地域ケアにおける看護職によるコミュニティ・エンパワメントの過程とコンピテンシー

Community Empowerment Processes and Competencies of Nurses in Community-based Care

要旨

　目的：地域ケアにおける看護職によるコミュニティ・エンパワメント（以下，CE）の過程とコンピテンシーを明らかにする．

　方法：看護職16名に対して半構造化面接を行い，CEの過程を複線径路等至性モデリングを用いて分析し，コンピテンシーを質的記述的に分析した．

　結果：看護職によるCEの過程は，コミュニティケアの志向期，創出期，定着期に区分され，【動機づけ】【活動準備】【ニーズ把握】【仲間づくり】【試行錯誤】【協働促進】【活動維持】の7段階があった．各段階のコンピテンシーには《暮らしに着眼した課題発見力》《新しい看護活動にむけた行動力》《多様な価値観への共感力》《対話を重視した人間関係構築力》《社会資源創出に挑む遂行力》《住民の主体性を尊重したケア調整力》《事業継続にむけた管理力》があった．

　結論：地域ケアにおける看護職によるCEは，住民や多職種と協働した活動の柔軟性と事業継続の困難性に特徴づけられた．

　Purpose: This study was conducted to identify community empowerment (CE) processes and competencies of nurses employed in community-based care.

　Methods: Semi-structured interviews were conducted with 16 nurses employed in community-based care. The processes of CE were analyzed using Trajectory Equifinality Modeling. Thereby, the competencies of the respective stages were assessed qualitatively.

　Results: Processes of CE followed by nurses in community-based care include three phases: “aspiring community care,” “producing community care,” and “establishing community care.” The “aspiring community care” phase includes the “motivating” and “preparing a project” stages. The “producing community care” phase includes the “identifying care-needs” “building companionship,” and “repeating trial and error” stages. The “establishing community care” phase includes the “facilitating collaboration” and “continuing an activity” stages. The competencies of the respective stage include “competency to discover issues particularly addressing daily life,” “competency to take action toward new nursing activities,” “competency to empathize with diverse values,” “competency to build relationships through dialogue,” “competency to accept challenges of social resource creation,” “competency to coordinate care with respect for people's autonomy,” and “competency to manage for business continuity.”

　Conclusion: The CE followed by nurses in community-based care was characterized by flexibility of activities in collaboration with people of multiple professions and by the difficulty of project continuation.