裁量権の拡大と業務委譲を伴う医療提供体制において就職時の新卒看護師が最低限求められる看護技術

Minimum Nursing Skills Required for Newly Qualified Nurses at the Time of Posting in the Medical Provision System with an Expanded Degree of Discretionary Power and Delegation of Responsibility

要旨

　【目的】今後期待される裁量権拡大と業務委譲を伴うチーム医療（新しい医療提供体制）下で、新卒看護師が就職時に求められる看護技術と水準について明らかにした。

　【方法】新しい医療提供体制を推進する医師、看護師を対象に148項目についてデルファイ調査をし、教育担当看護管理者を対象に最終的なデルファイ調査結果の妥当性の程度を質問した。

　【結果】16名がデルファイ調査に参加し、最終的な合意は49項目、残りのほとんどが60％以上の同意率だった。教育担当看護管理者は125名が分析対象となり、129項目で60％以上の妥当性の評価を得た。

　【結論】清潔・衣生活援助技術は業務委譲が可能なため知識を求めていた。診療の補助技術は、難易度が低く習得のばらつきが少ない技術は自立を求め、難易度が高く習得のばらつきある技術は指導下での実施を求めていた。臨地実習で単独実施できる技術、フィジカルアセスメント、救命救急処置技術は、自立を求めていた。

　Aim: This study investigates nursing skills and the standard required for newly qualified nurses at the time of their posting under the system of team medicine (new medical provision system) with an extended degree of discretionary power and delegation of responsibility.

　Method: A Delphi survey on 148 items pertaining to nursing skills with doctors and nurses promoting the new medical provision system was carried out and nursing managers in charge of education evaluated the final validity of the results.

　Results: Sixteen experts took part in the Delphi survey, there was a final consensus for 49 items, and the remainder had an agreement of 60% or more. The survey was administered to 125 nursing managers in charge of education and 129 items were evaluated as valid at 60% or more.

　Conclusion: Hygiene and clothing assistance skills required knowledge because they could be delegated. In medical care, newly qualified nurses should perform by themselves assistance skills with a low degree of difficulty and those that were relatively evenly, and they should implement under supervision skills that were difficult and unevenly acquired. Newly qualified nurses should perform by themselves skills that could be performed by oneself during practical training, physical assessment skills, and emergency medical procedure skills.