Health Support of Recipients by Welfare Caseworkers : Analysis of a Questionnaire Implemented at Urban Welfare Offices

【目的】生活保護受給者の自立支援の基礎となるのは健康への支援である。生活保護ケースワーカー（以下、CW）による受給者の健康支援を促進する要因と健康支援に関連する認識を明らかにすることを研究目的とした。【方法】3都市10福祉事務所のCW212人に質問紙を配布し、有効回答178人分を分析対象とした。作成した尺度に基づき健康支援得点を算出し、それを目的変数として関連要因を明らかにするために重回帰分析を行った。また、健康支援得点で2群（高群、低群）に分け、重要と考える健康課題、健康支援方策および職場環境整備の必要性についてCWの認識を比較した。【結果】健康支援得点には、CWとしての受給者への姿勢、高い仕事のやりがい感、職場における事例検討が有意に関連していた。重要と考える健康支援の課題は、精神保健と母子保健の領域の課題をあげるものが多く、健康支援得点の高群は低群に比し、児童虐待をあげる割合が有意に高かった。また、健康支援得点の高群は、健康支援方策では保健医療専門職との連携、栄養教室の開催、患者会や当事者グループ等の活用をあげる割合が有意に高く、職場環境の整備では、職場内での助け合い、他部署との友好な連携、支援策の相談と助言、保健医療専門職の配置などの項目すべてでかなり必要であると答える割合が高かった。【結論】CWによる健康支援を促進するには、CWの志気の高さとそれを支える職場内の取り組みが重要である。受給者の健康課題は、精神保健や母子保健の領域に多く認められた。健康支援に積極的に取り組んでいるCWは、健康支援方策についてより多くの方策が必要と考えており、また、職場環境整備の必要性についての意識もより積極的であった。受給者の健康支援では、世帯を担当するCWが受給者の健康状態への気づきやアセスメント力を高め、医療専門職との協働・連携につなげていける職場環境や体制づくりが重要である。[Purpose] Health support is fundamental of various supports for public welfare recipients. This study aimed to clarify promotion factors and awareness related to health support for recipients among welfare caseworkers (CWs). [Methods] Questionnaires were distributed to a total of 212 CWs at ten welfare offices in three different cities, and analysis was conducted on valid answers from 178 respondents. Health support scores were calculated based on a scale created for the study; using the score as the dependent variable, multiple regression analysis was conducted to clarify related factors. In addition, according to the health support score respondents were divided into two groups (the high score group and low score group), and CWs\u27 awareness of the importance of health issues, health support measures, and improvement of workplace environment were compared. [Results] A significant relationship was found between the health support score and the attitudes of CWs toward recipients, a strong sense of the work being worth doing, and case study meetings in the workplace. The health issues that the CWs considered important were those that involved mental health and maternal and child health, and the rate of child abuse being considered important in the high score group was significantly higher than in the low score group. Regarding health support measures, significantly higher rates were shown in the high score group than low score group in terms of cooperation with health professionals, holding nutrition classes, and cooperation with self-help groups. As improvement of workplace environment, the high score group showed higher rates in all of the items, such as helping others within the workplace, favorable cooperation with other sections, consultations and advice for support measures, and placement of health professionals. [Conclusions] For the promotion of health support by CWs, high levels of morale among the CWs themselves and supporting initiatives within the workplace are essential. Many health issues were identified in the areas of mental health and mother and child health. CWs who proactively make efforts for health support thought that larger numbers of health support measures were necessary, and they also had a stronger awareness of the necessity of workplace environment improvement. To promote health support of welfare recipients, it is necessary to enhance CWs\u27 assessment skills toward recipients health need, and workplace environment that assure cooperation with health professions is also important.黒田研二教授退職記念

Food Service Issues Relating to Food Allergies in Residential Nurseries and Children\u27s Care Homes : A Study Based on the Comments of Dieticians and Registered Dieticians with Regard to Their Use of Food Allergy Guidelines

乳児院・児童養護施設を対象におこなった食物アレルギーの給食対応に関する調査の自由記述欄の内容を分析し、食物アレルギーの給食対応に関して両施設にみられる課題およびガイドラインの有無別にみられる特徴を検討することを目的とした。自記式質問紙調査の自由記述欄に記入があり、ガイドラインによる取り組みに回答のあった施設のうち栄養士・管理栄養士が回答した乳児院30施設と児童養護施設71施設を分析対象とした。社会的養護に特徴的な課題として《施設体制》の【入所時のアレルギー情報把握】の欠如による〈緊急入所・情報不足による食事提供への不安〉、【小規模化における課題】が示された。ガイドラインの有無別にみると、乳児院での〈初発のリスクへの不安〉、児童養護施設での〈事故対応に対する不安〉〈重症児対応に対する不安〉といった不安感はガイドラインがない施設に見出された。ガイドラインがある乳児院の栄養士は《給食業務》の〈献立例〉の心配は少なく、《施設内連携》の〈情報共有・共通理解の重要性〉や〈職員間の認識差〉を課題ととらえていた。また、ガイドラインがある児童養護施設の栄養士は《食事場面》での【食事指導】や【児童の心理面への配慮】などの課題は少なく、施設外の情報交換を求めていた。以上のことから、ガイドラインがない施設の栄養士は、献立や食事指導の仕方などの児童に対しての直接的な支援が課題であると認識していたが、ガイドラインがある場合は、施設内連携・施設外連携などの児童を取り巻く職員間・部署間の情報共有や、他施設との関係を課題ととらえていることが推察された。The aim of this study was to analyze comments provided in our survey on the provision of allergy-appropriate food services in residential nurseries and children\u27s care homes, to examine the issues identified, and to compare facilities that used food allergy guidelines with those that did not. The facilities analyzed were 30 residential nurseries and 71 children\u27s care homes where dietitians responded through comments in self-administered questionnaires. Characteristic concerns with children\u27s social care related to problems with food services during an emergency admission due to lack of allergy information at the time of admission. Among dietitians that did not use food allergy guidelines, concerns such as anxiety around the risk of allergy onset were found at residential nurseries, and concerns about appropriate responses to accidents and to children with severe conditions were found among dietitians at children\u27s care homes. Dietitians that did use food allergy guidelines had little concern about using specific menus, but raised the importance of information sharing, having a common understanding, and recognizing differences in food allergy awareness among staff. Dietitians at children\u27s care homes that used food allergy guidelines had few issues with dietary guidance and less need for consideration of children\u27s psychological state, but sought additional information outside of the facilities. As indicated above, comments made by dietitians working at facilities without any food allergy guidelines acknowledged problems in providing adequate menus and dietary guidance. Where guidelines were used, challenges such as information sharing between staff and departments surrounding the children (including cooperation within and outside of facilities), and maintaining relationships with other facilities, were expressed.本研究はJSPS 科学研究費（課題番号16K12745）の助成を受けたものです

Changes in the Psychological State of Caregivers for Elderly Women : Comparison of Sons, Daughters, and Husbands as Caregivers

本研究は高齢女性を介護する介護者について、介護開始時と一定期間介護継続後の二時点で認知的介護評価がどのように変化するのかを続柄（息子・娘・夫）により比較し、さらに両時点の認知的介護評価に関連する事柄を明らかにすることを目的とした。調査対象者は、母を介護する息子介護者、母を介護する娘介護者及び妻を介護する夫介護者とした。居宅介護支援事業所等に質問紙配布を依頼し、回答者からの直接返送とした。配布数は286人で、回答数は94人であった（回収率32.9％）。内訳は息子12人、娘54人、夫24人、その他4人であり、その他を除いた90人を分析対象とした。調査項目は、被介護者の状況、介護開始時の就業の有無、介護保険の知識の程度、代替者の有無、他の介護の有無、日々の暮らし向き、家族や近隣友人からの支援の満足度、介護者と被介護者との関係に関する項目とした。従属変数は、肯定的評価と否定的評価を同時に測定できる認知的介護評価尺度を使用した。結果として、①一定期間介護継続後に、全体として介護における否定的評価は変化していなかったが、肯定的評価はいずれも有意に上昇していた。②続柄別では、夫介護者の介護継続不安感が上昇し、娘介護者の介護役割充足感、高齢者への親近感が上昇していた。③息子介護者は他の被介護者を過去または現在介護している割合が高く、ダブル介護の危険性を孕んでいた。④否定的評価、肯定的評価の両側面に被介護者への尊敬の程度が関連しており、介護が一定期間継続した後も続いていた。⑤近隣友人からの支援の満足度が認知的介護評価に関連していた。支援者は介護者と被介護者との関係やソーシャルサポートネットワークを適切にアセスメントし、介護者の意に適ったインフォーマルサポートが得られるようマネージメントを行う必要がある。This study aimed to clarify the changes in the cognitive state of caregivers of elderly women at the beginning of the care and the time of assessment and to identify issues related to cognitive caregiving appraisal at each time point. The respondents were the elderly women\u27s sons, daughters, and husbands who are their immediate caregivers. A total of 286 questionnaires were mailed to the respondents and 94 completed questionnaires (32.9% return rate) were returned. The caregivers who responded to the questionnaire were 12 sons, 54 daughters, 24 husbands, and 4 others. In all, 90 responses were analyzed. The survey items were condition of the care recipients, working situation of the caregivers, presence or absence of an alternative, economic situation, and relationship with the care recipients. The dependent variable was the cognitive caregiving appraisal scale. The results are as follows. (1) After a period of care, the negative caregiving appraisal did not change, but all positive caregiving appraisal significantly elevated. (2) The husbands of care recipients reported increased "anxiety about continuing caregiving," and the daughters of care recipients reported increased "fulfillment about the caregiving roles" and "affection for the elderly." (3) Sons of care recipients were at risk of caring for multiple recipients.(4) Both negative and positive appraisals were related to the degree of respect the caregivers had for the care recipients. (5) Satisfaction with support from neighbors and friends was related to cognitive caregiving appraisal. It is important for care professionals to properly assess the relationship between the caregivers, the care recipients, and the social support network in place.黒田研二教授退職記念

Investigating social support for people with dementia living in the community : An analysis of the narratives of them and their family members

本研究は、認知症の人の社会とのつながりや思いについて、本人と家族の語りを分析し、ソーシャルサポートの実際を明らかにすることで、認知症の人が望む暮らしや支援のあり方を考察することを目的に、認知症の人と家族等身近な支援者8組を対象に半構造化面接を行い、質的内容分析を行った。その結果、認知症の人の社会とのつながりや関係では、【家族に関すること】【介護サービスに関すること】【近隣との交流に関すること】【友人・親戚・同僚に関すること】【医療に関すること】の5つのカテゴリーが生成された。認知症の人のソーシャルサポートは、提供者としては家族が最も多く、情緒的・道具的サポートが大半を占め、次いで介護職が多かった。面接した認知症の人は長年の家族との暮らしの中で自己肯定感を深め、専門的な介護サービスにより楽しみや役割のある豊かな生活を維持していた。認知症の人が穏やかに生活する背景には、特に情緒的サポートの受領を認知症の人本人が感じていることと、家族が培ったソーシャルサポートネットワーク及び家族の対応力があった。認知症の人と社会のつながりは、家族や身近な支援者のソーシャルサポートにより発展し、本人の安定した暮らしに影響する。そのためには、認知症や個人の特性を理解した豊かなコミュニケーションによる本人の思いの尊重と、家族のネットワークを生かした支援が必要である。This study investigates the ways of living and support expected by people with dementia by analyzing narratives of them and their family members. Further, it also examines the association between social connections of people with dementia and social support. Semi-structured interviews were conducted with eight people diagnosed with dementia along with their family members. Afterwards, a qualitative content analysis of the narratives was performed. Regarding the types of social connection that people with dementia experience, five categories were identified. These include how connected they were to: their family; care services; neighborhood; friends, relatives, or co-worker; and medical care. The results indicate that individuals with dementia received much support from family, specifically emotional and instrumental support. Their self-esteem increased due to living with their family for many years and maintaining pleasurable, positive interactions while undergoing care service. For such people, it is clear that their lives are safe and emotionally supported. Besides, the problem-solving ability and the social support network that the family cultivates directly impact the social support received by the person with dementia. The connection between people with dementia and society develops through the social support of family members and close supporters, affecting the stability of the person\u27s life. To that end, it is necessary to support people\u27s thoughts through productive communication that understands dementia and individual characteristics, and that makes full use of the family\u27s network.黒田研二教授退職記念

土井洋一教授退職記念号発刊によせて

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都道府県・指定都市別にみた地域福祉権利擁護事業の利用実績およびその関連要因

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高齢者介護施設におけるサービス評価基準の開発 : サービス内容と施設運営状況との関係

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