精神科訪問看護で提供されるケア内容―精神科訪問看護師へのインタビュー調査から

Nursing Interventions Provided by Psychiatric Home Visit Nurses in Japan

要旨

　精神障害者に対する地域ケア施策において，精神科訪問看護は重要な役割を担っている．その効果については，精神科病棟への再入院の防止と在院日数の減少に影響を与えることが報告されているものの，提供されているケアの具体的な内容については十分に検討されていない．本研究は，精神科訪問看護で提供されているケア内容を網羅するケアリストを作成することを目的に，精神科訪問看護師18名を対象に，行った看護ケア内容についてインタビュー調査を行った．得られた援助内容について質的に分析し，「日常生活の維持.生活技能の獲得・拡大」「対人関係の維持・構築」「家族関係の調整」「精神症状の悪化や増悪を防ぐ」「身体症状の発症や進行を防ぐ」「ケアの連携」「社会資源の活用」「対象者のエンパワメント」の8つのケアの焦点と，それぞれの焦点について合計58のケア領域と222のケアコンテンツからなるリストを作成した．今後は，このリストを用いてケアの内容と量を測定していくことが期待される．

Abstract

　Psychiatric home visit nursing provides an important role in community care for people with mental disorders. Several reports indicated that home visits were associated with rate reduction of readmission to psychiatric wards and reduced hospital stays, however the type of care provided by visiting nurses has not been described. Thus, this study developed a description and categorization of care provided in psychiatric home visit nursing.

　Interviews were conducted with 18home visiting nurses.Data were analyzed qualitatively, and eight foci of care were extracted with 58care domains and 222care contents listed. The foci of care included：1) maintaining everyday life/life skills acquisition and expansion, 2) maintaining and building interpersonal skills, 3) coordinating family relationships, 4) psychological support / preventing the exacerbation of psychosis, 5) providing physical care / preventing exacerbation physical symptoms, 6) creating support networks / cooperating in community psychiatric support system, 7) facilitating social support use, 8) empowering consumers. This research contributes to ongoing efforts to identify and measure the amount and content of care as well as to the development of standards of practice for the psychiatric home visit.