老人看護専門看護師または認知症看護認定看護師が勤務する医療機関で行われたコロナ禍での院内デイケア

In-Hospital Daycare Services During the COVID-19 Pandemic at Medical Institutions that Employ Certified Nurse Specialist in Gerontological Nursing or Certified Nurse in Dementia Nursing

抄録

目的：老人看護専門看護師（以下，GCNS）または認知症看護認定看護師（以下，DCN）が勤務する医療機関で提供されている院内デイケアの実施方法および，コロナ禍を経験しながら継続している施設の特徴と感染予防対策のために生じた変化を記述し，院内デイケアを継続的に提供するための示唆を得ることである．方法：GCNSまたはDCNが勤務する医療機関1,101病院を対象にWeb調査を実施し，コロナ禍での実施群と中止群に分けて比較した．結果：有効回答率24.8％．コロナ禍では38か所（14％）の医療機関で実施されていた．院内デイケアの目的として実施群では，「BPSD・せん妄予防と改善」が中止群よりも有意に多かった．コロナ禍での工夫として，参加患者人数の縮小，プログラムの変更，職員数を減らすなどをして実施していた．考察：コロナ禍の多様な制約を受ける入院生活で，GCNSやDCNは院内デイケアの継続・中止の検討をしながら，認知症高齢患者によりよいケアを行うために柔軟に活動していた．院内デイケアは，認知症高齢患者の意欲低下やBPSD悪化予防および孤立感覚への対応などの患者ニーズからぶれない実施が，継続的な運営に必要であることが示唆された．

Objective: This study aims to explore the implementation methods of in-hospital daycare services provided at medical institutions that employ a Certified Nurse Specialist in Gerontological Nursing (GCNS) or a Certified Nurse in Dementia Nursing (DCN). Additionally, the characteristics of facilities that continued to provide these services throughout the COVID-19 pandemic and the changes introduced for infection prevention are identified. The overarching objective is to gain insights into how in-hospital daycare services can be sustainably provided.

Methods: An online questionnaire survey was conducted targeting 1,101 medical institutions that employ GCNSs or DCNs.

Results: The response rate was 24.8%. During the pandemic, 38 institutions (14%) continued to provide in-hospital daycare services. Among such facilities, significantly more cited “prevention and improvement of Behavioral and Psychological Symptoms of Dementia and delirium” as a primary goal, compared with those that suspended services during the pandemic. To adapt to the pandemic, various measures were implemented, such as reducing the number of patients, modifying or restricting programs, and decreasing staff numbers.

Discussion: GCNSs and DCNs demonstrated flexibility in their approach, continually evaluating whether in-hospital daycare should be continued or suspended while striving to provide better care for patients with dementia. The study suggests that in-hospital daycare needs to be implemented in a way that is consistent with the needs of patients with dementia, such as preventing deterioration of motivation and BPSD, and responding to a sense of isolation, in order to ensure its continuous operation.