ゼン ゲンゴキ ノ オヤコ コミュニケーション ニ ミラレル ダイベン

親はまだしゃべらない乳児とどのようにやりとりできるのだろうか。おとな同士のコミュニケーションがことばに大きく依存していることと比較すると,乳児とのやりとりは困難なものに感じる。しかし,実際に親は乳児とまるで通じ合っているかのようにコミュニケーションを行っている。このような視点で親子のやりとりを見直すと,前言語期の乳児に対して,親がまるで乳児の考えや感情,要求,拒否,希望を反映させているかのように,乳児の代わりに発話していることがわかる。たとえば,ごはんを食べている乳児に「おいしいねぇ」と言ったり,おむつ替えをしながら「ああ,さっぱりした」と言ったりするように,乳児の考えや感情をおとなが言語化する。つまり,親は自身の発話のアドレス性を操作し,子どもの声(Wertsch, 1991)を帯びた発話を行っているのである。本研究では,そのような発話を代弁(Parental Proxy Talk)とし,IDS(乳児に向けられた発話;Infant-Directed Speech)として分析する。本研究は,前言語期の乳児と母親のやりとりから,母親の発話を分析対象とする。母親の発話を誰を発話主体としていたか,誰の声であったかという視点でひとつひとつ分析した。その結果,4 つのタイプの代弁,すなわち,(1)子ども視点型の代弁,(2)親子視点型の代弁,(3)あいまい型の代弁,(4)移行型の代弁が見いだされた。How can parents communicate with their infants before the infants learn to talk? Even adult-adult communication requires effort. We communicate using verbal clues as well as cultural-historical preverbal ones.Nevertheless we can still end up misunderstanding each other. It is even more difficult to communicate if the partner in communication is a pre-verbal infant who does not speak and use common gestures yet. Carefully observing communication between parents and their infants reveals that parents keep talking to their infants usingParent Proxy Talk. Not only were they talking to their infants from their own perspectives, but they were also talking as a proxy, using their infants\u27 voices. The videotaped verbal and nonverbal mother-infant interactions were analyzed and revealed four types of Parental Proxy Talk; (1) from the child\u27s view, (2) from the views of both the mother and child, (3) from an ambiguous view, and (4) from a transitional view. It was discussed about a process of enculturation by focusing on Parental Proxy Talk

Development and Practical Test of Quality Indicators for Palliative Care in Patients With Chronic Heart Failure

Background: Palliative care is highly relevant for patients with heart failure (HF), and there is a need for quantitative information on quality of care. Accordingly, this study aimed to develop a set of quality indicators (QIs) for palliative care of HF patients, and to conduct a practical pilot measurement of the proposed QIs in clinical practice. Methods and Results: We used a modified Delphi technique, a consensus method that involves a comprehensive literature review, face-to-face multidisciplinary panel meeting, and anonymous rating in 2 rounds. A 15-member multidisciplinary expert panel individually rated each potential indicator on a scale of 1 (lowest) to 9 (highest) for appropriateness. All indicators receiving a median score >= 7 without significant disagreement were included in the final set of QIs. Through the consensus-building process, 35 QIs were proposed for palliative care in HF patients. Practical measurement in HF patients (n=131) from 3 teaching hospitals revealed that all of the proposed QIs could be obtained retrospectively from medical records, and the following QIs had low performance (<10%): "Intervention by multidisciplinary team", "Opioid therapy for patients with refractory dyspnea", and "Screening for psychological symptoms". Conclusions: The first set of QIs for palliative care of HF patients was developed and could clarify quantitative information and might improve the quality of care