特別支援学校の教職員による医療的ケアに対応した環境整備の工夫と今後の整備課題

医療的ケアを必要とする児童生徒に対する特別支援学校の施設整備課題　その２

抄録

 Following Part 1 of the research, this paper, Part 2 continuously focuses on the educational environment of students who have profound and multiple disabilities and need daily medical care in schools for special needs education. The objective of the whole research was to identify the points needed for the development of school facilities from the perspective of medical care.
 The research method and the analytical data used in Part 2 are the same as those in Part 1. The nationwide questionnaires were conducted in 2015, targeting all schools (281) for special needs education with a department of physical disabilities in Japan. The responses from 160 schools (56.9%) were collected. In the questionnaires, we established the following sections and divided the problems based on their features such as priority, facilities improvement, or teachers' creativity: 1) problems solved through repair or renovation, 2) problems remaining despite repair or renovation, 3) problems that teachers cannot solve by themselves, 4) considerable problems in school planning despite teachers' capacity to manage them, and 5) problems solved through teachers' creative use of space and human resources.
 The data was analyzed using KH coder developed by Higuchi (2001) as text mining software. A total of 688 problems were obtained from the questionnaires. The co-occurrence networks by using the software in each section were drawn; through this method commonality of the problems could be sought.
 In Part 1, the problems and teachers' requirements for improving school facilities through the analysis of section 1 -4 were recognized. In Part 2, based on the analysis of section 5, the teachers' creative usage of space and human resources to solve problems were illustrated. In addition, a cross-sectional study of 1–5 was implemented.
 From the results, three main points to improve the educational environment were discovered. First, regarding the classroom planning from the perspective of medical care, a major problem that need to be considered was the limited amount of space for activities in classrooms, which was much more limited than expected. In classrooms, teachers had a tendency to create a corner for medical care and set up various equipment up such as humidifiers and air cleaners to prevent infections from spreading, pots that contained hot water to wash medical care products, carts to put commodities on such as suction equipment, general educational materials and self-supporting tools.
 Second, we identified the specific needs to improve facilities aside from classrooms, they are; medical care rooms, restrooms and the water supply. Medical care rooms are required to be located near classrooms and the infirmary and they must have adequate space for vital checks and medical care for multiple students at the same time. Restrooms tended to have a lot of problems even after being repaired or renovated, so it was important to consider the number of restrooms, the required space for care and changing of diapers, plus the ease to support those with physical disabilities. Water supply is an absolute necessity in classrooms and lunch rooms in order to wash students' hands and the medical goods.
 Finally, the characteristics of each need tended to be different depending on the type of medical care required. For tube fed students, lunch rooms should have adequate space so they can spend lunch with their friends. For catheterization, there needs to be an appropriate number of special booths and space, a required bed, appropriate layout to support students and sufficient lighting. For tracheotomy and the suctioning of phlegm, air conditioners, humidifiers and air cleaners are vital to prevent the spread of infections.