乳幼児健診時の保健師の継続支援の必要性に関するアセスメントの実態

Current State of Nurses' Assessment of the Necessity of Continued Support in Infant Health Check-ups

要旨

　本研究は，3か月児および3歳児健診の面接場面において，保健師が継続的な支援が必要な事例かどうかを判断する際のアセスメント項目群の構成因子について検討することを目的とした．調査方法は横断的調査であり，政令指定都市2市のすべての保健所・保健福祉センターに勤務する常勤保健師293人を対象に，各アセスメント項目（3か月児健診では58項目，3歳児健診では65項目）の重視度を尋ねる自記式調査票を郵送した．アセスメント項目群の構成因子を分析するために探索的因子分析（主因子法，斜交回転）を行った結果，3か月児健診では，第1因子「家族の背景」，第2因子「家族のサポート力」，第3因子「対人関係のあり方」，第4因子「母親の体調」，第5因子「子どもへの接し方」，第6因子「子どもの気性」，第7因子「育児への対処」，第8因子「子どもの発育・発達」の8因子が抽出された．3歳児健診においても，第1因子「家族の背景」，第2因子「対人関係のあり方」，第3因子「家族のサポート力」，第4因子「子どもの生活状況」，第5因子「子どもの発達」，第6因子「育児への対処」，第7因子「子どもへの接し方」，第8因子「子どもの発育」の8因子が抽出され，3か月児健診と共通の内容と解釈される構成因子が5因子みられた．また，各因子と属性との関連を分析した結果，3か月児健診では第1因子「家族の背景」と地域性・教育背景に，第2因子「家族のサポート力」と地域性に関連がみられた．3歳児健診では，第3因子「家族のサポート力」，第7因子「子どもへの接し方」と地域性に，第5因子「子どもの発達」，第8因子「子どもの発育」と経験年数に関連がみられた．

Abstract

　The objective of the present study is to investigate the factors related to nurses' assessment of the necessity of continued support in 3-month and 3-year health check-ups. In the present cross-sectional survey, a self-administered questionnaire dealing with the importance of various assessment items (58 items for 3-month health check-up and 65 items for 3-year health check-up) was mailed to 239 full-time nurses working at all public welfare and health centers in two government-designated cities. An explanatory factor analysis (principal factor method, oblique rotation) was used to examine the factors related to assessment. As a result of the analysis, the following eight factors were identified for the 3-month health check-up:first factor, “Family background,” second factor, “Family support capability,” third factor, “Interpersonal relationships,” fourth factor, “Mother's physical condition,” fifth factor, “Behaviors toward the child,” sixth factor, “Child characteristic,” seventh factor, “Childrearing measures,” and eighth factor, “Child growth and development.” The following eight factors were identified for the 3-year health check-up:first factor, “Family background,” second factor, “Interpersonal relationships,” third factor, “Family support capability,” fourth factor, “Child's living environment,” fifth factor, “Child development,” sixth factor, “Childrearing measures,” seventh factor, “Behaviors toward the child,” and eighth factor, “Child growth.” The relationship of each factor to attributes was analyzed, and the results showed that, for the 3-month health check-up, the first factor “Family background” correlated to regionality and educational background, and the second factor “Family support capability” correlated to regionality. For the 3-year health check-up, the third factor “Family support capability” and the seventh factor “Behaviors toward the child” correlated to regionality, and the fifth factor “Child development” and the eighth factor “Child growth” correlated to the number of years of nursing experience.