特別養護老人ホームで働く看護師による病院との連携行動の実際とその評価―看護師の背景および看護実践能力との関連に焦点をあてて

Actual Situation and Evaluation of Collaborative Practice of Nurses in Nursing Homes for Older Adults: Focusing on the Background of Nurses and Nursing Practice Ability

抄録

　本研究の目的は，特別養護老人ホームで働く看護師（以下，特養看護師）による病院との連携行動の実際とその評価，および連携行動の評価に関連する要因を明らかにすることである．全国の2,000施設の特養看護師を対象に郵送法による無記名自記式質問紙調査を実施し，252人を分析対象とした．

　特養看護師による連携行動の評価（以下，「連携行動評価尺度」）と特養における看護実践能力（以下，「NCSI」）との相関分析の結果では，すべてにおいて正の相関（r＜0.2〜0.5）を認めた．このことから，特養において高い看護実践能力を発揮している看護師は，施設外の病院との連携においても連携行動をよく行えていることが示された．

　連携行動の評価に関連する要因は，「連携行動評価尺度」下位尺度合計得点の上位，下位の2群を従属変数とし，多重ロジスティック回帰分析を行った．分析の結果，連携行動の評価に関連する要因として，特養看護師の背景，および「NCSI」から計7項目が抽出された．このうち「NCSI」〔第2因子：多職種と連携する力〕は，特養看護師による病院との連携行動の評価に最も影響を及ぼすことが示された．一方で，〔第2因子〕の平均得点は「NCSI」4因子中で最も低く，特養看護師の多職種と連携する力を高める必要性が示唆された．

　This study aimed to clarify the actual situation and evaluation of collaborative practice with other hospital healthcare workers by nurses working in nursing homes for older adults (hereinafter referred to as nurses at special elderly nursing homes) and the factors related to the evaluation of collaborative practice. Using the postal method, an anonymous, self-administered, questionnaire survey was conducted with 2,000 nurses at special elderly nursing homes at 2,000 facilities nationwide: data from 252 participants were analyzed. In the results of the correlation analysis between the evaluation of collaborative practice by nurses at special elderly nursing homes (as assessed using the Collaborative Practice Evaluation Scale) and their nursing practice ability (as assessed using the NCSI), a positive correlation (r＜0.2−0.5) was observed in all cases. Hence, nurses at special elderly nursing homes with a high level of nursing practice ability are also able to collaborate well with hospitals outside the facility.

　Regarding factors related to the evaluation of collaborative practice, multiple logistic regression analysis was performed using total scores for the Collaborative practice Evaluation Scale to divide the sample into two groups (upper and lower groups), which were then used as the dependent variables. In total, seven items were extracted from the background of nurses at special elderly nursing homes and the NCSI as being related to the evaluation of collaborative practice. Among these, NCSI (Factor 2: Ability to collaborate with multiple professions) was shown to have the greatest influence on the evaluation of collaborative practice with other hospital healthcare workers of nurses at special elderly nursing homes. On the other hand, the average score of Factor 2 was the lowest among the four factors of the NCSI, suggesting the need to enhance the ability of nurses at special elderly nursing homes to collaborate with various professions.