飯田 貴映子

Abstract Long-term care facilities are increasingly important places for palliative and end-of-life care provision in Japan. While the importance of culture has been noted for palliative and end-of-life care, an exploration of its influence on care provision in long-term care settings has received little direct attention in Japan. Exploring staff views and beliefs in palliative and end-of-life care in these settings can potentially enhance our understanding of culturally oriented care and facilitate the development of tailored and more effective support practices. This study aimed to explore the cultural views and beliefs regarding palliative and end-of-life care among the staff in Japanese long-term care facilities. A qualitative exploratory study was conducted using focus groups with facility staff (N = 71) and semi-structured interviews with facility managers (N = 10) in the Kanto region of Japan. Thematic analysis was conducted according to Braun and Clarke's approach. The findings are presented in five key themes: ‘Changes in society's and family's end-of-life perspectives’, ‘Values and beliefs regarding death and dying’, ‘Anxiety and regret’, ‘Tensions in doing the right thing’ and ‘Ways of alleviating pressure’. The findings indicate that the provision of palliative and end-of-life care is underpinned by cultural nuances that influence care providers' approach and delivery. Recognising and understanding the cultural beliefs of staff around death, dying and end-of-life care are important in meeting the needs of residents. Palliative care education for staff in these settings should include cultural considerations that reflect changing societal views on death and dying.

BACKGROUND: Given the increase in the number of deaths within long-term care facilities (LTCFs), the need for palliative and end-of-life (EOL) care education among such facilities has been increasing. As such, a systematic synthesis of global palliative and EOL care educational approaches and evaluation can aid further educational development. OBJECTIVE: To synthesise the current literature on palliative and EOL care educational interventions for staff working in LTCFs and identify barriers to, and facilitators of, intervention implementation. METHODS: The study used an integrative review framework wherein indexed databases, namely, CINAHL, EMBASE, MEDLINE, PsycINFO, Web of Science, Cochrane Library and Japan Medical Abstract Society, were systematically searched for studies published in English and Japanese between 2007 and 2019. Search terms that are related to palliative care, LTCF, and education were combined to increase search sensitivity. The quality of the papers was assessed using Joanna Briggs Institute Critical Appraisal Tools and the Mixed-Methods Appraisal Tool. RESULTS: A total of 52 studies were included in the review. Our results suggested that although studies in this area and setting have been evolving, suboptimal developmental research and educational practices, global variability and unstandardised approaches to education and lacking viewpoints from service users have remained. Barriers to intervention implementation were also reported due to the specific characteristics of LTCFs, which include high staff turnover and considerable variation in professional skills and experience. CONCLUSIONS: Given the different LTCF types, systems and policies across each country or region, further research on standardised educational interventions with contextual considerations using large-scale studies with robust methodology is needed to meet the increasing demand for palliative and EOL care among the global ageing population. IMPLICATIONS FOR PRACTICE: Palliative and EOL care educational intervention for LTCF staff need to include more consideration of context, organisational culture and the user involvement throughout the process of education and research to enhance the quality of care in this complex setting.

OBJECTIVE: The objective of this qualitative systematic review is to evaluate and synthesize the recent literature on advance care planning (ACP) experiences of community-dwelling older people in interaction with community healthcare professionals. INTRODUCTION: The importance of healthcare professionals initiating ACP with their patients and clients has been reported. However, older people who live in the community have fewer opportunities to have discussions regarding ACP with healthcare professionals compared with those who live in other settings. Timely initiation of ACP and sustainable discussion among older people, families, and community healthcare professionals is expected, which may lead to improved palliative and end-of-life care in the community. INCLUSION CRITERIA: This review will consider studies that include individuals older than 60 years living in their homes in the community. Studies published in English or Japanese that focus on qualitative data and are published from 1999 to present will be considered. METHODS: The key information sources to be searched are: MEDLINE, CINAHL, Embase, PsycINFO, JSTORE, Scopus, Japan Medical Abstract Society, CiNii for published papers, and Google Scholar, ProQuest Dissertations & Theses Global, and MedNar for unpublished papers and gray literature. Eligible studies will be critically appraised using the standardized JBI tool. Qualitative research findings will be pooled using the meta-aggregation approach. Then the final synthesized findings will be graded according to the ConQual approach for establishing confidence in the output of qualitative research synthesis and presented in a Summary of Findings.

本報告の目的は、タイ王国コンケーン大学看護学部生受入れプログラムの開発から評価までの過程を振り返り、今後の留学生受入れプログラムの実施への示唆を得ることである。プログラムは、千葉大学大学院看護学研究科国際活動委員会が中心となって開発した。プログラムのテーマは、日本における看護学教育・研究を牽引してきた千葉大学看護学部の特徴を踏まえ、「千葉大学看護学部で看護を学ぶ-伝統と革新-」とし、千葉大学看護学部における教育を体験する等の3つの目標を設定した。各専門領域の協力を得て、講義・演習・現地視察による9の学習内容を含むプログラムを開発・実施した。プログラムの実施に当たり、研究科内の危機管理体制を構築し、学生ボランティア6名の協力を得た。留学生に対して評価アンケートを実施し、プログラムを評価した。評価アンケートの結果から、留学生は、日本の看護を知るとともに、自身がコンケーン大学で学習している看護と比較したり、日本で得た知識を自国での看護にどのように応用できるかを考えたりすることができていた。また、プログラム参加は留学生の今後の学習意欲やキャリア形成にも影響を与えたことが示唆された。学生ボランティアとの交流は、留学生の安心感や刺激につながったと考えられた。課題としては、効果的な学習と学生交流とのバランスを考えた留学時期の検討等が挙げられる。(著者抄録)

平成26年度国立大学改革強化推進補助金(亥鼻キャンパス高機能化構想)により平成27年3月に、国際交流実績のあるネパール連邦民主共和国、タイ王国、大韓民国の3か国の看護大学および関連施設を訪問し、部局間協定および学術・学生交流の推進について具体的に相互に検討し、アクションプランを作成した。訪問した大学は、HOPE International College(ネパール)、Khon Kaen University(タイ)、Seoul National University(韓国)であった。HOPE International Collegeでは、本研究科の国際プログラムへの大学院生の受験促進および学部で実施している「異文化看護演習」のアジアでの共同教育について検討された。また、ネパール大震災後の課題に取り組むための災害看護学における協働について話し合われた。Khon Kaen Universityにおいては、「異文化看護演習アジア」として学生の相互交換プログラムの実施および、教員と大学院生の参加する共同ワークショップの開催が検討された。Seoul National Universityにおいては、共同研究の推進など、大学院生と教員による学術交流を推進することとなった。2016年3月開催予定(千葉)の19th EAFONS(East Asian Forum of Nursing Scholars)の機会を活用した相互交流の準備が開始された。本実践報告では、グローバルに発展する看護学における学部と大学院教育に資する訪問活動の概要と結果について報告する。(著者抄録)

高齢者長期ケア施設における外国人看護職・介護職の就労の現状などを明らかにすることを目的に、関東地方の介護保健施設を対象にアンケート調査を行い、383施設(老人保健施設166施設、介護老人福祉施設170施設、療養型病床47施設)より有効回答を得た。その結果、108施設(27.4%)が外国人職員の雇用経験があり、雇用した職種は、ヘルパー85名(35.0%)、無資格介護職75名(30.9%)、介護福祉士18名(7.4%)、看護助手42名(17.3%)、EPA(経済連携協定)による介護福祉士候補15名(6.2%)、准看護師3名(1.2%)、看護師1名(0.7%)で、フィリピン出身者を雇用した施設が最も多く、以下、中国、韓国、ブラジルなどであった。

回復期リハビリテーション病棟において高齢脳卒中患者学習支援プログラムを実施した1事例(60代後半女性。左視床出血)について報告した。セッションという形式で計4回、看護師が患者と話し合いの場を設け、セッションごとのテーマ(第1回:体の痛み、第2回:再発予防、第3回:エクササイズ、第4回:家での過ごし方)に沿って傾聴の姿勢により患者の学習ニーズの表出を促し、その学習ニーズに対して教材を用いて説明し、また、一緒に体を動かす、主治医と連絡を取り合うなど、必要な学習支援を提供した。

Medical care is an organized service made possible by the cooperation of numerous professionals. With the bachelor's degree as a basis of career education, education which students can gain not only technical knowledge but also enable them to show their professionalism based on the concept patient (user)-centered care as a member of a medical organization is vital. Above all, it is essential fostering students' abilities to work inter-professionally which might become a driving force of a team medical care. The present project covers all students in all grades from the Departments of Nursing, Medicine, and Pharmacy; and it provides multistage and comprehensive interprofessional education through lectures, drills, and practical training. The core of the program is the fostering of communication skills, ethical sensitivity, and problem-solving skills. This program is designed to train autonomous health care professionals with healthy occupational views, a strong sense of social responsibility, a sound work ethic, well-balanced views, and a willingness to commit to lifelong learning. © 2010 Springer Japan.