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精神疾患をもつ親への応援型ショートケア開設に向けた応援の実践知の創出に関わる研究

基盤研究(C)

Project Year :

2023.04

2027.03

澤田いずみ, 小川賢一, 原田由香, 石川幸代, 道信良子, 原田瞳

Can caregivers make connection with community support resources through participation to parenting programs?

Grant-in-Aid for Scientific Research (C)

Project Year :

2022.04

2026.03

加藤則子, 塩田昇, 蓋若エン, 澤田いずみ, 梶原由紀子, 江上千代美, 麻生保子

“応援”概念に基づく精神障害をもつ人の子育て支援アプローチの開発に関わる研究

基盤研究(C)

Project Year :

2019.04

2023.03

澤田いずみ, 石川幸代, 塚本美奈, 道信良子, 小川賢一, 原田瞳

本研究の目的は、保健医療福祉分野における“応援”という概念を秋からにし、精神障害を持つ親への子育て支援における新たなパラダイムとアプローチを創出することである。目的１である「医療福祉分野の文献で使用されている“応援”の概念を明らかにすること」については、医学中央雑誌、最新看護検索，CiNii Article ,メディカルファインダーから検索した医療分野における応援の実践を報告した29文献を対象として、応援の概念分析を実施した。応援の前提要件、属性、帰結にかかわるカテゴリーが抽出され、これに基づいて“応援”の概念に関わる仮説モデルと定義を明らかにできた。現在、研究分担者と分析の妥当性の検討を行い、4月中に投稿予定である。目的２である、「北海道浦河町における精神障害を持つ親を対象とした当事者中心の対話型カンファレンス『応援ミーティング』参加者の応援のプロセスを明らかにする」は、COVID-19の感染拡大防鼠措置に関わる移動制限により実施できておらず、研究期間を1年延期することとした。目的１で行った概念分析の結果、導き出された応援の仮説モデルと定義の検証に関わるインタビューガイドを作成し、令和4年度に面接調査を実施する予定である。また、本年度は、これまで実施してきた精神障害を持つ親へのメンタルクリニックにおける子育てプログラムの成果と課題について、英文ジャーナルへの投稿を行った。現在、混合研究法に基づいて再分析を行い、再投稿に向けて執筆中である。

Study of the introduction and evaluation of early intervention program for mental health inpuberty

Grant-in-Aid for Scientific Research (C)

Project Year :

2018.04

2022.03

Yanagawa Toshihiko

The seminar format Teen Triple P (TTPS), developed in Australia, was introduced to prevent progression to problems surrounding adolescent child development, such as abuse, truancy, bullying, delinquency, violence, and suicide. The subjects were caregivers with children aged 11-15. Pre- and post-TTPS comparisons (57 participants) showed improvements in all items of the parenting style PS: laxness, over-reactive, and verbosity, and reductions in depression, anxiety, and stress of the parental mental status DASS, with high satisfaction CSQ. After 6 weeks of the program, the parents' (36 participants) PS and DASS effects were maintained, and CSQs were maintained for both emotional symptoms, problem behaviors, and inattention/hyperactivity improvements in the children's DASS.

Evaluation of effectiveness of delivering parenting program toward communities in remote area

Grant-in-Aid for Scientific Research (C)

Project Year :

2018.04

2021.03

KATO Noriko

In recent environment for raising children with weakening of human relations among communities, needs for parenting programs increased. For one of the programs named positive parenting program (Triple P), there merged the necessity to provide programs for families living in the remote area. So effectiveness of providing programs through home visit and videoconferencing technology was examined using psychological scales. Providing programs through home visit showed comparable effect to those providing in the clinics. Through videoconferencing technology, compared to control group who were not provided programs, there was statistical significance of the effect.

Effects of Positive Parenting Programs on Children's Psychosocial Problems

Grant-in-Aid for Scientific Research (C)

Project Year :

2017.04

2020.03

Fujita Ichiro

We examined the influence that parents' learning of the positive parenting program "Triple P" had on children's feelings and behaviors. The PSC (Pediatric Symptom Checklist) Japanese version health questionnaire was used to screen children for psychosocial problems. The number of people with a PSC score of 17 or above (with psychosocial problems) prior to group-work was 49.6% among 137participants, and it was reduced to 35.0% in the ex-post survey. McNemar test showed the posterior ratio of the number of people with a score of 17 or above was significantly reduced compared to the prior ratio. The mean value of PSC scores ± standard deviation was significantly reduced to 17.24 ± 9.06 before and 14.64 ± 8.56 after. Significant improvements were found in two realms: anxiety / disorders of human relations, school truancy and indefinite complaints. It was found that children's psychosocial problems could be improved by taking a positive parenting program for about 2 months.

Construction Circular Circulation Support Model for between Parents with Mental Illness and psychiatric medical service

Grant-in-Aid for Scientific Research (B)

Project Year :

2015.04

2019.03

Sawada Izumi, ITO eriko, UCHIDA azusa, TKAMURA mika, KURODA miyuki, YOSHINO junichi

We conducted the following activities: (1)providing parent support programs in mental clinics; (2)establishing a location for study participants to tell their opinions to community supporters; (3)survey on cognitive functioning and parenting activities; (4)a survey on the usefulness of oxytocin as an evaluation index for parenting support. Through the support program, participants showed improvements parenting attitudes. Through the participation in feedback activities, participants showed increases in behaviors of supporting others, and community supporters developed a raised awareness of the importance of support to focus on the strengths. However, parents had parenting experience with low care, and the characteristics of the cognitive functioning related to inadequate parenting attitudes. It is necessity to develop programs for dialogue about their parenting experiences and for cognitive function training. In addition, oxytocin seemed to be effective for evaluation indicators.

A study about effective delivery of family support activities among community

Grant-in-Aid for Scientific Research (C)

Project Year :

2015.04

2018.03

KATO Noriko

For providing enough parenting programs to those who have difficulty in child raising, we did interviews for health professionals within 5 cities with various population sizes. Providing budgets, professionals for family support and easy accesses parenting program family who are with problems of clinical level. Official statistics for the number of children who were need protection, reported child maltreatment, school absence and delinquency could be effective in showing long term effect of community family intervention. In a city near metropolitan area, 8.3 % of 3-year-old children were within clinical range of mental health problem. In the city, the system is not well arranged to introduce families to adequate parenting programs and the amount of personnel who can provide programs was very small compared to those needed.

Trial evaluation of nursing care for child rearing of parents with schizophrenia using psychiatric outpatient service based on a community network

Grant-in-Aid for Scientific Research (B)

Project Year :

2011.04

2015.03

SAWADA IZUMI, MIYAJIMA Naoko, TSUKAMOTO Mima, TAKAHASHI Yumiko, MASAOKA Keiko, IKEDA Nozomu, ONO Mami, KAGEYAMA Setsuko, ITO Eriko, UCHIDA Azusa, TAKAMUA Mika

The purpose of this study was to evaluate nursing care for parents with schizophrenia through the use of outpatient service based on a community network. A nurse and a PSW working in a mental clinic employed the Positive Parenting Program (triple P) for parents using the mental clinic. Triple P was utilized individually and for group support of the parents and improved their rearing attitude and reduced stress. A ripple effect on interpersonal relationships and self-help activity was also found. For parents with schizophrenia, it was the foundation of support for their power of assertion and to build relationships with their supporters, including their families. Individual consultation and home visiting by psychiatric nurses based on an active cooperative network with various facilities was useful. Nursing care including a parenting program for parents with schizophrenia seemed to be effective based on the good relationship among the patients, their families, and the community network.

A Study into Nursing Care Program for Schizophrenic People during Pregnancy, Delivery, and Parenting.

Grant-in-Aid for Scientific Research (B)

Project Year :

2007

2010

SAWADA Izumi, MIYAJIMA Naoko, YOSHINO Junichi, HIRATUSKA Shiho, KONNO Miki, TAKAHASHI Yumiko, NOMURA Miki, MARUYAMA Tomoko, KAGEYAMA Setsuko

This study was carried out for the ultimate purpose of developing a nursing care guideline for schizophrenic mothers during their pregnancy, delivery and parenting. It involved field work at pioneering facilities ; a questionnaire-based descriptive study of nurses from 128 health and medical institutions ; interviews with 24 nurses ; and interviews with two schizophrenic mothers. The study identified aggravated symptoms resulting from reduced medication during pregnancy ; fragile family background and poor interpersonal skills as specific needs of schizophrenic mothers, as well as the need to provide, on an ongoing basis, a multi-faceted and -tiered support to the mother and her family from early in pregnancy to ensure their smooth transition into the parenting life. There was also a lack of collaboration among nurses. A care guideline was developed on the basis of these findings to support schizophrenic mothers from pre-pregnancy through to parenting stages. The guideline, which has been highly evaluated in clinical practice, is expected to guide the nurses to forming a common ground of understanding in the care of schizophrenic mothers.

Evaluation of influences on reproductive function involved a sleep disorder for prospects of work-life balance.

Grant-in-Aid for Scientific Research (C)

Project Year :

2007

2010

KATAKURA Yoko, KISHI Reiko, MARUYAMA Tomoko, SAWADA Izumi, OKUI Toyo

Responding to those emerging social demands will require the development help women works. Today, the employment systems need for night-work or shift-work for women and others. In experimental results, formation of reactive oxygen species (ROS) on aged female rats was increased compared with young after night shift-work simulation activities. Female rats showed more high flexibility than male for night activity. The results will be used to improve the employment systems of health personnel and other night workers.

交替制勤務による睡眠障害が女性就労者の健康に与えるライフ・ステージ別影響解明

萌芽研究

Project Year :

2004

2005

片倉洋子, 岸玲子, 丸山知子, 澤田いずみ, 奥井登代

多様な産業分野に女性労働者が増加しているが現在の労働現場における環境整備では男性中心に行われ女性固有の健康問題についてはまだ配慮が充分ではない。種々の勤務形態の中でも交代制勤務に伴う夜間、長時間勤務による身体、精神影響等女性も多くの問題を抱えている。早期の段階で身体、精神的健康問題の発見のために、非侵襲的、客観的な健康影響指標について検討を行うことを目的として以下の研究を実施した。 1.交代制勤務の勤務前と終了後に勤務形態による健康影響の1つとして平衡バランス機能との関連について重心動揺計を用いて測定するために、動揺計について検討を行い携帯可能な軽量機器を開発した。軽い計測器に関しては重心の安定が悪く、置く場所の状態に左右されてしまうなどの欠点が種々あったことから、重心動揺計本体の軽量化により安定した計測、短時間で正確な計測の可能性について試作機器を製作し検討を行い、安定性、精度、計測項目の多様性など充分使用できるものであることが実証された。 2.身体的精神的疲労、ストレスなどにより起こる生理機能を非侵襲的に測定することを目的として、今年度はラットを用いて実験的に検証を行った。16時間以上の長時間勤務と夜勤を想定し、活動期を逆転長時間とし活動期の前後で白血球細胞の活性酸素種の測定、過酸化水素による影響をフローサイトメーターで調べた。活性酸素種は長時間活動期後に増加し、サイクルを経るごとに増加していた。またストレス指標ともなる一本鎖DNA損傷につてもコメット法にて測定を行った。長時間活動期前には損傷は見られなかったが活動後にはDNA損傷が増加していた。 3.女性のライフ・ステージによる負担程度の計測や交代制勤務に伴う睡眠状況によるホルモンへの影響を知るために唾液中コルチゾール、8-OHdG、DHEAを測定するため予備的検討を行った。 4.質問紙により生活状況や睡眠、ストレス状況の知見を得るために、調査票作成のための検討を行った。

Nursing activities and evaluation of child's hospitalization as an opportunity to become nonsmoking parents

Grant-in-Aid for Scientific Research (C)

Project Year :

2003

2006

KONNO Miki, MARUYAMA Tomoko, IZUMI Hisako, SAWADA Izumi, UEMURA Kouta

This study was carried out (1) to explore parental smoking status at a child inpatient unit and (2) to evaluate nursing activities from the point of view of the nurse and the parents taking their child's hospitalization as an opportunity to stop smoking. 1.Report of parental smoking status at home We administered a questionnaire to smoking parents with children admitted to the child inpatient unit. Fifty of the 118 parents (42.4%) responded. Most patients were exposed to passive smoking by their parents at home. Parents acquired pertinent knowledge about smoking cessation or separate smoking from an original brochure. Parents who were less concerned about smoking cessation tended to see smoking as a kind of stress relief. In contrast, parents concerned about smoking cessation tended to be anxious about family members' health. They cared about smoking cessation intervention by professionals while their children were in the hospital. 2.Nursing activities and evaluation of the program for "supporting parental smoking cessation and health" in the maternal-child unit Parents with admitted disabled children were recruited in the program "supporting parental smoking cessation and health" in 2005-2006. Of them, 61 participated. Their knowledge about smoking improved significantly. However, there were no changes in the number of cigarettes they smoked or the stage of readiness to quit smoking. Nurses also improved their smoking knowledge significantly. They had to make efforts as experts to raise unconcerned smokers' awareness. It also confronted them with their reluctance to discuss cessation of smoking with vulnerable parents. The unit produced a cessation-oriented atmosphere.

Psychosocial state and Respite service for Married couple of Child-rearing period

Grant-in-Aid for Scientific Research (B)

Project Year :

2003

2005

MARUYAMA Tomoko, SAWADA Izumi, YOSHINO Zyunichi, KONNO Miki, SUGIYAMA Atuko, YOSHIDA Yasuko

To develop the respite service system for the married couple of a child-rearing period, the research was done by the following purposes. 1.A psychosocial state and the communications pattern between married couples. 2.Execution and the effect of the respite service on the child-rearing women. The questionnaires were distributed to about 400 women who had 3 to 4 years old child who was able to have received cooperation in a current longitudinal study and her husband. Content of the questionnaires is Marital love scale, Child care stress scale, Duke-UNC social support scale, and GHQ30 etc. The collection rate was female 65%, and the husband 39%. The focus group interview was done to 8 women and the 4 husbands. The content of the interview was marital relations and is to bringing up a child. And the data base of the graduate of the nursing junior college who was not working by the Sapporo City living now was made for the respite service volunteer. The meeting of Kalugamo was held 16 times in total. The holding theme is an aromatherapy, a stretch, a yoga, and a tea seminar, etc. The Child care corner by the volunteer and Nursing students was installed for the women can come to the meeting with her child. The number of averages of participants was 20 people, and the number of children of participation averages was 16 people. The number of participation total was about 230 people. The participation reason was "It was interested in the theme" about 90 percent, "I wanted to divert oneself" about 60 percent, "There was Child care corner" about 40 percent, and "invited by the friend" about 30 percent. MCL was investigated and compared before and after the participation of the meeting. As a result, the value of the pleasure affection and the relaxation had risen after it had taken part in a meeting. In a word, the effect that it was possible to relax by participating in the meeting was achieved.

Study on the health status of women who separate because of intimate partner's violence and the long-term influence of violence

Grant-in-Aid for Scientific Research (C)

Project Year :

2003

2005

SAWADA Izumi, MARUYAMA Tomoko, YOSHINO Junichi, KONNO Miki, KATAKURA Yoko

Purpose The purpose of this research was to determine the health status of women who separated because of their intimate partner's violence and the long-term influence of violence. Method The primary investigation was conducted on one-hundred women who had fled to private shelters because of their intimate partner's violence and had separated. Self-administrated questionnaires included inquiries about the frequency of 32 physical and mental symptoms, the IES-R22 (The Impact of Event Scale), Zung questionnaire (depression self-test), medical services received or demanded, the kinds and frequency of the partner's violence, status of life habits and demographic factors. There were 67 respondents (67.0%) and 50 of them agreed to a secondary investigation. The secondary investigation was performed via a semi-structured interview about health history during living with the partner and after the separation. For 14 of the women interviewed, more than three years had passed after the separation. Results In the primary investigation, the results about heath problems while living with the partner suggested that about 80% of the women had felt depressed and most women had had limited contact with society, including medical services. After separation, about 50% of them suffered from moderate to severe depression, sleeplessness and fatigue. Of the women who were aware of health problems, 50% recognized the relation between the partner's violence and health. Some physical and mental symptoms moderated as time passed, but some women felt severe symptoms of depression or PTSD even over five years after separation. The secondary interview investigation showed that lack of social support, poverty and adjustment disorders of children as a result of the partner's violence influenced the process of recovery of women's health. Intimate-partner violence seemed to have a long-term influence on the women's health. Thus, a comprehensive support system should be organized for such women and their children.

夫婦間暴力における夫との離別に関する妻の意思決定プロセスに関する質的研究

若手研究(B)

Project Year :

2001

2002

澤田いずみ

<研究目的>夫婦間暴力における妻の離別に関する意思決定プロセスを明らかにし、看護支援に関して考察すること。 <研究方法>夫婦間暴力の駆け込みシェルター代表者を介してシェルター利用者に面接協力を求め、承諾が得られた7名に1対1の半構成面接を行った。逐語録をデータとし、継続的比較分析を行った。 <結果および考察>分析の結果、5つのカテゴリーが導き出された。カテゴリー1「暴力を生み、反復させる夫婦間の責任の不均衡」:夫は何かにつけて妻に責任を負わせようとし、日常生活の些細なことやライフイベントをきっかけに暴力が起こっており、男性優位の社会通念や夫のアルコール問題が背景に語られていた。カテゴリー2「不均衡な生活を暴力で維持しようとする夫」:夫は暴力をエスカレートさせながらも、妻を引き止めるために一時的に暴力を停止し、不均衡な生活を維持しようとしていた。カテゴリー3「不均衡な夫との生活に生き抜く支えを模索する妻」:妻たちは、過酷な生活を様々に意味づけ、生き抜く支えを見つけ、暴力をコントロールしようとしていた。夫と子どもとの生活への愛着や暴力から受ける痛み、暴力はなくなるという希望がせめぎ合い、離別への決意が揺れ動いていた。カテゴリー4「離別の決意を促進する原動力」:暴力はコントロールされることはなく、妻たちの生命や支えとしていた子どもをも破壊し始めるとき離別への決意を促進されていた。そして、「あなたは悪くない」という周囲の言葉が離別への決意を支えていた。カテゴリー5「容易ではない離別の実行」:夫の監視や、援助資源の不足、心身の痛み、先行きの見えなさから離別の実行は容易ではなく、離別を猶予せざるを得ない過程が語られた。シェルターの存在が離別に見通しを与え、実現に導いていた。看護支援には、妻たちのせめぎ合いを理解し、夫婦間暴力に関する正しい知識と情報を提供することが重要であると考えられた。

A study on factors related to woman's stress during childcare and domestic violence and on the structure of nursing approach

Grant-in-Aid for Scientific Research (C)

Project Year :

2000

2002

RITA Wingort, SAWADA Izumi, YOSHINO Zyunichi, MARUYAMA Tomoko, YOSHIDA Yasuko

We carried out a longitudinal study for two years on women who had childbirth four months earlier. The purpose was to reveal the condition of the wife's stress and violence from her husband and analyze related factors. Over 90% of its target population were housewives, 90% of which lived in nuclear families. Approximately 90% reported that the child had no health problems. The findings indicate the followings : 1. Approximately 90% enjoy taking care of their children and feel fulfilled. However, roughly 80% feel tired, and about 50% claim that the child is annoying and irritating. 2. The GHQ result reveals that approximately 50% are under considerable stress for a post-parturition period from ten months to 1.5 years. They suffer from physical symptoms and sleep disturbances. 3. Approximately 90% of the women show few signs of child abuse. Nonetheless, about 50% ignore the child or slap its hand, head or bottom sometimes. Such conducts are more frequently reported towards 1.6 year-old children than to 10-month old children. Roughly 20% of husbands are involved in similar conducts towards 10-month-olds and approximately 40%, for 1.5 year-olds. 4. About 90% report no domestic violence, but 30〜40% of women have experienced psychological abuse including disregard and abusive language from their husbands. Some 10% of wives have experienced slapping, watch and non-cooperation for contraception from their husbands. 5. Conjugal violence is related to unsatisfactory social support, conjugal relations, previous experience of being abused, conjugal violence between parents, unwanted pregnancy and mental health. Violence by husband is related to the risk of child abuse. The findings indicate the critical necessity of support for childcare such as improving financial aid, spreading the practice of a childcare leave, nursing service and early support to cut the link between conjugal violence and child abuse.

児童虐待における親と看護婦間の援助関係成立を困難にする要因についての研究

奨励研究(A)

Project Year :

1997

1998

澤田いずみ

1. 研究目的医療機関における児童虐待への早期クライシス介入の機能を高めるため,看護婦が虐待された子どもを通じて虐待者である親と出会うとき,看護帰一親間の援助関係を困難にする要因を明らかにすること。 2. 研究実施状況 (1) 1次調査:自記式質問紙による郵送調査児童虐待ならびに虐待する親に対する看護婦の認識と虐待事例との遭遇状況を把握することを目的に,札幌市内の総合病院の小児科,整形外科,脳外科,皮膚科,形成外科,救急部門に勤務する看護婦447名を対象に調査を行なった。回収数は428名(回収率87.2%)であり,うち有効回答数は313名(73.1%)であった。このデータについて単純集計を行ない,さらに,親への認識に関連する要因に関して統計的分析を行なった。この結果について成果報告を行なった。 (2) 2次調査:児童虐待事例に関する聞き取り調査 1次調査の結果,児童虐待事例と遭遇したことのある看護婦は89名であった。このうち25名から協力の申し出があり,12名の看護婦に虐待事例における親と看護婦の関わりについて面接調査を行ない,5例の虐待事例が把握された。 (3) 3次調査:予後調査 5例のうち3例は児童相談所へ通告され・1例は精神科外来でフォロー,1例は死亡であった。児童相談所に継続されたケースに関しては児童相談所より通告後の経過に関して情報を得た。 3. 研究結果看護婦の児童虐待に関する知識には課題が多く,親との援助関係成立にも影響を及ぼしていた。虐待の発生背景に関する認識とともに,他機関とのネットワーク形成の重要性について認識を深めていく必要があることが示唆された。今後,看護婦に対する継続教育の検討と,他職種の児童虐待に関しての認識について調査を行なう必要があると考えられる。

Empowering care competence of male elderly by group approaches in community

Grant-in-Aid for Scientific Research (C)

Project Year :

1996

1998

SAEKI Kazuko, IZUMI Hisako, SAWADA Izumi

This study aimed to explore an intervention program for home care to male elderly and its evaluation method. Caring competence was defined as recognition of own aging, knowledge and skill regarding physical care and house keeping, and using social support resources. 1) Outcome : knowledge, skill and attitude regarding home care By quantitative evaluation, elderly persons gained significantly more knowledge about social support resources than before the program. But there were no significant difference in self-efficacy on caring skills and attitude about home care Therefore by quality data analysis, they were found to have more concern regarding home care and to learn much so that they recognized the issues of home care as sever problem for themselves. Elderly understood home care from two view points ; receiving care and giving care. They identified the condition for giving good home care. In addition, they thought about the necessity of learning to be a good carereceiver, their aging lives, socialization of elderly caring, and the importance of health self-control. 2) Feature of caring competence of male elderly There was no statistical difference between male and female in self-efficacy on caring skills, knowledge of social resources and attitude toward home care. But they had different concerns about home care. Males thought about it from a political stand point and females thought about it in terms of family relationships and daily caring behaviors. 3) Evaluation of group approach for elderly As they participated in group works positively way, it proved that a group approach which was an aggressive learning style was a useful method for the elderly.

子どもの虐待と夫婦間暴力における予防と治療のための看護支援に関する研究

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