看護職者に求められる遺伝看護実践能力―一般看護職者と遺伝専門看護職者の比較

Competency of Genetic Nursing Practice in Japan: A Comparison between Basic ＆ Advanced Levels

要旨

　本研究の目的は，遺伝医療において「遺伝専門看護職者を含む一般看護職者」「遺伝専門看護職者」にどのような実践能力が求められているのかを明らかにすることである．方法は，コンセンサスメソッドのひとつであるデルファイ法を参考にして4段階からなる調査を行った．第1次調査として遺伝医療に携わっている看護職を対象に聞き取り調査および文献の検討を行い，7領域89項目からなる遺伝看護の能力の事項を抽出し，第2次調査では質問紙郵送調査を遺伝医療の有識者20名を対象に実施した．第3・4次調査では，40都道府県，113施設から承諾の得られた遺伝医療に携わっている看護職者，医師等，491名に質問紙郵送調査を行った．質問紙法においては，著者らが作成した遺伝看護の能力89項目について，A：一般看護職者，B：遺伝学を専門に学んだ看護職者，C：看護職者の能力として適切でないから，いずれかを選択してもらった．データ収集期間は，2000年8月から2001年3月．最終的には調査対象者は295名，回収率は60％であった．

　一般看護職者には，『生活支援』，『精神的支援』，『クライエントの希望の明確化』能力が選ばれた．また，遺伝専門看護職者には，『正しい遺伝情報の提供と交換』，『他機関への照会と連携』，『クライエントの理解の支援』が選ばれた．以上の結果より，遺伝看護における「遺伝専門看護職を含む一般看護職者」と「遺伝専門看護職者」に求められる実践能力が明らかとなった．

Abstract

　The purpose of this study was to survey experienced genetic health care provider's perceptions of the level of practice competency required for Basic Level and Advanced Level Genetic Nursing. Basic level refers to the general nurse and the advanced level refers to the genetic nurse. The respondents who agreed to participate in the study were 491 nurses and physicians who were involved in genetic care in 113 institutions of 40 prefectures. The questionnaire we developed was comprised of 89 items in seven areas of competency for genetic nursing. The respondents were asked to assign the competency items to one of the following nursing levels :（a）General Nurse; （b）nurse who specializes in Genetic Nursing ; or（c）not appropriate for the nurse. Data were collected from January to March 2001. The Delphi Method was used to explore areas of agreement regarding competency fit among the respondents. Three iterations of the survey, resulting in a response rate of 60 ％（295 respondents）, provided sufficient clarity for assigning levels of competence.

　Respondents selected the following areas of competence for the General Nurse: living support, psychological support and identifying client's needs. For the Genetic Nurse they selected : provision and exchange of appropriate genetic information among health care providers, reference and collaboration with other institutions and helping clients to understand their conditions and characteristics. As a result, competency of the Basic Level and the Advanced Level were clarified in Genetic Nursing. The results help provide directions for the furtherance of genetic education in nursing in Japan.