京都大学 / 新制・課程博士 / 博士(人間健康科学) / 甲第25212号 / 人健博第118号 / 京都大学大学院医学研究科人間健康科学系専攻 / (主査)教授 任 和子, 教授 宮下 美香, 教授 片岡 仁美 / 学位規則第4条第1項該当 / Doctor of Human Health Sciences / Kyoto University / DFAM

The study investigated the perceptions of student nurses and supervisors with regard to the block system used in the general nurse diploma programme in Zimbabwe. Their perceptions were elicited so that the researcher could identify the positive and negative aspects of the blook system which respectively promote and inhibit or obstruct the teaching and learning of student nurses. The study was conducted at the Harare, Parirenyatwa, Mpilo and United Bulawayo Schools of Nursing and in Mashonaland East province. A cross·sectional descriptive survey research design was used to obtain accurate information about the block system. Data was collected from nurse teachers, clinical teachers and sisters in charge of wards/units by means of structured interviews and from community health nurses and student nurses by means of self-administered questionnaires. The following positive aspects of study blocks were identified: the availability of time for student nurses to acquire knowledge, skills and attitudes without fear of hurting patients, the availability and willingness of nurse teachers to teach, the attendance of study blocks as groups and straight off duties. During clinical area placements, the integration of theory and practice took place, and there were opportunities for student nurses to apply the knowledge and skills they learnt during study blocks and to work as members of health teams. The negative aspects of the study blocks that were identified included too much theory content taught in each study block, inadequate demonstrations, a shortage of nurse teachers, no periods for individual study, a theory-practice gap and the too-frequent use of the formal lecture teaching method. The negative aspects of the clinical area placements included the inadequate teaching/supervision of student nurses, excessive night duties for student nurses, a shortage of qualified staff: clinical allocation of student nurses not based on study block content, inadequate clinical teaching by nurse teachers, and unplanned clinical teaching. Most clinical teaching was performed by peers and the most junior professional nurses. / Health Studies / D.Litt. et Phil. (Advanced Nursing Sciences)

The study investigated the perceptions of student nurses and supervisors with regard to the block system used in the general nurse diploma programme in Zimbabwe. Their perceptions were elicited so that the researcher could identify the positive and negative aspects of the blook system which respectively promote and inhibit or obstruct the teaching and learning of student nurses. The study was conducted at the Harare, Parirenyatwa, Mpilo and United Bulawayo Schools of Nursing and in Mashonaland East province. A cross·sectional descriptive survey research design was used to obtain accurate information about the block system. Data was collected from nurse teachers, clinical teachers and sisters in charge of wards/units by means of structured interviews and from community health nurses and student nurses by means of self-administered questionnaires. The following positive aspects of study blocks were identified: the availability of time for student nurses to acquire knowledge, skills and attitudes without fear of hurting patients, the availability and willingness of nurse teachers to teach, the attendance of study blocks as groups and straight off duties. During clinical area placements, the integration of theory and practice took place, and there were opportunities for student nurses to apply the knowledge and skills they learnt during study blocks and to work as members of health teams. The negative aspects of the study blocks that were identified included too much theory content taught in each study block, inadequate demonstrations, a shortage of nurse teachers, no periods for individual study, a theory-practice gap and the too-frequent use of the formal lecture teaching method. The negative aspects of the clinical area placements included the inadequate teaching/supervision of student nurses, excessive night duties for student nurses, a shortage of qualified staff: clinical allocation of student nurses not based on study block content, inadequate clinical teaching by nurse teachers, and unplanned clinical teaching. Most clinical teaching was performed by peers and the most junior professional nurses. / Health Studies / D.Litt. et Phil. (Advanced Nursing Sciences)

The purpose of this study was to establish if, and to what extent, management of nursing colleges enhanced personnel development with regard to the professional and personal development of nurse educators and clinical preceptors. From the literature survey, it was concluded that an effective personnel development programme that included all nursing personnel involved in the education and training of student nurses, was imperative for the rendering of continuous quality nursing education. The importance of co-operation between management of nursing colleges and nursing management of clinical facilities regarding the development of personnel involved in the education and training of student nurses, was emphasised. A programme for personnel development in nursing colleges was developed. The programme included suggestions for the educational development of both nurse educators and clinical preceptors/ registered nurses involved in the education and training of student nurses. It was suggested that nursing colleges should initiate the programme. Research consisted of an in-depth literature review about the management of personnel development in the educational milieu and a survey with regard to the management of the development of personnel involved in the education and training of student nurses. Principals of nursing schools, nursing educators, nursing directors of health services and clinical preceptors in clinical settings formed the population for the study. The theoretical framework used in this research with regard to personnel development in nursing schools, was Donabedian's theory on structural, process and outcomes standards as applied to quality improvement, as well as Alspach's theoretical foundation of nursing staff development. The focus of this study was to use data generated through research to develop a personnel development programme for all registered nurses involved in the education and training of student nurses. The most important conclusions of this research were as follows:  Personnel development was provided for nurse educators and clinical preceptors/ registered nurses involved in the education and training of student nurses in the clinical setting, but it did not necessarily meet the personal and professional developmental needs of these professionals.  The specific developmental needs of nurse educators and clinical preceptors/ registered nurses were related to educational skills, higher cognitive skill and skills related to research.  Available resources at nursing colleges did not facilitate and support the development of nurse educators and clinical preceptors involved in the education and training of student nurses. The main conclusion was that the establishment of a Department of Personnel Development at nursing colleges could provide for the educational needs of both nurse educators and clinical preceptors/ registered nurses, would benefit the personal and professional development of all learners involved and, ulitmately, would enhance the quality of patient care rendered by student nurses. / Advanced Nursing Sciences / D.Litt. et Phil. (Advanced Nursing Sciences)

A quantitative, descriptive research study was conducted at a nursing college to investigate the nature of nursing learners' exposure to computer assisted instruction and computer-based learning, the perceived benefits of this exposure, and the problems that they had encountered. Learners, who had been exposed to computer assisted instruction and computer-based learning, participated. A self-administered, structured questionnaire was administered to collect data. The research results revealed that the learners had limited exposure to educational computer packages, and computer-based learning activities. They encountered numerous problems. Although the learners derived many benefits from computer assisted instruction, this did not result in effective learning. They indicated that they preferred computer assisted instruction more than traditional teaching methods. This study contributed towards recommendations on improving learners' access to the necessary facilities, equipment and educational computer software. The researcher also recommended strategies to ensure that computer assisted instruction is based on sound educational principles. / Health Studies / M.A. (Health Studies)

The purpose of this study was to determine the factors associated with choosing mental health nursing as a career, and to explore the possible ways of improving recruitment and retention of mental health nurses in Kenya. Quantitative, explorative descriptive research was conducted. Data collection was done by using questionnaires and focus group discussions. Three groups participated in the study: practicing mental health nurses (n=10), post-basic mental health nursing students (n=10) and final year basic nursing students (n=184). The findings revealed that basic nursing students do not intend to pursue a career in mental health nursing, and that there is an aging population of mental health nurses. The barriers to the mental health field include stigma, a poor working environment and inadequate career guidance. Marketing, policy and regulatory reforms, as well as positive work environments have been identified as strategies for improving the recruitment and retention of mental health nurses in Kenya. / Health Studies / Thesis (M.A. (Health Studies))

African Americans diagnosed with diabetes are less likely to self-manage diabetes-specific modifiable risk factors. As a result, utilization of healthcare services occurs at a greater rate than other racial groups, and thereby incurs higher than expected healthcare costs. This ethnographic study explored the elements of diabetes educational material African Americans in a large city in the southern part of the United States found most useful to facilitate self-management of their disease. Bandura's self-efficacy theory provided the theoretical framework. Research questions addressed the preferred educational content, layout of material, and methods for educational delivery and caregiver support. A purposive sample of 30 African Americans with diabetes who had engaged in diabetes education classes participated in this study. Data were collected through in-depth personal interviews, which were inductively coded and then categorized around emergent themes. A key finding of this study is that participants preferred group learning formats, but perceived educational material to be confusing and difficult to understand. They also expressed some preferences for the use of color, pictures, and presentation of graphical information that may provide the basis for a revision of educational materials. Interestingly, participants indicated a tendency to seek out church members rather than family for support. The positive social change implications of this study include recommendations to healthcare professionals to adopt educational curricula that reflect cultural nuances and needs of target populations in order to support better health outcomes for at-risk populations and cost efficiency improvements.

<p>Syftet med denna kvalitativa studie var att undersöka hur elever med neuropsykiatriska funktionshinder upplever tiden i grund- och gymnasieskolan. Mina frågeställningar handlade om i vilka sammanhang eleverna upplevde svårigheter kopplade till funktionshindren, på vilka sätt skolan visade förståelse för dessa svårigheter, hur skolan löste de problem som uppstod, vad skolan kunde ha gjort mer samt vilka starka sidor hos eleverna som var betydelsefulla i skolan. Jag intervjuade sex ungdomar i åldrarna 18 - 21 år. Jag använde mig av halvstrukturerade intervjuer. Resultatet, som analyserades ur ett sociokulturellt perspektiv, visade att eleverna upplevde svårigheter i skolan i flera olika sammanhang. Stora klasser och störande ljud i klassrummet förvärrade elevernas koncentrationssvårigheter. Projektarbeten utan strikta ramar och att tvingas redovisa inför klassen utgjorde ett stort hinder för flera av eleverna, medan undervisning på för låg nivå ledde till bristande studiemotivation. Under högstadietiden upplevde eleverna stress och svårigheter att hitta till klassrummen. Annat som medförde problem var bland annat fobier, sömnstörningar och att delta i skolidrotten. Utanförskap och mobbing i elevgrupperna var vanligt förekommande. Även lärare utsatte eleverna för kränkande särbehandling genom utpekande handlingar, skuldbeläggande och bestraffningar. Eleverna upplevde att de oftast möttes av oförståelse och okunskap från skolan. Endast enstaka lärare visade förståelse. Skolans åtgärder sattes oftast in väldigt sent och lösningarna på problemen blev därför kortvariga. Vissa åtgärder gjorde till och med större skada än nytta. Eleverna berättade om sina starka sidor och menade att dessa hjälpte dem genom åren i skolan. Av resultatet framgick att mindre klasser, men också kunskap hos lärarna och förmågan att samtala med eleverna och lyssna på dem, är viktiga medel för att kunna ta tag i problemen på ett tidigt stadium och skapa en skola för alla.</p> / <p>The purpose of this qualitative study was to get knowledge of experiences of the years in compulsory school and upper secondary school by pupils with neuropsychiatric disabilities. The questions dealt with when and where in school the pupils had difficulties connected to their neuropsychiatric disabilities, in what way they were met with understanding for their difficulties, how the school solved the problems, what the school could have done more and what qualities the pupils possessed that helped in school. I interviewed six youngsters in the ages of 18 - 21. I used half-structured interviews. The result was analysed in a sociocultural perspective and showed that the pupils had difficulties in many ways at school. Big classes and noises in the classroom made their concentration difficulties worse. Projects in school without strict directions as well as appearances before the class became huge barriers for some of the pupils, while teaching at a too low level led to a lack of motivation. In upper level of compulsory school the pupils felt stress and difficulties in finding classrooms. Some other problems were phobias, insomnia and participating in school gymnastics. Bullying and exclusion from fellowship was usual. Even teachers were insulting the pupils by indicating them as outsiders, blaming them for their difficulties and punishing them. The pupils experienced that they were mostly met with misunderstanding and a lack of knowledge from the school. Just a few teachers were sympathetic. The school mostly took measures very late and the solutions therefore became short-lived. Some of the measures made the problems even worse. The pupils told me about their strong sides that helped them through school. The result showed that smaller classes as well as teachers knowledge and ability to converse and listen to the pupils are important instruments to be able to face the problems in an early phase and create a school for all kinds of minds.</p>

This descriptive survey study investigated the value of faculty practice among Commission of Collegiate Nurse Education (CCNE) Accredited Nursing Schools. The sample included all CCNE accredited schools that offered a Masters degree. Subjects from the 66 schools in the sample the dean and three Nurse Practitioner faculty who are teaching a clinical course. Response rate was 51% for the deans and 35% for the faculty. The opinions of deans were compared to the opinions of faculty on the views of faculty practice as research and the incorporation of faculty practice in the tenure and merit review system. The results showed faculty and deans differed on the value of faculty practice as research. However, only 6.5 % of statistically significance difference was contributable to whether the response was from a dean of a faculty. There was no significant difference to the inclusion of faculty practice in the tenure and merit review system. Boyer's expanded definition of research was used as a theoretical background. Deans viewed faculty practice more important as compared to the traditional faculty expectation of research than faculty did. The operational definition of faculty practice was that it required scholarly outcomes from the practice. Deans were more willing than faculty to acknowledge there were scholarly measurable outcomes to evaluate faculty practice than faculty were. The greatest difference in opinion of outcomes was the deans were more willing to accept clinically focused articles as an outcome than faculty were. Faculty were asked how the money from faculty practice was distributed. Faculty overwhelmingly reported that money generated from faculty practice most often goes to the individual faculty member. Suggested areas for future research involve investigation of the role of tenure committees in tenure decisions relating to research and faculty practice.

The aim of the research is to explore the first year experiences of two groups of undergraduate student nurses. The research takes a holistic approach to the investigation of the first year experience. In part, a curriculum change is used as a way to find out about the first year experience, with the research looking at how the introduction of enquirybased learning (EBL) into a curriculum impacted on the first year. The curriculum change is described in detail in chapter 1. The objectives of the thesis were to: 1. Examine the first year experience of nursing students. 2. Describe the curriculum change, the rationale for the change and the context within which this occurred. 3. Compare the demographic profiles of two groups of students one following a ‘traditional’ curriculum and the other using ‘EBL’; to compare students who chose to leave the courses with those who successfully completed first year. 4. Compare experiences with expectations of first year between nursing students undertaking a ‘traditional’ and an ‘EBL’ curriculum. 5. Propose strategies to enhance the student experience and rates of retention in first year undergraduate nursing students. The context for the research is described in chapter 1 – the literature review. This chapter explores the literature on the first year experience from both national and international perspectives. Inevitably, it reviews issues relating to student retention, which is the focus for much of the first year experience literature. The literature review argues that the contemporary context of nursing education requires nurse educators to consider the whole first year student experience when developing curricula that are fit for purpose. While the content of a course is important, the approaches to teaching need to facilitate learning within a diverse student population and need to prepare students to continue to learn in an increasingly dynamic healthcare environment. The chapter goes on to 2 argue that the issues that impact on the students’ first year experiences (e.g. relationships with peers and with academic staff, external domestic and personal circumstances) can be mitigated through curriculum development and other means (such as the availability and effectiveness of student support). The context of the particular nursing course along with the curriculum change and the rationale for the change are described. It can be argued that the retention literature takes a deficit approach to the improvement of the first year experience. Such an approach can be viewed as one that emphasises the factors that cause people to leave (or puts them ‘at risk’), and attempts to address these. On the other hand, a positive approach to the improvement of the first year is one in which measures and interventions aim to enhance the overall experience for all students, not just those who are seen as ‘at risk’. That said, the policy drivers for improving retention cannot be ignored and are discussed within the context of HE and nursing education. Finally, it is contended that the first year experience has not been widely explored within nursing literature and merits attention for a number of reasons, including the policy context and the need to determine whether student nurses have differing needs from students within other specialities. In chapter 2 the research methodology and research methods are described. An overview of case study research is provided and the approach taken within this thesis is described, along with a rationale for its use. The philosophical perspective is discussed with particular emphasis on the relationships between the methodology and the methods used to investigate the first year experience of students. It is argued that case study research is an appropriate methodology to investigate a complex area and provides an opportunity to utilise a number of methods so as to get to a ‘thick’ description of the phenomenon (the first year experience). All students in the two groups under investigation were asked to complete an expectations questionnaire, and an experiences questionnaire. Everyone who chose to leave the courses was asked to undertake an in-depth focused interview, although not all agreed. A sample of students who successfully completed first year was also asked to undertake an in-depth 3 focused interview. Finally, a sample of students was asked to complete a diary for the duration of the first year. The use of multiple methods is fitting, given the case study approach and the aim to create a ‘thick’ description, and an in-depth understanding of the first year experience. The use of the same research methods across the different groups of students allows for some comparisons to be made between the ‘traditional’ and ‘EBL’ curriculum students, and between leavers and stayers. The chapter also describes the approaches to data analysis. Chapter 3 presents the findings from the two questionnaires. Relevant demographic variables are reported, and the quality of the educational experience is measured in relation to the ways in which experiences meet expectations. This chapter shows that the two groups (‘traditional’ and ‘EBL’) are similar in terms of demographic variables. It also shows that the participants appeared to expect a ‘connected’ curriculum experience, but that the experience did not always match expectations. In chapter 4 the findings from the interviews and diaries are presented. Four themes are identified, with a number of categories in each. The themes (and categories) are: relationships with people (broadening horizons, knowing self and others, being supported and valued); the classroom experience (feeling inspired, becoming empowered, engaging with the learning experience); the practice experience (feeling inspired, becoming empowered, engaging with the learning experience); and professional education (motivation, preparedness, making adjustments). The chapter demonstrates the differences and similarities between the groups of students, before introducing the links to the quantitative findings, and to relevant research findings from the literature. Chapter 5 – the Discussion - brings together the findings from the qualitative and quantitative data as the case study. A conceptual framework is presented as a way in which the findings can be framed and through which future research can be organised. The assertion is made that the better the relationships, and the closer that experiences meet 4 expectations, the more likely it is that the student will have a ‘good’ experience and therefore be successful. The first year is seen as the foundation for future experiences on a course. While there are some areas that are particularly relevant to nursing students, it seems that the first year experience of student nurses is similar to that seen in other disciplines. Similar issues are identified within the thesis as within the wider literature, although nursing students’ issues may manifest themselves in slightly different ways (e.g. issues with practice placements/learning). In chapter 6, a number of conclusions are drawn that may enable future curriculum development to take a more holistic view of the student experience. Recommendations for practice are made and a focus for future systematic research is proposed. It is asserted that the conceptual framework that has been developed from the findings has allowed for a contribution to be made to the theoretical debate that relates to enhancing the first year experience and, in particular, to propose policy changes within the HE sector that may improve retention rates. This opening section has provided the reader with the context from which the ideas and focus for the thesis have developed, and has provided an overview of the aim and objectives of the research. It provided signposts for the full thesis and its component parts.