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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.

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大学教員が展開する『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。1年間の活動実績から、来談者にとっての、精神神経科や心療内科に求めるものとは異なるニーズが示唆された。そこで、2年目の活動実績の検討ならびに継続来談者への面接調査を行い、来談者のニーズおよび相談の効果について検討した。その結果、相談件数は1年目の約1.8倍に増加しており、来談理由については、精神的問題をもつ子どもの親としての悩みや家族関係のストレスが過半数を占めていた。自分自身の健康問題では抑うつ状態が最も多く、その半数は神経科に通院服薬中であり、その他に通院中の心療内科から紹介された人もいた。これらのことから、来談者の多くは精神科・神経科、心療内科などの医療機関の活用もしくは補完的な機能に関するニーズを有しているものと考えられた。継続来談者への面接調査の結果をも含めて検討した結果、(1)専門的な判断や助言、(2)じっくりと話を聴いてもらうこと、(3)適切な社会資源の情報、などに関するニーズが明らかになった。相談による効果については、継続来談者には、(1)心理的な安定が得られた、(2)問題解決への動機づけが高まった、(3)専門的な情報や助言を主体的に活用するようになった、(4)状況の改善や自己効力感の高まりが得られた、(5)悩みはありながらも安定した生活を営めるようになった、などの前向きな変化がみられた。, In accordance with the purpose of the "Community Healthcare Room" project, in 2003 the representatives of this research set up the Mental Health Consultation Room with a base at the College of Nursing Art and Science, University of Hyogo. Since then, mental health nursing consultation has been provided by faculty members teaching mental health and psychiatric nursing. This paper reports the results of a study that examined the needs of clients and effects of the consultations, through a review of activities during the second year of the project's operation and interviews with those who continue to visit the consultation office. The number of consultation cases in the second year increased to 1. 8 times the number seen in the first year. As for the reasons for visiting the mental health consultation room, the majority of reasons cited were worries as a parent who has a child with mental health problems or stress from family relationships. Among visitors who had their own health problems, the largest number of people complained about depressive moods, half of whom see a psychiatric doctor regularly and take medication. There were some people who visited the consultation room on the recommendation of their psychiatric doctors. From these findings, it is suggested that many visitors expect the consultation room to perform complementary functions with a medical institution such as a psychiatric clinic and psychosomatic medicine clinic. As a result of examining the results of interviews with those continuing to go to the consultation room, in addition to findings from past activities, the following needs of visitors have been identified : (1) professional judgment and advice ; (2) active listening ; and (3) information on and referral to appropriate social resources. Regarding the effects of consultation, the following positive changes were seen in visitors (1) increased mental stability ; (2) increased motivation for solving problems ; (3) more proactivity in seeking professional information and advice ; (4) improved conditions and increased selfefficacy ; and (5) becoming able to have a stable life despite someworries.