援助の必要性を見極める―乳幼児健診で熟練保健師が用いた看護技術

Identifying the Need to Support with Client: Nursing Competencies of Expert Public Health Nurses in Routine Health Examinations for Children

要旨

　保健師が乳幼児健診で用いている技術と実践活動内容を明確にすることを目的として，グラウンデッドセオリー法による質的帰納的研究を行った．本稿では，保健師が対象を捉え見極めていくプロセスに焦点を当てた．

　5府県11の市町村に勤務する経験年数5年以上の17人の熟練した保健師を対象とし，半構造的面接と参与観察によりデータを収集し，継続的に比較分析した．

　本研究では，保健師が健診において対象者に援助を行う前に≪援助の必要性の見極め≫を行っていることが見出された．このプロセスは，＜センシティブな視点で見る＞，＜思いの根を引き出す＞，＜問題を明確にする＞，＜受けとめを予測する＞という4つのカテゴリで説明された．これらは，保健師が母親とのやり取りを進めていく中で同時的，複合的，また繰り返し行われているものであった．

　これらの結果は，保健師が健診において用いている，対象への援助を意図した看護技術を示すものであり，今後の保健師活動の質の向上に寄与できるものと考える．

Abstract

　The purpose of this research was to explore the practice of expert public health nurses in routine health examinations for children by using the Grounded Theory Approach. This study focused on the process through which public health nurses comprehend and identify their clients.

　Data were collected using semi-structural interviews and observation of 17 public health nurses with over 5 years of experience who work in 11 cities of 5 prefectures. The results were analyzed by the continual comparative analysis method.

　Findings in this research can be identified as follows : “Identifying the necessity to support clients” was clarified as being an essential first step in providing support for clients. This process was explained by 4 categories : Inspection with sensitivity, Attempting to draw out mothers' true feelings, Clarifying their problems, and Predicting their states of mind. These were simultaneous, repetitious and composite steps when the public health nurses were communicating with the mothers.

　These results showed the nursing competencies which public health nurses utilize in routine health examinations for the support of clients. The findings suggest that these can contribute to the improvement of the quality of public health nurses' practice in future.