ASOURCE Times

地域中核病院として感染患者を受け入れ
「未知のウイルス」への不安、偏見で精神的負担

Hekinan City is located near the Chita Peninsula in the Mikawa region of Aichi Prefecture, and Hekinan Municipal Hospital is a regional core hospital, with particular emphasis on emergency medical care, advanced medical care, and rehabilitation medical care. The number of beds is 319. Although it is not a designated medical institution for infectious diseases, we started accepting patients infected with the new coronavirus in August 2020, and by September 2021, 168 patients had been hospitalized. In addition, antibody cocktail therapy has been available since September.
In fact, in April 2020, a nosocomial infection of the new coronavirus occurred at our hospital, and medical treatment was restricted. Citizens have different perceptions, and some were worried that there were infected patients in the hospital they visited, while others gave a yell to the municipal hospital. Taking this opportunity, we formulated a new way of proceeding with the business of giving top priority to infection control, and accepted patients infected with the new coronavirus as a cooperating hospital of a designated medical institution for infectious diseases in the region.
In accepting infected patients, the infection control certified nurse (ICN) and the infection control team (ICT) played a central role in taking various measures throughout the hospital. We restricted the flow of people from the outside, such as setting the entrance for outpatients to one place at the front entrance and prohibiting inpatients from visiting. We decided to set up a fever outpatient clinic outside the hospital to accept fever and perform inspections there. We have reported 4 hospital beds (currently 6 beds).
The placement of nurses and others was also a difficult task. Currently, we have two to three people from each ward engaged in dealing with infected patients for two months, and we are organizing a rotation in which half of them are replaced every month. Initially, we also prepared to re-educate the nurses entering the rotation to wear personal protective equipment (PPE).
However, since it was August when we started accepting infected patients, the fever outpatient department was a tent installed in a parking lot, so nurses fully equipped with PPE endured the heat and were exposed to the rain and wind while being infected. It was a job in a harsh situation where I also protected. Currently, the garage where the official car of the hospital enters is a fever outpatient, and although it can withstand the rain, the environment is not so good due to the heat of summer and the cold of winter.
Not only the fear of infection by an unknown virus, but also the staff of the hospital where the infected patient occurred, the staff such as nurses and doctors suffered from prejudice and discrimination in nursery schools and schools, and blamed them. It was also what we owed. Some people have gently refused to make a reservation at their favorite beauty salon. Now that we have a better understanding of the new coronavirus, such overt prejudices are diminishing, but we continue to bear the mental burden.

コロナ前から温めていた「保健室」の設置
自分を見つめ直すきっかけ作りが重要

Before the Korona-ka, as with many medical institutions, the work of nurses was extremely busy at our hospital, and there were some who were on leave or retired due to mental health problems, but due to the acceptance of patients infected with corona, we did so. The situation has been spurred on. I myself have been suffering, and after seeing my colleagues and subordinates suffering and suffering, I wanted to do something about it, so I started the "in-hospital infirmary" in April 2021. It embodies my thought, "If you have any concerns or concerns, please feel free to contact us." There is no permanent room like the infirmary of a school or a company, but we rent a vacant conference room four times a month for half a day to listen to the story.
The "Infirmary" concept has been warmed up since I obtained two qualifications, an industrial counselor and a certified public psychologist, in 2018. This is because I thought it necessary to establish a mental health care system for nurses in order to provide nursing that is close to patients.
A safety and health committee has been set up in general companies, and in order to protect the health and safety of employees, workplace managers, health managers, and industrial physicians play a central role. Many companies have health offices (health management offices) to monitor the health of their employees. Our hospital also has a health and safety committee, but there are no specialized members, there is no infirmary, and we have not been able to care for the mental health of our staff.
With the Korona-ka, this concept can be realized at once. As a member of the Health and Safety Committee, I proposed the establishment of this in-hospital infirmary, which was approved within the committee, and I was able to obtain the permission of the hospital director. The coincidence of a change in my own position also overlapped. Until 2018, I worked in the ward as a ward chief and took care of patients with the nurses who are subordinates, but now as a "playing army", I will provide medical treatment guidance in both the ward and outpatient department, and I will report directly to it. There are no more subordinates. With the flexibility of time, I was able to reach out to any nurse at equal distances because I wasn't tied up in the workplace. As a person in charge of the infirmary, it is perfect.
My job in the infirmary is to listen to the counselor as it is. In many cases, the counselor has some haze and finds it difficult to work. The person himself knows the cause, but he can't put it into words well, and he gets confused. When I talked to him little by little, I felt sorry for my seniors because I couldn't work properly, I said bad things about my colleagues, and it was hard to work at night while raising children. I think that by "verbalizing" the cause of such haze, the person can get noticed and reconsider himself. He also leaves the infirmary, saying, "I feel refreshed." The infirmary is only four times a month, but it's a moment when I'm glad I set it up.

ストレス対処の基本はセルフケア
子育てコミュニティなど新たな構想も

　保健室は、問題解決の場ではありません。私と話すことで自分自身のストレスに気付き、言語化して、もやもやを整理するきっかけの場です。メンタルヘルスのケアはセルフケアが重要だからです。「自分は元気」と思っている人でも、ストレスを抱えていることもあります。
　例えば、患者さんに寄り添う看護を目指す人にとって、コロナ感染患者の看護時にPPEを着け、フィジカルディスタンスを取ることは、理想とする看護に反することがストレスになっています。本人が自覚しないまま、そうしたストレスが蓄積され、徒労感や悩みになっているのです。それに気づく方法の一つとして、スマホのアプリを活用して「毎週金曜日はストレスチェックの日」として、ゲーム感覚で自身の状態を知るように促しています。
　一方で、コロナ禍によって明るい活動も生まれました。感染患者を受け入れ始めたころは、職場はその対応に追われ、不安を抱える通院患者さんもいました。それでも当院を受診してくれた方に、職員からのお礼のメッセージを掲示したところ、多くの患者さんから励ましの声が寄せられました。
　こうした声に応えるための活動の一つとして、少し荒れていた病院の中庭をきれいにしようという提案が職員から上がり、園芸などが好きな仲間が、休憩時間などを利用して少しずつ整備していきました。今では季節の花が咲き、池には鯉が泳ぎ、病院に来る人にも職員にも癒しの場になっています。職場でもない、家庭でもない、「サードプレイス」として中庭は癒しや元気を与えてくれる場所になりました。
　今後は、保健室だけでなく、例えば子育て中の看護師が集まって語り合う場、新人看護師がそれぞれの悩みを打ち明ける場などを作ることが出来たらと考えています。ピアカウンセリングのように、同じような立場や悩みを抱える人たちが集まって、同じ仲間として相談し合える場を作るなどして、メンタルヘルスケアの幅を広げたいと思っています。
　こうした構想は時間がかかるでしょうし、私自身もいずれは異動することになるので、この思いをつなげたいと願っています。幸い、産業カウンセラーや公認心理師の資格を取るために、どうやって勉強したのかと聞いてくる若い看護師もおり、また他職種でも産業カウンセラーの資格を持つ人が興味を持っていて、後継者は必ず現われると思います。