介護老人保健施設での医療行為において認知症高齢者のpersonhoodを維持する看護実践

Nursing Practices for Medical Procedures to Maintain Personhood of Older People with Dementia at Geriatric Health Services Facilities

抄録

　本研究の目的は，介護老人保健施設（以下，老健）において医療行為を実施する際に，認知症高齢者のpersonhoodを維持するための看護実践を明らかにすることである．豊富な認知症ケアの実践経験を有する看護師8人を対象に半構造化面接を行った．質的記述的に分析した結果，【本人が望む生活を軸に医療行為の必要性や優先度を検討する】【理解力に合わせた納得できる方法で説明を行う】【医療行為をどのように受け止めているかを汲み取ったうえでかかわる】【医療行為を日常生活に溶け込ませるように実施する】【安全で痛みや不快感が少なく医療行為を実施できるように工夫する】の5カテゴリーが生成された．本研究では，personhoodを高める相互行為であるポジティブ・パーソン・ワークに相当する看護実践が多く見いだされた．また，老健の看護師は，医療行為を日々のケアと一続きであるととらえ，その人らしい日常生活を維持しながら実施できるよう工夫しているという特徴が示された．

　This study aimed to elucidate nursing practices employed to preserve the personhood of older people with dementia when performing medical procedures in geriatric health services facilities. Semi-structured interviews were conducted with eight nurses with extensive experience in dementia care. Through a qualitative descriptive analysis, the following five categories were identified: “Determining whether medical procedures are necessary or a priority for the person to live their desired life,” “Providing explanations satisfactorily to the person's ability to understand,” “How the person perceives the medical procedures is considered before involvement,” “Performing medical procedures in a way that integrates them into daily life,” and “To ensure medical procedures are performed safely, causing minimal pain and discomfort.” Many of the nursing practices identified in this study aligned with the principles of positive person-work, reflecting positive interactions that bolster personhood. The study also showed that nurses in geriatric health service facilities consider medical procedures a continuum of daily care and try to implement them while maintaining the person's daily life.