論文

This study aimed to examine nursing ward managers' perceptions of pain prevalence among older residents and the strategies of pain management at the Health Service Facilities for the Elderly Requiring Care (HSFERC) in Japan and to investigate the factors related to the prevalence. Nursing ward managers in 3,644 HSFERC were asked to participate in this study. Questionnaires were sent to them regarding pain prevalence among the older residents in their wards, their provisions for pain care, and other pain management strategies. The perceived pain prevalence factors were examined statistically. The final sample comprised 439 participants (12.0%). A total of 5,219 residents (22.3%) were recognized as suffering from pain on the investigation day. Only 8 wards (1.8%) used pain management guidelines or care manuals, and 14 (3.2%) used a standardized pain scale. The ward managers' age (p = .008) and nursing experience (p = .006) showed a significant negative association with pain prevalence estimation. Moreover, there was a significant association between the groups' pain prevalence estimation and the nursing managers' beliefs that older adults were less sensitive to pain (p= .01), that pain was common among older people (p = .007), and that the time to treat residents' pain was insufficient (p = .001). The ward managers' perceptions regarding pain prevalence varied; the perceived pain rates were possibly lower than the actual percentages. Insufficient pain management strategies at the HSFERC were also suggested. An appropriate pain management strategy for Japanese aged care and its dissemination are urgently required.

本研究は、看護政策に携わる看護職の現在の職業・立場につくまでの経験を明らかにし、彼らの意見から看護職の看護政策に関する興味・関心を高める方略についての示唆を得ることを目的とした。看護政策へ携わる看護職6名を対象に半構造的インタビューを実施し、質的に分析した。分析の結果、看護政策に携わる看護職の現在の職業・立場につくまでの経験として「看護政策に関心を持ったきっかけとなった経験」、「看護政策への理解を深めた体験」、「周囲の人々から対象者への反応」の3カテゴリーが、看護政策に関する興味・関心を高める方略についての意見や考えとして「看護政策への関心を高める上での障害」、「看護政策への関心を高めるために考えられる取り組み」の2カテゴリーが得られた。将来看護政策に携わりたいと考える看護職にとって、看護政策に直接携わる人との関わりが重要であるとともに、基礎教育の段階で医療・看護政策に関する内容を学び、看護以外の分野の知識や海外の医療制度・看護実践について知ることが有益であることが示唆された。また、今後より多くの看護職が看護政策に関心を持つようになるための体制を考える上で、多忙な臨床現場でも効率的に看護政策に関する情報が得られる環境整備や看護職の情報リテラシーを高める取り組み、若年層に対するアプローチが重要であることが示唆された。(著者抄録)

Aim. This article is a report of the development and psychometric testing of the Stressor Scale for Clinical Research Coordinators. Background. Job stress is viewed as a situation where working conditions interact with individual worker characteristics and result in disruption of psychological or physiological homeostasis. Clinical research coordinators, also known as research nurses, are professionals who play a central role in clinical trials. They face various problems associated with their responsibilities; however, few studies have reported on their stress. To manage their stress, it is necessary to identify the sources of stress (i.e. stressors). Method. The 56-item preliminary instrument was developed based on literature review and expert discussions. A total of 589 clinical research coordinators in 186 hospitals in Japan were surveyed in 2011. Statistical analyses on construct and concurrent validity, internal consistency, and test-retest reliability were performed. Results. A six-factor solution with 23 items was selected using exploratory factor analysis: 'quantitative workload', 'conflict with investigators', 'ambiguity of work', 'conflict with other clinical research coordinators and with supervisors', 'demands from an affiliate other than the hospital', and 'difficulty in caring for trial participants'. Confirmatory factor analysis affirmed construct validity, with a demonstrated acceptable fit between the factor structure and the observed data. All factors had significant correlations with burnout and psychological distress, which indicated acceptable concurrent validity. Cronbach's alpha coefficients ranged from 0·73-0·82. Intra-class correlation coefficients indicated almost satisfactory test-retest reliability. Conclusion. Our new instrument has acceptable validity and reliability for evaluating job stressors for clinical research coordinators.

This study examined the experiences of staff members from seven Japanese hospitals who had been treated aggressively by older dementia clients. Altogether, 170 questionnaires were analyzed. In the past year, 75.3% and 63.5% of staff members had experienced physical and verbal aggression, respectively. Working numerous night shifts, working shifts other than 3-shifts, and being allotted assignments with clients who had a lower average level of physical capacity were the factors associated with recurrent client aggression. Those staff members who spent adequate time caring for their clients, who gained client consent before providing care, and who tried to build a trusting relationship with their clients were found to have experienced less aggression. Burnout, which is likely to enhance the risk of the staff mistreatment and neglect of older clients, was found to be higher among those who experienced aggression.

Long-stay refers to a long visit abroad by retired middle-aged and older people. This study describes the attitudes/opinions of elderly Japanese long-staying subjects and healthcare providers in Thailand. Two cross-sectional questionnaire surveys were conducted in Chiang Mai Province, Thailand. Questionnaires were sent to a sample recruited from a self-help group of Japanese elders in Thailand (n= 68) and to Thai healthcare providers (n= 101). About half of the Japanese subjects routinely used a Thai medical service, although only 15% had been admitted to the hospital. Half of the Japanese subjects thought the quality of Thai medical services was high. Many elderly Japanese subjects were unable to speak either English or Thai, leading to communication difficulties. About 80% of healthcare professionals found no difference between caring for elderly Japanese subjects and people from Thailand. Most healthcare providers agreed that Japanese language training should be available to medical staff as translators were not always available. Healthcare providers agreed with the Thai government policy promoting long-stays. The most recognized obstacle in caring for Japanese long-stay elderly was the language barrier. More research on Japanese elders staying abroad is needed to promote effective communication between Japanese elderly and other ethnic healthcare professionals.

目的:在宅高齢者終末期の時期別期間とこの間に実施された訪問看護の頻度と体制について,がんとがん以外の事例を比較しつつ明らかにする.方法:「良い」看護を提供していると判断される訪問看護ステーションの看護師31名から65歳以上のがん・がん以外の事例1件ずつ聴取し,終末期期間を分け「開始期」「維持期」「悪化期」「臨死期」について分析した.各期の期間・訪問頻度等を集計しがんとがん以外の事例を統計的に比較検討した.結果:がん以外の事例はがん事例に比べ開始期と悪化期が有意に長く,長さは多様だった.訪問頻度はがん事例では臨死期から高く,がん以外の事例は悪化期から高くなった.緊急訪問はがん以外の事例の臨死期に約半数で実施されていた.結論:がんとがん以外の事例で異なる経過と訪問看護の提供状況が見られ,事例毎に適切な看護が提供できるような制度上の工夫が看護師の技術向上とともに求められる.(著者抄録)

本学では、臨床実践に近い形での看護の知識・技術の統合を目指し、夜勤実習、看護管理実習、外来看護実習、中央診療部門見学実習の4つの実習から構成される看護の統合と実践実習を行っており、今回、その効果を、実習に参加した看護学専攻4年生41名への自由記述を含むアンケート調査から検討した。その結果、学生の7割が実習に「とても満足している」「満足している」と回答し、自由記述からその理由として、他部門の業務内容や管理職の役割など未知の事柄を学べたという【新たな学習内容】、患者対看護師以外の【異なる視点からの看護】、【既習内容の統合】【就職後の具体的イメージの獲得】といった内容が挙げられた。

三重県内の保健師の在日外国人への保健活動の実態を明らかにすることを目的にアンケート調査を行い、278名より回答を得た。その結果、外国人への保健活動の経験がある者は209名(75.2%)で、保健活動対象者の出身国はブラジル、フィリピン、中国の順で、母子・小児保健が多いことが分かった。

本研究は、訪問看護の認知症ケア構造の概念化を目的に、訪問看護師12人に半構成的面接を行い、グラウンデッド・セオリー・アプローチを参考とし分析した。協力者のうち女性は11人、看護師経験年数は平均17.2年、訪問看護師経験年数は平均8.8年であった。事例13人のうち、女性9人、年齢は60〜80代、要介護度は2〜5であった。訪問看護師の認知症ケアには、1)家に入れてもらう、2)継続して家に入れてもらえる状況をつくる、3)生活上の問題を解決する、4)療養者に楽しみをつくる、5)サービスを利用しながら療養体制を整える、6)家族が介護しながらも生活できるよう支援する、7)サービスを再調整し訪問看護を徐々に縮小する、という実践プロセスが抽出された。また、プロセスの基礎となる8)療養者・家族の経過を展望しそれを踏まえて実践する、というカテゴリーが抽出された。認知症療養者への訪問看護では経過を展望し段階を踏んで援助する必要性が示唆された。(著者抄録)

In this article we describe our study of assistance for family decisions and caregiving by Japanese home care nurses to families of elderly relatives at the end of life. The participants were 31 nurses who had been evaluated as providing good end-of-life care. We carried out semistructured interviews concerning the practice of family support in two cases (cancer and noncancer). We conducted a qualitative analysis using the constant comparative approach and derived several categories inductively. Home care nurses are responsible for (a) estimating the possibility of dying at home, (b) visualizing what is coming and what can be done, (c) proposing where and how the family can say goodbye, (d) building family consensus, (e) coordinating resources, and (f) offering psychological support for end-of-life care. End-of-life family care by home care nurses is a process in which multiple components of care are provided with changing content as death approaches.

高齢者ケア施設において医療処置を含むケアを安全に提供するために看護職に求められる役割は大きい。本研究は、全国の高齢者ケア施設の看護職61名を対象に、(1)医療処置を安全・確実に行うための工夫、(2)医療処置を介護職と連携して安全・確実に行うための工夫、(3)経験した危険な場面・失敗した場面、それぞれの特徴を明らかにすることを目的とした。吸引・排痰ケアなどの6つの医療処置について上記3つの質問を行い、自由記述にて得た回答に基づきカテゴリーを作成した。安全・確実に行うための工夫として"予防的なケアを実施する"などの5つ、介護職と連携して安全・確実に行うための工夫として"介護職から看護職へ報告すべき内容や基準を定める"などの7つ、危険な場面・失敗した場面として"対象者に有害事象・症状が実際に生じた場面"などの5つのカテゴリーを得た。看護職が、限られた物的・人的資源の中で可能な限り入居者個々の状態に応じ予防的な視点からケアを行い、介護職との連携においては個々の施設の状況に合わせてケア提供の分担の条件等を設定していたことが示された。(著者抄録)

Aim: Most family caregivers continue their caregiving for frail relatives after admitting them to long-term care facilities. The characteristics of this caregiving differ from those related to caregiving in home-care settings. Thus, a new tool to evaluate the burden of family caregivers in institutional settings is needed. The aim of this study was to develop a new scale, the Caregiving Burden Scale for Family Caregivers with Relatives in Nursing Homes, and to confirm its validity and reliability. Methods: We conducted two cross-sectional questionnaire surveys. The participants were a convenience sample of family members of residents in seven nursing homes for the validation study and in three nursing homes for the test-retest study in Japan. Statistical analyses examined exploratory/confirmatory factor analyses, internal consistency, concurrent/discriminate validity, and test-retest reliability. Results: A four-factor solution with 16 items was selected as the most interpretable questionnaire. In the confirmatory factor analysis, the indices of fitness highly supported these results. The Cronbach's alpha coefficient for the total score was 0.86 and varied between 0.77 and 0.87 in the four domains. The scale showed moderate correlation with the Nursing Home Hassles Scale, suggesting its concurrent validity. The four domains had only a medium correlation with each other, indicating discriminate validity. Conclusions: The developed scale has acceptable validity and reliability for measuring the caregiving burden of family members with relatives in Japanese nursing homes. Future studies using the scale might lead to the improvement of care for family members with relatives in a long-term care setting.

経口水分摂取量の目測の実態を把握し、その誤差に容器の性質や目測の状況がおよぼす影響を検討することを目的に、患者の水分摂取量を目測した経験をもつ同一病院に勤務中の看護職者11名を被験者に、実際に目測に使用されている5種類の容器を用いて、容器からの水分の減少量を目測させる実験と、8分目まで入った容器の水分量を目測させる実験を行った。目測する容器の順番についてはランダムに決定した。その結果、容器内の水分に関する目測の誤差に関連する容器の性質として、形状・透過性・簡単な目盛りの有無、が明らかになった。この結果から、誤差を少なくするためには、容器の外形を筒状に近づけること、透明な容器であれば50mlごと程度の簡易な目盛りをつけることが有効であると考えた。

手術室における褥瘡予防対策は看護師の重要な役割であるが、固定器を用いる人工股関節置換術では褥瘡発生が多くみられ、褥瘡予防の取り組みが必要である。本研究では、人工股関節置換術後の褥瘡発生を予防する目的で、保護面積を広くするなど、固定器の接触部位の皮膚保護方法を変更し、その効果を検証した。保護方法変更前後で属性を比較し、方法変更後(方法B)では有意に糖尿病患者が多かった(p=0.02)。保護方法を変更した結果、有意ではなかったものの(p=0.23)、褥瘡発生率は変更前(方法A)の27.8%から変更後(方法B)には12.9%に減少した。糖尿病患者が多い中でも褥瘡発生率が減少したことより、新たな皮膚保護方法が褥瘡予防に有効であった可能性が示唆された。(著者抄録)