在宅重症心身障がい児とその家族の愛着形成過程と影響要因の検討—複線径路・等至性アプローチによる分析

Factors Influencing Attachment Formation in Homebound Children With Severe Multiple Disabilities and Their Families: A Trajectory Equifinality Approach Analysis

要旨

　目的：本研究では在宅重症心身障がい児とその家族の愛着形成過程における影響要因の検討を行うことを目的とした．

　方法：在宅重症心身障がい児の家族10名を対象に半構成的面接を実施し，主観的感情はライフラインメソッドを活用した．複線径路・等至性アプローチを用いMAXQDAで分析した．

　倫理的配慮：大阪市立大学大学院看護学研究科倫理委員会で承認を得た（承認番号30-4-3）

　結果：愛着形成過程について第1期は【予期せぬ困難】，第2期は【在宅での安心感の探索】，第3期は【地域コミュニティへのつながり創出】と時期区分された．影響要因として社会的助勢10カテゴリおよび社会的方向づけ7カテゴリが導かれた．

　考察：家族は，生命の危機と向き合い，在宅ケアのため気の抜けない生活の中で地域受け入れ体制への不安を抱えながら子どもとのかかわりを模索した．家族を支える地域エンパワメントが高まることは，安定的な愛着形成過程の支援につながると考える．

　Purpose: This study aimed to examine the influencing factors of the attachment formation process for homebound children with severe physical and mental disabilities and their families.

　Method: Semi-constructive interviews were conducted with 10 family members of homebound children with severe physical and mental disabilities, and the lifeline method was utilized for subjective emotions. Analysis was performed with MAXQDA using the trajectory equifinality approach.

　Results: The attachment formation process was divided into three phases: Phase 1 was the [unexpected difficulties period], phase 2 was the [search for a sense of security at home period], and phase 3 was the [creating ties to the local community period]. Ten categories of Social Guidance and 7 categories of Social Direction were identified as influencing factors.

　Discussion: Families faced a life-threatening situation and sought a relationship with their child, while having anxieties towards the local community's acceptance system in the midst of a restless life for the sake of home care for their child. It is believed that increased community empowerment to support families will lead to support for a stable attachment formation process.