日本語版NEECHAM混乱・錯乱状態スケールの術後せん妄対策としての導入可能性

Possibility of Introducing the Japanese Version of the NEECHAM Confusion Scale as a Strategy for Prevention of Postoperative Delirium

要旨

　消化器外科病棟で手術を受ける65歳以上の患者84名を対象に，看護師が日本語版NEECHAM混乱・錯乱状態スケールを用いて，術後1〜7日目までの患者の混乱・錯乱状態を評価した．その後看護師31名を対象に，NEECHAMの使用をルーチンワークとする可能性等について質問紙調査を実施したところ，「スケールを使用してせん妄の観察力や判断力がアップした」という者は全体の22.6％，「スケール使用による業務負担が大きい」という者は76.7％，病棟でのスケール使用のルーティン化については，「今の忙しい病棟では望まないが，もう少し余裕のある状況であれば望む」が35.5％，「望まない」が38.7％，「なんともいえない」が22.6％であった．今後の課題として，事前研修や業務量などの環境調整，NEECHAM評価をいかに患者ケアに生かすかという観点からのスーパービジョンや，事例検討会の開催等の必要性が示唆された．

Abstract

　In this study, nurses working in a digestive surgery ward used the Japanese version of the NEECHAM Confusion scale to screen 84 elderly patients (＞65 years) for delirium and confusion on days 1-7 after gastrointestinal surgery. Subsequently, 31 nurses completed the questionnaires about the possibility of introducing the scale as a strategy for prevention of postoperative delirium. As a result, 22.6％ of the nurses reported that using the scale improved their observation and judgment skills, and 76.7％ reported that the burden of its implementation was very heavy. Furthermore, regarding the possible introduction of this scale, 35.5％ felt that the scale could not be introduced in current busy wards (units), but would like to it to be introduced if they had sufficient time. Another 38.7％ did not wish the scale to be introduced, and 22.6％ chose “Anything can be said about it.” As future subjects, the necessity of prior training, environmental management such as the amount of business, and supervision/case conferences with a viewpoint how to use the NEECHAM efficiently in patient care were suggested.