2. 公的介護保険制度制定年以降の事例研究における高齢者の血液透析継続上の看護問題・課題に関する文献研究

A review of nursing problems from case studies of the elderly undergoing hemodialysis treatment following the enactment of public long-term care insurance

　本研究の目的は，公的介護保険制度制定年以降に報告された血液透析継続上の高齢者の事例研究における看護問題・課題を明らかにすることである．

　「医学中央雑誌Web版Ver5.0」において，「看護」「高齢者」「介護」「血液透析」をキーワードとして2016年2月24日に文献検索した．抽出された事例研究57件中，60事例を【高齢者の看護問題】【家族の看護問題】【支援システムの課題】に分類し，看護問題・課題を分析した．研究対象の看護問題は【高齢者の看護問題】「非効果的健康管理」（13件），【家族の看護問題】「介護者役割緊張，家族機能障害」（11件），【支援システムの課題】「在宅療養支援体制の不足」（9件）の順に多かった．【高齢者の看護問題】「非効果的健康管理」は，食事・服薬管理など高齢者自身の自己管理に関する研究，「介護者役割緊張，家族機能障害」は家族の介護負担感に関する研究，「在宅療養支援体制の不足」は，すべて在宅支援体制の未整備に関する研究であったが，地域包括ケアによる多職種連携・介護保険制度の活用により看護問題・課題解決策を導くことができていた．

　これらの結果から，血液透析受療中の高齢者・家族には地域包括ケアによる多職種連携・介護保険制度の活用が看護問題・課題解決策を導く手段として有用であることが示された．

　The purpose of this study was to analyze nursing problems reported following the enactment of the public long-term care insurance system based on case studies of the elderly receiving hemodialysis treatment. A literature search was conducted on February 24, 2016, using Igaku Chuo Zasshi （ICHUSHI） Web version Ver. 5.0 with the keywords “nursing”“elderly”“care” and “hemodialysis.” The characteristics of nursing problems were analyzed after the research content was classified into “nursing problem of the elderly,”“family nursing problem,” and “issues with the support system”. Of the 57 case studies, 60 cases examined, the most numerous problems were “nursing problem of the elderly” and ”ineffective health management” （13 cases）, “family nursing problem” and ”nervousness in caregiver duties and family dysfunction” （11 cases）, and “issues with the support system” and “lack of home medical support system” （9 cases）. For “nursing problem of the elderly” and “ineffective health management,” studies related to the self-management of meals, medication, etc., were the most numerous. For “nervousness in caregiver duties and family dysfunction,” studies related to caregiving ability and sense of responsibility were the most numerous, and for “lack of home medical support system,” it was studies related to the inadequacy of home support systems. We were able to guide nursing problems solution by utilizing multi-occupational collaboration and nursing care insurance system through regional inclusive care. These finding indicated that for the elderly and family receiving hemodialysis treatment, it is beneficial as a means to guide nursing problems solving measures by utilizing multi-occupational collaboration and nursing care insurance system by community inclusive care.