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背景：沖縄県では発達障害児の早期発見・早期支援の充実が急務となっており、その療育体制が整備されつつある。発達障害児の多くが保育園を利用しており、早期療育の重要な担い手として保育士の質向上が課題である。目的：本研究の目的は保育士が発達障害または疑いのある子どもをどのように発見しているか、また彼らにどのように支援しているかを年齢別に把握することであった。方法：対象は沖縄県南部３市にある保育所90ヵ所に勤務する保育士878名であった。郵送による自記式質問紙法であり、内容は保育士の基本属性、障害児保育の有無、担当事例の特徴、療育支援の内容等であった。結果と考察：546名から回答を得た。現在発達障害児（疑い含む）を保育している者は約４割であり、保育士から特別支援を受けているのは170事例中７割であった。保育士が挙げた１～３歳児の早期発見に役立つ子どもの行動特徴は53項目と多数であったが、重要な指標の不足も明らかになった。また、早期支援は子どもへの支援、親への支援、社会的支援など多様であったが、記述数は早期発見の３割にとどまり、各問題行動に対応できてないことが明らかになった。結論：早期発見と早期支援の重要性から保育士の質向上のために、子どもの年齢を考慮に入れた実用的で継続的な研修の必要性が示唆された。, Background: It is now recognized that early detection and intervention for children with developmental disorders (DDs) should be improved, and the developmental disorders system is building to provide the comprehensive services and supports these children and their families require in Okinawa. Because many of children with DDs are cared by day care workers in day care centers, improving the quality of day care workers is a priority matter. Purpose: Our goal was to determine by age of children how day care workers identified children with DDs and suspected children, and what early interventions they provided in day care settings. Method: Eight hundred seventy-eight day care workers in 90 day care centers at 3 cities in southern Okinawa were asked to complete self-report questionnaire. Result: The data was obtained from 546 day care workers. Approximately 40% of them were taking care of 170 children with DDs including suspected children. Seventy percent of those children were provided special interventions by them in day care settings. They gave 53 behaviors or characteristics of children one to three years of age as the warning signs that they were concerned, but they didn't notice any critical warning signs of DDs. They provided a variety of therapeutic and supportive services to eligible children and their parents, but the number of early intervention they described was a mere 30% of those about early detection. Conclusion: It was suggested that day care workers needed to be given practical and continuous training so as to assure their adequate capacity to detect the DDs by the Age of 3 years and deliver early intervention services to children with DDs and their families.

[目的]本研究の目的は、沖縄県A島の児童虐待防止活動に関わる関係職種の教育的ニーズを明らかにし、教育プログラム開発の基礎資料とすることである。 [対象と方法]対象は、沖縄県A島の児童虐待症例に出会う可能性のある病院看護師、保健福祉職員、保育士、母子保健推進員、民生委員・児童委員の計576名である。方法は留置法による自記式質問紙法で、記述統計及び質的内容分析法により職種別分析を行った。 [結果]有効回答数323名であった。対象は経験年数及び年齢に幅があった。児童虐待に高い関心のある者の割合は保健師・福祉職の100％から看護師の50％まで差があった。虐待に関する就職後の教育・研修の経験は、職種により違いがあった。虐待、または疑い親子との関わりでの困難に関する自由記載ではコミュニケーション、親と連絡がとれない、関わり方等があげられた。各職種が考えた彼らに必要な能力は、アセスメント、コミュニケーション、連絡・調整、支援・ケア方法、知識、対人関係・人間性の6項目に分類できた。また、各職種が求める支援は組織内外からの相談・助言・スーパーバイズや、他機関・他職種の積極的関与、資源の充実、連絡体制・連携体制の構築、情報提供、法的権限の強化等であった。 [結論]関係職種の教育的ニーズから共通性の高い教育内容として効果的コミュニケーション、アセスメント、他機関・他職種との連携、情報共有の必要性が示唆された。, [Background] Due to amendment of the child abuse prevention law and child welfare law, the role of professionals in relation to child abuse prevention has expanded and diversified. Therefore, education to enhance of knowledge and skills is required. [Object] The purpose of this study was to clarify educational needs of professionals in relation to child abuse prevention activity in an island in Okinawa, and to obtain basic material of the education program development. [Methods] A total of 323 professionals volunteered to participate (nurses, public health nurses, welfare staff, maternity and child health promoter, and social workers). Participants completed questionnaires. The data was analyzed by using descriptive statistics and content analysis techniques. [Results] There were a wide range of ages and working experiences, and educational backgrounds in participants. All of the public health and welfare professionals reported interest in child abuse prevention, yet only half of the hospital nurses in the pediatric and the ambulant units did so. Educational and training experience after employment showed differences depending on the occupation. The difficulties in taking care of abusive parents and their children were in the items‘communication’, ‘out of contact with parents’, and ‘how to deal with’. The competencies participants perceived to be required in their practice consisted of 6 items such as ‘assessment’, ‘communications’, ‘referral/coordination’,‘caring and support’, ‘knowledge’, and ‘interpersonal relationship/humanity’. Also, supports needed were ‘consultation, advice and supervision from the inside and outside of the organization’, ‘positive participation of multiagencies and any other professionals’, ‘sufficient resources’, ‘systems for the referral and‘working together’, ‘information sharing’, and ‘strength of privilege’. [Conclusion] This study suggests that effective communication, assessment, working together with other organizations and occupations, and information sharing are required as educational contents for professionals.

[背景]児童虐待は早急に解決すべき社会的健康問題となっており、その防止活動に病院の周産期病棟等で働く看護師や助産師も大いに期待されているが、十分に機能しているとは言い難い現状にある。 [目的]本研究の目的は沖縄県の周産期病棟・NICU看護師・助産師を対象に、児童虐待の経験と認識を検討することにより、彼らに必要なコンピテンシーを特定し、看護教育に資することである。【対象と方法】対象は沖縄県2病院の周産期病棟・NICUで働く看護師・助産師113名である。方法は留置法による自記式質間紙法である。分析は記述統計及び質的内容分析法である。 [結果]回収率は93％、有効回答数は104名であった。看護基礎教育での児童虐待受講者4割、児童虐待に関心の高い者6割であった。児童虐待リスク妊産褥婦に遭遇した者は4割であり、その判断の根拠は、母親の子どもへの態度、社会経済的状態、母親の心理状態、虐待に関する経験等8カテゴリーであった。児童虐待への関心度と助産師免許及び手引きＡの周知との間、及び助産師免許とリスク妊産褥婦との接触間に相関があった。彼らに必要なコンピテンシーは、コミュニケーション、アセスメント、連携・調整等のスキルであり、その他、知識、及び人間性・平等性・信頼性などの態度が特定された。 [結論]児童虐待に関する基礎教育では関心を高めることを目標とし、発見と看護支援の実践力は継続教育で実施する必要性とその内容が示唆された。, [Background]Child abuse have become a major social health problem that should be resolved effectively in Okinawa. Though nurses are expected to have their roles preventive activities for child abuse in various settings, they seemed not to be prepared for effective functioning against child abuse cases in hospitals. [Purpose]The aim of this study was to identify their competencies needed by maternal nurses, nurse midwives and NICU nurses in working for pregnant, puerperal women and their infants. [Method]Subjects were 113 nurses and nurse midwives working in NICU and maternity units in 2 hospitals in Okinawa. They were asked to complete the questionnaires. [Results]104 nurses or nurse midwives completed the questionnaires. Approximately 40% of them learned about child abuse in basic program of nursing schools, junior colleges and/or colleges for nurses' certification and 60% of them interested in nursing of child abuse. Forty percent of them encountered pregnant and puerperal women at risk of child abuse. The 8 categories of nurses' assessment were factors related with maternal attitudes towards their child, their social-economical state, maternal psychological state and child-abuse history et. Relationship between degree of interest towards child abuse and midwifery as well as knowing guide book A was found. Also there 'was relationship between midwifery and experience with pregnant/ puerperal women. Their competencies working in their units were identified such as communication, assessment, skills of co-operation/coordination, knowledge and attitudes of humanity, equality and reliability. [Conclusion]In basic education for child abuse, having interest should be stressed, while identification and necessity of nursing intervention of practice and contents of continuous education were suggested.