退院支援における専門職種間連携の変化のプロセス：Relational Coordination理論を基盤としたアクションリサーチ

The Process of Changes in Interprofessional Work in Hospital Discharge Support: Action Research Based on Relational Coordination Theory

要旨

　目的：退院支援においてRelational Coordination理論を基盤としたアクションリサーチを行い専門職種間連携に生じる変化のプロセスを明らかにした．

　方法：退院支援に関わる専門職種16名が参加し，そのうち5名のコアメンバーが研究を推進した．退院支援を要する患者12名とその家族に対して2職種以上による面談を実施した．

　結果：12事例を分析し，専門職種間連携の変化の観点から3つのフェーズ〈定石通りの退院支援に起きる専門職種間の退院目標の食い違いと患者の思いを知ろうとしていなかったことへの気づき〉〈退院に向けた面談に同席する専門職種が広がり，患者・家族の語りを一緒に見聞することによる創造性の向上〉〈専門職種間の相互依存性を高め患者・家族の抱える難題に向き合う対応力の進歩〉を見出した．

　結論：RC理論を基盤としたアクションリサーチを通じて退院支援における専門職種間連携の変化のプロセスが明らかになった．

　Objective: The aim of this study is to conduct action research based on the relational coordination theory for discharge support in order to clarify the process of changes occurring in interprofessional work.

　Method: The study design is Action research, which was conducted for 6 months. The study participants include sixteen professionals who are involved in discharge support, of which five people promoted the study as core members. Twelve patients and their families who required discharge support were interviewed by two or more professionals based on the RC theory(shared goals, shared knowledge, mutual respect, and communication), then the results were reflected.

　Results: We analyzed 12 cases and found three phases from the perspective of changes in interprofessional work. Phase 1 was "becoming aware of discrepancies in discharge goals when conducting discharge support done by the book as well as the fact that they were not trying to understand the patients' thoughts". Phase 2 was "as the professionals attending the interview for discharge increase, creativity is improved by seeing and hearing the stories of the patients and their families together. Phase 3 was "having a progress in coping ability to meet the challenges patients and their families are facing by increasing interprofessional dependency".

　Conclusions: Through the action research based on the relational coordination theory the changing process of interprofessional work in discharge support was clarified.