在宅ケア論演習による学習効果 : 経時的状況設定における訪問看護疑似体験から

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(73) . ቇ⠌ ᄢࠞ࠹ࠧ࡝࡯ ⋡ᮡ. ਛࠞ࠹ࠧ࡝࡯. ዊࠞ࠹ࠧ࡝࡯. ≮㙃⠪ߩ∔ ↢ᵴߩ႐ߦ߅ߌࠆᖱႎ ₵㑐߆ࠄⷰኤ߇ᆎ߹ࠆ ᖚߣ↢ᵴ࡮ ෼㓸ߩ․ᓽ ⚻ᷣ㕙 ࠾࡯࠭ߩᄙ ⥄ቛߩ㑆ขࠅ 㕙⊛್ᢿ ኅᣖ࡮෹ੱ㑐ଥߣᓎഀ. ᖱႎ෼㓸ߩᣇᴺ Ԙ. వ౉ⷰ߳ߩߣࠄࠊࠇ. ↢ᵴ႐㕙ߢߩ⁁ᴫ್ᢿ. ↢ᵴ႐㕙ߢ ↢ᵴߩ႐ߦ߅ߌࠆ⋴⼔ ߩࠤࠕᣇᴺ ⋡ᮡ㨯⋴⼔⸘↹ߩ․ᓽ ߩㆬᛯߣၮ ᧄᛛⴚߩᔕ ↪ ԙ. ≮㙃⠪ߩ⥄Ꮖㆬᛯ‫ޔ‬ᗧ ᕁ᳿ቯ߳ߩᡰេ ࠤࠕߩఝవ㗅૏ߩ್ᢿ. ࠤࠕᤨ㑆ߩ㈩ಽߩᔅⷐ ᕈ ࠤࠕߩ႐ߦࠃࠆេഥᣇ ᴺߩㆬᛯ. Ԛ. ⥄┙ࠍᡰេߒߚេഥ ኅᣖන૏ߢߩᡰេ ↢ᵴⅣႺ߳ߩᡰេ ‛ຠߩᎿᄦ. ޿ߟ߽ߣ⇣ߥࠆੜ⚦ߥᖱႎࠍᢅᗵߦࠠࡖ࠶࠴ߔࠆ ↢ᵴߩ႐ߪ⾆㊀ߥᖱႎ߇ᄙ޿ ↢ᵴⅣႺ࡮↢ᵴ⠌ᘠߥߤᣣᏱ↢ᵴ⁁ᴫࠍ᣿⏕ߦᛠីߔࠆ ᳇୥㧔᳇᷷࡮Ḩᐲ㧕ࠍ⍮ࠆ 㒢ࠄࠇߚᤨ㑆ߢή㚝ߩߥ޿᭽ߦᵈᗧߔࠆ ੖ᗵࠍ૶߁ ታ㓙ߩ↢ᵴߩ႐ߦⴕ߆ߥ޿ߣಽ߆ࠄߥ޿ߎߣ߇ᄙߊ޽ࠆ ੐೨ᖱႎߦ᝝ࠄࠊࠇߥ޿ ታ㓙ߦⷰኤߒߚౝኈ߆ࠄ੐೨ᖱႎࠍୃᱜߔࠆ ⸘↹޽ࠅ߈ߢߪߥߊߤߩࠃ߁ߥ⁁ᴫߦ޽ࠆ߆ࠍᔨ㗡ߦ⸰໧ߔࠆ ੐೨ᖱႎ߆ࠄൎᚻߦ≮㙃⠪௝ࠍ૞ࠅ޽ߍߥ޿ ⿠ߎࠅߘ߁ߥ∝⁁ࠍ੍᷹ߔࠆ ⅣႺ߆ࠄ↢ᵴ਄ߩ⺖㗴ࠍផ᷹ߔࠆ ⴫ᖱ߿઀⨲߆ࠄᕁ޿ࠍኤߔࠆ ⸒⪲࡮ᕁ޿࡮ਇ቟ࠍ⡞߈‫ࠆ߃ᝒࠍ࠭࡯࠾ޔ‬ ↢ᵴⅣႺࠍ್ᢿߒ⃻⁁ࠍᛠីߔࠆ ࠮࡞ࡈࠤࠕ⢻ജࠍ್ᢿߔࠆ ⸰໧ߒߡߘߩ႐ߢࠕ࠮ࠬࡔࡦ࠻ࠍߔࠆᔅⷐ߇޽ࠆ ᄙ㕙⊛࡮✚ว⊛ߥ್ᢿ߇ᔅⷐߢ޽ࠆ ↢ᵴࠍ㐳ᦼ⊛ߦߺߡ⸘↹ߔࠆ ߤ߁ߔࠇ߫ᣣᏱ↢ᵴࠍᔟㆡߦㅍࠇࠆߩ߆ࠍ⠨߃ࠆ ⋡ᮡࠍኅᣖ࡮≮㙃⠪ߣ౒᦭ߔࠆᔅⷐ߇޽ࠆ ࠾࡯࠭ࠍ᳹ߺขߞߚࠤࠕౝኈࠍ⠨߃ࠆ ⸰໧ߒߡ޿ߥ޿㑆ߩߎߣࠍ⠨߃ߡ⸘↹ߔࠆᔅⷐ߇޽ࠆ ኅᣖࠍᏎ߈ㄟࠎߛࠤࠕࠍ⸘↹ߔࠆ ᭂജ◲නߢኈᤃߥᣇᴺߢലᨐ߇ᓧࠄࠇࠆᣇᴺࠍ⠨߃ࠆ ⥄┙ߢ߈ࠆࠃ߁ߥេഥᣇᴺࠍ⸘↹ߔࠆ ᒰᣣߩࠤࠕౝኈࠍ≮㙃⠪࡮ኅᣖߣ౒᦭ߔࠆ ≮㙃⠪࡮ኅᣖߩᒝߺࠍᵴ߆ߒ‫ࠍ┙⥄ޔ‬ଦߔ ↢ᵴⅣႺࠍࠃࠅࠃߊߔࠆߎߣߢ࿷ቛ≮㙃߇౞Ṗߦㆊߏߖࠆ Ꮧᦸࠍዅ㊀ߔࠆ ⥄Ꮖ᳿ቯ⢻ജࠍ㜞߼ࠆࠤࠕ߇ᔅⷐ ⸰໧ᤨ‫≮ޔ‬㙃⠪ߩ࠾࡯࠭㧔ᕁ޿㧕ߦᴪߞߚࠤࠕࠍⴕ߁ ⸘↹ౝኈࠍવ߃‫ޔߒ⺣⋧ޔ‬หᗧࠍᓧࠆ ኾ㐷⊛ߥ┙႐߆ࠄ್ᢿߔࠆ ᕁ޿㧔࠾࡯࠭㧕ࠍఝవߔࠆ 㒢ࠄࠇߚᤨ㑆ߩਛߢఝవ㗅૏ࠍߟߌࠆ ࠾࡯࠭ߣ⁁ᴫ߆ࠄኾ㐷⊛ߦఝవ㗅૏ࠍߟߌࠆ ኅᣖ߳දജࠍଐ㗬ߔࠆߎߣߦࠃࠅᤨ㑆ࠍ⍴❗ߐߖࠆ ᄾ⚂ߒߡ޿ࠆߩߢᤨ㑆ౝߦ⚳ੌߔࠆᔅⷐ߇޽ࠆ ᔅⷐߥࠤࠕࠍ㗅ᐨࠃߊⴕ߁ ⸰໧ᤨߩ⁁ᴫ㧔≮㙃⠪ߩዬ႐ᚲ㧕ߦวࠊߖߚᣇᴺߢࠤࠕࠍⴕ߁ ߘࠇߙࠇߩኅᐸߢߩᣇᴺࠍขࠅ౉ࠇࠆ ↢ᵴ࡝࠭ࡓ߿↢ᵴ⠌ᘠߦߢ߈ࠆߛߌวࠊߖࠆࠃ߁ߦߔࠆ ੐೨ߦၮᧄ⊛ᛛⴚࠍ⠌ᓧߒᔕ↪ߔࠆᔅⷐ߇޽ࠆ ឭଏߩ႐㧔ࠬࡍ࡯ࠬ㧕ߦ೙㒢߇޽ࠆ ቟ోࠍ㈩ᘦߒߚ਄ߢ⥄┙ࠍଦߔᣇᴺߢⴕ߁ ቟ᭉߦⴕ߁ ḩ⿷ᗵࠍਈ߃ࠆࠤࠕࠍឭଏߔࠆ ≮㙃⠪ߣኅᣖߩᕁ޿㧔࠾࡯࠭㧕ߦᴪߞߡࠤࠕࠍឭଏߔࠆ ኅᣖߣ޿߁න૏ߢࠨࡐ࡯࠻ߔࠆ ෺ᣇߩ⽶ᜂ߇ᦨዊ㒢ߣߥࠆᡰេࠍߔࠆ ↢ᵴߔࠆⅣႺ߽ࠤࠕߩኻ⽎ߢ޽ࠆ ࠤࠕߒ߿ߔ޿ⅣႺߠߊࠅ߇ᔅⷐ߇޽ࠆ ੐೨ߦ‛ຠߩḰ஻ࠍߔࠆ ᔅⷐߥ‛ຠࠍ⥄ቛߦ޽ࠆ߽ߩߢᎿᄦߔࠆᔅⷐ߇޽ࠆ ㊄㌛⊛ߥ⽶ᜂࠍ߆ߌߥ޿ࠃ߁ߦߔࠆ ∋ഭߩ⒟ᐲ㧔੺⼔⽶ᜂ㧕ࠍ್ᢿߔࠆ ਇ቟࡮ᔃ㈩ߩ⁁ᴫ‫ޔ‬࿎ߞߡ޿ࠆߎߣߥߤ࠾࡯࠭ࠍᝒ߃ࠆ ੺⼔ߩ⍮⼂࡮⢻ജ߿੺⼔ߩ᭽ሶ. ੺⼔↪ຠߩ⚻ᷣᕈ ੺⼔⠪ ኅ ੺⼔⠪㧔ኅᣖ㧕ߩ⁁ᴫ ᣖ㧕߳ߩ੺ ⼔ജߦኻߔ ࠆᡰេ ኅᣖ⥄りߩ↢ᵴߦኻߔࠆᕁ޿‫↢ޔ‬ᵴ਄ߩ໧㗴ࠍ⍮ࠆ. ⸥ㅀੱᢙ㧔㧕㧺㧩㊀ⶄ࿁╵. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(74) . ቇ⠌ ᄢࠞ࠹ࠧ࡝࡯ ⋡ᮡ. ਛࠞ࠹ࠧ࡝࡯. ዊࠞ࠹ࠧ࡝࡯. ੺⼔⠪㧔ኅᣖ㧕߳ߩᡰ ੺⼔ߦኻߔࠆ᳇ᜬߜ߇⴫಴ߢ߈ࠆࠃ߁ߦߔࠆ េ ࡄࡦࡈ࡟࠶࠻ߦࠃࠆᜰዉߪౝኈ߇ᱷࠆߩߢਇ቟シᷫߦ᦭ലߢ޽ࠆ. ᕁ޿ ኅᣖߩ࠾࡯࠭㧕ߦᴪߞߡࠤࠕࠍឭଏߔࠆ ኅᣖߪ‫≮ޔ‬㙃⠪ߩᕁ޿ࠍઍᑯߒߡ޿ࠆߎߣ߇޽ࠆ ㆡቱ‫౒ޔ‬หߢࠤࠕࠍⴕ߁ Ԛ ⋧⺣ߦኻߔࠆᡰេ߇ᄢಾߢ޽ࠆ ኅᣖߦ߽ߢ߈ࠆ੺⼔ᣇᴺߩឭ᩺ࠍߔࠆ㧔ᜰዉߩᎿᄦ㧕 ੍᷹ߐࠇࠆ໧㗴ߦߟ޿ߡኻᔕ㧔⸘↹㧕ࠍ⠨߃ߡ߅ߊ ੍㒐⊛ߥࠤ ੍᷹ߣኻಣ ࠕ ⿠ߎࠅ߁ࠆ໧㗴ߦ੍᷹⊛ߦ㑐ࠊࠆ ✕ᕆᤨߩኻᔕߩ㊀ⷐᕈ ኻಣᣇᴺࠍ⺑᣿ߒߡ߅ߊ. ⋧⺣ߣᖱႎ ⋧⺣ߣᖱႎឭଏ࡮⺞ᢛ ࠨ࡯ࡆࠬౝኈ࡮ታᣉ࿁ᢙ࡮ㆊਇ⿷ߥߤ⋧⺣ࠍฃߌࠆ ԛ ឭଏ࡮⺞ᢛ ␠ળ⾗Ḯߩᖱႎឭଏࠍⴕ߁ ⸰໧⋡⊛ࠍߒߞ߆ࠅવ߃ࠆ ≮㙃⠪࡮੺ ࠦࡒࡘ࠾ࠤ࡯࡚ࠪࡦ ⼔⠪㧔ኅ ⸒⺆⊛࡮㕖⸒⺆⊛ࠦࡒࡘ࠾ࠤ࡯࡚ࠪࡦࠍ਄ᚻߊߣࠆ ᣖ㧕ߣߩ㑐 ⹤ߒ߿ߔ޿ⅣႺࠍߟߊࠆ㧔ᤨߦߪ‫≮ޔ‬㙃⠪ߩ஥߆ࠄ㔌ࠇߡ㧕 ଥᕈߩ᭴▽ ᗧะࠍ᳹ߺขࠆ ≮㙃⠪࡮ኅᣖ߆߆ࠊࠅࠍᄢಾߦߔࠆ. Ԝ. ⸥ㅀੱᢙ㧔㧕㧺㧩㊀ⶄ࿁╵. ⸰໧એᄖߪኅᣖ߇੺⼔ࠍߒߡ޿ࠆߎߣࠍᏱߦᗧ⼂ߔࠆ ኅᣖ㧔੺⼔⠪㧕᷷߳߆޿ᔃߩߎ߽ߞߚഭ޿ߩ৻⸒߇ᄢಾߢ޽ࠆ ዅᢘߔࠆ᳇ᜬߜࠍᜬߟ ଔ୯ⷰߩዅ㊀ ᗧᕁࠍዅ㊀ߔࠆ ⋡✢࡮┙ߟ〒㔌࡮┙ߜ૏⟎ߦ᳇ࠍߟߌࠆ ࡑ࠽࡯ ޿߈ߥࠅࠤࠕߦ⒖ࠄߥ޿ ᜿ᜦ࡮ᷡẖߥりߛߒߥߺ࡮ᝄࠆ⥰޿ 㑐ଥᕈࠍ▽ߊߚ߼ߦᄢಾ㧔╙৻ශ⽎ࠍ⦟ߊߔࠆ㧕 േំߔࠆߣਇାᗵࠍਈ߃ࠆ ᛛⴚജߩᓇ㗀⽿છࠍᜬߞߡⴕ߁ ޽޿߹޿ߥ⁁ᘒ㧔⍮⼂㧕ߢኻᔕߒߥ޿ࠃ߁ߦߔࠆ ⪭ߜ⌕޿ߡኻᔕߔࠆ ᛼ߒઃߌߦߥࠄߥ޿ ⊛⏕ߥ⋡ᮡ࡮⋴⼔⸘↹࡮⋴⼔੺౉߇ᄢಾߢ޽ࠆ ⋴⼔⋡ᮡߣ⸘↹ߩᅷᒰ ⅣႺ߇⇣ߥߞߡ߽⋴⼔ߩ⾰߇଻ߡࠆࠃ߁ߦߔࠆ. ᕈ ḩ⿷ᐲ࡮ࠤࠕߩ෻ᔕ. ≮㙃⠪ߩ෻ᔕ߿ᗵᗐࠍ⏕⹺ߔࠆᔅⷐ߇޽ࠆ ԝ ∋ഭ⁁ᴫࠍ⏕⹺ߔࠆ ߹ߚ᧪ߡ߽ࠄ޿ߚ޿ߣ޿߁᳇ᜬߜࠍᜬߞߡ߽ࠄ߁ ᰴߩ⸰໧߹ߢߩ቟ᔃ࡮቟ᭉߦ࿷ቛ≮㙃߇ߢ߈ࠆࠃ߁ߦߔࠆ ࿷ቛࠤࠕߢ ⋴⼔ߩᓎഀ ߩ⋴⼔ߩᓎ ޽ࠅߩ߹߹ߩᆫߢ↢ᵴߢ߈ࠆࠃ߁ߦߔࠆ ഀ ዋߒߢ߽㐳ߊ࿷ቛ≮㙃߇⛮⛯ߢ߈ࠆࠃ߁ߦᡰេߔࠆ ≮㙃⠪࡮ኅᣖߦߣߞߡ㗬ࠇࠆሽ࿷ߢ޽ࠆ ૕㛎ߦࠃࠆ ↢ᵴߩ႐ߢߩࠤࠕߩឭ ኅᣖ߳㈩ᘦߩᄢಾߐ߇ࠊ߆ߞߚ ଏ ⊒⷗ ⸰໧ߔࠆ⋴⼔Ꮷ߇໑৻ᖱႎࠍᓧࠆߎߣ߇ߢ߈ࠆሽ࿷ߢ޽ࠆ ⥄ቛߢߪࡌ࠶࠼ߦ⥁ᐥߒߡ޿ࠆߣߪ㒢ࠄߥ޿ ⸘↹ㅢࠅߦߪታᣉߢ߈ߥ޿ߎߣ߇ᄙ޿ ᣣ㗃߆ࠄ⋴⼔Ꮷࠍା㗬ߢ߈ࠆ㑐ଥߠߊࠅ߇ᄢಾ ⸰໧⋴⼔ߩᄾ⚂ߦ㑐ߔࠆ ḩ⿷ߣࠤࠕലᨐߪ⛘ኻᔅⷐߢ޽ࠆ ߎߣ ⋴⼔Ꮷߢߥ޿ߣߢ߈ߥ޿㧔ኾ㐷ᕈ㧕ߎߣࠍឭ᩺ߔࠆ ⸰໧⋴⼔⸘↹ᦠߩ⋡⊛‫⸥ޔ‬タౝኈ߇ℂ⸃ߢ߈ߚ ⸰໧⋴⼔ߩࠪࠬ࠹ࡓ ࠣ࡞࡯ࡊ⊒⴫ࠍㅢߒߡ ᭽‫ߥޘ‬េഥᣇᴺ߿ᜰዉᣇᴺࠍ⍮ࠆߎߣ߇ߢ߈ߚ ࡑ࠽࡯ࠍりߦߟߌࠆ ੹ᓟߩ⥄Ꮖ ࡑ࠽࡯߳ߩᗧ⼂ൻ ‫⺖ ޓ‬㗴 ᷡẖߥേ૞ࠍ⷗⋥ߔ ‫ޓ‬ ⺈ታߥኻᔕ߇ߢ߈ࠆࠃ߁ߦߥࠆ ߘ ශ⽎ߩࠃ޿ធߒᣇ߇ߢ߈ࠆࠃ߁ߦߔࠆ ߩ ࠦࡒࡘࡦࠤ࡯࡚ࠪࡦ⢻ ⸒⺆⊛࡮㕖⸒⺆⊛ࠦࡒࡘ࠾ࠤ࡯࡚ࠪࡦᛛⴚࠍ⏴ߊ ઁ ജ ≮㙃⠪ߛߌߢߪߥߊ‫ޔ‬ኅᣖߣࠦࡒࡘ࠾ࠤ࡯࡚ࠪࡦ߇ขࠇࠆ ⋧ᚻߦᱜ⏕ߦ⺑᣿ߢ߈‫⺞ޔ‬ᢛߢ߈ࠆ⢻ജࠍߟߌࠆ ኅᣖో૕ߩ⁁ᘒࠍᛠីߢ߈ࠆࠃ߁ߦߔࠆ ࠕ࠮ࠬࡔࡦ࠻⢻ജ ߐ߹ߑ߹ߥ੐ᘒߦኻᔕߢ߈ࠆ್ᢿജࠍりߦߟߌࠆ㧔⥃ᯏᔕᄌߥኻᔕ㧕. ⍮⼂࡮ᛛⴚߩୃ✵. ⹏ଔࠍฃߌࠆᆫ൓ ⥄Ꮖ⎇㐭. ↢ߓ߿ߔ޿໧㗴߇੍᷹ߢ߈ࠆࠃ߁ߦߔࠆ ∔ᖚߦኻߔࠆᱜߒ޿⍮⼂࡮ᛛⴚࠍりߦߟߌࠆ េഥᛛⴚࠍᓳ⠌ߒ↢ᵴߩേ߈ߦวࠊߖߡㅪ⛯ߒߡߢ߈ࠆࠃ߁ߦߔࠆ ⸰໧೨ߦਁోߩḰ஻ࠍߔࠆ ࠤࠕਛ߽≮㙃⠪߿ኅᣖߩ෻ᔕ‫ޔ‬๟࿐ߩ⁁ᴫ߇ⷰࠇࠆࠃ߁ߦߥࠆ ᤨ㑆ߩ㈩ಽߣല₸⊛ߥ૶޿ᣇ ੺⼔଻㒾‫␠ߤߥࠬࡆ࡯ࠨ␩⑔ޔ‬ળ⾗Ḯߩ⍮⼂ࠍりߦߟߌࠆ ࠤࠕᓟ‫ޔ‬ᗵߓߚߎߣߥߤᗵᗐࠍ⡞ߊ⠌ᘠࠍりߦߟߌࠆ ኤߔࠆജࠍりߦߟߌࠆ Ⓧᭂ⊛ߦ㑐ࠊࠆᆫ൓. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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