佐藤 奈保

本研究は、医療的ケアを要する幼児に対する保育所などでの保育・看護の実際に関する国内研究を概観し知見を整理するとともに、医療的ケア児に対する保育の場での看護の示唆を得ることを目的にスコーピングレビューを行った。医中誌WEBとCiNiiを用い国内文献を検索し、選定基準を満たした17文献を分析対象とした。保育所などにおける医療的ケア児に対する保育・看護の実際に関する知見を統合した結果、【園生活を基盤にした、安全な医療的ケアの実施・調整と医療的ケア児の体調管理】、【医療的ケア児への個別な支援と他児とともに育つ保育の実践】、【医療的ケア児の保育にかかわる専門職や保護者との情報共有と連携】の三つのカテゴリーと九つのサブカテゴリーが生成された。以上より、園生活において、医療的ケア児の安全確保を基盤に、自立心を支え仲間とともに活動する環境調整という共通した視点があり、保育士と看護職の協働の必要性が示唆された。

The aim of this study was to explore father's involvement in rearing a child with profound intellectual and multiple disabilities (PIMD). In-depth, semi-structured interviews were conducted with seven fathers in Japan, and the data were analyzed using a qualitative inductive method. The relationship between the parents, in the context of childrearing, influenced father's involvement with their child with PIMD. Fathers improved their self-confidence in childrearing by discussing and sharing about their child's conditions and caregiving approaches with their spouse. Moreover, fathers' experience of being acknowledged and entrusted by their spouse with childrearing motivated and enhanced their involvement. On the contrary, fathers struggled with concerns regarding their family's future, the balance between childrearing and work, and their own health status. The current findings contribute to nurses' understanding of father's involvement in childrearing a child with PIMD and the development of support focusing on the parental dyadic relationship and coparenting behavior.

BACKGROUND: This study examines how the parents of adolescents and young adults with biliary atresia, surviving with their native livers, transfer medical treatment responsibility to their children, and how becoming a living liver transplant donor affects this process. The basis for the study was that becoming a living liver transplant donor may influence the transfer of responsibility. METHODS: A qualitative, descriptive design was employed using a modified grounded theory approach. Data were collected from eight parents from November 2016 to August 2017 through semi-structured interviews conducted in two Japanese hospitals. Interpretive analysis from the viewpoint of the analytical theme and analytical focus person was conducted, resulting in a diagram and storyline explaining the process. FINDINGS: Five categories were generated from one father and seven mothers (aged 40-60 years) of outpatients (aged 17-25 years): parental ability to cherish the child's "now" (live in the moment); put the brakes on their child's life; learn as they go; leave the child's life to the child; and openly express reservations about becoming a living liver transplant donor for their child. DISCUSSION: Parental transfer of responsibility for treatment may be influenced by close-knit parent-child relationships, perception of the child's growth, and parental concern about becoming a living donor. APPLICATION TO PRACTICE: Care providers should understand parent-child relationships and the parents' concerns about becoming living donors, thereby enabling them to recognize that medical treatment control must be relinquished to foster children's autonomy as adults.

＜文献概要＞目的:被災した女性の観点から、被災した女性が避難生活や生活再建における生活上の困難にどのように対応してきたのか、その体験を明らかにし、被災した女性への看護実践の示唆を得ることである。方法:平成28年熊本地震で被災した成人女性6名を対象に半構造化面接を行い、得られた面接データをKJ法の手順に従って構造化した。結果:最終ラベルのシンボルマークは6枚に集約された。それらの構造を検討した結果、被災した女性が体験した生活上の困難への対応とは、被災下で【助け合えるつながり】を支えに生活の【不自由さを凌ぐ】とともに【利他の心で助け合い】、【愉快さを忘れずに前進】した一方で、実のところ【体の悲鳴】が上がっていた体験を経て、【誰一人置き去りとならない地域の災害への備えが肝心の考えに至る】であった。結論:KJ法による構造化により、被災した女性への看護実践において、平時から被災下で住民同士の助け合いや支え合いが生まれる共感力を高める防災活動や、被災下で女性の健康悪化を予防する支援が重要であることが示唆された。

本研究の目的は、在宅生活する学齢期の障がい児の母親の就労とその関連要因を明らかにすることである。全国肢体不自由児PTA連合会に登録する全特別支援学校212校のうち、本研究の協力に承諾を得た89校を通じて、障がい児家族へ郵送法の無記名自記式質問紙調査を行った。調査票を4,707人に送付した結果、主養育者1,659人の返送があり(回収率35.2%)、回答者が男性、子どもの年齢・就労の欠損値を除外した1,501人を分析対象とした。本研究の分析対象の母親は、就労群580人(41.3%)、非就労群825人(58.7%)であった。多重ロジスティック回帰分析の結果、母親の就労に有意に関連があったのは、子どもの重症度が低い(OR=0.932、95%CI:0.904〜0.958)、健康関連QOLの精神的健康度が高い(OR=1.025、95%CI:1.003〜1.049)、祖父母の同居あり(OR=2.157、95%CI:1.407〜3.322)、家族機能のきずなが強い(OR=1.067、95%CI:1.011〜1.128)、サービス利用時間が長い(OR=1.067、95%CI:1.044〜1.092)であった。本研究の結果から、学齢期の障がい児を育てながら就労を希望する母親へ、祖父母を含む家族全体の協力、子どもの重症度に応じた必要なサービスが利用できる体制整備等の課題が示唆された。(著者抄録)

Background: In Japan, owing to the progress in medical technology, more children with congenital life-threatening conditions survive than ever before. Nurses who care for these children may also influence decision making in difficult situations. Aim: We aimed to describe Japanese nurses' approach toward medical decision making when caring for families of infants with congenital life-threatening conditions. Frequently, these nurses must care for and support parents with ambivalent feelings. Design: Qualitative descriptive study. Methods: Participants were recruited from neonatal intensive care unit and paediatric wards at a university hospital in Japan from June to July 2016. Data were collected using semi-structured interviews and qualitatively analysed. Results: Japanese nurses described these situations as “decision making regarding the child's medical care” and “daily life at hospitals.” The themes included support of parents and the choices made about their children, nurses giving or holding their opinions about care choices, or withholding their opinions during decision-making events. The narratives included 5 focus areas: the parents the children, the family as a whole relationship between families and health care providers and the effect of the clinical environment on the children and families. Conclusion: When caring for children with life-threatening congenital conditions, nurses should develop supportive relationships with parents and contribute to the clinical decision-making process with empathy and based on the most current research data.

BackgroundWith the growing number of severe congenital heart disease (CHD) surgeries, some hospitals in Japan are experiencing difficulty meeting the demand for CHD surgery. As a result, CHD surgery preparation is difficult for mothers of these infants. AimsTo examine the stress and coping of mothers whose infants needed CHD surgery and to identify the factors that influenced maternal coping. MethodsSemistructured interviews were conducted with 11 mothers whose infants had undergone CHD surgery. Qualitative analyses of transcribed interviews were performed. ResultsThe coping of mothers for surgery began when mothers received news of their infant's CHD diagnosis. Maternal stress appraisal and coping changed as surgery approached. In particular, maternal coping was influenced by diagnosis event, symptoms of their child, anticipated number of surgeries, presence of chromosomal abnormality, and infant age. ConclusionThe stressors and coping challenges of mothers whose infants needed CHD surgery changed as the surgery date approached, and these were influenced by 5 factors.

The purpose of the current study was to describe the following: maternal coping with the prospect of becoming the living-donor liver transplant for their child; the daily lives of school-age children surviving biliary atresia with their native liver; and to explore the relationship between these individuals. Semistructured interviews were conducted with 6 school-age children surviving biliary atresia with their native liver and their mothers. The interviews were conducted from June to August 2014, and a qualitative content analysis was used. Results showed that mothers realized a possible need for transplantation in the future, which contributes to emotional and practical uncertainties. The mothers coexisted with this uncertainty and preferred to use a buffering strategy. In contrast, the children did not consider their illness and future and did not adhere to a therapeutic regimen. It is suggested that living with uncertainty about the health and survival of their children is advantageous for mothers. However, problems related to the psychosocial aspect and child's adherence may occur in the future. In addition, problem-solving coping strategies for mothers and the independence of chronically ill children with liver disease should be promoted.

The purpose of this study was to describe the beliefs of Japanese mothers caring for a child with disabilities to advance knowledge about beliefs of Japanese families experiencing illness. A semistructured interview was conducted with eight mothers who had a child with disabilities (physical, intellectual, and/or developmental). The interview invited their reflections about mutual thoughts of family members and family relationships in the context of daily life of caring for a child with disabilities. Data were qualitatively analyzed inductively and deductively and compared with the Common Tentative Framework of Japanese Family Beliefs developed from previous research. The analyses highlighted new understandings of the influence of Japanese cultural and societal beliefs on the family's experience of having a child with disabilities. Clinical implications are discussed and directions for future research suggested.