看護学部 看護学科
清水 佐知子 教授
専門分野：看護マネジメント、ヘルスサービスリサーチ、基礎看護学

看護業務の「段取り」を学ぶ必要性

　大学教育では知識・技術の習得が中心であり、現場で求められる「仕事の段取り力」を学ぶ機会はほとんどないのが現状だ。この熟練看護師の「経験知」を新人看護師でも系統的かつ効率的に学べるようになれば、看護の質が向上し、医療チーム全体の業務が円滑に進むだろう。清水教授は世界的にも研究事例が少ない看護師の「段取り」に着目し、効果的な学習方法の確立をライフワークとしている。

「段取り」に大きな影響を及ぼす「看護観」

　研究に着手するにあたり、清水教授はまず「段取り」の概念を明らかにするところからスタートした。 段取りが何で構成され、どのようなものに影響されるのか、一つひとつ紐解いていく作業である。研究は、業務管理（目標設定、スケジューリング）、業務推進（多重課題への対応）、業務改善、リスク管理へと進展した。「看護師の段取りにその人の看護観が大きな影響を与えていることがわかり、興味深く感じました」と清水教授は振り返る。「看護師にインタビューする際、“段取り”という言葉に対し『仕事を早く終わらせること』だと捉え、拒否感を示す方がいることが分かりました。しかし、段取りとは、業務を効率よく進めることで生産性が向上し、時間的余裕が生まれることで心理的な安定をもたらします。結果として患者・本人・チームすべてに良い影響を与える創造的な仕事につながります」と説明する。

新人看護師のための学習プログラムを作成

　さらに看護師へのインタビュー調査を続け、熟練看護師がどのように段取りをしているのか、新人看護師がどのように段取り力を獲得していくべきか、そのプロセスを検証した。現在、その知見をもとに学習プログラムの作成に取り組んでいる。

　学習プログラムでは段取りの概念を用いながら、業務の優先順位づけを行う。看護の現場では緊急かつ頻繁に多重課題が発生するが、何を優先し、多重課題の発生をいかに減らすかを学ぶ。

　「例えば、患者Aさんのトイレ介助中に、患者Bさんのナースコールが鳴るという『多重課題』が発生したとき、どう動くべきか。熟練看護師は、そもそもAさんへの声かけを工夫するなど、多重課題の発生そのものをコントロールしています。このように、従来は『経験と勘』に頼っていた熟練の判断のプロセス（段取り）を、新人看護師が体系的に学べるように学習プログラムを設計しています」

　現在、清水教授は教育工学の研究者と協力してインストラクショナルデザインの考え方を採り入れながら、学習者の目標・活動・評価のサイクルを効果的に回す学習プログラムを設計中だ。 「完成後は卒業直前の学部生や卒後間もない新人看護師の教育への活用を想定しています。このプログラムを通じて、段取り力を引き上げて、現場の看護をよりスムーズに、質の高いものにする一助にしていただきたいです。さらに看護師がいつでもアクセスできるデータベースを構築できればより役立つため、ともに開発できる病院や企業、大学・研究機関との協働を希望しています」

School of Nursing, Department of Nursing
Professor Sachiko Shimizu
Areas of specialization: Nursing management, health services research (HSR), fundamental nursing

Improving “Dandori” Skills What Type of Learning Program Helps Improve the Quality of Nursing Care?

The need for learning the “dandori” for nursing care

The current situation is that university education focuses on acquiring knowledge and skills, and there are almost no opportunities to learn “dandori for work,” which are skills required on-site. If new nurses could efficiently and systematically learn the “knowledge from experience” that skilled nurses have, the quality of nursing care would improve and the operations of the entire medical team would most likely run more smoothly. Professor Shimizu has been conducting research that focuses on the “dandori” for nurses, a topic with limited case studies globally. She has made it her life’s work to establish an effective learning method.

“Nursing philosophy” has a significant impact on “dandori”

Before starting her research, she first clarified the concept of “dandori.”
It entailed the work of unraveling each aspect one by one, such as what does “dandori” consist of and what is it affected by. Research developed from operation management (goal setting, scheduling), operations execution (handling multiple tasks), operations improvement, to risk management. “It became clear that a nurse’s ‘dandori’ is greatly affected by his or her nursing philosophy and I thought that was very interesting,” she said, looking back. “While interviewing nurses, we noticed that some of them expressed some resistance toward ‘dandori’ since they understood the word to mean something like ‘getting the work done quickly.’ But, ‘dandori’ improves productivity by working efficiently and brings about psychological stability by freeing up more time. As a result, it leads to a creative job that has a positive impact on the patient, the nurse themselves, and the team as a whole,” she explains.

Creating a learning program for new nurses

Continuing their interviews of the nurses, they verified the process of how skilled nurses were carrying out “dandori” and also how new nurses should acquire “dandori” skills. Currently, she is involved in creating a learning program based on the knowledge gained from these interviews.

In this learning program, tasks are prioritized using the concept of “dandori.” At the nursing workplace, multiple tasks occur urgently and frequently. Students learn what to prioritize and how to lessen the occurrence of multitasking.

“For example, how should a nurse proceed when a ‘multitasking’ situation occurs where the nurse call rings for Patient B while they are assisting Patient A with toileting. To begin with, a skilled nurse would come up with a way to talk to Patient A and control the situation so that multitasking would not be necessary. In this way, we are designing our learning program so that new nurses can systematically learn the skilled judgment process (‘dandori’) that traditionally relied on ‘experience and intuition’.”

Working in collaboration with educational technology researchers and incorporating concepts of instructional design, she is currently designing a learning program that effectively uses the learner’s goal-action-evaluation cycle.

“After it’s completed, we intend for it to be used for the education of undergraduate students who are just about to graduate and new nurses who have just graduated. I hope that this program raises the level of ‘dandori’ skills and helps on-site nursing care to run smoother and elevates it to a higher quality. Furthermore, since it would be even more useful if we could build a database that nurses could access at any time, I’m hoping that we can collaborate with a hospital, corporation, university, or research institution so that we can develop one together.”