Evaluation of a training program on initial actions against anaphylaxis in children with food allergies in nursery schools

学位記番号：看博甲11

小学校養護教諭が行う児童虐待対応に校内組織体制が与える影響

本研究の目的は，小学校養護教諭を対象に児童虐待に関する校内組織体制について調査し，児童虐待を疑ったり 気づいたりする経験との関連，校外機関との連携の現状を明らかにすることにより，今後の小学校養護教諭が行う 児童虐待対応の在り方について検討することである．A 県内の全公立小学校（344校）に勤務する全養護教諭を対 象とし，児童虐待に関する校内組織及び校外機関との連携について自記式質問紙調査を実施し，146人から回答を 得た．結果，児童虐待に関する校内組織体制の設置の有無が，児童虐待の早期発見に影響を与えていることが示唆 された．また，校内で児童虐待に気づいたり疑ったりした場合においても，児童相談所などの校外機関と連携をし なかった理由は，「児童虐待の確証がもてなかったり，相談又は通告後のことを不安に思ったりしている」などが 明らかとなり，児童虐待の対応や校外機関に関する知識や情報の不足が原因の一因であることも示唆された．今後 は，児童虐待の発見の遅れを防ぐために，校内組織体制の確立を難しくしている要因について明らかにするととも に，関係職種や校外機関が互いの役割を理解し，具体的にどのように連携を図ることが有効であるかを検討するこ とが必要である．With the aim of determining appropriate ways for elementary school yogo teachers to respond to child abuse, this study examined school organizational systems for child abuse with regard to their influence on how yogo teachers suspect and identify cases of child abuse and collaborate with external parties or organizations. Self-report questionnaires on school organizational system for child abuse and collaboration with external parties were distributed to every yogo teacher in all 344 elementary schools in Prefecture A. Questionnaires were collected from 146 yogo teachers (response rate 42.2%). Findings suggested that the existence of a school organizational system to handle child abuse was related to early detection of child abuse. The reason for not collaborating with external parties even when child abuse was suspected or identified was that the teachers either did not feel certain the abuse was happening or were concerned about the outcome of consulting or reporting the situation to external parties. This suggests yogo teachers lack of knowledge and information about the external parties involved in handling child abuse. To prevent delay in detecting abuse, future studies should explore factors related to difficulties in establishing necessary organizational systems, and examine how each discipline and involved party can better understand each other's roles and specifically how they can effectively collaborate with each other

保育所（園）における食物アレルギーによるアナフィラキシーショックに対する救急処置体制構築に必要な要素

本研究の目的は，保育所（園）の管理者が食物アレルギー児のアナフィラキシーショック時の対応に必要だと認識している要素とエピペン® を持参する子どもへの対応の課題を明らかにすることである．A 県内の認可保育所（園）419ヵ所の施設長を調査対象とし，郵送法により無記名方式のアンケート調査用紙を送付した．アナフィラキシーショック発現時の救急処置体制を作るために必要だと思われる要素について自由記述をしてもらった．結果，回収116件中66件の記述があり，120記録単位が得られた．得られた記録単位を質的帰納的に分析した．アレルギー児の緊急事態発生時の救急処置体制を作るために必要な要素は，【研修受講・実演訓練の実施】【迅速な対応のための園内・園外の連携体制整備】【マニュアル・アクションプランの作成】【職員・他職種間の情報共有】【危機管理意識】【緊急時のアセスメント力】【専門職の配置の改善】の7つのカテゴリーに分類された．また，エピペン® を持参する子どもを受け入れている保育所（園）11施設が苦慮していることや課題についての記述についても内容分析を行った．その結果，事故が起こった時の救急処置対応のマニュアルを整え，全ての職員が自己の役割を理解し，その役割を果たせるように全職員が研修を受講すること，シミュレーション訓練を行っておくこと，それらの教育的支援のために看護職配置を推進していく必要性が示唆された．The purpose of this study is to clarify the factors of emergency treatment systems corresponding anaphylactic shock by food allergies and the problems for prevention of food allergies of the child bringing EpiPens at nurseries.　Anonymous questionnaires were sent by mail to the directors of 419 certified nurseries in Prefecture A.　The questionnaire included also free space for description according to the factors of emergency treatment systems for cases of anaphylactic shock.　The description in the space was recognized to 66 of the 116 retrieved questionnaires, and the responses were divided into 120 records and analyzed by qualitative inductive analysis.　Items necessary for establishing emergency treatment systems for children with allergies were placed into the following seven categories:“ seminars and on-the-job training, ”“ internal and external emergency contact systems for quick response, ”“ creation of action plans and manuals, ”“ sharing of information among nursery staff and other professionals, ”“ awareness of crisis management, ”“ assessment skills for times of emergency, ” and“ improved placement of professional staff.”　The description according to actual problems in 11 nursery that accept child bringing EpiPens were also analyzed.　The results indicated a need to promote placement of nursing professionals to provide educational assistance for organizing emergency treatment manuals, a need for complete staff participation in training seminars so that all members understand their roles during an emergency, and a need for conducting simulation drills

児童虐待対応における家族支援に関する小学校養護教諭の役割認識

【目的】本研究の目的は，養護教諭の児童虐待対応における家族支援に対する役割認識と今後学校における児童虐 待対応の家族支援の在り方について検討することである． 【方法】A 県内の公立小学校に勤務する11名の養護教諭を対象に2011年6月～8月にインタビュー調査を行い，質的 帰納的分析を行った． 【結果】養護教諭の児童虐待対応における家族支援の役割認識は，【防止教育の充実を図る】【相談しやすい環境を 整える】【校内外で連携して継続的な支援をする】【早期発見と対応】【保護者の負担を軽減する】【保護者との信頼 関係を築く】の6つのカテゴリーで整理された．小学校に勤務する養護教諭は虐待の予防から早期発見と保護者の 負担が軽減するような子育て支援を含む継続的な対応という役割があると認識していることが明らかになった． 【結論】今後，養護教諭の児童虐待対応における家族支援を進めていくためには，養護教諭の学校等における適切 な児童虐待防止の取組をサポートしてもらえる地域や社会の支援体制の構築や研修体制の充実が喫緊の課題であ る．今回明らかになった結果を踏まえて，調査対象を拡大する等，さらなる研究の蓄積をする必要がある．Purpose 　This study aimed to investigate how Yogo teachers perceive their roles in providing support to families in child abuse cases and what future forms of family support should be provided in cases of child abuse. Method 　Interviews were conducted with 11 Yogo teachers employed at public elementary schools in Prefecture A from June to August 2011, and a qualitative inductive analysis of the interview data was conducted. Results 　Roles perceived by Yogo teachers for providing support to families in child abuse cases were categorized into the following six categories: working to enhance preventive education. creating an environment conducive to consultation. out-ofschool connections and continuous support. early detection of abuse and addressing it. reducing the burden on guardians. and building trust relationships with guardians. Yogo teachers perceived their roles to include prevention, early detection, and ongoing work to address of child abuse, such as providing child-rearing support to reduce the parenting burden on guardians. Conclusion 　Pressing topics for the future include improving training programs and constructing community support and social support systems for helping Yogo teachers take appropriate preventive measures against child abuse.　In light of these study results, further accumulation of research results through expansion of the surveyed population is needed

保育所看護職者の配置形態の違いによる保育保健活動の現状と課題

本研究の目的は，保育所看護職者を対象に保育保健活動の担当状況を調査し，保育所での配置形態による関連を 明らかにし，今後の保育所看護職者の配置に関する課題を検討することである．A 県内の保育所に勤務する看護職 者71名のうちA 県保育協議会の研修会に参加した保育所看護職者41名を対象とし，自作の質問紙調査を行った． 保育保健活動30項目の担当状況を『子どもへの支援』『家族への支援』『多職種・関連機関との連携・協働』の3つ のカテゴリーに分類し，「クラス担当配置」と「フリー配置」の配置形態による差異を比較した．結果，3つのカテ ゴリーのいずれも，「フリー配置」の方が保育保健活動の担当状況の平均値が高かった．保育所看護職者が，その 専門性を発揮し保育保健活動を遂行するためには，配置形態の改善が必要であることが示唆された．The aims of this study were to examine the current responsibilities of nurses in child healthcare activities conducted at day care centers, clarify the relationship between their work responsibilities and style of work allocation at these centers, and discuss the issues relating to the work allocation of nurses at these centers for the future. Research was carried out with 41 nurses who participated in a workshop run by the childcare council in Prefecture A, out of a total of 71 nurses working in day care centers in the prefecture. The nurses responded to a questionnaire created by the authors. The 30 questionnaire items concerning the allocation of healthcare activities in the day care centers were divided into three aspects: support for children, support for families, and cooperation with various professionals and related agencies. Differences in the three aspects were compared between nurses responsible for particular classes and nurses not tied to responsibilities for particular classes. The results revealed that mean scores were higher for the nurses not tied to responsibilities of particular classes in all three aspects examined. This indicates that in order for nurses at day care centers to make best use of their specialized skills and knowledge, and carry out child healthcare activities, the styles of work allocation must be improved

臨地実習における看護学教員と実習指導者に関する研究動向と課題

本研究の目的は，臨地実習における看護学教員と実習指導者に関する論文を分析し，研究動向と課題を明らかに することである．医学中央雑誌Web. 版を用いて「臨地実習」「看護学教員」「実習指導者」をキーワードとした原 著論文の検索を行った．文献レビューシート一覧を作成し，研究の種類・デザイン，研究方法，研究内容等の分 析を行った．その結果，対象文献は54件であり，研究の種類は量的研究が50.0％と半数を占め，研究デザインは因 子探索研究が最も多く47.5％であった．研究対象者は，実習指導者が最も多く41.9％，研究者の所属は看護大学が 35.2％であった．対象文献を内容分析の手法を用いて分類した結果，【看護学教員と実習指導者の連携・協働に関 する研究】【臨地実習指導におけるやりがいや困難感に関する研究】【効果的な臨地実習指導の検討に関する研究】 【臨地実習の評価に関する研究】【実習指導者の資質向上に関する研究】の5つのカテゴリーで構成された．今後の 研究課題として，1．看護学教員と実習指導者のそれぞれが認識している役割についての研究，2．看護学教員と実 習指導者の異なる役割や専門性・視点の明確化，3．看護学教員と実習指導者の連携・協働のあり方，4．指導力や 教授活動への自己効力感を高めるための要因，5．学生からの臨地実習評価の蓄積と分析，6．実習指導者講習会の 効果の分析，の6つを得た．The aims of this research were to analyze published papers relating to nursing teachers and clinical instructors responsible for clinical practicums, and from the results clarify research trends and issues in this area. Original papers containing the keywords 'clinical practicum' (rinchijisshu), 'nursing teacher' (kangogakukyoin), and 'clinical instructor' (jisshushidosha) were identified in a literature search of Ichushi Web. A summary of the literature review was created and examined for aspects including research type, design, methods, and contents. In total 54 papers were reviewed. Among them, in terms of research type, 50% were based on quantitative research and, in terms of research design, 47.5% used factor analysis. The highest percentage of research, 41.9%, investigated clinical instructors, and 35.2% of the researchers belonged to colleges of nursing. Based on the content analysis results, the studies were classified into five categories:【 studies on cooperation between nursing teachers and clinical instructors】;【studies on the sense of reward and difficulties in clinical practicum guidance】;【 studies on effective guidance in clinical practicums】;【 studies on evaluation of clinical practicums】;【 and studies on improving the quality of clinical instructors】. Future topics for research were summarized in the following six areas: 1) research on the roles perceived by nursing teachers and by clinical instructors; 2) clarification of different roles, expertise, and perspectives for nursing teachers and clinical instructors; 3) desirable ways for nursing teachers and clinical instructors to cooperate; 4) factors for improving self-efficacy in leadership and teaching activities; 5) accumulation and analysis of students' evaluation of clinical practicum sessions; and 6) analysis of the effectiveness of clinical instructors' seminars

Trend of research on role of nurses working in nursery schools

Purpose : The obj ectives ofthis paper were to review previous studies ab out the roles of nurses who work in nursery schools, and to identify research trends and issues that need to be addressed. Methods : Searching Japanese references from 1990 to 2010 in Japana Centra Revuo Medicina Web, Ver.4 and Citation lnformation by National Institute of lnformatics (CiNii) using keywords "nursery school," "nurse," and "role," this study explored the current practice conditions and roles of nurses working at nursery schools. Results: Twenty seven articles were retrieved for analysis, of which more than 70% reported results of quantitative research. Studies about directors and managers constituted 34.2% of the articles, and those about nurses, 28.9%. This study identified current nurse practice conditions in nursery schools and the roles and duties expected of nurses by nursery school administrators, managers, and parents. In addition, nursery school nurses identified some limitations and restrictions placed on their nursing and health activities, while they expressed desires to more broadly exerci se their professional skills. Discussion : In order to promote health and safety of children in nursery schools and improve the assignment of nursery school nurses, it is necessary to understand the current conditions and issues of nursing practice and health care, as well as an empirically grounded analysis of support for these nurses