Aomori University of Health and Welfare
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The Effective of Action Research based on SSM in the Improvement of Nursing Care
No full textpublisher青森市国立情報学研究所の「学術雑誌公開支援事業」により電子化されました。本研究の目的はアクション・リサーチの一つであるソフトシステムズ方法論(SSM)の活動に参加した看護職員が、自らの認識と行動を変化させて、業務改善を自律的に推進することを明らかにし、アクション・リサーチの有効性を検証することである。研究方法は質的研究である。看護業務改善のワークショップとして、「私たちがめざす新しい看護とは」をテーマにSSMの7ステージ2サイクル実施した。データはワークショップの経過の中で作成された資料でSSMのプロセスを再現し、ラーニングを抽出した。また、サイクル(1)終了後に参加メンバーを対象としたアンケート調査を行った。結果、SSMの活動に参加したメンバーは病院の機構改革に伴って看護職が抱えている問題を明確にし、自らの看護に対する認識を変化させた。そして「ルーティーンワーク中心のケアから生活支援を焦点とした看護の必要性」、「看護職と介護スタッフと連携して業務を遂行するために関係性を見直すこと」の二つの課題を見出した。また、SSM活動を通して、看護職の看護に対する認識が変わり、行動変容につながった。さらに、行動の成果を実感した看護職は、看護を変えなくてはという新たな「思い」が触発され、継続的、自律的な業務改革に結びつくことが認められた。これらのことから、SSMの活動が現場の問題を明らかにし、参加者が自律的に問題解決に取り組むことにおいてアクション・リサーチの有効性が検証された。
The purpose of the study was to trigger the changes in the perception and behavior of the nursing staff toward nursing care and to promote the improvement of the nursing service focusing on the support of the life through activities of the Soft System Method (SSM), which is one of the action research methodologies. The study involves 12 nursing staff members of a convalescent ward in M hospital that belongs to a radius of the medical services in A prefecture. They participated in a service improvement workshop on the subject of "What is new nursing care we aim at?" In the workshop, seven stages of SSM were conducted twice using the process of SSM. Based on the data gained from the process of the workshop, the SSM process was reproduced and the learning process was extracted. Moreover, the questionnaire was conducted targeting on the members participated after the cycle (1) ended. As a result, members participated clarified the problems that nursing stuff have at the scene on their own receiving the changes in the reform of the organization in M hospital. That is, two issues are clarified; "the necessity of the nursing that focuses on from the routine-works-centered caring to the support of the life" and "the improvement of the relationship between nursing staff members and care staff members in order to perform the business with cooperation". It was also proved that the members conducted the improvement of the operation on their own by realizing the members' changes of the behavior and being triggered new "feeling" toward solving the problems
The present conditions of health in the perinatal period in Aomori prefecture (part2)
No full textpublisher青森市国立情報学研究所の「学術雑誌公開支援事業」により電子化されました。「青森県における新生児を健やかに育て、良好な予後と豊かな母子関係を得る」ために、ライフスタイルの改善、健全な妊娠促進、母体健康管理の向上、メンタルヘルスケアの促進、豊かな母子関係を得るための育児支援を掲げ、これらに関する実態調査を平成15年から前方視的に行ってきた。本稿はこの調査の中で、妊娠中期の妊婦を対象に行なった2回目の質問紙調査についての報告である。1回目調査で2回目以降の研究協力の同意が得られた1,279名のうち有効回答は1,062で有効回答率は83%であった。平均28.42±1.49週の妊婦で、初産婦が38.5%、平均年齢29.69歳であった。体調は初期と比べて良いと自覚しているものが多かったが、体重増加が40%、貧血28%、切迫流産20%、むくみ14%、などの異常を指摘されていた。家族形態では核家族が59%、拡大家族38%、シングル0.8%であった。専業主婦が52.5%ともっとも多く、妊娠により退職した者は17.7%であった。妊娠中期では初期よりも健康意識が高くなっているが、喫煙者は少なくないと思われた。保健指導の受講率は病院が45.8%、保健センター42.6%、母親学級55.9%で、いずれかで指導を受けたものは81%であった。異常を指摘され、病院で保健指導を受けたものは54.3%であった。保健指導が健康意識に影響している可能性も示唆され、妊娠中期における保健指導の充実が必要であると思われた。身体的な安定、配偶者の有無、相談できる人の有無は妊娠に対する気持ちや対児感情との関連が認められた。妊娠に対する気持ちや対児感情は健康意識との関連が認められた。より健康的な妊娠経過を促すために心理社会的な支援が重要であると示唆された。
The objective of the study is to propose the model of pregnant women for mother's and children's healthcare in Aomori. We started the survey from 2003. We conducted the data collection in the early and middle term of pregnancy and at one month postpartum. We report the results in the middle term of pregnancy in this article. 2065 pregnant woman participated in the first survey. 1279 women had agreed the next survey and 1062 women in thee middle term of pregnancy answered. Many of the subject felt the body condition was good, but about 50% women were diagnosed some trouble. The awaveness about health in the middle period was higher level than in the early period. But only 54.3% subjects who had been diagnosed some trouble were provided health guidance. It seems that health care worker should promote the health guidance more. The greater physical condition, the greater emotional condition and feeling to baby. The presence of husband and consultant around women were affected to good emotional condition and feeling to baby. Good feeling of pregnancy and baby influenced to good health awaveness. Thus medical professional should support psychosocial needs of pregnant women
Aims and current state of Comprehensive Care for Health, Medical services, and welfare in Aomori
No full textpublisher青森市国立情報学研究所の「学術雑誌公開支援事業」により電子化されました
Confused understanding in statistical handbooks on the two-sided and one-side probability for the Fisher's exact probability test
No full textpublisher青森国立情報学研究所の「学術雑誌公開支援事業」により電子化されました
Iryo shisetsu oyobi kaigo shisetsuto niokeru kango kiroku no genjo
No full textpublisher東京特集1 看護記録の法的整備に向けて「看護記録の実態と法的整備の在り方に関する研究」を基に
研究報
A structure of family functions in Japanese families with adolescents
No full textpublisher青森市国立情報学研究所の「学術雑誌公開支援事業」により電子化されました。子育て期の家族は子どもの成長・発達に伴い、様々な変化に対応しなければならない。家族のライフサイクルからみた思春期の子どもをもつ家族は、家族の発達段階における「教育期」にあたり、現代の思春期の子どもが抱える社会問題も踏まえて、家族がこの時期の発達段階を移行するためには危機的な状況も多く、社会的なサポートが必要であると考えられる。そこで、本研究では、独自に開発した尺度を用いて、思春期の子どもをもつ家族の家族機能を評価してその特徴を明らかにし、社会的サポートを含めた家族への看護に関する示唆を得ることを目的とした。A町に住む中学生の子どもをもつ463名の父母を対象に『家族機能』、『自己効力感』、『QOL』について測定した結果、家族機能においては「絆」という情緒的機能が高く、また「役割分担」の機能が低いことが明らかとなった。『自己効力感』では、この時期の父母ともに「能力の社会的位置づけ」が低く、思春期の子どもをもつ家族の発達課題である職業生活や夫婦生活の見直しからの影響が推測されるなど家族のライフサイクルの特徴がうかがえる結果であった。父母間の比較においては、『自己効力感』、『家族機能』ともに母親が低値であり、小さな子どもをもつ養育期と同様に母親の負担が大きいことが推測された。『QOL』では、母親の「友人関係」が重要であり、友人を作る場の確保など思春期にある家族の家族機能の特徴をふまえて地域保健活動や家族看護実践を行っていく必要性が示唆された。
The purpose of this study was to evaluate a structure of family functions in families with adolescents living in a rural Japanese town. It is becoming increasingly difficult for anyone to fulfill the multitude of responsibilities that the family itself is transformed from a unit that protects and nurtures young children to one that is a preparation center for the adolescent's entrance. Therefore, health care professionals must be prepared for accommodating special needs for families during adolescence. A questionnaire was administered to parents whose children were in a junior high school in a northern Japanese town. An Ex post facto survey design was used. A new inventory was developed for evaluating family functions based on the results from our previous studies. Other scales related to family functions, such as self-efficacy and quality of life (QOL) scale were also included in the questionnaire. Structural equation modeling was utilized for developing a model explaining the relationship among different types of family functions. There were valid responses from 280 family units (father=197, mother=266). The reliability of the scales were sufficiently high(α=.83〜.93). The item means for family functions, self-efficacy, and QOL were high. Father's scores for self-efficacy and family functions were significantly higher than the one's among mothers. It was suggested that the friendship subscale in family functions was more important than the other subscales. Most parents with adolescents focus on such major midwife issues as reevaluating their marriage and careers. The findings of this study indicated that the childbearing families require more needs and support
Nurses' attitudes toward alternative cancer therapies
No full textpublisher青森国立情報学研究所の「学術雑誌公開支援事業」により電子化されました。This study aims to investigate nurses' attitudes toward alternative cancer therapies. A self-administered questionnaire designed by the researcher was distributed to 1154 nurses at 223 facilities. 743 of them responded, for a response rate or 64.4%. 439 of the 741 nurses (59.2%) reported having been asked for advice on alternative therapies by cancer patients, and 367 (53.1%) reported difficulty in responding to such inquiries. To the question "What is your attitude toward alternative therapies?", the top response (49.4%) was "It is neither positive nor negative." To the multiple-choice question "What do you think are the benefits of alternative therapies to cancer patients?", many respondents chose "Patients or their families find satisfaction in having done all they can to fight the disease," "Patients can reduce their anxiety," and "Patients can find hope and encouragement." To the multiple-choice question "What do you think are the adverse influences of alternative therapies on cancer patients?", many respondent chose "Those therapies pose a great financial burden", "Those therapies are of dubious effectiveness and safety," and "The patients may fall victim to unscrupulous businesses." These results suggest that nurses regard alternative therapies as effective in the sense that the therapies can give cancer patients satisfaction, anxiety and hope, but that the nurses found it difficult to respond to requests for information on alternative therapies, because their effectiveness and safety have not been scientifically proven
A comparison of family functions in Japanese families with young children and adolescents
No full textpublisher青森国立情報学研究所の「学術雑誌公開支援事業」により電子化されました。家族は地域社会の影響を受けて似る傾向があり、家族機能の検討には地域性を踏まえることが重要である。加えて現代の子どもが関わる社会問題が深刻化する中で子育て期の家族は、子どもの成長・発達に伴う様々な変化に対応しており、家族が危機に陥らないよう支援を考える上では家族の発達段階をも含める必要があると考えられる。そこで、本研究では、同一地域で独自に開発した尺度を用いて測定した、養育期の家族と思春期の子どもをもつ家族の家族機能を比較評価し、発達段階の異なる家族の家族機能の特徴を明らかにし、子育て期の家族への看護支援の示唆を得ることを目的とした。A町に住む就学前の子どもをもつ458名の父母と、中学生の子どもをもつ376名の父母を対象に『家族機能』『自己効力感』『QOL』について測定・分析した結果、『家族機能』の「役割分担」と「友人関係」で養育期の家族が高く、関係性の再構築という発達課題達成に望ましい状態であった。反対に『QOL』の「余暇時間」は思春期の家族が高く、養育期に比べてゆとりがあり、今後に関心を持って夫婦関係を見直す、自分自身を見つめるという発達課題達成に望ましい状態と推察された。しかし、父母間で比較すると、養育期・思春期の家族ともに母親の方が『自己効力感』『家族機能』ともに低値であった。拡大家族が多い地域であり、子どもが成長すると次は老親の世話が加わるなど、発達段階に関わらず母親の負担が大きい状況が推察された。また、少子化の影響から子どもに触れ合う機会が少なく、母親は自分の判断や育児行動の適切性に不安を常にもっているといわれており、『自己効力感』の低さに影響していると考えられた。父親もまた、『自己効力感』の「能力の社会的位置づけ」は高い値ではなかった。自己効力感の高低は個人の行動全般にわたって影響し、行動変容を起こすには肯定的な効力予期、結果予期が重要とされる。危機に陥らないよう、移行期の変化に柔軟に対応した行動変容ができるように、父親・母親の自己効力感が高められるような支援の必要性が示唆された。『QOL』では「友人関係」で養育期・思春期とも母親が高値を示し、特に兼業・専業農家地区で高かった。母親にとって友人関係が重要であり、ゆとりがない時期でも身近で友人関係を育むことができるよう、市街地だけではなく町の周辺地域においても場の確保など支援活動を行う必要性が示唆された。
The purpose of this study was to compare family functions between families with young children and families with adolescents in order to understand the type of support needed by families in various stages of childrearing. It is necessary to understand regional characteristics and the developmental stages of families when considering what support is necessary for various family structures. This study compared the structural characteristics of families with young children and families with adolescents as measured through a survey developed and conducted independently, and aimed to understand the support required for families with children at various stages of development. A questionnaire was administered to 458 parents with young children and 376 parents with adolescents and family functions, self-efficacy and QOL were measured. The results showed subscales of role-sharing and friendship higher in the family functions for families with young children, suggesting that these subscales represent important items for this developmental stage. Subscale of leisure time in QOL marked higher for families with adolescents, representing this subscale as an important item for this developmental stage. Mothers of both age groups scored low for self-efficacy and family function. In spite of the fact that there were more extended families in the area where the survey was conducted, there still remains a heavier burden on the mothers, suggesting that anxiety over childrearing may affect the fall in the birthrate. Fathers of both age groups also scored low for self-efficacy, suggesting the necessity of providing support for self-efficacy to parents so that they will be able to deal flexibly with the transition stage of children. The subscale of friendship marked high for QOL by mothers of both age groups. This suggests the necessity of providing support to mothers to help them find friends in the neighboring area
Survey on cancer patients who adopt alternative therapies
No full textpublisher青森国立情報学研究所の「学術雑誌公開支援事業」により電子化されました。This study investigates the adoption of alternative therapies by cancer patients and the proper way of nursing cancer patients who adopt such therapies. Semi-structured interviews were conducted with 68 cancer patients who had agreed to cooperate. It was found that 44 of them (64.7%) had tried one or more alternative therapy and that such therapies totaled 60 kinds. Herbal products accounted for 46 of these therapies, constituting a majority. Extract of the mushroom Agaricus blazei Murill was taken by 44 patients (75.0%). The average cost of alternative therapies was 38,000 yen per month. The reported benefits included "easing of the side-effects of anticancer agents" and "enhanced immunity." The reported problems included "unaffordably high price" and "doubts about efficacy." Patients' also had these comments about the alternative therapies: "It's a ray of hope," "It will help me to recover my energy, and it enhances my healing power" and "The anticancer effects are dubious." These results suggest that cancer patients who adopt alternative therapies should be nursed with an understanding given to the commitment to overcome illness, with information given to help patients make their own decisions while respecting their wishes and values, and with protection from detriments given to patients and their families