「児童虐待」の概念分析  [in Japanese] Child abuse and neglect: a concept analysis  [in Japanese]

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Abstract

<b>目 的</b><br> 児童虐待防止への介入の必要性の判断や介入の評価指標とする児童虐待の本質を捉えた尺度の開発につなげ,さらに将来的な周産期における児童虐待防止への支援の発展と,児童虐待予防活動の基盤づくりへの示唆を得ることを目的とした。<br><b>方 法</b><br> Rodgers(2000)の提唱する概念分析のアプローチ法を用いた。9つのデータベースとして,医中誌Web,CiNii,MEDLINE,CINHAL,PsycINFO,SocINDEX,Minds,National Guideline clearing-house,trip databaseを使用し,検索用語は「児童虐待(child abuse),妊娠(pregnant women),産後(postnatal),育児(child care)」とした。最終的に,英語文献26件,日本語文献32件の計58件と,日本小児科学会の発行している「子ども虐待診療手引き(2014)」を分析対象とした。<br><b>結 果</b><br> 5つの属性【養育者から子どもへの一方的な支配関係】【養育者の自覚の有無に関係しない行為】【子どものwell-beingを害する行為】【子どものwell-beingを保つ行為の欠如】【子どもの状況】,5つの先行要件【養育者の要因】【子どもの要因】【社会環境の要因】【複数要因の重なり】【適切な介入の不足】,5つの帰結【子どもの保護】【養育者の否認と孤独】【サバイバーの健康への影響】【母になったサバイバーの苦悩】【世代間伝播】が抽出された。代用語に「child maltreatment」が抽出され,関連概念に「しつけ」「shaken baby syndrome(揺さぶられっこ症候群)」「Munchhausen Syndrome by proxy(代理ミュンヒハウゼン症候群)」が抽出された。分析の結果,本概念を「養育者から子どもへの一方的な支配関係から成る,養育者の自覚の有無に関係しない行為による子どもの状況を基盤とした,子どものwell-beingを害する行為,及び子どものwell-beingを保つ行為の欠如である」と再定義した。<br><b>結 論</b><br> 本概念分析の結果は,児童虐待の本質を捉えることにつながり,今後の研究において児童虐待を測る尺度を開発する基盤となりうる。また本概念分析により,児童虐待による子どもへの長期的な健康への影響や,次世代への児童虐待の繰り返しの可能性が示され,児童虐待発生前の妊娠期からの予防の必要性,特に周産期で主な支援対象となる母がサバイバーであった場合の母に対する介入の必要性が示唆された。さらに周産期における児童虐待防止への支援については,妊婦のみならず,そのパートナーや子ども,社会環境も含めて支援対象であると認識し,それらの要因に対する適切な介入が必要である。

<b>Purpose</b><br>The purpose of this study was to summarize the attributes, antecedents and consequences of the concept of child abuse and neglect, which could then serve as the bases for the development of a child abuse and neglect screening tool to guide the prevention of child abuse and neglect during the perinatal period.<br><b>Method</b><br>Literature was identified from nine databases: Ichushi-Web, CiNii, MEDLINE, CINAHL, PsycINFO, SocINDEX, Minds, National Guideline Clearinghouse, and TRIP database using the keywords child abuse, pregnant women, postnatal, and child care. Relevant findings of 26 articles in English, 32 articles in Japanese and the 2014 Japanese Guide for Medical Treatment of Child Abuse and Neglect were analyzed using Rodgers's 2000 concept analysis model.<br><b>Findings</b><br>Five attributes were identified: 1) one-sided controlling relation to the abused child, 2) caregivers either unaware or aware of own behavior, 3) child's experience, 4) harm to the child's well-being and 5) failure to protect child's well-being. Five antecedents were identified: 1) caregiver factors, 2) child factors, 3) socioeconomic factors, 4) the overlapping of multiple factors and 5) a lack of appropriate intervention. Five consequences were identified: 1) child's security, 2) caregiver denial and isolation, 3) effects on the prospective health of survivors, 4) distress of surviving mothers and 5) intergenerational diffusion of abuse. Lastly, one surrogate term, child maltreatment, and three related concepts, (discipline, shaken baby syndrome, Munchhausen syndrome by proxy) were found. Based on this analysis, the concept of child abuse and neglect was defined as: the child's experience of crisis with or without the caregiver's awareness, including harm to the child's well-being and a lack of action to guard the child's well-being based on the one-sided controlling relationship of the child's caregiver.<br><b>Conclusion</b><br>This analysis summarizes the current concept of child abuse and neglect, which could provide a basis upon which to develop a child abuse and neglect screening tool. The analysis clearly demonstrated the possibility of long-term harm to abused children, repeating child abuse and neglect and the importance of appropriate preventive interventions during the gestational period, especially, the importance of appropriate interventions for grown-up survivors to prevent their repetition of child abuse and neglect. Moreover, effective prevention entails recognizing interventions are required not only for pregnant women but also for their partners and children and must include improved instrumental support and other multiple factors.

Journal

  • Journal of Japan Academy of Midwifery

    Journal of Japan Academy of Midwifery 29(2), 207-218, 2015

    Japan Academy of Midwifery

Codes

  • NII Article ID (NAID)
    130005127641
  • Text Lang
    JPN
  • ISSN
    0917-6357
  • Data Source
    J-STAGE 
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