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| 1.
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Katayama, Miho ; Kitaoka, Kazuyo ; 片山, 美穂 ; 北岡, 和代
概要:
Objectives: To explore the psychosocial process in mothers that continue to fulfill their parenting responsibilities des
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pite a depressed mood.Methods: Semi-structured interviews were performed with 11 mothers with suspected depression based on Edinburgh Postnatal Depression Scale （≥ 9） or with strong anxiety about parenting that was detected at the 1-month postpartum examination or the 2 ‒ 4-month newborn house visit. The grounded theory approach was used for the analysis.Results: The mothers found <difficulties in parenting>, and ultimately reached a state of either <awareness of own inability> or <confidence in oneʼs own parenting> through various routes. For example, depressed mothers, without help from their own mother and/or husband, felt lonely and isolated in <solo parenting>. Gaining «awareness of the current situation» was a decisive point. Those that gained awareness of their own effort became able to have a <change of mood> and <confidence in oneʼs own parenting>, while those that did not gain awareness of their own effort underwent <parenting with a sense of resignation>, leading to <awareness of own inability>. Upon encounters with difficult <sudden incidents> during parenting, the lack of <connection to social support> immediately led depressed mothers to <awareness of own inability>.Discussion: Mothers with depressed mood, without support, have limited capability to continue fulfilling their parenting responsibilities. The results of this study suggest that depressed mothers require support to prevent exhaustion from their own mothers, psychological support from their husbands, and support to reduce the sense of loneliness and isolation from their social networks.<br />目的：抑うつ状態にありながらも育児を継続している母親の心理社会的プロセスを明らかにする。方法：産後 1 か月健診時または生後２～４か月の新生児家庭訪問時、エジンバラ産後うつ病自己調査票による抑うつ状態が疑われる 9 点以上の高得点者あるいは、育児不安が強く抑うつ傾向が高いと判断された母親 11 名に半構成的面接を行った。分析にはグラウンデッド・セオリー・アプローチを用いた。結果：抑うつ状態にある母親は、日々≪子どもへの対応の困難さ≫を感じていたが、その後に辿るプロセスはさまざまな形を呈しており、最終的に≪できない自分の自覚≫あるいは ≪子どもの対応への自信≫のどちらかに至っていた。母親は身近にいる実母や夫からの支援や理解が無いと≪自分ひとりの育児≫となり、孤独な孤立した育児となっていた。しかし、育児プロセスの中で【現状への気づき】ができるかどうかが重要な分岐点となっていた。現状の自分の頑張りに気づけた場合は≪気持ちの切り替え≫ができ≪子どもの対応への自信≫となっていた。自分の頑張りに気づけなかった場合は≪あきらめの育児≫となり≪できない自分の自覚≫となっていた。また育児中、対処困難な≪突発的な出来事≫が起こった時、≪ソーシャルサポートとつながる≫ことができないと、直ちに≪できない自分の自覚≫となっていた。考察：抑うつ状態にある母親が自ら持つ育児能力だけで育児を継続するには限界がある。抑うつ状態にある母親が安定して育児継続できるためには、支援者である実母には疲弊防止の支援、夫には精神的サポート、ソーシャルサポートには孤独感・孤立感の解消が求められていることが示唆された。
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| 2.
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Morioka, Hiromi ; Kitaoka, Kazuyo ; 森岡, 広美 ; 北岡, 和代
概要:
This study was performed to examine the conditions surrounding the existence of mentors on Japanese nurses, and to exami
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ne how the existence of mentors affects the workplace environment and associated occupational stress as well as the influence on willingness of nurses to continue working. Data were collected in a cross-sectional manner using a questionnaire distributed to a total of 1,517 nurses working in seven hospitals in Japan. The number of valid survey responses was 1,275 （average valid response rate = 95.0%）. The Japanese Mentoring Functions Questionnaire with nine items, the Japanese Areas of Worklife Survey （AWS）, and the Japanese Maslach Burnout Inventory-General Survey （MBI-GS） were used in this study to examine mentoring, the workplace environment, and occupational stress, respectively. We created an original scale to measure willingness to continue working. Approximately 60% of the nurses had mentors. Notably, more nurses in their 20s and 30s had mentors than those in their 40s or older. Nurses that had mentors showed significantly greater willingness to continue working. On the AWS, five scales of control, reward, community, fairness, and values, except workload, revealed a significantly higher accommodation state in the workplace. On the MBI-GS, those nurses that had mentors reported significantly lower levels of exhaustion and cynicism, while professional efficacy was significantly higher. In analysis by Structural Equation Modeling （SEM）, “mentors affect community in the workplace environment” and “mentors affect feeling of professional efficacy” were selected as the final models. The final model showed a significant relationship between the existence of mentors and the desire to continue working in the current place.<br />本研究の目的は、日本の看護師を対象として、メンターの存在に関する実態を調べ、メンターの存在が職場環境や職業性ストレスにどのような影響をおよぼすか、さらに看護師の就業継続意思への影響を検討することであった。 質問紙法により横断的にデータ収集を行い、対象者は、7 つの病院に勤務する全看護者とし、合計 1,517 名であった。有効回答数は、調査票 1,275 票（平均有効回答率＝ 95.0％）であった。メンターは日本版 Mentoring Functions Questionnaire-9 items、職場環境は日本版 Arear of Worklife Survey（AWS）、職業性ストレスは日本版バーンアウト測定尺度 Maslach Burnout Inventory-General Survey（MBI-GS）を用いて測定した。看護師の就業継続意思は、独自に作成した尺度を使用し測定した。 約６割の看護師がメンターを持っていた。特に、20 歳代や 30 歳代の看護師の中でメンターを持つ者の割合が、40 歳代以上の看護師と比べて高かった。メンターを持つ看護師のほうが、就業継続意思が有意に高かった。AWS で測定した職場環境に関しては、仕事の負担を除く裁量権、報酬、共同体、公平性、価値観の 5 つの側面による職場適合状態が有意に高くなっていた。また、MBI-GS に関して見ると、メンターのいる者の疲弊感とシニシズムが有意に低く、逆に職務効力感が有意に高くなっていた。最終的に共分散構造モデル解析をした結果、メンターは、看護師の職場環境の中でも共同体に影響を、また職務効力感に影響をおよぼしているという最終モデルが選ばれた。就業継続意思との関係については、メンターは今勤務している部署で働き続けたいとの間に有意な関係が認められた。
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Kawaguchi, Megumi ; Kitaoka, Kazuyo ; 川口, めぐみ ; 北岡, 和代
概要:
This study presents the process of associating with experiences by parents of children with schizophrenia from onset to
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continuation of life in the community. Semi-structured interviews were conducted among 14 parents of children with schizophrenia. The results were analyzed using Kinoshitaʼs modified grounded theory approach. Based on the results, two categories and 13 concepts were extracted. When children with schizophrenia experienced onset, their parents ʻcontinued living without consideration as hallucination/delusion.ʼ When the children were diagnosed as having schizophrenia, the parents were shocked by psychosis, and started the process of the [expectation of independence as parents.] This shock was influenced by the parentsʼ prejudice. The parents associated with their experience by ʻbelieving full recoveryʼ of children, and ʻtried every possible means to keep pace with others of the same generationʼ when children showed recovery. They also associated with their experience by ʻreprimandʼ children when children experienced recurrence. The parents repeatedly experienced these two associations and ʻwere not able to decide what to do to address hallucination/delusion.ʼ However, they were gradually able to ʻrespect their childrenʼ and ʻenjoying oneʼs own life apart from the role of a parentʼ based on the central concept of ʻfeeling relief from a family association,ʼ and entered the process of the [recognition of the recovery limits.] The parents were able to ʻaccept a life within the range of the childʼs abilityʼ by ʻaccepting the child with schizophrenia,ʼ which led to continuation of the childʼs life in the community. Associates of ʻaccepting the child with schizophreniaʼ and ʻaccepted a life within the range of the childʼs abilityʼ were influenced by ʻabandoning full recovery.ʼ However, parents became devoted to ʻpreparing for the future after the death of parentsʼ for the child as they grew older, and the feeling of ʻhoping for independence that they cannot abandonʼ for the child arose in the parentsʼ mind, causing conflict with ʻaccepting a life within the range of the childʼs abilityʼ in the parentsʼ mind.<br />子が統合失調症の発症から地域での生活を継続していくまでに、その親はそれらの経験とどう付き合っていったかのプロセスを明らかにした。統合失調症の子をもつ親 14 名を対象として，半構構造化面接を実施し、木下の修正版グランデッド・セオリー・アプローチを用いて分析した。結果，2 つのカテゴリー，13 の概念を抽出した。 子の発症当時の親は、子の症状を「幻覚・妄想と捉えず生活を継続」していた。子が診断を受けることで親は精神疾患への衝撃を受け、【親としての自立への期待】のプロセスに入っていた。この衝撃には、親自身の偏見が影響していた。親は、子の「完治を信じる」ことを行い、子の回復が見られると「同世代と足並みを揃えるために手を尽くす」ことを行っていた。また、子が再発を経験すると「叱咤激励する」ことを行っていた。この二つを幾度も経験することで親は「幻覚・妄想への対応に迷走」していた。しかし、「家族会から安心を得る」ことをコアの概念として、「子を尊重する」ことや「自分の人生を楽しむ」ことができるようになり、【回復の限界の認識】のプロセスに入っていた。親は、「統合失調症の子を受容する」ことで「子のできる範囲の生活を受け入れる」ことができ、子の地域での生活継続に至っていた。「統合失調症の子を受容する」と「子のできる範囲の生活を受け入れる」ことには、「完治を諦める」ことが影響していた。その一方で，年齢を重ねるにつれ，子の「親亡き将来の準備をする」ことに力を注ぐようになり，子の「自立への捨てきれない望みを抱く」思いが沸き上がり、「子のできる範囲の生活を受け入れる」こととの間で，心の葛藤を生んでいた。
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| 4.
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Aijo, Ritsuko ; Katayama, Miho ; Kitaoka, Kazuyo ; 相上, 律子 ; 片山, 美穂 ; 北岡, 和代
概要:
Objectives: This study examined the relationship between job satisfaction and intention to remain in the nursing profess
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ion among hospital nurses.Method: A self-administered questionnaire survey was conducted among nurses working at a hospital to evaluate their attributes, intention to remain, and job satisfaction levels. The Revised Job Satisfaction Inventory for Nurses (JSN-R) was used to assess job satisfaction levels.Results: Multiple regression analysis of 406 valid responses extracted explanatory variables for nursesʼ intention to remain in their profession from 16 subscales of the JSN-R. Significant relationships were observed for the following: “Intention to remain in the same department” with “Collaborative relationship among nursing team,” “Amount of work,” “Salary,” and “Work environment”; “Intention to remain in the same hospital” with “Relationship with superiors,” “Relationship with hospital staff other than physicians,” and “Salary”; and “Intention to remain in the nursing profession” with “Relationship with hospital staff other than physicians,” “Salary,” and “Exercising your abilities.” Conclusion: This study indicated that there is a relationship between job satisfaction among nurses and intention to remain in the nursing profession.<br />目的：病院勤務の看護師を対象に，職務満足と就業継続意思との関係を明らかにした。 方法：一病院に勤務の看護師に自己記入式質問紙調査を実施し，属性・就業継続意思・職務満足について尋ねた。 職務満足は改訂版看護師職務満足尺度（JSN-R）を用いた。 結果：有効データ 406 票に重回帰分析を行い，JSN-R の 16 下位尺度から就業継続意思を説明する変数を抽出した。 「今勤務している部署で，働き続けたい」には看護チームの協力関係，業務量，給与，労働環境が，「今勤務している病院で，働き続けたい」には上司との関係，医師以外の他職種との関係，給与が，「看護師として，働き続けたい」には医師以外の他職種との関係，給与，能力の発揮が各々有意となった。 結論：本研究において、看護師の職務満足と就業継続意思との間にはある関連が認められることが明らかとなった。
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| 5.
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Kawamura, Midori ; Kitaoka, Kazuyo ; 川村, みどり ; 北岡, 和代
概要:
This study was performed to elucidate the framework of subjective cognition about themselves and their life to date in i
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ndividuals with schizophrenia who had experienced long-term hospitalization in a psychiatric hospital and were currently living in the community to support the life of these individuals in the community. Semi-structured interviews (about ３0 minutes × ３ times per person) were conducted with eight individuals with schizophrenia living in the community for ≥ 1 year after having been hospitalized for ≥ ３ years in total (including one hospitalization period lasting ≥ 1 year). The KJ method, an affinity diagram developed by Kawakita that serves as a tool for organizing ideas and data, was used to divide interview data into 10 groups, or islands: “wanting to escape from the negative situation,” “being admitted to hospital = assurance of security,” and “turning to religion for salvation” indicating hospitalization as an uncontrollable situation with a strong sense of powerlessness, and “not being afraid of the past” and “fighting to avoid re-hospitalization,” showing that after hospital discharge, individuals with schizophrenia looked for a place where they could keep some distance from their past and exert some control over the present. While living in the community, they were secretly “yearning for marriage,” while “keeping an easygoing attitude about their position in society,” “trying to overcome the barriers between themselves and healthy individuals,” and “being encouraged by the realization of being ordinary,” suggesting that they longed for their own place in the community. Finally, “learning from agonizing events to change oneself” suggested that individuals with schizophrenia intend to change themselves through their various experiences during and after hospitalization. Taken together, these findings suggest that to provide adequate care to individuals with schizophrenia living in the community after long-term hospitalization, it is necessary to understand their views about community life, in addition to understanding their past medical history, especially prolonged hospitalization, which constitutes a large part of their outlook on life and the world. It is also important to conform to their pace because individuals with schizophrenia tend to have challenges with voluntary impulse control.<br />本研究は、統合失調症者の地域生活を支援するため、精神科病院で長期入院を経験し現在は地域で暮らす彼らの、今までの自分自身および生活に対する主観的認知の構造を明らかにすることを目的とした。通算 ３ 年以上（継続 1 年以上を含む）入院し、現在は 1年以上の地域生活を送る統合失調症者 8 名に約 ３0 分の半構造化面接を ３ 回ずつ行った。面接内容は、KJ 法により 10 のグループ「島」に統合された。入院とは【理不尽な状態から抜け出したい】【病院＝守られる安心】【信仰に救いを求めて】といった、コントロール不能で無力感の強い状態であった。退院後は【過去に怯えない【】再入院しない闘い】といった、過去と距離を取りつつ、コントロールできる立ち位置を模索していた。地域生活では【結婚生活への憧れ】を秘めつつ、【社会的なポジションにおいて無理しない】【健常者との壁を越えたい】【普通の実感を励みに】といった、自分に合った居場所を希求する意識がみられた。【苦悩からも学び、自分を変えていく】ことで、入院中・退院後のさまざまな体験の意味を考え、自己を変容する姿勢がみられた。長期入院後に地域で暮らす統合失調症者に適切なケアを提供するためには、本人の人生を構成する過去の長期入院を含め、地域生活に関する現在の本人の見解を理解する必要がある。そして、主体的なコントロール感覚の獲得は彼らの課題であるため、統合失調症者本人のペースに合わせることも大切である。
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Kato, Mayumi ; Kobayashi, Motoko ; Ishida, Kazuo ; Inagaki, Yoshinobu ; Shogenji, Miho ; Asakawa, Yasuyoshi ; Uemura, Sayoko ; Kitaoka, Kazuyo ; Huong, Thi Thu Pham ; 加藤, 真由美 ; 小林, 素子 ; 石田, 和生 ; 稲垣, 嘉信 ; 正源寺, 美穂 ; 浅川, 康吉 ; 植村, 小夜子 ; 北岡, 和代 ; フォン, ティ トゥ ファム
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坂上, 章 ; 相上, 律子 ; グェン, ティ トゥ フォン ; 片山, 美穂 ; 長田, 恭子 ; 北岡, 和代
概要:
This study was performed to examine the effects of emotional labor and work-related stressors along with the relation be
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tween emotional labor and burnout in psychiatric nurses in Japan. A self-administered questionnaire survey was sent to the director of nursing at a mental hospital, who then sent the surveys to all 169 nurses at the hospital. From among existing measures, we chose the Japanese version of the Maslach Burnout Inventory-General Survey （MBI-GS）, to measure burnout; the emotional labor scale to measure emotional labor; and the Japanese version of the Areas of Worklife Survey （AWS） to measure work-related stressors. Multiple regression analysis was applied to the data, with three subscales （exhaustion , cynicism , and professional efficacy ） of the Japanese MBI-GS as dependent variables. The significant predictors of exhaustion were reward and workload （from the Japanese AWS） and display of negative emotions to patients （from the emotional labor scale）. Significant predictors for cynicism were reward , workload , and values （Japanese AWS） and display of negative emotions to patients （the emotional labor scale）. For professional efficacy, only marital status and reward （from the Japanese AWS） were found to have significant effects. The present study revealed some effects of emotional labor, particularly negative emotional labor. However, work-related stressors, notably reward, workload, and values, had greater effects on worker burnout. Some forms of emotional labor, such as empathy for patients and display of positive emotion , emotional dissonance, and emotional sensitivity requirements , were found to have no effect on worker burnout. In clinical practice, it is necessary to ensure that psychiatric nurses do not take on a disproportionate number of patients whose care would require negative emotional labor. It is also important that new nurses are trained by experienced nurses who demonstrate good awareness when engaging in negative emotional labor and know how to persuade patients. Furthermore, instead of simply assuming that emotional labor degrades mental health, we should actively pursue ways to allow professionals to exhibit empathy for patients and to handle emotional dissonance and sensitivity as needed. To prevent burnout among psychiatric nurses, organizations need to evaluate the nursesʼ performance, prevent individual nurses from becoming overworked, and reflect the nursesʼ sense of value in work. In this way, we can prevent burnout among psychiatric nurses and thereby provide better quality care to the patients.<br />日本の精神科看護師を対象として、感情労働と職場ストレッサーの双方がバーンアウトにおよぼす影響を検討し、精神科看護師の感情労働とバーンアウトとの関係を明らかにすることを目的とした。1 単科精神科病院に勤務する看護師 169 名を対象に自己記入式質問紙調査を実施した。バーンアウトは日本版MBI-GS （Maslach Burnout Inventory-General Survey）を、感情労働は感情労働尺度を、職場ストレッサーは日本版 AWS （Areas of Worklife Survey）を採用し、測定した。 日本版 MBI-GS の 3 下位尺度を被説明変数とした重回帰分析を行った結果、‘ 疲弊感 ’ では日本版 AWS の ‘ 報酬 ’ と ‘ 仕事の負担 ’、感情労働尺度の ‘ 患者へのネガティブな感情表出 ’ が有意な説明変数となった。‘シニシズム’では日本版AWS の ‘ 報酬 ’、‘仕事の負担’、‘ 価値観 ’、感情労働尺度の ‘ 患者へのネガティブな感情表出 ’ が有意な説明変数となった。‘ 職務効力感 ’ では ‘ 婚姻状況 ’ と日本版 AWS の ‘ 報酬 ’ のみが有意な説明変数となった。 感情労働の中でも、ネガティブな感情労働のバーンアウトへの影響を認めることができたが、職場ストレッサーがおよぼす影響の方がより大きいと考えられた。精神科看護師のバーンアウトを予防してより質の高い看護を提示していくためには、組織全体で看護師の仕事の成果等を正しく評価すること、看護師個々に仕事の負担がかかりすぎないように配慮すること、看護師の価値観を仕事に反映させることを重要視し、取組んでいく必要がある。
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長田, 恭子 ; 北岡, 和代
概要:
This study was performed to examine changes after talking to alleviate suicidal ideation in people with depression or bi
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polar disorder that have attempted suicide, and to clarify the role of the researcher in this process. Data were collected through unstructured interviews with participants suffering from depression or bipolar disorder that were hospitalized because of attempted suicide. The interview began when they emerged from the crisis situation, and continued after discharge from hospital. From the contents of the interview, we analyzed the parts where emotions and thoughts before and after suicide were expressed and the remarks of the researcher. The participants were five women, and the interview number ranged from three to eight times. We extracted six categories based on analysis of participantsʼ narratives. There were four categories regarding strong obsession with death and great anxiety and loneliness: “Obsession with death,” “Loneliness the same as before suicide attempt,” “Anxiety about an uncertain future,” and “Losing self-confidence by confronting reality.” In addition, there were two categories regarding alleviation of suicidal ideation and newfound affirmation of life: “Feeling inclined to live” and “Developing motivation for life.” Throughout the interview process, the researcher strove to “wait patiently for participants to express their feelings and thoughts,” never hurrying them or interrupting their remarks. In the second half of the interview, to address participantsʼ everyday problems “the researcherʼs ideas were shared so that participants could change their behavior.” When attendees made an effort and experienced behavioral changes, the researcher focused on the positive by “urging participants to be aware that they are changing and to notice what they are doing.” The results of this study clearly showed that after a suicide attempt patients with depression were moving forward but still vacillating between life and death. Even those that were hopeless and desperate enough to choose their own death had taken definite steps toward the future. Nurses need to recognize this, come close to their wavering emotions, and provide support to help them think positively and find hope for the long term.<br />本研究は、自殺企図を行ったうつ病あるいは双極性障害をもつ者の希死念慮を緩和していく過程における語りの変化と研究者の関わりを明らかにすることを目的とした。自殺未遂が原因で入院となったうつ病あるいは双極性障害をもつ者を対象に、ナラティヴ・アプローチの原則に基づいた非構造化面接を行った。面接内容より、自殺に至るまでや自殺企図後の感情や思考が表現されている部分とその前後の研究者の発言を分析対象とした。 参加者は女性 5 名、面接回数は 3 ～ 8 回であった。参加者の語りを分析した結果、1）死への執着があり不安や孤独感が強い時期には【死への執着】【自殺前と変わらない孤独感】【先がみえない不安】【現実に直面することによる自信喪失】の 4 つのカテゴリー、2）自殺念慮が緩和し生きることを肯定し始めた時期には【生きることに気持ちが向く】【生への意欲の芽生え】の 2 つのカテゴリーが抽出された。研究者は、参加者が考えや気持ちを表現できるようにゆっくり待つ姿勢を示した。面接の2回目以降は、参加者が多面的な見方ができるよう、また変化を自覚できるよう問いかけた。参加者は生と死の間を揺れ動きながらも前に進んでいること、一度は自ら死を選ぶほどの絶望の淵に立たされた人であっても、わずかながらの希望をもち将来に向かって歩き始めていることが明らかになった。看護師は、自殺企図に至ったうつ病者の揺れ動く気持ちに寄り添い、肯定的に思考を変化させて希望を見出せるよう長期的にサポートしていくことが重要だと考えられる。
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論文 |
論文
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大江, 真吾 ; 北岡, 和代 ; 長田, 恭子
概要:
This study was performed to determine the views and expectations of patients with pervasive developmental disorders（PDD）
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regarding nurses. Semi-structured interviews were conducted with 10 patients with PDD. Five categories were extracted based on quantitative descriptive analysis of the data: people whose presence is insignificant; people who do not understand me; people who bring a sense of relief; people who provide support; and an expectation of understanding. While patients had negative thoughts regarding nurses as insignificant and as people who did not understand them, they also associated nurses positively with relief and support, revealing their ambivalent views regarding nurses. Furthermore, patients had an expectation of being understood by nurses. These findings suggest that it is important for nurses to understand the hardships experienced by PDD patients and build relationships with them through communication and nursing care. Using these newly built relationships taking their characteristics into account, nurses should provide advice to patients, thereby encouraging them to express their needs and hopes for the future. As PDD patients may make few expressions, it is necessary to convey what the patients would like to say and what they are thinking to family members and physicians.
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