Development of a clinical reasoning model for midwives to ensure the safety of epidural anesthesia deliveries.

2023 Fiscal Year Final Research Report

• Project/Area Number: 19K11063
• Research Category: Grant-in-Aid for Scientific Research (C)
• Allocation Type: Multi-year Fund
• Section: 一般
• Review Section: Basic Section 58070:Lifelong developmental nursing-related
• Research Institution: Tokyo Metropolitan University
• Principal Investigator: Adachi Kumiko 東京都立大学, 人間健康科学研究科, 教授 (30336846)
• Co-Investigator(Kenkyū-buntansha): 菱沼 由梨 東京都立大学, 人間健康科学研究科, 准教授 (50583697) ; 石川 紀子 静岡県立大学, 看護学部, 准教授 (90806308)
• Project Period (FY): 2019-04-01 – 2024-03-31
• Keywords: 硬膜外麻酔分娩 / 臨床推論 / 助産師

Outline of Final Research Achievements

The purpose of this study was to develop a clinical reasoning model for epidural anesthesia delivery. A simulated scenario of epidural anesthesia delivery and a video based on the scenario were created and viewed by the study participants, and a semi-structured interview was conducted to determine whether the participants were performing clinical reasoning, including information gathering and assessment. The study subjects were 12 midwives who provided care for epidural anesthesia delivery. Clinical reasoning scenes were extracted from the narratives of 12 midwives, analyzed, and organized according to existing clinical reasoning methods.
The results of the analysis showed that midwives' clinical reasoning methods during epidural anesthesia sentences were classified into six clinical reasoning methods: pattern recognition, multiple branches, thorough examination, hypothetical deduction,integrative patient-centered mode, and dual-process theory.

Free Research Field

助産学

Academic Significance and Societal Importance of the Research Achievements

臨床推論に関する研究は、これまで医学を中心に行われている。助産師を対象としたものは、分娩期の助産師の臨床推論をテーマとしたもの、臨床推論能力の向上のための提案やトレーニング法についての調査はあるが、臨床推論そのもののプロセスについて検討したものはない。硬膜外麻酔分娩時の助産ケアの研究については、提供するケア、判断に関する調査は行われているものの、臨床推論の研究までには至っていない。
言語化が難しい助産師の認知領域について、助産師の臨床推論をモデルとして提示することは、硬膜外麻酔分娩の経験が少ない助産師学生や新人の助産師が臨床推論を行う上での一助となるとともに、適切な助産診断に繋がる。