論文

The purpose of this study was to clarify administrators' perspectives on availability of recommended strategies for end-of-life (EOL) care for cancer patients at long-term care (LTC) facilities in Japan. A cross-sectional survey was conducted with administrators at Japanese LTC facilities. Participants were surveyed about their facilities, reasons for hospitalization of cancer patients, and their perspectives on availability of and strategies for EOL care. The 97 responses were divided into medical facility (n∈=∈24) and non-medical facility (n∈=∈73) groups according to physician availability. The most frequent reasons for hospitalization were a sudden change in patient's condition (49.4%), lack of around-the-clock care (43.0%), and inability to palliate symptoms (41.0%). About 50% of administrators believed their facilities could provide EOL care if supported by palliative care experts. There was no significant difference between facility types (P∈=∈0.635). Most administrators (81.2%) regarded unstable cancer patients as difficult to care for. However, many (68.4%) regarded opioids given orally as easy to administer, but regarded continuous subcutaneous infusion/central venous nutrition as difficult. Almost all administrators believed the most useful strategy was transferring patients to hospitals at the request of patients or family members (96.9%), followed by consultation with palliative care experts (88.5%). Although LTC facilities in Japan currently do not provide adequate EOL care for cancer patients, improvement might be possible with support by palliative care teams. Appropriate models are necessary for achieving a good death for cancer patients. Interventions based on these models are necessary for EOL care for cancer patients in LTC facilities.

看護基礎教育における家族看護学教育の実態を明らかにすることを目的に、全国の看護基礎教育機関(4年制大学、短期大学、専門学校)のカリキュラム担当者を対象にアンケート調査を行い、174校(4年制大学49校、短期大学6校、専門学校119校)より有効回答を得た。その結果、全体の7割以上の学校で家族看護学を教育していたが、その教授方法と内容、教育時間数は学校により大きな差があり、その内容は患者の背景としての家族の状況理解を目指す学校から、家族システム看護の実践を教授・実習する学校まで幅広いことが分かった。また、実習到達目標や到達度チェックリストに家族看護に関する項目のある学校は約4分の1と少なく、家族看護を学ぶ必要性への認識が漠然としていることが窺えた。

東京都内の特別養護老人ホーム3施設の入所者の在宅生活時における家族介護者189例を対象に無記名自記式調査票による質問紙調査を行った.分析対象となった家族介護者145例中,精神的健康が低かった人は59例であった.ロジスティック回帰分析で,精神的健康と関連がみられたのはソーシャルサポート,入所者に対する面会時間であり,精神的健康はソーシャルサポートを受けている人ほど高く,面会時間が長い人ほど低い傾向を認めた.施設高齢者の家族介護者に精神的健康を害している人が存在することが示された.家族介護者の精神的健康の向上には,家族会などのサポートグループの紹介や,家族の面会に着目し入所者と家族介護者のコミュニケーションを促進する援助を行うことが,有効であると考えられた

PURPOSE: The purpose of this study was to examine the mental health and related factors with family caregivers for the elderly in special-care nursing homes for the aged. METHODS: We conducted a questionnaire survey among family caregivers for elderly living in three special-care nursing homes in Tokyo. The questionnaire included factors from the General Health Questionnaire-28 (GHQ-28) pertaining to family caregivers, the elderly, and the relationships between them. The GHQ-28 was used to measure the mental health of the caregivers and a logistic regression model was applied for the analysis. RESULTS: Of the 145 family caregivers surveyed, 59 (40.7%) exhibited low mental health (GHQ-28> or = 7). The logistic regression analysis revealed that family caregivers with low mental health had lower social support (OR: 0.10 (0.03-0.29)) and had longer visiting times (OR: 5.80 (1.79-18.82)). DISCUSSION: The results suggested that many family caregivers for elderly persons in institutions may have poor mental health and that it is necessary to provide them with support. It is concluded that self-help groups for families and the promotion of communication between the elderly and their family caregivers might be effective for this purpose.

医療チームが良い関係を築けずにいた小児癌治療中の女児(初回面接時10歳)と40代の母親を中心とするその家族に,コンサルテーション・リエゾンとして介入し,修復に結びつけた事例を紹介した.当事例における一番の問題は,医療チームの側に「困った子」「愛情の薄い母親」といった見方が固定しかけており,治療環境が破壊の危機に瀕していたことであった.患者や家族が示した行動や態度の背後にある心理の理解を医療チームに促すことによって医療チームの共感性を機能させ,治療環境を回復することがコンサルテーション・リエゾンの最重要課題であると考える