 8 and 12 months, respectively. The proportion of confirmed by the in interviewer at 12 months resulted in 84%. Conclusion: The results indicate that is a discrepancy but were what first-year nurses say they know and what they actually know. Therefore it is important for senior nurses, who are responsible for training of first-year nurses, to be aware of it. And it is incumbent on senior nurses to ascertain the level of knowledge of their junior nurses to prevent malpractice.