抄録
本研究の目的は, 双胎の周産期医療過誤訴訟判例から, 個々の具体的な場面に即して助産師に求められる業務と責任および医師との連携を明確にし, 助産師の自律と母子の安全を重視した臨床実践を追及することである。助産師の行動が明瞭に記載されている3判例を選択し, 日本助産学会が提唱する「日本の助産婦が持つべき実践能力と責任範囲」のうち, 「I妊娠期のケアとその責任範囲」「II分娩期のケアとその責任範囲」に焦点を当てSHELLモデルを用い分析した。その結果, 判例1は「妊娠経過の診断」「分娩開始の診断」, 判例2は「産婦と胎児の健康状態の診断」「異常発生時の判断と臨時応急の手当て」, 判例3は「妊娠経過の診断」において, 事故に至るいくつかの要因が存在することがわかった。同種の医療事故を防止するためには, 助産師業務の見直しや自己研鑽が必要である。SHELLモデルを適用すれば, Sとしてマニュアルなどの作成と見直し, Hとして医療水準に応じた教育体制の整備と医療機器の有効活用および施設, 構造上の問題への対応, Eとして助産師の適正配置と業務の確立および発言しやすい雰囲気の職場づくり, Lとして医師との業務上の合議と患者情報の共有が必要と考える。
The purpose of this study is to clarify care and responsibility of midwives their need to cooperate with obstetricians in each case through perinatal malpractice litigations involving twinning, and to discover effective clinical practice that are important for mother and neonatal safety. Three cases in which the action of midwives were clearly indicated were selected. Using SHELL model the 3 cases were analyzed focusing on "Care and scope of responsibilities during pregnancy" and "Care during birth and scope of responsibility" in "The practical skills and responsibilities that a midwife should have" that the Japan Academy of Midwifery suggest. Some factors that cause medical accidents were revealed on "Examination for evaluation of state of pregnancy to date" and "Examination at the outset of delivery" in case 1, and "Examination of condition of the client and fetus" and "Identification of abnormalities when they occur and giving emergency treatment" in case 2, and "Examination for evaluation of state of pregnancy to date" in case 3. In order to prevent the similar accidents, midwives have to improve their technique of care and carry out self-study. In addition, under each criterion of SHELL, making and improving the manual or SOFTWARE, preparing the education system in step with the advances of medical technology, solving the problems in the structure of equipment, and using the effective medical apparatus or HARDWARE, establishing relationships of the work place making it easy to speak, and assigning midwives as ENVIROMMENT, and discussing about and sharing the patient information with obstetricians as LIVEWARE are required.
