Permalink : http://hdl.handle.net/2115/35620

JaLCDOI : 10.14943/34135

KEYWORDS : public health nurse;visit numbers;visit judgment;schizophrenic patient;保健師;訪問回数;判断;統合失調症

本研究は，地域精神保健福祉活動における保健師の統合失調症者に対する訪問指導において訪問回数の判断を困難にする要因を検討することを目的とした。統合失調症者の訪問指導を行っている保健所保健師を対象に無記名自記式質問紙法を実施し，自由記載内容を質的に分析した。結果，訪問回数評価が「不適切である」と判断した理由には11サブカテゴリーが得られ，それらは5カテゴリーに分類できた。「わからない」の理由として，13サブカテゴリーが得られ，それらは4カテゴリーに分類できた。「不適切である」，「わからない」理由を比較した結果2つの同じカテゴリー，すなわち【統合失調症者の特性の影響】と【対象理解不足】が認められた。訪問の必要性の判断を困難にしている場合，関わり初期から，事例の十分な情報収集とアセスメントをし，対象理解の再検討をすること，また保健師個々の判断ではなくチーム全体で事例検討し判断能力を向上させていくためのサポート体制を充実することが重要であることが示唆された。
The purpose of this study was to clarify factors making it difficult that public health nurses (PHNs) decide how often they should visit schizophrenic patients. Subjects were PHNs working at ten health centers located in areas where were relatively affluent in social resources in Hokkaido, who made nursing home visits to schizophrenic patients. A self-administered and unsigned questionnaire was collected by mail. The questionnaire included demographics of the PHNs and each case, the frequency of visits, and the assessment of the frequency. What respondents freely wrote the reasons why they judged the frequency of visit 'not just' and 'no understandable', were analyzed by Berelson's contents analysis. 11 subcategories were obtained from the reasons of 'not just'. and were classified into 5 categories. 13 subcategories were obtained from the reason of 'no understandable' and classified into 4 categories. After comparing categories from reasons of 'not just' and of 'no understandable', two similar categories were obtained: the influence of a schizophrenic characteristic and lack of object understanding. In the case where the judgment of frequency of visits was difficult, the case should be examined by the entire team, and it was suggested that we should make a support system for improving judgment capabilities complete.