Examination of Conceptual Model for 'Mental Health Nursing Consultations'

本研究の代表者らは、《まちの保健室》事業の趣旨に基づき看護系大学で展開される「専門相談」の一環として、精神看護学担当教員による『こころの健康相談』を立ち上げ、平成15年度より実践している。これまでの活動実績と、来談者のニーズおよび相談の成果に関する調査結果から、当活動は地域の関連専門機関との補完的な役割を担い得るという実践的意義が示唆された。そこで、今回は、当活動独自のアプローチと役割の探求を目的として、相談記録の質的帰納的分析ならびに地域の関連機関の専門職への面接調査を実施した。平成17・18年度の全相談件数65件に関する相談記録を分析した結果、、、、、、、、などのアプローチの要素が抽出され、来談者のニーズに応じて組み合わされていることが明らかになった。また、地域の関連機関に所属する専門職のうち研究協力に同意の得られた10名(医師5名、精神保健福祉士2名、臨床心理士2名、保健師1名)に対する面接調査の結果、、、といった当活動への認識、、、などの役割期待が語られるとともに、活動頻度を増やすことや連携体制についての提案が得られた。以上の結果および考察を踏まえて、大学を拠点とした看護師による『こころの健康相談』の実践活動について、概念モデルの試案を作成した。今後は妥当性の検討および精錬を重ね、活動の普及と人材育成に貢献し得る実践モデルを開発することが課題である。
As a part of the specialized consultations developed at a nursing-affiliated university based on the concepts of the Town Healthcare Room project, the researchers in this study have been undertaking mental health nursing consultations since 2003. The needs and the benefits of the consultees were examined by ongoing interview surveys and the written questionnaire surveys of the consulties. As a result, it is suggested that these activities can cover complementary roles with related specialized organizations. Then with the goal of finding an original approach to these activities, we undertook a qualitative analysis of the approach offered by the consultation process and conducted studies via related regional organizations on the awareness of and role expectations toward the activities. The following findings were obtained. A qualitative analysis of the records of 65 consultations in 2005 and 2006 revealed the elements of the approach, including the recipience of worries, the recognition of one's own strengths, a review of the stress situation, an increase in coping competence, advice on psycho-education, the provision of specialized knowledge regarding illness and treatment, an assessment of mental state, and the provision of information on social resources, as well as a variety of techniques combined to address the needs of the consultees. Of specialists who belonged to regional organizations, ten persons agreed to cooperate in the research (five physicians, two mental health welfare workers, two clinical psychologists, and one public health nurse). As a result of the interview surveys, we heard about awareness of the activities, including their "ease of use," "feeling safe to talk about issues," and "nurse's own role," as well as their coverage of areas that specialized organizations can not cover, regional contributions that can only be made by a university, the specialized nature of nursing, and other role expectations, and at the same time we received suggestions to step up the frequency of the activities and proposals regarding the liaison system. In view of the above findings and considerations, we prepared a proposal for a concept model of mental health nursing consultation activities based at a university.