過疎地域を含む広域合併自治体の支所保健師活動遂行における課題

Challenges in Carrying out the Activities of Branch Health Nurses in Widely Merged Municipalities, Including Depopulated Areas

要旨

　目的：過疎地域を含む広域合併自治体の支所保健師活動遂行における課題を明らかにする．

　方法：支所を有する広域合併自治体の保健師を対象に，半構造的インタビューを実施し，逐語録を質的記述的に分析した．

　結果：【少子高齢化・交通不便に考慮を要する保健事業】，【社会資源・専門職が乏しい中での多い発達・精神障害への対応】等の過疎地域の特性からなる課題，【過疎地域の保健福祉業務全般を担う一人判断に必要な力量】，【中堅以上に遠隔地の支所業務と経験を望まれるが少ない人材】等の過疎地域における支所業務の課題，【業務や地域事情が大きく異なる支所異動後の業務対応】等の本庁業務と過疎地域の支所業務が異なる2重構造の課題の計8カテゴリーが生成された．

　結論：過疎地域の特性からなる課題がある中，保健師が対処できる支所保健師活動遂行上の課題解決として，支所業務を念頭においた保健師の力量形成が重要となる．

　Purpose: To identify the challenges in carrying out the activities of branch health nurses in widely merged municipalities, including depopulated areas.

　Methods: Semi-structured interviews were conducted with public health nurses in wide -area merged municipalities with branch office functions, after which the verbatim recordings were analyzed qualitatively and descriptively.

　Results: The following issues related to the challenges of depopulated areas were identified: “Health services need to take into account the declining birthrate, ageing population and inconvenience of transportation,” “Dealing with the high number of developmental and psychological disorders amidst a lack of social resources and professionals,” In addition, the challenges of branch office operations in depopulated areas were identified: “Competence required for a single person to take responsibility for overall health and welfare work in depopulated areas,” “Remote branch operations and experience desired for mid-level public health nurses and above, but few personnel,” Finally, the challenges of the dual structure, where the operations of the main office differs from the operations of the branch offices in depopulated areas were identified: “Dealing with operations after transferring to a branch office where operations and local conditions differ greatly.” Overall, 8 categories were identified.

　Conclusions: While there are issues that arise from the characteristics of depopulated areas, it is important to develop the competence of public health nurses with branch office work in mind, as a solution to the issues that public health nurses can deal with in carrying out the activities of branch office public health nurses.