Abstract
Purpose: The 2019 novel coronavirus (COVID-19) pandemic has reshaped our lives and communities. In the medical field, primary care providers were required to continue providing medical and long-term care despite the global shortage of protective equipment against the progressing infection. How did frontline primary care facility administrators experience the COVID-19 pandemic? Were they required to change our attitude and behavior during the COVID-19 pandemic? Methods: To explore this, we conducted a semi-structured interview survey. Four researchers interviewed the administrators of 20 clinics (7 general practitioner clinics and 13 dental clinics) and 11 long-term care services (7 visiting nurse home services and 4 resident long-term care and home help services) in Japan. We conducted interviews with administrators either face-to-face or using remote communication devices. The interview results were analyzed using a qualitative descriptive approach. Results: We interviewed 31 primary care facility administrators and found three attitude categories: (1) self-awareness of being responsible for the business site, (2) self-awareness of contributing to the community through medical care, (3) self-awareness for respecting the life of each local resident. Further, we found five behavior categories: (1) Taking action to protect the staff, (2) taking Measures to safeguard the facility, (3) establishing and implementing infection control policies, (4) ensuring service continuity and community service, and (5) collaborating in community infection control efforts. Conclusions: Frontline administrators of primary care facilities displayed strong transformational leadership during the COVID-19 pandemic.
Translated Abstract
目的:COVID-19の大流行は私たちの生活と地域社会を大きく変えた.医療従事者は世界的なCOVID-19の流行によって個人防護具が不足する中で,医療・看護・介護を提供し続けなければならなかった.第一線で活躍するプライマリ・ケアの事業所管理者たちは,COVID-19によるパンデミックにおける自事業所に対してどのような認識をもち,彼らはどのような行動をとり,この危機に対応したのだろうか.本研究の目的は,COVID-19のパンデミック禍におけるプライマリ・ケアの事業所管理者たちの姿勢と行動を危機管理の視点から明らかにすることである. 方法:本研究はプライマリ・ケアの事業所管理者に対する半構造化面接調査を行った.4人の研究者が日本の20の診療所(開業医診療所7,歯科診療所13)と11の介護サービス(訪問看護ステーション7,入居型介護・ホームヘルプサービス4)の管理者に,対面,もしくは,遠隔通信機器を用いてインタビュー調査を行った.インタビュー結果は質的記述的アプローチを用いて分析した. 結果:31名のプライマリ・ケアの事業所管理者にインタビューを行った結果,1事業所に責任を持つという自覚,2医療を通じて地域に貢献するという自覚,3地域住民一人ひとりの生活を尊重するという自覚,の3つの認識に関するカテゴリーが見出された.また,行動面では1職員を守るための行動をとる,2施設を保護するための対策を講じる,3施設の感染対策の方針を策定し実施する,4サービスの継続と地域サービスを確保する,5地域における感染対策に協力する,の5項目がみられた. 結論:第一線のプライマリ・ケアの事業所管理者はCOVID-19パンデミック時に,強力な変革的リーダーシップを発揮し,自事業所のみならず,地域の医療・看護・介護サービスの提供が停止しないよう行動していた.
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