脳神経病棟看護師向け「身体拘束外し多因子介入プログラム（MIN-PR）」の実装とアウトカム評価

The Implementation Study and Outcome Evaluation of “Multifactorial Intervention Program for Nurses in Removing Physical Restraints(MIN-PR)” in Brain Neurological Care Settings

抄録

【目的】「身体拘束外し多因子介入プログラム（以下，MIN-PR）」を開発・実装し，実装アウトカムである脳神経病棟看護師（以下，看護師）の採択，実行可能性，適切性，受容性，価値観，優先度を評価した．

【方法】MIN-PRは，身体拘束や認知症ケアに関する看護師への教育介入，多職種チームアプローチ，身体拘束の代替援助で構成した．老人看護専門看護師が看護師28人に介入した．その後，実装アウトカムについて10段階評価および半構造化面接を行い，分析は記述統計および内容分析を行った．

【結果】実装アウトカムである優先度（5.0），採択（5.1）が低値であり，受容性（8.4），適切性（7.4），価値観（7.2）は高値であった．内容分析では「身体拘束を外す援助を実施する」（適切性），「業務が優先される」（優先度）などのコードが抽出された．

【結論】MIN-PRの実装により看護師が身体拘束を外す援助を実践することができたが，業務が優先される組織風土もあるため，現場の状況に沿ったMIN-PRに修正していくことが必要である．

[Purpose] We developed and implemented “a multifactorial intervention program for removing physical restraints (MIN-PR)” and evaluated the implementation outcomes of adoption, feasibility, appropriateness, acceptability, values, and priority of neurological ward nurses.

[Method] MIN-PR consisted of education for nurses on physical restraints and dementia care, multidisciplinary team approach, and alternative methods of support to physical restraints. A gerontological nursing Certified Nurse Specialist administered intervention to 28 nurses. Afterwards, a 10-point rating and semi-structured interviews were conducted regarding the implementation outcomes. Analysis was performed using descriptive statistics and content analysis.

[Result] The implementation outcomes of priority (5.0) and adoption (5.1) had low scores, while acceptability (8.4), appropriateness (7.4), and values (7.2) had high scores. Content analysis extracted codes such as “Assisting to remove physical restraints” (appropriateness), and “Tasks take priority” (Priority).

[Conclusion] The implementation of MIN-PR enabled neurological ward nurses to provide assistance in removing physical restraints, but because some organizational climates prioritize work, it is necessary to modify MIN-PR to suit the situation on site.