急性錯乱状態患者に対する看護婦の診断に至る過程—情報の活用に焦点を当てて

Nurses' Diagnostic Process of the Patient with Acute Confusional State: Focus on the Way to Use Clinical Informations

はじめに

　急性錯乱状態（Acute Confusional State）は一過性の脳の機能低下による徴候・症状の一群と言われ^1），その代表的な症状としては，居場所が分からなくなりつじつまの合わないことを言う，突然チューブ類を抜去するなどがあげられる。本邦ではせん妄，ICU症候群，術後精神障害等として知られている。その発生頻度はICU入室後患者で30〜60％^2），入院・術後高齢者では24〜80％^3,4）と報告されている。病態生理学的・発達段階的・状況的要因の複雑な相互関係に基づくとされる急性錯乱状態は，難易度の高い手術や高齢患者の増加などに伴い，ますます見逃すことのできない重要な合併症のひとつとなることが予測される。

　1970年以前の急性錯乱状態の介入・研究は，主として精神医学や心理学領域で精力的に検討されてきた^5）。1970年以降，看護学領域においても，発症要因，看護介入と予防的看護，発生頻度などの研究が盛んに行なわれはじめ，看護独自の機能と意識の高まりが示されつつある。

　The Purpose of this study was to describe the nurses' diagnostic process of the patient with the Acute Confusional State and the differences between nurses who have the shorter experience of their job and the longer one.

　Subjects were 20 nurses (average age 25.1, SD=3.32) who currently work at the ICU, CCU, and the surgical ward. Interview technique was used to collect the data.

　The following results were obtained.

　1) The informations which nurses paid attention to could be classified into “cognitive patterns”, “attitude and behavioral patterns”, “emotional patterns” and “physical patterns”. And these contents were the typical symptoms of Acute Confusional State, the causes of confusion and the prodromal symptoms.

　2) Nurses interpreted and set up one or plural hypothetical diagnoses concerning with the causes of confusion and the other health problems which had common symptoms.

　3) The main diagnostic criteria of Acute Confusional State which nurses showed were disorientation, perception disorder, delusion, dangerous behavior, hypoprosexia, inappropriate communication, persistent desiring and repeated inappropriate behavior, hyperkinesis, and physical harm.

　4) About more than half the subjects set up one hypothetical diagnosis from plural informations, and verified it by re-information-seeking.

　5) Nurses who had longer experience paid attention to and got more informations from various origins of information, used more internal and external resources, and verified the plural hypothetical diagnoses with seeking informations.