熟練保健師の家庭訪問における支援技術―思考と行動の特徴

Home-Visit Care Provided by Experienced Public Health Nurses and Their Skills: Characteristics of Their Thoughts and Activities

要旨

　本研究の目的は，熟練保健師が家庭訪問において，何を見て，何を考えながら支援行為を行っているのか，その思考と行動の特徴を明らかにすることである．対象はA県内の自治体に勤務している熟練保健師13名で，家庭訪問による支援事例を1～2例挙げてもらい，半構成的インタビューにより聞き取りを行った．その中で，保健師の思考と行動の部分を抽出し，得られた内容をKJ法で分析した．その結果，【まず，現場に行って見る】【信頼関係を構築する】【状況をよく観察する】【支援者と実権者を見極める】【本人や家族の力量を見積もる】【連携の可能性を探る】【優先順位を考える】【地域住民との相互関係を蓄積する】の8つの概念が抽出された．熟練保健師は信頼関係・相互関係の構築を基盤とし，家庭訪問における現地性を重んじ，地域住民の通常の生活状況を踏まえた上での観察から，問題の本質を把握し，本人や家族の力を引きだしながら，周りの人々と協力して支援行為を行っていた．

Abstract

　In this study, we focused on home-visit care provided by skilled public health nurses, and examined the characteristics of their thoughts and activities, including their viewpoints. The subjects were thirteen experienced public health nurses working at local governments in Prefecture A. We conducted semi-structured interviews, asking them to talk about home-visit care services they provide (one to two cases for each person). Using the KJ method, we analyzed the responses related to their thoughts and activities, and the following eight concepts were extracted：“ importance of visiting the community,”“development of trusting relationships,”“close observation of situations,”“recognition of supporters and persons in charge,”“assessment of potentials of care recipients and their families,” “seeking the possibility of collaboration,” “setting priorities,”and “establishment of close ties with community residents.”The skilled public health nurses provided care support in collaboration with community residents, placing an emphasis on the development of trusting relationships with them as well as regional characteristics, to effectively utilize the potentials of care recipients and their families and identify the essence of problems through the observation of typical living situations in the community.