新人看護師のリフレクション支援に向けたプリセプター育成プログラムの検討

Examination of the Preceptor Education Program to Facilitate Clinical Reflection of New Nurses

要旨

目的：新人看護師（以下，新人）のリフレクション支援を目指したプリセプター育成プログラム（以下，プログラム）の有効性を検討する．

方法：【研究デザイン】単一対象への介入研究．【対象者と対象者数】A大学病院のプリセプター76名．【分析方法】リフレクション支援4回の自己評価を比較した．2組のリフレクション支援場面について，問いかけのタイプと新人の発語を数量的に分析した．

結果：プリセプターの自己評価は，支援スキルの「発言を待つ」等20項目中14項目，支援態度の変化の「自己の傾向に気づく」等3項目で，3回目以降が有意に高かった（P < .05）．2組の支援場面では，継続的な支援によって，プリセプターAは「追及型」から「確認型」が増え，プリセプターBは「確認型」から「引き出し型」が増え，それぞれ新人の考えを引き出すような問いかけができるように変化していた．

結論：プリセプターの支援の変化から本プログラムは，新人の臨床体験のリフレクションを支援できるプリセプター育成に有効であることが示唆された．

Objective: The purpose of this study was to examine the effectiveness of the preceptor education program to facilitate reflections about the clinical experiences of new nurses.

Methods: [Research Design] Intervention study on a single subject. [Subjects] Seventy-six preceptors of a University Hospital. [Methods of Analysis] Self-evaluations of preceptors on reflection support sessions, which were conducted four times, were compared. The types of preceptors' questions were classified at the supporting reflection in two pairs. Additionally, the amount of remarks of new nurses in the session was quantitatively analyzed.

Results: In respect of self-evaluations by the preceptors, 14 out of 20 items concerning support skills, including “wait for remarks of the new nurse”, and three items concerning changes in attitude toward support, such as “Notice my tendency” were significantly higher in and after the third sessions (P < .05). In the two sets of support situations, with continuous support, there was an increase from “pursuing type” to “confirmation type” questions for Preceptor A and from “confirmation type” to “eliciting type” questions for Preceptor B, which demonstrated that the preceptors had changed in such a way that they could ask questions that elicited ideas and thoughts from the new nurses.

Conclusion: The changes in the preceptors' support approaches suggest that this program is effective in developing preceptors who can support the new nurses' reflection on their clinical experience.