介護医療院における重度要介護高齢者に対する「快適な排便ケア」実践の実態

Current Status of “the Care of Comfortable Defecation” for Older Adults in Integrated Facility for Medical and Long-term Care

抄録

　医療と生活の両方の機能を併せ持つ介護医療院において，重度要介護高齢者に対する快適な排便ケアは重要である．本研究は，介護医療院における看護職の重度要介護高齢者に対する快適な排便ケアの実態を明らかにすることを目的とした．快適な排便ケアの実践項目は独自に作成した51項目で，全国の介護医療院に勤務する看護職を対象に無記名の自記式質問紙調査を行い，405人から回答を得た．重度要介護高齢者に対する快適な排便ケアの実態については，アセスメントに基づく便秘改善のためのケアの平均得点は2.7±0.4点，苦痛と羞恥心に配慮したケアの平均得点は3.2±0.4点，チームアプローチの平均得点は2.8±0.5点であった．最も平均得点が高かったのは苦痛と羞恥心に配慮したケアで，最も平均得点が低かったのはアセスメントに基づく便秘改善のためのケアのなかの排便機能に関する項目であった．高齢者の負担を最小限にするためにも，多職種での話し合いの場を設けることや，理学療法士や作業療法士との協働，移乗用リフトの活用などの必要性が示唆された．

　Integrated facilities for medical and long-term care combine the functions of both medical care and daily living，and comfortable defecation care at these facilities is important for older adults with serious care needs. The aim of this study was to clarify the circumstances surrounding comfortable defecation care provided by nurses in integrated facilities for medical and long-term care for older adults with serious care needs. Fifty-one original practical items for comfortable defecation care were prepared and used in an anonymous self-administered questionnaire survey for nurses working in integrated facilities for medical and long-term care，nationwide. Responses were received from 405 nurses. Regarding the current status of comfortable defecation care for older adults with serious care needs，the mean score for defecation care based on assessments was 2.7±0.4 points，the mean score for care with consideration of distress and embarrassment was 3.2±0.4 points，and the mean score for a team approach was 2.8±0.5 points. The highest mean score was for the item of care with consideration of distress and embarrassment，and the lowest mean score was for items，based on assessments，related to defecation function in defecation care. To minimize the burden on older adults，it was suggested that strategies such as establishing opportunities for people in different disciplines to talk with each other，coordinating with physical therapists and occupational therapists，and using transfer lift，were necessary.