{"created":"2023-08-18T01:58:15.385324+00:00","id":2000012,"links":{},"metadata":{"_buckets":{"deposit":"6bd4f922-c211-4277-9379-7e530f218576"},"_deposit":{"created_by":17,"id":"2000012","owners":[17],"pid":{"revision_id":0,"type":"depid","value":"2000012"},"status":"published"},"_oai":{"id":"oai:tachibana.repo.nii.ac.jp:02000012","sets":["2"]},"author_link":[],"control_number":"2000012","item_10006_date_granted_11":{"attribute_name":"学位授与年月日","attribute_value_mlt":[{"subitem_dategranted":"2020-09-18"}]},"item_10006_degree_grantor_9":{"attribute_name":"学位授与機関","attribute_value_mlt":[{"subitem_degreegrantor":[{"subitem_degreegrantor_language":"ja","subitem_degreegrantor_name":"京都橘大学"}],"subitem_degreegrantor_identifier":[{"subitem_degreegrantor_identifier_name":"34309","subitem_degreegrantor_identifier_scheme":"kakenhi"}]}]},"item_10006_degree_name_8":{"attribute_name":"学位名","attribute_value_mlt":[{"subitem_degreename":"博士（看護学）","subitem_degreename_language":"ja"}]},"item_10006_description_17":{"attribute_name":"フォーマット","attribute_value_mlt":[{"subitem_description":"application/pdf","subitem_description_type":"Other"}]},"item_10006_description_7":{"attribute_name":"抄録","attribute_value_mlt":[{"subitem_description":"【研究の背景】\n感染症による不本意な死を防ぐことは医療従事者の責務であり，リーダーシップをとって取り組まなければならない課題といえる．感染を防止する最も基本的で重要な対策は手指衛生である．しかし，医療現場の医療従事者の手指衛生遵守率は低く約4割とされ，行動変容を目的とした戦略の推進が掲げられている（World Health Organization [WHO], 2009）．けれども，未だ決定的な成果は示されていない．手指衛生研究に適用されている行動理論の多くは，行動の直近の認知の因子を「意思」と仮定しその組成を説明するものである．しかし，意思は必ずしも行動を反映していなかった（O'Boyle, Henly, & Larson, 2001）．そこで，このギャップを埋める因子の特定が必要とされた．この仲介因子に焦点を当てる理論の一つに，The Health Action Process Approach （HAPA）がある．これは，行動に至るまでのプロセスを，意思までのMotivational（動機づけ）相と意思からのVolitional（意志）相に分けて説明した上で，特に意志相における因子に焦点をあて，その因子がプランニングと自己効力であるとするものである（Schwarzer, 2008）．\n【研究目的】\n新人看護師教育におけるHAPA理論を適用した手指衛生遵守のための介入の効果を明らかにすることである．\n【研究方法】\n研究デザインは，比較群をもつプレテスト－ポストテストデザインである．2か年計画で行い，介入群と比較群は，同じ病院で年ごとに割り付けた．介入は，いつ，どこで，どのように行動するのかという計画を立案するアクションプランニング，予想される障害とその対処についての計画を立てるコーピングプランニング，及び手指衛生の実践と自己評価による自己制御の発動の適用により行動化を促進させるものであった．2回の研修と3か月の臨床実践を含んだ．主要なアウトカムは研究者ら（山本ら,2019）が開発した5つの因子からなる新人看護師の手指衛生認知尺度（以下，HAPA項目と略す）及び直接観察によって得た手指衛生の実施率であった．手指衛生の実施率は手指衛生遵守率に類似するが，手指衛生の手技を所要時間のみから判定する方法をとったため，これと区別して設定した．その際，場面と所要時間両方の適切性を満たす手指衛生実施率（以下，実施率と略す）に加え，場面が適切と判断されれば手技の達成度は問わない実施率（以下，場面実施率と略す）の2種類を算出した．副次的なアウトカムは，介入群における介入時の成果物である．データ収集はベースライン，介入の中間，直後，2か月後の4時点で行った．データ分析は，HAPA項目は点数化し，項目毎，項目の得点を合計した因子毎について各時期における両群の比較及び各因子の群別の評価時期間の比較を行った．手指衛生の実施率については，まず観察された場面の偏りの有無と偏りが実施率に影響を及ぼす程度についての分析を行った後に，時間経過に伴う差における両群の比較及び群別の評価時期間の比較を行った．成果物のうち，グループワークの内容については，逐語禄を意味のまとまり毎にコード化し，類似性に基づきカテゴリー化した．倫理的配慮として，京都橘大学研究倫理委員会の承認を得た（承認番号16-41）．\n【結果】\n47名が研究参加者となり，最終的に分析対象となったのは，介入群19名，比較群21名であった．HAPA項目の因子毎の比較では，コーピングプランニング，アクションプランニング，アウトカム予期の得点がいずれも2か月後において介入群が有意に高かった（p=.025, .029, .001）．アウトカム予期は中間，直後においても介入群に高かった（p=.005,.007）．また，HAPA項目では，セルフエフィカシー，意思，コーピングプランニング，アクションプランニング，アウトカム予期の全ての因子内で1つ以上の項目の得点が主に直後，2か月後において比較群に比べ介入群は有意に高かった．比較群ではベースラインから2か月後にかけて有意にセルフエフィカシー得点が低下（p=.023）していたのに対し，介入群ではベースラインから中間にかけてセルフエフィカシー得点が低下（p=.026）したものの，直後にかけて上昇傾向にあった．加えて介入群では，意思はベースラインから直後にかけて（p=.046），コーピングプランニングはベースラインから直後（p=.029），2か月後までも上昇（p=.039）がみられていた．場面実施率の両群の比較では，ベースラインから直後の差が介入群に有意に大きく（p=.045），群別では比較群においてベースラインから直後にかけて有意に低下していた（p=.012）．また，実施率では両群に有意差は認められず，群別では比較群においてベースラインから2か月後にかけて有意に低下していた（p=.007）．グループワークからは，行動化を妨げる要因として，〈忙しさから時間がとれない〉等のサブカテゴリーからなる【行動化を妨げる個人外の要因】等が抽出された．\n【考察】\n今回の介入後介入群では，2か月後において，コーピングプランニング，アクションプランニング，アウトカム予期の因子の得点が高値を示していた．また，場面実施率においては，ベースラインから直後の差が比較群に比べて有意に大きかった．比較群の場面実施率が直後にかけ有意に低下していたことから，本介入は場面実施率の維持に効果を示した可能性が示唆された．これらのことから，本介入に用いたプランニング，自己制御の発動といったHAPA理論の適用は手指衛生に関する認知面を強化し，適切な場面における手指衛生の実施に一定の効果を示したのではないかと考えられる．しかし，本来の手指衛生遵守率に近い実施率についての明らかな向上は認められなかった．これについては，グループワークから，手指衛生の時間を十分にとることができないといった個人外の要因が関連していることが推察された．\n【結論】\n本研究におけるHAPA理論を適用した介入は手指衛生に関する認知面を強化させ，適切な場面での手指衛生の実施に一定の効果を示した可能性が示唆された．HAPA理論の適用は新人看護師の適切な場面における手指衛生行動についての意思－行動ギャップを埋める戦略となり得ると考える．一方で，手指衛生遵守率に類似する実施率の維持については示すことができず，手指衛生の時間を十分にとることができないといった個人外の要因の影響が推察された．今後，この要因に対する介入との組み合わせについても検討していきたい．","subitem_description_language":"ja","subitem_description_type":"Abstract"},{"subitem_description":"[Background]\nHealthcare workers (HCWs) are responsible for the prevention of involuntary deaths due to infectious diseases and must take a leadership role in such efforts. Hand hygiene is the most fundamental and important measure for the prevention of transmission of pathogenic microorganisms. However, the rate of adherence of HCWs to the recommended hand hygiene procedures in medical settings is low and is estimated to be approximately 40%, and strategies to induce behavioural changes among HCWs have been undertaken (World Health Organization [WHO], 2009); however, no definitive results have still been demonstrated. Many health behaviour theories adopted in previous hand hygiene studies explained the composition with an assumption that ‘intention’ is the most proximal cognitive antecedents of behaviour. However, the ‘intention’ did not always reflect behaviour (O'Boyle, Henly, & Larson, 2001). Therefore, a factor to fill this gap was required to be identified. One of theories focusing on this mediator is the Health Action Process Approach (HAPA). In this theory, the process before an action is taken is divided into the motivational phase until an intention is formed and the volitional phase after an intention is formed; then, a particular focus is placed on factors in the volitional phase, which are planning and self-efficacy (Schwarzer, 2008).\n[Objective]\nTo clarify the effects of intervention to improve hand hygiene compliance based on the HAPA theory in the education for novice nurses\n[Methods]\nThis was a pre-test–post-test design including a comparison group. The study was conducted according to a 2-year plan in which HCWs in the same hospital were allocated to an intervention group and a comparison group each year. The intervention included facilitation of action through action planning to plan when, where and how to act; coping planning to devise a plan for tackling possible barriers and coping with them and hand hygiene practice and self-evaluation to exercise self-regulation. Two training sessions and a 3-month clinical practicum were included. Primary outcomes were a 5-factor Hand Hygiene Cognitive Scale for novice nurses (HAPA items) developed by the authors (Yamamoto et al., 2019) and the rate of hand hygiene practices based on direct observation results. The rate of hand hygiene practices was similar to the rate of adherence of HCWs to the recommended hand hygiene procedures, but differed in that the practice of the hand hygiene procedure was judged based only on the duration of the entire procedure; therefore, the former was distinguished from the latter. The author calculated the following two different rates of practice: (1) hand hygiene practices rate satisfying both My five moments for hand hygiene and duration of the entire procedure criteria (practices rate) and (2) the rate of practice satisfying the My five moments for hand hygiene criteria regardless of whether the procedural criteria were satisfied (practices rate at My five moments for hand hygiene). Secondary outcomes were intervention deliverables in the intervention group. Data were collected at baseline, at the mid-point of the intervention and immediately and 2 months after the intervention. In the data analysis, HAPA items were converted to scores, following which comparisons were made for individual item scores and factor score (sum of item scores) between the groups at four time points. Further, comparisons were made for factor score between time points within each group. For the rate of hand hygiene practices, the author first analysed whether there was any bias in the observed My five moments for hand hygiene and if any, how large was the effect of bias on the rate of practices. Then the author performed intergroup comparisons regarding changes over time and intragroup comparisons between time points. Among deliverables, the verbatim record of group work content was analysed to code semantic groups, which were then categorised based on similarities. The study was approved by the Research Ethics Committee of Kyoto Tachibana University (approval number, 16-41).\n[Results]\nForty-seven healthcare workers participated in this study; of them, 19 in the intervention group and 21 in the comparison group were finally included in analyses. Among HAPA factors, scores for coping planning, action planning and outcome expectancies 2 months after the intervention were significantly higher in the intervention group (p = .025, .029 and .001, respectively). Outcome expectancies scores at the mid-point of and immediately after the intervention were also higher in the intervention group (p = .005 and .007, respectively). Among HAPA items, scores for at least one item in all factors of self-efficacy, intention, coping planning, action planning and outcome expectancies were significantly higher in the intervention group than in the comparison group, mainly immediately and 2 months after the intervention. While the self-efficacy score decreased significantly from baseline to 2 months after the intervention in the comparison group (p = .023), the self-efficacy score decreased from baseline to the mid-point of the intervention (p = .026) but then tended to increase immediately after the intervention in the intervention group. In addition, the intention score increased from baseline to immediately after the intervention (p = .046), and the coping planning score increased from baseline to immediately (p = .029) and even 2 months (p = .039) after the intervention in the intervention group. The intergroup comparison of the practices rate at My five moments for hand hygiene showed that the change from baseline to immediately after the intervention was significantly larger in the intervention group (p = .045), and the intragroup comparison within the comparison group showed a significant decrease from baseline to immediately after the intervention (p = .012). The practices rate did not differ significantly between the two groups, and it decreased significantly from baseline to 2 months after the intervention in the comparison group (p = .007). Factors hampering action that were extracted from the group work included [non-personal factors hampering action], which comprised subcategories such as <I am too busy to spare time>.\n[Discussion]\nIn this study, scores for the factors of coping planning, action planning and outcome expectancies 2 months after the intervention were higher in the intervention group. Moreover, the change in the practices rate at My five moments for hand hygiene from baseline to immediately after the intervention was significantly larger in the intervention group than in the comparison group. Because the practices rate at My five moments for hand hygiene decreased significantly immediately after the intervention in the comparison group, the results suggest that the intervention was effective for maintaining the practices rate at My five moments for hand hygiene. These findings show that HAPA theory-based elements of the intervention used in this study, such as planning and self-regulation, strengthen the cognitive aspect of hand hygiene and have been effective, to a certain extent, for hand hygiene practice at My five moments for hand hygiene. However, no appreciable improvements were observed in the practices rate, which is close to the rate of adherence of HCWs to the recommended hand hygiene procedures. The group work analysis suggests that non-personal factors, such as insufficient time allocation for hand hygiene, may explain the lack of improvements.\n[Conclusion]\nThese findings suggest that the HAPA theory-based intervention in this study enhanced the cognitive aspect of hand hygiene and was effective for hand hygiene practices at My five moments for hand hygiene to a certain extent. The author considers the use of the HAPA theory can provide a strategy to bridge the intention–behaviour gap in novice nurses about hand hygiene behaviour at My five moments for hand hygiene. However, the results failed to show the maintenance of the practices rate, a parameter close to the rate of adherence of HCWs to the recommended hand hygiene procedures, suggesting an influence of non-personal factors, such as insufficient time allocation for hand hygiene. In the future, the author would like to consider combinations with an intervention for these factors.","subitem_description_language":"en","subitem_description_type":"Abstract"}]},"item_10006_dissertation_number_12":{"attribute_name":"学位授与番号","attribute_value_mlt":[{"subitem_dissertationnumber":"甲第9号"}]},"item_10006_publisher_5":{"attribute_name":"公開者","attribute_value_mlt":[{"subitem_publisher":"京都橘大学","subitem_publisher_language":"ja"}]},"item_10006_version_type_18":{"attribute_name":"著者版フラグ","attribute_value_mlt":[{"subitem_version_resource":"http://purl.org/coar/version/c_970fb48d4fbd8a85","subitem_version_type":"VoR"}]},"item_creator":{"attribute_name":"著者","attribute_type":"creator","attribute_value_mlt":[{"creatorNames":[{"creatorName":"山本, 容子","creatorNameLang":"ja"},{"creatorName":"ヤマモト, ヨウコ","creatorNameLang":"ja-Kana"}],"nameIdentifiers":[{"nameIdentifier":"00321068","nameIdentifierScheme":"e-Rad","nameIdentifierURI":"https://kaken.nii.ac.jp/ja/search/?qm=00321068"}]}]},"item_files":{"attribute_name":"ファイル情報","attribute_type":"file","attribute_value_mlt":[{"accessrole":"open_access","displaytype":"detail","filename":"ktu_dr_2020nuk09_a.pdf","format":"application/pdf","licensetype":"license_11","mimetype":"application/pdf","url":{"label":"博士論文の要旨および審査結果の要旨","objectType":"abstract","url":"https://tachibana.repo.nii.ac.jp/record/2000012/files/ktu_dr_2020nuk09_a.pdf"},"version_id":"14731b1c-7389-4bb3-9f8f-48b5d730b681"},{"accessrole":"open_access","displaytype":"detail","filename":"ktu_dr_2020nuk09_b.pdf","format":"application/pdf","licensetype":"license_11","mimetype":"application/pdf","url":{"label":"全文","objectType":"fulltext","url":"https://tachibana.repo.nii.ac.jp/record/2000012/files/ktu_dr_2020nuk09_b.pdf"},"version_id":"cda7319a-6460-45c4-857c-beff2fd81e32"}]},"item_language":{"attribute_name":"言語","attribute_value_mlt":[{"subitem_language":"jpn"}]},"item_resource_type":{"attribute_name":"資源タイプ","attribute_value_mlt":[{"resourcetype":"doctoral thesis","resourceuri":"http://purl.org/coar/resource_type/c_db06"}]},"item_title":"新人看護師教育におけるThe Health Action Process Approach (HAPA) 理論を適用した手指衛生遵守のための介入と効果","item_titles":{"attribute_name":"タイトル","attribute_value_mlt":[{"subitem_title":"新人看護師教育におけるThe Health Action Process Approach (HAPA) 理論を適用した手指衛生遵守のための介入と効果","subitem_title_language":"ja"},{"subitem_title":"Intervention to improve hand hygiene compliance based on the Health Action Process Approach (HAPA) theory in the education for novice nurses and its effects","subitem_title_language":"en"}]},"item_type_id":"10006","owner":"17","path":["2"],"pubdate":{"attribute_name":"公開日","attribute_value":"2023-08-31"},"publish_date":"2023-08-31","publish_status":"0","recid":"2000012","relation_version_is_last":true,"title":["新人看護師教育におけるThe Health Action Process Approach (HAPA) 理論を適用した手指衛生遵守のための介入と効果"],"weko_creator_id":"17","weko_shared_id":-1},"updated":"2023-10-19T07:49:18.423293+00:00"}