Difficulties faced by care managers in interventions for family members who abuse the elderly: interviews with care workers

取得学位 : 博士（保健学）, 学位授与番号 : 医博甲第1859号 , 学位授与年月日 : 平成19年3月22日, 学位授与大学 : 金沢大学, 審査結果の報告日 : 平成19年2月23日, 主査 : 城戸 照彦 , 副査 :泉 キヨ子, 佐伯 和

高齢者虐待事例への介護支援専門員の初期の支援に対する認識に関する研究

【目的】介護支援専門員が高齢者虐待事例のケアマネジメント初期において,認識するケアマネジメントの困難さとその要因を明らかにする。【方法】質的帰納的因子探索型の記述的研究方法を用いた。対象は高齢者虐待事例を担当経験のある,居宅介護支援事業所勤務の介護支援専門員である。職種による困難さを考慮し介護職を対象とした。研究者が非構造化面接を実施し,逐語録をデータとして分析に用\u27いた。分析では虐待の状況や対応の困難さ,考え方などに焦点を当て,データをコード化し,類似するデータの概念を検討しながらカテゴリー化した。介護者・要介護者と介護支援専門員の関係に焦点をあて,継続比較分析を行った。金沢大学医学系研究科医の倫理委員会の承認を得た。【結果】介護支援専門員21名から,ケアマネジメントに関する困難さ,虐待家族への介入に関する困難さが抽出された。ケアマネジメントの困難さに関しては,‘被害者がおかれた悲惨な状況を放置できない\u27,‘介護保険のサービスを使うことだけがこの人たちへできる援助\u27と,‘虐待者である介護者に契約を解除する権限がある\u27という認識があった。また,‘介入すると虐待が悪化する心配がある\u27,‘被害者より加害者への対応を優先せざるをえない\u27,‘虐待者である介護者が要介護者のニーズを決定\u27があり,帰結は,‘介護者が受け入れるケアプランを作成せざるをえない\u27であった。以上から"虐待者である介護者による潜在的なケアマネジメントの支配"という中核カテゴリーが抽出された。虐待家族への介入に関しては,介護者である‘虐待者と対時することが怖い\u27,‘虐待者との間に心理的な壁が存在する\u27という認識があった。また,‘虐待者である介護者との関係を維持しなければならない\u27役割の一方で,介護支援専門員の介入で‘家族関係に波風を立てたくない\u27と認識していた。そして,‘虐待の根底にある家族関係への介入には至れない\u27,‘虐待家族にも家族の絆はあると信じたい\u27という認識があった。以上から,"介護支援専門員の理念ではたちうち出来ない虐待者への無力感"という中核カテゴリーが抽出された。The purpose of this study is to analyze the difficulties perceived by care managers who confront elderly abuse inflicted by family members. The research was executed according to the grounded theory approach. Participants were care managers who had handled elderly abuse cases. They (n=21) were all female, and had a mean of 4.3 ± 0.7 years of experience as a care manager.The cognitions kind of two difficulties was extracted from the data. One of difficulty about care management were as follows: the terrible situation of the people abused cannot be ignored; the long-term care insurance service is the only support for these people; the abusive caregiver has the authority to cancel the contract; there is concern that intervention might increase the abuse; prioritizing how to deal with the abuser rather than the abused is unavoidable; the abusive caregiver decides the needs of the individual requiring care; and the only option is to create a care plan that is acceptable to the caregiver. Th e core category that was ultimately extracted was "tacit control of care management by the abusive caregiver".One of difficulty about intervention to abusive families were as follows: fear of confronting the abuser, unwelcome atmosphere to care manager\u27s visit, having to continue the relationship with an abusive caregiver, unwillingness to upset the family relationship, inability to intervene in a family relationship that is the root cause of abuse, and wanting to believe in family bonds even in an abusive family. The core category that was ultimately extracted was the feeling of powerlessness in being unable to take on the abuser due to the principle of respect for caregivers\u27 decisions.It is evident from this study that care managers recognize that the contract that forms the basis of care management in cases of abuse is a factor contributing to the difficulties they experience. It was suggest the need to establish a system that supports care managers in order to promote appropriate care management.研究課題/領域番号:17592292, 研究期間(年度):2005-2006出典：「高齢者虐待事例への介護支援専門員の初期の支援に対する認識に関する研究」研究成果報告書　課題番号17592292 (KAKEN：科学研究費助成事業データベース（国立情報学研究所）)　　　本文データは著者版報告書より作

母親とその 5-7 か月児の睡眠行動の主観的および客観的評価

Purpose: The purpose of this study was to assess the sleep behaviors of Japanese mothers subjectively and objectively and their ５- to ７-month-old infants. Methods: The participants were ３６ pairs of mothers and their ５- to ７-month-old infants. Each mother and infant were regarded as a pair and their sleep behavior was observed. Sleep behavior was assessed subjectively and objectively. The subjective data was collected using the self-administered Pittsburgh Sleep Quality Index Japan (PSQI-J) and Kwansei Gakuin Sleepiness Scale (KSS) questionnaires, and the objective data was collected using a Lifecorder GS (Suzuken Co., Ltd., Nagoya, Japan) accelerometer. Lifecorder GS data were collected over the same period for both mothers and infants.Results: The mothers’ subjective PSQI-J sleep assessment score averaged ６.００ ± ２.５８ and their average sleep efficiency was ８４.５７ ± １１.９６%. The Lifecorder GS objectively measured the mothers’ average sleep efficiency at ７５.２１ ± ８.２９% and the number of periods of awakening spanning １０ minutes or more as ３.６４ ± １.５６ periods. Subjective and objective sleep efficiency data were significantly different (p<０.０１). The average sleep efficiency for infants, as measured by the Lifecorder GS, was ６６.７０ ± ９.５９%, and their average number of periods of awakening spanning １０ minutes or more was ６.３４ ± １.６１ times. The correlation coefficient for mother and infant sleep duration was ０.４４ (p<０.０１). There were two types of awakening during sleep; one in which the mother’s awakening preceded the infant’s, and the other in which the infant’s awakening preceded the mother’s. It was confirmed that sleep and awakening could be bidirectional between the mother and the infant.Conclusions: There was a significant difference in the subjective and objective sleep efficiency data for mothers who had ５- to ７-month-old infants. The mothers did not feel that their sleep efficiency had been adversely affected due to sleep interruption to care for their infants, however, objectively it was confirmed that sleep efficiency was lowered. The researchers think there is a need to develop education to improve sleep quality for Japanese mothers and their infants while carefully maintaining the child-raising culture

家族介護者の睡眠と血圧日内変動と疲労感の追跡調査

: We prospectively followed family caregivers to examine changes in sleeping patterns, ambulatory blood pressure, and fatigue status three years after the initial survey. : 67 family caregivers who enrolled in the first survey conducted between 2001 and 2004. : We asked the participants to enroll in the follow-up survey by mail. We interviewed care condition and asked to write self-reported activity recording for those who gave the written informed consent. An actigraph was used to determine sleep status and ambulatory blood pressure was monitored for 24-hour period. The Cumulative Fatigue Symptoms Index-Housewife was used. The research proposal was approved by the ethics committee of the faculty of Medicine, Kanazawa University. : The changes in the first and second survey results were tested by the Wilcoxon matched-pairs signed-ranks test according to presence of continuation of home care. : Of 67 eligible participants, 66 were alive. Of those, two were hospitalized, and 24 remained as primary caregivers. Thirty-three participants agreed to enroll in the second investigation. Fourteen participants continued home care and 19 ceased to provide care because of the death or hospitalization of care receivers. Of 14 caregiving participants, no significant changes were found for sleep status, blood pressure measurements, and fatigue status although the number of participants with hypertensive treatment increased by two. In 19 non-caregivers group, nap time in the daytime became significantly longer and the mean duration of nap increased by 54 minutes, and chronic fatigue was relieved significantly. No significant changes in the blood pressure measurements were detected although additional two people were under hypertension medication. : This study did not show any clear difference of health condition between those continuously engaged in home care and those who had discontinued giving care. In the 19 former caregivers, the daytime nap time was significantly increased with a reduction in the feeling of fatigue. These results may be attributable to the cessation of home care. : The cessation of caregiving activities led to increased nap time and contributed to the reduction of chronic fatigue. The increasing number of participants with hypertensive treatment suggests additional care is necessary for aging participants, especially for those continue to provide care.【目的】介護を長期間続けることによる心身への影響を明らかにするため、家族介護者の３ 年後の転帰と、同一者の３年後の睡眠、血圧日内変動、および疲労感の追跡調査を行った。 【対象】2001年から2004年に行った初回調査から３年経過した家族介護者67名。 【方法】対象者の転帰を郵送で調査し、再調査を依頼した。書面での同意を得た者に対し介 護状況に関する面接調査と24時間自記式行動調査を行った。Actigraphにより24時間の睡 眠時間を測定した。携帯型無拘束間接型血圧装置により24時間の血圧変動を測定した。疲 労感は The Cumulative Fatigue Symptoms Index-Housewifeより調査した。 【分析】初回調査と追跡調査の比較は、在宅介護の継続の有無別に、事例ごとに対応した Wilcoxon符号付き順位検定を行った。 【結果】家族介護者67名の３年後の状況は、66名が生存しており、そのうち２名は入院、在 宅介護を継続していた者は24名だった。64名中、追跡調査に同意した者は33名だった。そ のうち在宅介護を継続していた者が14名、要介護者の死亡や入院により介護していなかっ た者が19名だった。在宅介護を継続していた14名の初回調査と追跡調査の結果を比較した 結果、睡眠時間、血圧、疲労感には有意差がみられなかった。３年後の降圧剤内服者は２ 名増えて８名だった。介護していなかった19名は、３年後の方が日中の仮眠時間が有意に 長く平均54分増えており、疲労感が有意に軽減していた。血圧には有意差がみられず、内 服者は２名増えて８名だった。 【考察】本研究では、在宅介護継続者と介護を継続していなかった者との間に健康状態の有 意な差は認められなかった。介護を中断していた19名は、日中の仮眠時間が有意に長く疲 労感が軽減していた。このことは在宅介護を継続していなかったことに起因すると考えら れる。 【結論】介護の中断は、仮眠時間が増えて疲労感の軽減に貢献することが示唆された。高血 圧の治療者数の増加は、加齢、とくに在宅介護を継続していくためには、高血圧の治療の 追加が必要であることを示していると考える。[原著:Originals

Difficulty in the family relationship of Asian women married to Japanese men during child rearing

目的：日本人男性を夫にもつ子育て中のアジア系外国人女性を対象に、家族との関係で抱く困難感を明らかにすることを目的とした。方法：日本人男性を夫にもつ未就学児を養育するアジア系外国人女性 11 名にインタビューガイドに準じた半構造化面接を行い、質的記述的に分析を行った。語られた内容は意味のあるまとまりごとに抽出し、それらを要約してコード化し、コード間の共通性や差異性に注目して分類・統合しながら、サブカテゴリー、カテゴリーを生成した。結果：分析の結果、日本人男性を夫にもつ子育て中のアジア系外国人女性が家族との関係で抱く困難感として、≪母国と異なる家事や子育て文化の違いへの戸惑い≫≪異文化の壁により表出できない本音≫≪日本人である義母の考えを優先≫≪受け入れてもらえない自身の価値≫≪夫と子どもへの期待を支えとしての日本での生活≫の 5 つのカテゴリーが見出された。考察：養育期に、母親が外国人ゆえに、母国言語の伝承が許されず、家族から閉め出されたという思いをもつ事態は、母親の精神的ストレスや育児、家族内の人間関係にも影響するため、アジア系外国人女性が家族の中で尊重されることが大切であると考える。保健師などの支援者は、夫婦が相互に習慣や文化、価値観を理解し、尊重し合えるよう、他のアジア系外国人女性やその夫から話を聞けるような機会や日本人家族のアジア系外国人女性に対する態度を変える働きかけとして、異文化の理解ができるような場の提供を行うことも大切であると考える。Objectives: This study was performed to clarify difficulties in family relationships of Asian women married to Japanese men in relation to child rearing.Methods: We collected data through semi-structured interviews from 11 Asian women married to Japanese men while rearing pre-school-age children. Using the recorded content, codes were created for statements. Subcategories were established from the codes, and categories were created from each of the subcategories.Results: Five categories of difficulties experienced in the family relationships were as follows: they were bewildered at cultural differences with regard to child rearing and housework; they felt that they could not show their real feelings because of consciousness of cross-cultural barriers; they have to obey the instructions of their Japanese mother-in-law; their Japanese family does not accept their values; they can live in Japan only for the sake of their children and husband.Discussion: In the child rearing period, when a woman feels that her mother has been excluded from her family’s language because of her foreign nationality, and her family is locked out, this has a negative effect on her mental well-being, parenting, and family relations. It is important that foreign Asian women are respected in their families in Japan. To gain an understanding and respect for each other’s habits, cultures, and values, it is important to provide opportunities to hear from other Asian foreign women and their husbands and develop ways to change Japanese families’ attitudes toward foreign Asian women in Japan

地震発生時における住民の共助の意向の実態と関連する要因-地震による被災経験を持たない地域における調査-

目的：災害時における住民の共助の意向および避難行動要支援者を助けようとする意志に関する実態の調査と、それらに関連する要因を明らかにすることである。 方法：A 県 B 市 C 地区の 15 歳以上の住民 4370 人に無記名自記式質問紙調査を行い、 3651人の回答者中2861人から有効回答を得た（有効回答率78.4%）。調査内容は、基本属性、災害時における対応、災害に備える行動、災害に関する認識、地域への愛着・つながりとした。結果：災害時における共助の意向のある者は 78.1%、避難行動要支援者を助けようとする意志のある者は 79.5% であった。また、災害時における共助の意向、避難行動要支援者を助けようとする意志の両方に地域防災活動への参加の必要性、災害時に助け合える隣近所の人がいることが関連していた。考察：災害時における共助の意向を有することおよび避難行動要支援者を助けようとする意志を有することには、災害時のことを考える機会を日頃から持つこと、平常時から住民同士の交流を深める機会をつくることが必要であることが示唆された。Aim: This study was performed to investigate residents’ willingness to cooperate and help others requiring support with evacuation in the event of a disaster, and to identify factors linked to these traits. Methods: An anonymous, self-administered written survey was conducted with 4370 residents aged ≥15 in District C, City B, Prefecture A. Of the 3651 responses received, 2861 were valid (valid response rate, 78.4%). The survey covered basic attributes, coping in the event of a disaster, actions to prepare for a disaster, understanding of disasters, and attachment to and relations within the community.Results: The percentage of people who were willing to cooperate in the event of a disaster was 78.1%, and the percentage who would be willing to help others requiring support with evacuation was 79.5%. Necessity of participation in regional disaster prevention activities and having neighbors who help each other in a disaster were both found to be contributing factors to willingness to cooperate and help others requiring support with evacuation in the event of a disaster.Discussion: This study suggested that having the opportunity to think about how they would cope at the time of a disaster and to create opportunities to deepen exchanges between residents under normal conditions were necessary for willingness to cooperate and help others requiring support with evacuation in the event of a disaster

Clarification of parentsʼ recognition of children\u27s condition with developmental disorder and feelings about school enrollment before attending consultation session and after admission

本研究の目的は A 市就学サポート相談会（以下、相談会）に参加した発達障害児を持つ保護者の、相談会前と就学後における子どもの状態の捉えと就学に関する思いを明らかにすることである。　研究対象は、Ａ市発達相談センターの継続相談者で、２016 年度相談会に参加した発達障害児（疑いを含む）を持つ保護者 ２0 ケースの相談支援記録で、保護者の語った子どもの状態の捉えと就学への思いの記述を質的記述的に分析した。分析は相談会前と就学後のそれぞれにおいて行った。本研究は、金沢大学医学倫理審査委員会の承認を得て実施した。　相談会前における保護者の子どもの状態の捉えとして【子どもの発達に生活する上で支障となる特性がある】【学校生活でやっていけないかもしれない】【自分の子どもは相談の対象ではない】、就学に関する思いとして【通常学級・地域の学校への強い希望】【子どもに合わせた就学環境を整えたい】【生活力が付く就学先を選びたい】のカテゴリが抽出された。就学後では子どもの状態の捉えとして【学校生活に適応できている】【学校で適切な行動がとれていない】、就学に関する思いとして【情報共有による学校生活への安心【】順調に学校生活が送れそうな予感】【就学先への不満】のカテゴリが抽出された。　発達障害の子どもに適した就学環境を整えていくためには、保護者自身が子どもの特性を把握するとともに、就学先への申し送りを行う力を付けられるよう支援していくことが必要と考える。This study was performed to clarify parents’ recognition of their child’s conditions of developmental disorder and feelings about school enrollment before attending consultation sessions and after school admission.Consultation support records of ２0 parents of children with developmental disorders (including children suspected to be developmentally disabled) who had attended multiple consultation meetings in A city were examined. The parents’ descriptions of their child’s condition and feelings about the child’s school admission were analyzed qualitatively. The analysis was conducted before the consultation session and after school admission. This study was conducted with the approval of the Medical Ethics Committee of Kanazawa University.Before the consultation, the parents’ recognized the following: “The child has developmental characteristics that interfere with quality of life,” “Worried about the child’s school life,” and “Consultations do not pertain to my child.” Their feelings about school enrollment were as follows: “Strong desire for entrance to normal classes/local school,” “Want a suitable school environment for the child,” “Want to choose a school where the child can acquire life skills.” After admission, the parents recognized the following: “The child can adapt to school life” and “The child does not behave appropriately at school.” Their feelings about school enrollment were as follows: “Peace of mind about school life through information sharing,” “Feel that school life will go smoothly,” and “Dissatisfaction with school.”To prepare for enrollment of a child with a developmental disability in a school with a suitable environment, parents must recognize the particular characteristics of their child. It is necessary to support the parents to enable them to describe and inform the school of their child’s condition