Japanese

Title	熟練訪問看護師の訪問対象者に対する「なんとなく変」の気づきと臨床判断
Subtitle	原著
Authors	岩野千尋, 塚本康子
Authors (kana)
Organization	新潟医療福祉大学
Journal	日本在宅看護学会誌
Volume	10
Number	1
Page	22-31
Year/Month	2021 / 8
Article	原著
Publisher	日本在宅看護学会
Abstract	「要旨」 目的: 熟練訪問看護師が対象者に「なんとなく変」と気づいた際, どのような事象を捉え, どのような臨床判断がなされていたのかを明らかにする. 方法: 熟練訪問看護師7名を対象に半構成化面接を行い, 質的記述的方法により分析した. 結果: 「なんとなく変」の気づきは, 【いつもと違う見た目】【反応・応答が鈍い, いつもより口数が少ない】など8つのカテゴリーが抽出され, 臨床判断は【観察結果から直観的に判断する】【現在の状況について現病歴・既往歴から瞬時に分析的な推論をし行為に至る】などの9つのカテゴリーに集約された. 結論: 熟練訪問看護師の「なんとなく変」という気づきの大半は直観的な気づきであり, 異変にいち早く気づくために看護師と対象者の関係性が重要であることが明らかとなった. 熟練訪問看護師は瞬時に推論し, 判断と同時に行為を行っていた. 臨床判断を行うためには, 看護師としての対象者に対する責任や知識の獲得への意欲が必要であり, 臨床判断能力を高めるためには, 行為への省察が重要であることが示唆された.
Practice	看護学
Keywords	熟練訪問看護師, 気づき, 臨床判断, 直観, experienced home visiting nurse, noticing, clinical decision, intuition

English

Title	The Gut Feeling of Experienced Home Visiting Nurses for their Patients and the Clinical Decisions that they Make
Subtitle
Authors	Chihiro Iwano, Yasuko Tsukamoto
Authors (kana)
Organization	Niigata University Of Health And Welfare
Journal	Journal of Japan Academy of Nursing for Home Care
Volume	10
Number	1
Page	22-31
Year/Month	2021 / 8
Article	Original article
Publisher	Japan Academy of Nursing for Home Care
Abstract	[Abstract] Aim: To investigate what experienced home visiting nurses notice in their patients when they have a gut feeling as well as what kind of clinical decisions they make in such a situation. Methods: Semi-structured interviews were conducted with seven experienced home visiting nurses. A qualitative, descriptive study design developed by Hiroko Yatsu was used in analyzing interview data. Results: Eight categories were generated for the gut feeling of nurses for their patients, including: different appearance from usual and slower response/reaction and fewer utterances than usual. For clinical decisions, nine representative categories were generated, including: making intuitive decisions based on observation and immediately making an analytical assumption about the patient's current condition and taking action based on the patient's current and past history. Conclusion: It was found that the gut feeling of nurses is mostly derived from intuitive thinking. Results suggest that the relationship between the nurse and the patient is key for early detection of abnormal changes in the patient. Experienced home visiting nurses in this study made decisions based on quick assumptions on which they acted straight away. Findings suggest that, for nurses to improve their clinical decision-making skills, they should self-reflect on their actions.
Practice	Nursing
Keywords	experienced home visiting nurse, noticing, clinical decision, intuition

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