ケアスタッフのPerson-centred Careの意識や実践を測定するための尺度の開発に関する研究の動向

Trends of Developing of Tools to Assess Attitudes and Practice Regarding Person-centred Care Among Care Staffs

　Person-centred Careの実践をめざした取り組みにおいて，認知症高齢者の変化とケアスタッフの意識や実践の変化を評価することは重要である。特にPerson-centred Careの実践を簡便に評価する手法として，スタッフに対する質問紙法は有効である。しかし，スタッフのPerson-centred Careの意識や実践の評価尺度は，開発・使用された地域や施設形態などで，長期療養施設における個人のニーズや興味を重視したケア（individualized care），長期入所施設における業務よりも人を第一に考えた取り組み（person-directed care）などと名称に相違がある。その原因として，Person-centred Careの基本概念の多義性が影響していると考えられた。

　本稿では，医療施設のスタッフを対象として開発された「Measure of individualized care」「Person-centred climate questionnaire-staff version」「The person-centred care of older people with cognitive impairment in acute care scale（POPAC）」，長期入所施設のスタッフを対象とした「Approaches to dementia questionnaire（ADQ）」「Person-directed care measure」「The person-centered care assessment tool（P─CAT）」「Measure of individualized care」「The tool for understanding residents' needs as individual persons（TURNIP）」など，さまざまな評価尺度を紹介している。

　これらの評価尺度の中で日本語版の検討がなされているのは，ADQのみであり，今後日本においてさらなる尺度の開発が必要である。また，欧米では，Person-centred Careの意識や実践に関する評価だけではなく，その実践を可能にする看護師の達成感や自信に関する尺度も開発されており，看護現場におけるPerson-centred Careの実践をさまざまな側面から検討していくことの重要性が示唆された。

　In practice, when evaluating person-centred care (PCC)，capturing changes in the elderly with dementia as well as changes in attitudes and practice methods of the care staff, is important. The questionnaire method is an especially effective and simple approach used to evaluate PCC in practice. However, depending on the locations and/or types of facilities where the tool was developed/used, the evaluation index, which is used to determine the attitudes and practice methods among the care staff, is often named in a different way, such as “individualized care” or “person-directed care”. Ambiguity of the basic concept for PCC was considered to be influential as a significant cause of this phenomenon. The following evaluation indexes have been developed and introduced for staff members working at medical facilities; Measure of individualized care, The person-centred climate questionnaire-staff version，The person-centred care of older eople with cognitive impairment in acute care scale (POPAC)．Also, the following evaluation indexes have been developed and introduced for staff members working at long term care facilities; Approaches to Dementia Questionnaire (ADQ)，Person-Directed Care Measure，The person-centered care assessment tool (P-CAT)，Measure of individualized care，The Tool for Understanding Residents' Needs as Individual Persons (TURNIP．Among these evaluation indexes, ADQ is the only tool being discussed with regards to being translated into Japanese; therefore further development of a Japanese version of evaluation tools is required. Moreover, in Europe, questionnaires for evaluating a sense of accomplishment and confidence among nurses, which allows them to practice, are also developed in addition to the tools for evaluating their attitudes and practice as related to PCC. That said, it was suggested that discussions regarding PCC in the nursing practice from various perspectives, is important.