@article{oai:iuhw.repo.nii.ac.jp:00001269,
 author = {水尾, 智佐子 and MIZUO, Chisako},
 issue = {1},
 journal = {国際医療福祉大学学会誌, Journal of the International University of Health and Welfare},
 month = {Feb},
 note = {目的：日本では硬膜外麻酔分娩は産婦のニーズにより増加傾向にある．硬膜外麻酔分娩に対応できる助産師の実践能力を高めるために，助産師に求められる臨床推論を明確化しておく必要がある．本研究では硬膜外麻酔分娩における助産師の臨床推論の概念分析を行った．
方法：Walker & Avant による概念分析を用いた．
結果：硬膜外麻酔分娩における助産師の臨床推論の概念として，3 つの先行要件，3 つの属性，2 つの帰結が導き出された．この概念は【リスクの知識】【異常を回避できる知識】【分娩全体を見通す先見】が先立ち，【状況認知】【解釈】【経験知】を基盤に【分娩を生理的機序に近づける助産ケア】や【重篤な状況回避】をもたらすための思考プロセスと定義できた．
考察：硬膜外麻酔分娩における助産師に必要とされる臨床推論の概念が明確になった．硬膜外麻酔分娩においてリスクや異常を予測する助産師のアセスメントや臨床推論の能力育成のために，今後，本概念の定義や先行要件を基盤とした思考モデルの開発が期待される．さらに，本概念の先行要件の教育や臨床推論のトレーニングを行うことにより，助産師の硬膜外麻酔分娩における助産実践の向上につながると考えられる．, Background: In Japan, the use of epidural anesthesia for delivery is increasing due to the needs of parturient women. In order to improve midwives’ practical ability during epidural anesthesia delivery, it is necessary to clarify the clinical reasoning required of them. In this study, we conducted a conceptual analysis of midwives’ clinical reasoning during epidural anesthesia delivery.
Methods: Walker & Avant’s conceptual analysis was used to conduct this study.
Results: Three categories of prerequisites, three categories of attributes, and two categories of consequences were extracted as concepts of midwives’ clinical reasoning during epidural anesthesia delivery. These concepts were defined as a thought process to bring about “midwifery care that brings the delivery closer to the physiological mechanism” and “avoidance of serious situations” based on; “situational awareness”, “interpretation” and “experiential knowledge”, and preceded by; “knowledge of risk”, “knowledge to avoid abnormalities” and “foresight to foresee the entire delivery”.
Discussion: The concepts of clinical reasoning required for midwives during epidural anesthesia delivery have been clarified. In the future, development of a thinking model based on the definition of these concepts and prerequisites is expected in order to foster midwives’ assessment and clinical reasoning ability to predict risks and abnormalities during epidural anesthesia delivery. Furthermore, by providing education on the prerequisites of these concepts, as well as training on clinical reasoning, it is considered that they will lead to the improvement of midwifery practice during epidural anesthesia delivery.},
 pages = {98--106},
 title = {硬膜外麻酔分娩における助産師の臨床推論の概念分析},
 volume = {28},
 year = {2023},
 yomi = {ミズオ, チサコ}
}