要介護高齢者の社会に関与する自発性を引き出す看護実践の要素—社会貢献への支援における要介護高齢者と看護師の関わり合いから

Key Elements of Nursing Practice That Promote Self-Motivated Social Engagement in Older Adults Requiring Long-Term Care:Insights from Interactions between Nurses and Care Recipients

抄録

　本研究の目的は，要介護高齢者の社会貢献への支援を行い，その支援における要介護高齢者と看護師関わり合いから，要介護高齢者の社会に関与する自発性を引き出す看護実践において重要となる要素を明らかにすることである．要介護高齢者4人への関わり合いの意味から，看護実践の要素を導き，質的帰納的に分析した．その結果，社会に関与する自発性を引き出す看護実践の要素は，【老いと障害による苦悩を生きる高齢者とその苦悩に寄り添い共揺れする】【老いと障害による内的体験を鵜呑みにせず真のニーズをとらえる感受性を研ぎ澄まし実践する】【患者—看護師関係を超えて取り巻く人々の力を借りその人らしさを見いだす実践を継続する】【当事者の他者に関与する力を信頼し，共に育ち合い喜び協奏者として看護実践を磨く】であった．苦悩に共揺れしつつ感受性を磨いて個別性を導くという援助関係を形成する力に加え，関係者を巻き込み，要介護高齢者の他者に関与する力を信頼して協奏者となる態度を基盤に，要介護高齢者が社会に関与できる主体として再び立ち現れるプロセスを共に創造していくことが重要である．

This study explores the key elements of nursing practice that elicit self-motivated social engagement among older adults requiring long-term care, based on the interaction between nurses and care recipients while supporting the recipients' roles as active members of society. Through qualitative inductive analysis, we investigated the significance of interactions between nurses and four older adults requiring care, with the aim of deriving the key elements of nursing practice. Based on the analysis, the key elements of nursing practice that elicit self-motivated social engagement were as follows. First, nurses remain fully present with older adults, sharing in their emotional journey as they navigate the challenges of aging and disability. Second, they refine their sensitivity to better discern genuine needs beyond superficial expressions of internal struggles with aging and disability. Third, they extend beyond the nurse-recipient relationship to provide ongoing support and work together with the community to help older adults uncover and sustain their sense of self and individuality. Fourth, they trust in the capacity of those involved to engage with others while fostering mutual growth as joyful collaborators in nursing practice. In addition to relationship-building skills that resonate with patients' struggles and enhance sensitivity to identify individual needs, it is essential for nurses to involve other stakeholders and, with an attitude of trusting the ability of older adults in long-term care to engage with others, become collaborators who help co-create the process through which they re-emerge as active participants in society.