自ら支援を求めない児童虐待事例の養育者との関係形成における困難の構造—市町村保健師へのインタビュー調査から

Structure of Difficulties in Forming Relationships with Involuntary Caregivers in Cases of Child Abuse: Results of a Survey of Municipal Public Health Nurses

要旨

　目的：自ら支援を求めない児童虐待事例の養育者との関係形成において保健師が抱く困難の構造を明確にすること．

　方法：A県内の市町村保健師5名に半構造化面接を実施し，KJ法を用いてデータを構造化した．

　結果：保健師が直面する困難は，【手応えの不確実さ】，【養育者の性格特性の難しさ】，【不安の先行と増大】，【切られないよう腐心する難しさ】，【「子どもの最善の利益」が二の次になる苦悩】，【重圧と孤 立】であった．

　結論：保健師と養育者の関係形成のために次の3点が示唆された．養育者のトラウマの理解，関係形成とリスク判断という対立した使命を分けること，そしてスーパーバイズを受ける機会の必要性である．

　Objective: To clarify the structure of difficulties experienced by municipal public health nurses in forming relationships with involuntary caregivers in cases of child abuse.

　Methods: Semi-structured interviews were conducted with five municipal public health nurses in Japanese prefecture A and the data obtained were structured using the KJ method.

　Results: The difficulties faced by public health nurses were “uncertainty in response”, “difficulties in the caregiver's personality”, “anxiety increases ahead of time”, “difficulty of being careful not to break the relationship”, “distress arising from the fact that ‘the best interests of the child' are secondary” and “pressured and isolated.”

　Conclusions: The following three points were suggested for the formation of the relationship between public health nurses and caregivers. It was necessary to understand the trauma of the caregiver, separating the conflicting mission of relationship formation and risk judgment, and to have the opportunity to receive a supervision.