助産学実習における継続事例実習の現状と課題 : 教育機関による実態調査を通して

Abstract

助産学実習における継続事例実習の実態調査を行い効果的な方法について示唆を得ることを目的とした。平成24年4月現在助産師教育を実施している大学院、大学、大学専攻科・別科、短期大学、専門学校の計164校の助産学担当者を対象に平成23年度の継続実習状況について調査用紙を郵送した。結果は、回収数(回収率%)が大学院2(20.0)、大学部(38.8)、専攻科8(40.0)、短期大学3(50.0)、専門学校21(48.8)、合計67(40.9)であった。継続実習未実施は大学5校(15.2%) のみであった。事例数は2例以上が大学院100%、大学12.1%、専攻科・短期大学・専門学校21.9%であった。受持ち開始は妊娠中期が、それぞれ50.0%、18.2%、53.1%であった。抵娠中の保健指導はすべての教育機関で5回前後実施していた。各教育機関は妊娠期の保健指導を重視し、分娩期の待機体制を整備して分娩介助実習を行い、産褥期のケアと家庭訪問ができるようにしていた。また 課題は実習施設および継続実習対象者の確保、教員不足であった。大学における継続実習の有無と卒業時の到達度には統計的な有意差がなかった。背景として妊娠期の保健指導を複数の事例で行い、分娩介助事例の産褥期を受持つ等の工夫が行われていたことが考えられた。

The present study aimed to survey practical training using continuous case studies during midwifery practica in order to obtain suggestions for effective methods of implementing midwifery studies. A questionnaire survey regarding the implementation of practical training using continuous case studies in academic year 2011 was sent to the person responsible for midwifery studies at 164 schools, including graduate schools, universities, postgraduate programs (one-year programs), junior colleges, and vocational schools that provided midwifery education as of April 2012. A total of 67 responses (response rate, 40.9%) were received from 2 graduate schools (response rate, 20.0%), 33 universities (38.8%), 8 postgraduate programs (40.0%), 3 junior colleges (50.0%), and 21 vocational schools (48.8%). Practical training using continuous case studies was implemented at all educational institutions except for 5 (15.2%) universities. Two or more continuous case studies were followed at 100% of graduate schools; 12.1% of universities; and 21.9% of postgraduate programs, junior colleges, and vocational schools, and students began caring for these cases from the second trimester of pregnancy at 50.0%, 18.2%, and 53.1% of these institutions, respectively. All educational institutions provided prenatal health guidance around 5 times. All educational institutions prioritized prenatal health guidance; had an on-call system for labor and taught practica in delivery assistance; and were able to provide puerperal care and home visits. Issues comprised insufficient teaching staff and difficulty securing facilities to conduct practical training and cases to serve as continuous case studies. No significant differences were observed in the level of achievement at graduation between universities with and without practical training using continuous case studies. This lack of difference was likely due to the implementation of measures such as providing prenatal health guidance to multiple cases and assisting in labor during the puerperal period.