犬山 彩乃

type:text [要旨] 本研究の目的は，独居の認知症高齢者の在宅生活継続に影響する要因のうち認知症高齢者本人の要因を明らかにすることである。在宅生活を継続している独居認知症高齢者の担当ケアマネジャー11名に半構造化面接を行い，得られたデータは国際生活機能分類（ICF）を分析枠組みとして質的帰納的に分析した。ただし，認知症高齢者本人の要因を明らかにすることが目的のため，環境因子は除外した。結果，独居の認知症高齢者の在宅生活継続に影響する要因として，健康状態は【認知症の診断が確認されている】等２テーマ，心身機能・身体構造は【介護用品の利用によって保たれている心身機能がある】等４テーマ，活動は【意思の伝達とコミュニケーションが出来る】等５テーマ，参加は【地域のひとや家族に対する関わり方が継続している】等３テーマ，個人因子は【趣味や嗜好，対人関係から分かる変化していない本人の価値観がある】等３テーマが抽出された。認知症高齢者は，日常生活の中で促進要因にある自らの力の発揮によって独居の在宅生活継続が可能となっていた。また，入院や一時的な体調の変化によって，機能低下が生じた場合でも，住み慣れた自宅という環境に戻ることや福祉用具の利用を含めた適切な支援を受けることで機能の維持や回復につながっていた。独居の認知症高齢者の在宅生活継続には，様々な要因が相互に影響しあっており，ICFの視点を用いてこれらの情報を整理することは有効であると示唆された。 [SUMMARY] This research aims to explore factors about older people with dementia impacting their ability to continue living alone at home. Semi-structured interviews were held with 11 care managers in charge of older people with dementia continuing to live alone at home. Inductive, qualitative analysis was conducted on the data obtained using the International Classification of Functioning, Disability and Health (ICF) as the analytic framework. However, environmental factors were excluded since the aim was to explore factors about the older people with dementia themselves. Analysis resulted in eliciting the following themes as factors impacting the ability of older people with dementia to continue living alone at home. Two themes for health conditions include “whether dementia diagnosis and confirmation exists.” Four themes for body functions/body structures include “functions maintained through utilization of nursing care products.” Five themes for activity include the “ability to convey intentions and communicate.” Three themes for participation include “continued involvement with community residents and family,” and three themes for personal factors include “an unchanged sense of values understood from the individual’s interests, preferences, and personal relationships.” Older people with dementia were able to continue living alone at home by demonstrating their own strengths in reinforcing factors within day-to-day life. Even when function declines due to hospitalization or temporary changes in health, returning to a familiar home environment and receiving appropriate support, such as utilization of assistive products, led to maintaining functions and recovery. This study suggests the importance of using the ICF perspective to organize information on functions in everyday life that affect each other.

type:text [要旨] 本研究の目的は，受け持ち病棟看護師と退院後同行訪問を行った訪問看護師の気づきと看護活動の変化および，連携の変化を明らかにすることである．受け持ち病棟看護師と同行訪問を行った訪問看護師７名に対して，受け持ち病棟看護師とのディスカッション（同行訪問直後），個別の半構成的面接調査（同行訪問直後，同行訪問３か月後），さらに，在宅医療介護従事者における顔の見える関係評価尺度による質問紙調査（同行訪問前，同行訪問3か月後）を実施した．ディスカッションおよび個別面接調査のデータは，質的内容分析を行い，在宅医療介護従事者における顔の見える関係評価尺度については同行訪問前，同行訪問３か月後の得点について比較した．質的内容分析の結果，同行訪問直後の気づきは，同行訪問対象者，病院との連携，自身の看護活動に関連した６カテゴリーにまとめられた．同行訪問３か月後の看護活動の変化は，同行訪問対象者を取り巻く状況への理解の深まり，病棟看護師へのフィードバックを行うなどの看護活動の変化と，同行訪問前と変わらない考え方を含む６カテゴリーにまとめられた．顔の見える関係評価尺度の訪問前と３か月後の各下位尺度得点および合計得点の平均値の変化に有意差はなかった．以上より，受け持ち病棟看護師との同行訪問は，訪問看護師にとって，同行訪問対象者に対する理解が深まり，多職種との連携に向けた看護活動へと変化をもたらす機会になると考えられた． [Abstract] This research aims to clarify realizations of visiting nurses who implemented joint postdischarge visits with primary care ward nurses, changes in nursing care practices and changes in collaboration. Seven visiting nurses who implemented joint visits with primary care ward nurses were given a questionnaire using a “measurement scale to quantify the face-to-face cooperation level among home health care providers” (pre-visit, 3 months after visits), discussions were held with the ward nurses (immediately after visits), and individual semi-structured interviews were held (immediately after visits, 3 months after visits). Qualitative content analysis was conducted on verbatim records of discussions and interviews, and quantitative data was compared before and after. As a result of qualitative content analysis, realizations that occurred immediately after joint visits were compiled into 6 categories. They are related to the patients, cooperation with hospitals, and the nurses’ own nursing practices. Changes in nursing practices 3 months after joint visits were compiled into 6 categories, including realizations about circumstances surrounding patients, changes in nursing activities such as giving feedback to ward nurses, and keeping the same approach as before joint visits. Results showed no significant difference existed in pre-visit or 3-month post-visit scores for the “measurement scale to quantify the face-to-face cooperation level among home health care providers.” Based on the above, for visiting nurses, it is conceivable that joint visits with primary care ward nurses deepen understanding of patients and become opportunities to bring change in nursing practices in cooperation with various professionals.

type:text [要旨] 本研究の主要な目的は，訪問看護師との退院後同行訪問による病棟看護師の気づきと同行訪問後の看護活動の変化を明らかにすることである．副次的な目的は，受け持ち病棟看護師が抱く患者に関するイメージおよび地域における連携の変化を探索することである．受け持ち患者の退院後に訪問看護師との同行訪問を行った病棟看護師７名に対して，訪問看護師とのディスカッション，半構成的面接調査，患者のイメージ，在宅医療介護従事者における顔の見える関係評価尺度に関する質問紙調査を同行訪問前から同行訪問３か月後に実施した．ディスカッションとインタビューの逐語録は質的内容分析，量的データについては前後比較を行った．退院後同行訪問による気づきは，【自分が行った看護を評価する】【今後の退院支援の方向性が明確になる】など８カテゴリー，退院後同行訪問後の看護活動の変化は，『患者のアセスメントと支援の幅が広がった』『患者の退院後の生活を見据えた支援を行うようになった』など10カテゴリーにまとめられた．患者のイメージの変化は，同行訪問後，「消極的－積極的」「孤立－連帯」の２項目において有意に肯定的なイメージに変化した．同行訪問前と３か月後における顔の見える関係評価尺度の得点には有意差はなかった．以上より，訪問看護師との同行訪問は，受け持ち病棟看護師にとって自分の看護を評価する機会となり，その後の看護活動の改善に活かされていることが示唆された． [Abstract] The primary aim of this research is to explore realizations of primary care ward nurses through joint post-discharge visits with visiting nurses and changes in their nursing practices after the joint visits. A secondary aim is to explore changes in images of patients held by primary care ward nurses and changes in collaboration in the community. Seven primary care ward nurses who implemented joint visits with visiting nurses after patient discharge held discussions, were given semi-structured interviews and a questionnaire on their images of patients by semantic differential method, and a measurement scale to quantify the faceto- face cooperation level among home health care providers prior to and 3 months after the visits. Qualitative content analysis was conducted on verbatim records of discussions and interviews, and quantitative data was compared before and after. Realizations resulting from joint post-discharge visits were organized into 8 categories, including “evaluating my own nursing” and “clarification of the future directionality of discharge support.” Changes in nursing practices after joint post-discharge visits were organized into 10 categories, including “broader patient assessment and support” and “an enhanced provision of support that anticipates a patient’s life after discharge.” After the joint post-discharge visits, patient images shifted toward the positive with a significant difference in the 2 items, “passive-active” and “isolated-connected.” No significant difference existed in pre-visit or 3-month post-visit scores for the measurement scale to quantify the face-to-face cooperation level among home health care providers. Given the above, this research suggested that for primary care ward nurses, joint visits with visiting nurses became opportunities to evaluate their own nursing and were utilized to improve subsequent nursing activities.

type:text 本研究の目的は，フィンランドならびにイギリスの地域における認知症高齢者と家族への服薬支援を明らかにし，日本の認知症ケアへの示唆を得ることである． フィンランドとイギリスの高齢者医療・ケアの専門職等24人に対して，認知症高齢者の薬物療法と服薬支援に関する半構造化面接を実施し，(1)国としての高齢者の薬物療法のシステム，(2)認知症の薬物療法の実施体制，(3)個々の認知症高齢者の服薬支援のための具体的方法，(4)認知症高齢者が適切に服薬するための家族への支援方法，(5)服薬支援に関する関係者間の連携方法について内容分析を実施した． フィンランドでは，薬物療法における情報の一元管理や看護職を対象とした薬物療法に関する教育プログラム，メモリーナースの自治体への配置が国レベルで展開され，看護職が個々の認知症高齢者の薬物療法を支援していた．イギリスでも，精神症状・行動障害は不適切なケアによって発症し，向精神薬は認知症高齢者の予後に不利益をもたらすことから，処方しないという対応が徹底されていた． さらに両国では，副作用を発見するために，家族や多職種によるモニタリングと連絡・相談が円滑にできる体制が整っていた． 日本においては看護師が認知症の薬物療法に関する専門性を高めて積極的に支援するとともに，副作用も含め処方薬に関する情報の集約と連絡・相談体制の構築，さらに多職種の連携による効果や副作用のモニタリングによって，向精神薬の低減を目指すことが必要であると示唆された． The purpose of this research is to explore assistance provided in drug administration to elderly with dementia and their families in Finland and the United Kingdom (UK) to gain suggestions for dementia care in Japan. Semi-structured interviews regarding drug therapy and assistance in drug administration to elderly with dementia were held with 24 professionals providing care and treatment to the elderly in Finland and the UK. Content analysis was conducted on (1) the nationwide drug therapy system for elderly, (2) the system for implementing drug therapy for dementia, (3) specific methods of assistance in drug administration for each elderly individual with dementia, (4) methods of assistance for families so that elderly with dementia appropriately take drugs, and (5) collaborative methods among relevant individuals regarding assistance with drug administration. In Finland, unified management of information on drug therapy, education programs on drug therapy for nursing professionals, and placement of memory nurses in municipalities have been developed at the national level. Nursing professionals provide assistance with drug therapy for individual elderly patients with dementia. In the UK, psychotropic drugs are not prescribed since they are detrimental to the prognosis of elderly with dementia and psychiatric symptoms/behavioral disorders appear due to inappropriate care. Furthermore, in both countries there are established systems that enable the smooth implementation of monitoring and communication/consultation between families and various professionals for the purpose of discovering side effects. This suggests there is a necessity in Japan for nurses to improve their expertise in drug therapy for dementia and actively provide assistance. In addition, systems should be created to gather information and provide communication/consultation on prescription drugs, including their side effects. Furthermore, a reduction in psychotropic drugs should be targeted by monitoring effectiveness and side effects through collaboration among various professionals.