血液透析施術中の状況変化に対するベテラン臨床工学技士の対応とそれに必要な内在知識の明確化  [in Japanese] Clarification of Expert Medical Staff Behaviors and the Internalized Knowledge Necessary for Dealing with Situational Change during Hemodialysis Treatment  [in Japanese]

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Author(s)

Abstract

血液透析の臨床工学技士が医療安全や質を高めるためには,個々の患者の疾患や当日の体調等の状況に応じた施術内容の細かな調整・変更(状況判断・対応)が必要となる.一方,これまでの新人技士教育は,穿刺技能や血液透析装置の操作方法等に関するテクニカルスキルの向上が主な対象であったため,各技士が自身の経験に基づいて状況判断・対応を実施しており,新人とベテランとで施術パフォーマンスに差異が生じている現状にある.本稿では新人教育を念頭に,ベテランと新人の施術に関する差異の分析やヒアリング調査を行い,ベテランが行っている状況判断・対応の内容と,それを行うために必要な経験に基づく内在知識をそれぞれ明確化した.

In clinical hemodialysis, medical staff are expected to adjust or change the contents of operation depending on situational change, i.e. situation awareness and adjustment when the patient is undergoing medical treatment, such as each patient's condition or diseases. On the other hand, the present education of novice staff covers only technical skills, such as procedures of puncture and operation of the hemodialysis device. Staff, therefore, carry out situation awareness and adjustment based on their long-time experience, so novices cannot perform as well as experts. This is one of the educational problems of novice staff during hemodialysis treatment.  Therefore, the purpose of this study is to clarify the contents of situation awareness and adjustment that experts use and the internalized knowledge necessary for it. The method was to analyze the differences between experts and novices by observing experts' and novices' performance, and conducting a hearing survey of experts. As a result, this study revealed that experts were able to perform 25 items of situation awareness and adjustment. In order to perform those, experts had internalized knowledge of 69 items related to medical characteristics of each operation, awareness of their own skills, each patient's disease and characteristics of each patient's satisfaction. When a patient is undergoing medical treatment, however, expert staff refer to the checklist which shows the contents of operation less number of times than novice staff. Such behaviors contribute to shortening the time of operation, but we think that staff perform situation awareness and adjustment that is unsuitable for the situation. We believe that methods to educate the novice staff can be improved based on these results, and consequently, medical satety and the quality of hemodialysis treatment can rise.

Journal

  • Journal of Japan Industrial Management Association

    Journal of Japan Industrial Management Association 66(2), 130-138, 2015

    Japan Industrial Management Association

Codes

  • NII Article ID (NAID)
    130005093520
  • NII NACSIS-CAT ID (NCID)
    AN10561806
  • Text Lang
    JPN
  • ISSN
    1342-2618
  • NDL Article ID
    026619005
  • NDL Call No.
    Z4-298
  • Data Source
    NDL  J-STAGE 
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