増野 園惠

Abstract Background With the increasing threat of hazardous events at local, national, and global levels, an effective workforce for health emergency and disaster risk management (Health EDRM) in local, national, and international communities is urgently needed. However, there are no universally accepted competencies and curricula for Health EDRM. This study aimed to identify Health EDRM competencies and curricula worldwide using literature reviews and a cross-sectional survey. Methods Literature reviews in English and Japanese languages were performed. We searched MEDLINE, EMBASE, CINAHL (English), and the ICHUSHI (Japanese) databases for journal articles published between 1990 and 2020. Subsequently, a cross-sectional survey was sent to WHO Health EDRM Research Network members and other recommended experts in October 2021 to identify competency models and curricula not specified in the literature search. Results Nineteen studies from the searches were found to be relevant to Health EDRM competencies and curricula. Most of the competency models and curricula were from the US. The domains included knowledge and skills, emergency response systems (including incident management principles), communications, critical thinking, ethical and legal aspects, and managerial and leadership skills. The cross-sectional survey received 65 responses with an estimated response rate of 25%. Twenty-one competency models and 20 curricula for managers and frontline personnel were analyzed; managers' decision-making and leadership skills were considered essential. Conclusion An increased focus on decision-making and leadership skills should be included in Health EDRM competencies and curricula to strengthen the health workforce.

INTRODUCTION: Health workforce development is essential for achieving the goals of an effective health system, as well as establishing national Health Emergency and Disaster Risk Management (Health EDRM). STUDY OBJECTIVE: The objective of this Delphi consensus study was to identify strategic recommendations for strengthening the workforce for Health EDRM in low- and middle-income countries (LMIC) and high-income countries (HIC). METHODS: A total of 31 international experts were asked to rate the level of importance (one being strongly unimportant to seven being strongly important) for 46 statements that contain recommendations for strengthening the workforce for Health EDRM. The experts were divided into a LMIC group and an HIC group. There were three rounds of rating, and statements that did not reach consensus (SD ≥ 1.0) proceeded to the next round for further ranking. RESULTS: In total, 44 statements from the LMIC group and 34 statements from the HIC group attained consensus and achieved high mean scores for importance (higher than five out of seven). The components of the World Health Organization (WHO) Health EDRM Framework with the highest number of recommendations were "Human Resources" (n = 15), "Planning and Coordination" (n = 7), and "Community Capacities for Health EDRM" (n = 6) in the LMIC group. "Policies, Strategies, and Legislation" (n = 7) and "Human Resources" (n = 7) were the components with the most recommendations for the HIC group. CONCLUSION: The expert panel provided a comprehensive list of important and actionable strategic recommendations on workforce development for Health EDRM.

軽症者等療養施設(宿泊施設)に入所中の新型コロナウイルス感染症患者が救われたと感じた言葉掛けやサポートを、著者らが看護業務に従事した兵庫県下に設置された4つの宿泊施設に入所した16歳以上の患者へのアンケート調査から検討した(有効回答107名)。調査は令和3年1月26日から2月28日までの第3波の期間に行った。その結果、宿泊施設に入所した感染者は、自身の病状以上に家族や職場等の周囲への影響に不安を感じており、「家族・友人・職場」から受けた【休息を促し心身を気遣う言葉掛け】【罪悪感を和らげる言葉掛け】【メール等での継続的なやりとり】などが救いとなっていた。また、感染したことを知られたくないために周囲に相談できず、必要な情報を得られないことで不安が増大しており、医療者から受けた気持ちが楽になった、救われたように感じたサポートとして、【体調の把握や確認と症状経過の説明】【保健所(保健師)からの毎日の電話】といった「具体的な対応」や、【安心できる口調での会話と傾聴】【不安への気遣いと対応】などの「精神面への配慮」が挙げられた。

<title>Abstract</title><sec> <title>Background</title> How community-based group resistance exercises affect the transition from robustness to frailty remains unclear. Thus, we conducted a retrospective cohort study to determine whether the trajectory from robustness to frailty over age differed depending on the duration of participation in group exercises. </sec><sec> <title>Methods</title> We analyzed the Kihon Checklist (KCL) score of community-dwelling elderly residents of Sumoto city, Hyogo prefecture, who participated in community-based group resistance exercises between April 2010 and December 2019. Finally, 2567 older individuals were analyzed using multilevel modeling. The explanatory variables of interest were the frailty score measured using the KCL for each individual, where 0–3, 4–7, and ≥8 points denoted robustness, pre-frailty, and frailty, respectively. We considered age, sex, systolic blood pressure, pulse, duration of participation, and change in KCL score from baseline as possible confounders. Participants were classified as follows based on the duration of participation in the exercises: &lt;3 times, short-term participation group; 4–6 times; mid-term participation group; and 7–13 times, long-term participation group. The mean duration from the baseline physical test for the total sample was 2.35 years (SD=2.51). </sec><sec> <title>Results</title> The participants’ mean total KCL score at baseline was 4.9±3.7. Multilevel modeling analysis revealed that the KCL scores changed by 0.82 points for each additional year of age (<italic>p</italic>&lt;0.001) and changed by − 0.93 points for long-term participate group (<italic>p</italic>&lt;0.001). The Estimated Marginal Means (EMM) of the KCL score was 3.98 (95%CI: 3.69, 4.28) points in the short-term participation group and was significantly worse than that of the long-term participation group at 70 years of age (<italic>p</italic>=0.001). The EMM was 4.49 (95%CI: 4.24, 4.74) at 75 years of age in the mid-term participation group and was significantly worse than that of the long-term participation group. The EMM was 3.87 (95%CI: 3.57, 4.16) in the long-term participation group and significantly better than that of the short-term (<italic>p</italic>&lt;0.001) and mid-term (<italic>p</italic>=0.002) participation groups. </sec><sec> <title>Conclusion</title> Participation in community-based group resistance exercises prolongs the transition from robustness to frailty. The improved KCL scores at baseline in the long-term participation group remained in the robust range at 75 years of age, which suggests the importance of initiating participation before the onset of functional decline. </sec>

BACKGROUND: The effects of group exercise on the physical function of community-dwelling older adults remain unclear. The changes in lower extremity muscle strength, timed up and go (TUG) time, and the motor fitness scale (MFS), over time, among older adults who expressed a willingness to participate in community-based physical exercise groups, were determined using multilevel modelling. METHODS: We analyzed data of 2407 older adults between April 2010 and December 2019 from the registry of physical tests of community-based physical exercise groups. We conducted a retrospective cohort study to assess the effect of physical exercise on lower extremity muscle strength, TUG time, and MFS scores. The durations of the exercises were evaluated by frequency of physical test's participate. RESULTS: A deterioration in lower extremity muscle strength was found in the short-term participant group only. However, in the mid-term and long-term participation groups, lower extremity muscle strength showed a trend of improvement. The TUG time and the MFS score were negatively correlated with increasing age in both groups divided by the duration of participation. However, there was a slower rate of deterioration in the long-term participation group. DISCUSSION: Lower extremity muscle strength, TUG time, and MFS scores decline with increasing age and there were differences in the slope of deterioration that depended on the duration of participation in community-based group exercise. CONCLUSION: Participation in group exercise improved lower extremity muscle strength, TUG time, and MFS scores of older adults living in a community. The positive effects of group exercise were dependent on long-term participation.

目的 人口減少と高齢化が進む中山間地域在住高齢者における訪問看護に対する認知度を把握し,関連する項目について明らかにすることで,在宅医療人材不足が深刻な地域における,訪問看護の適正利用の促進と在宅ケア体制の整備に向けて,訪問看護に対する住民ニーズを探索する上での基礎資料とすることを目的とした。方法 中山間地域であるA県北部の二次医療圏B地域の5市町在住の65歳以上の元気〜虚弱高齢者を対象に,無記名自記式質問紙調査を実施した。質問項目は,訪問看護の認知度に関する項目(名称・サービス内容・サービス内容別認知度),基本属性,介護保険サービス利用に関する項目,健康要因に関する項目,社会関係要因に関する項目とした。訪問看護のサービス内容認知度と各項目との単変量解析およびロジスティック回帰分析により関連する項目について分析した。結果 578件の有効回答のうち(有効回答率60.0%),訪問看護の名称は526人(91.0%)が認知していたが,サービス内容については375名(64.9%)の認知度であった。内容別では,「療養上の世話」(73.0%),「病状の観察」(64.0%)の順に認知度が高い反面,「精神障がい者の看護」(19.9%)と「ターミナルケア」(27.2%)の認知度が低かった。訪問看護サービス内容認知度の有無を従属変数としたロジスティック回帰分析では,訪問リハビリテーションの認知度と,別居家族・親族とのソーシャルサポートが有意に影響していた。結論 訪問看護サービスの内容別の認知度に差があり,認知度が低いながら社会的要請が高い精神障がい者やターミナルケアに対する訪問看護の意義と,地域住民へもたらす価値をいかに可視化し伝えていくかが課題として示された。訪問看護のサービス内容認知度には訪問リハビリテーションの認知度と別居家族・親族のソーシャルサポートが影響しており,背景として,訪問リハビリテーションを普及促進している地域医療体制の後押しによる住民ニーズの高まりと,地元を離れた別居家族の介護参加のあり方の一端がうかがえた。訪問看護サービスの具体的な内容の認知度向上により,地域住民の潜在ニーズの発掘と適正利用につながることから,リハビリテーション専門職とのさらなる連携強化と,別居家族・親族による介護体制の特徴を加味した情報発信上の工夫が必要である。(著者抄録)

The Sendai Framework for Disaster Risk Reduction 2015-2030 placed human health at the centre of disaster risk reduction, calling for the global community to enhance local and national health emergency and disaster risk management (Health EDRM). The Health EDRM Framework, published in 2019, describes the functions required for comprehensive disaster risk management across prevention, preparedness, readiness, response, and recovery to improve the resilience and health security of communities, countries, and health systems. Evidence-based Health EDRM workforce development is vital. However, there are still significant gaps in the evidence identifying common competencies for training and education programmes, and the clarification of strategies for workforce retention, motivation, deployment, and coordination. Initiated in June 2020, this project includes literature reviews, case studies, and an expert consensus (modified Delphi) study. Literature reviews in English, Japanese, and Chinese aim to identify research gaps and explore core competencies for Health EDRM workforce training. Thirteen Health EDRM related case studies from six WHO regions will illustrate best practices (and pitfalls) and inform the consensus study. Consensus will be sought from global experts in emergency and disaster medicine, nursing, public health and related disciplines. Recommendations for developing effective health workforce strategies for low- and middle-income countries and high-income countries will then be disseminated.

BACKGROUND: The Western Pacific region constitutes one-quarter of the world's population and has diverse health needs. While dialogue on and promotion of advanced practice nurses are ongoing, this study investigated the current responsibilities of nurses in advanced roles, future healthcare needs, and the implications of these components for nurses' professional development within the Western Pacific region. METHODS: This study employed three phases, a descriptive survey on the current status of nurses in advanced roles in the Western Pacific region, followed by a Delphi survey, and exploratory interviews. A total of 55 national experts with clinical, academic, and/or government-related backgrounds from 18 countries participated from December 2017 - December 2018. The descriptive survey via email to identify the status of nurses in advanced roles and a working definition was developed. This formed the basis for the Delphi survey, which identified key barriers and challenges for enhancing the development of nurses in advanced roles within the country (round 1) and for the region (rounds 2 and 3). Lastly, semi-structured individual interviews were conducted to identify strategies for establishing nurses in advanced roles to improve equitable access to healthcare. RESULTS: Thirty-seven roles and characteristics were identified and categorized for nurses performing advanced roles. Emergency care, critical care, elderly health, child health, and rural/remote communities were identified as fields with particular need for nurses in advanced roles in the Western Pacific region. Providing effective services, influencing government leadership, and advocating for health system sustainability were deemed necessary to improve equitable healthcare access. We found that nurses in advanced roles are not limited to clinical tasks within the hospital but are poised for active participation in primary healthcare, education/teaching, professional leadership, quality management, and research. CONCLUSIONS: Demand for nurses in advanced roles is high in the Western Pacific region and 15 items were identified across five core strategic areas to enhance development of nurses in advanced roles. Governmental-level recommendations include establishing legislative protection, improving systems for remuneration, strengthening supportive channels, and conducting national needs assessments.

Little scientific evidence exists on ways to decrease the psychological stress experienced by disaster responders, or how to maintain and improve their mental health. In an effort to grasp the current state of research, we examined research papers, agency reports, the manuals of aid organisations, and educational materials, in both English and Japanese. Using MEDLINE, Ichushi-Web (Japanese search engine), Google Scholar, websites of the United Nations agencies, and the database of the Grants System for Japan’s Ministry of Health, Labour, and Welfare, 71 pertinent materials were identified, 49 of which were analysed. As a result, 55 actions were extracted that could potentially protect and improve the mental health of disaster responders, leading to specific recommendations. These include (1) during the pre-activity phase, enabling responders to anticipate stressful situations at a disaster site and preparing them to monitor their stress level; (2) during the activity phase, engaging in preventive measures against on-site stress; (3) using external professional support when the level of stress is excessive; and (4) after the disaster response, getting back to routines, sharing of experiences, and long-term follow-up. Our results highlighted the need to offer psychological support to disaster responders throughout the various phases of their duties.

Emergencies and disasters typically affect entire communities, cause substantial losses and disruption, and result in a significant and persistent mental health burden. There is currently a paucity of evidence on safe and effective individual- and community-level strategies for improving mental health before, during, and after such events. In October 2018, the World Health Organization (WHO) Centre for Health Development (WHO Kobe Centre) convened a meeting bringing together leading Asia Pacific and international disaster research experts. The expert meeting identified key research needs in five major areas, one being “Psychosocial management before, during, and after emergencies and disasters”. Experts for this research area identified critical gaps in observational research (i.e., the monitoring of long-term psychological consequences) and interventional research (i.e., the development and evaluation of individual- and community-level interventions). Three key research issues were identified. First, experts underscored the need for a standardized and psychometrically robust instrument that classified the mental health/psychosocial risk of people within both a clinical and community setting. Then, the need for a standardization of methods for prevention, screening, diagnosis, and treatment for affected people was highlighted. Finally, experts called for a better identification of before, during, and after emergency or disaster assets associated with greater community resilience.

【目的】訪問看護サービス導入事例における在宅療養中の高齢者の重症化予防のアウトカムとそれをもたらした訪問看護の援助内容を明らかにし、訪問看護による重症化予防のアウトカム評価指標を検討した。【方法】経験豊かな訪問看護師を研究協力者とし、過去1〜2年の間で経験した訪問看護事例で、訪問看護サービスが入ることで重症化を予防できたと判断する事例を想起してもらい、訪問看護導入時と調査時の間の利用者の変化の内容とその事例への訪問看護師の意図的な援助内容について語ってもらい、分析データとした。【結果】経験豊かな訪問看護師4名より13事例を聴取し、うち介護度が軽度の7例を分析対象とした。7例中5例において服薬の自己管理の改善が確認され、定期外受診の減少も含めると全ての事例について、救急車呼び出し回数の減少あるいは入院回数の減少など医療の利用が適正化されていた。看護職はすべてのケースにおいて、身体面のアセスメントに基づいたセルフケアの指導を行っていた。【考察】服薬の自己管理と医療利用の適正化は、訪問看護による本人・家族のセルフケア向上を反映する簡便な評価指標とできると考えられた。今後は、予防の観点から訪問看護の結果評価を適用する適切な対象設定を検討し、訪問看護師のエンパワメントにつながるような簡便なツール開発が求められる。(著者抄録)

【目的】過疎・高齢化が進む中山間地域の訪問看護ステーション(以下、訪看ST)管理者が求めている、管理運営上の支援ニーズおよび訪問看護提供上の支援ニーズを明らかにし、地域特性とニーズに見合った支援の手がかりとなる基礎資料を提示する。【方法】A県訪問看護連絡協議会所属の中山間地域であるBブロックの訪看ST管理者に対し、個別に半構成的面接を実施した。得られた面接内容は逐語録に起こしてテキストデータとし、質的意味を損なわない範囲内で区切って抽出・コード化し、意味内容の類似性と相違性を比較しながら類型化し、抽象度を高めながらサブカテゴリー化およびカテゴリー化を進めた。【結果】研究協力が得られた訪看ST管理者は12名であった。分析の結果、8つのカテゴリーと21のサブカテゴリーが生成された。訪看ST管理運営上の支援ニーズとして、【安定的運営のための人材確保】、【人材育成のための条件整備】の2つのカテゴリー、訪問看護提供上の支援ニーズとして、【広範囲の訪問看護エリアをカバーする必要性】、【在宅療養継続への支援体制構築】、【訪問看護の普及と有効活用の必要性】、【地域住民との濃密な関係性への配慮】、【介護者不在への対応】、【療養生活上の困りごとに対する迅速な対応】の6つのカテゴリーが抽出された。【考察】中山間地域における訪問看護を取り巻くニーズの充足には、訪看ST管理者の相談・支援体制の充実、地理的条件を緩和した多様で効率的な教育・研修機会の提供、地域特性に応じた中山間地域型の地域包括ケアシステムの工夫開発を推進するとともに、訪問看護による予防的介入効果の検証など、地域全体に向けた訪問看護の魅力と有効性に関する発信および利用促進の必要性が示唆された。(著者抄録)

地域の医療施設における看護職の継続教育の実態および施設が持つニーズを明らかにすると共に、看護職の継続教育に対して大学がどのような役割を果たすことができるのか、地域との連携のあり方について検討した。126施設を対象に調査し、63施設から回答を得た。看護職に対する継続教育の実施体制は概ね整っており、約7割の施設で看護部門内に教育担当者が配置され、8割を超える施設で教育委員会が設置されていた。9割以上の施設で教育研修計画に基づいた教育研修が実施され、9割近くの施設で何らかの教育プログラムを用いて継続教育を実施していた。継続教育に関する課題として、教育担当者の確保とその能力が挙げられた。大学が地域に向かって果たせる役割は大きく、積極的に活動を進めて行くことが求められる。

日本災害看護学会ではネットワーク活動の一環として明石市花火大会・歩道橋事故のおりに対応にあたった病院に聞き取り調査を行った.その結果,中・小規模病院の中にはマンパワー確保のために緊急呼び出しを行うなど,対応に苦慮したところも見受けられた.対応にあたった看護婦の中には心理的な苦悩を覚えた人も少なくなく,フォローの重要性が示唆された.災害時緊急対応の経験や対策本部設置の実践からマニュアル等について見直し・検討を行っている病院も多数あった