急性期病院の看護師が入院時に行う高齢者へのせん妄予防ケアの実態

Conditions of Delirium Prevention Care Provided to Older Adults by Nurses on Admission to Acute Hospitals

抄録

　本研究の目的は，急性期病院の看護師が入院時に行う高齢者へのせん妄予防ケアの実態を明らかにし，せん妄予防ケアの実践や教育への示唆を得ることである．急性期病院の看護師459人を対象に無記名自記式質問紙調査を行い，282人（回収率61.4％）から回答が得られ，そのうち259人（回収数の91.8％）を分析対象とした．その結果，看護師の9割は1か月以内にせん妄ケアを経験し，せん妄の因子や予防の必要性を理解していた．一方，認知症やせん妄に関連する研修受講者や，カンファレンスの実施が少ない現状が明らかとなった．入院時のせん妄予防ケアの実践では，住み慣れた環境の再現，回想法，就寝前の足浴やマッサージなどの実施は4割に満たず困難度も高かった．今後は，急性期病院の看護師が，入院時よりせん妄予防ケアを実践していけるように予防ケアの具体的な方法や組織全体でのせん妄予防ケアへの取り組みに向けて支援していく必要性が示唆された．

　The purpose of this study is to identify the conditions of delirium prevention care that nurses provide to elderly adults upon admission to acute hospitals and find suggestions regarding delirium prevention care education and practice. We conducted an anonymous, self-administered questionnaire survey of 459 acute hospital nurses. Responses were received from 282 nurses (collection rate 61.4%), of which 259 responses were subjected to analysis (91.8% of responses collected). Among these 259 nurses, 90% had provided delirium care within a month preceding the survey and understood the risk factors for delirium and the necessity of delirium prevention care. On the other hand, the number of participants who received training related to dementia and delirium and the number of conferences held were low. Among delirium upon admission prevention methods, the reproduction of a familiar environment, reminiscence therapy, and foot baths or massages before bedtime were implemented by fewer than 40% of the respondents, and they found it difficult to provide this care. It was suggested that support is needed to create well-defined preventive care methods and organization-wide efforts for delirium prevention care so that nurses at acute hospitals can effectively implement this care upon admission.