デルファイ法による脳卒中患者に必要なフィジカルアセスメントの検討（第1報）—脳神経に焦点をあてて

Delphi Study on the Required Level of Physical Assessment of Stroke Patients by Nurses Part 1: Focus on the Examination of the Cranial Nerves

要旨

目的：脳卒中リハビリテーション看護認定看護師（以下SRN）が活用の必要性を認識している，脳卒中患者に対する脳神経のフィジカルアセスメント項目を明らかにし，臨床現場において望まれる実施到達度とその項目について検討することである．

方法：デルファイ法を用いて，全国のSRN 126名に，郵送にて質問紙調査を3回行った．内容的妥当性と信頼性を検討した脳神経の診査40項目について調査し，コンセンサスを示す同意率は51％に設定した．

結果：第1回調査105名・第2回調査86名・第3回調査87名から返信があり，実践レベルでは急性期30項目・回復期23項目，アセスメントレベルでは急性期8項目・回復期7項目がコンセンサスを得た．

結論：実践レベルが選択された項目は，看護師が臨床場面で正常・異常の判断を行うことが必要な項目であり，アセスメントレベルが選択された項目は，多職種の情報を共有することが可能な項目であることが示唆された．

Purpose: This study aimed to clarify the skills required by nurses for the physical assessment of the cranial nerve in stroke patients to conduct this test and whether any item can be practiced at any level of the acute and recovery phases, which is regarded as essential by Certified Nurse in Stroke Rehabilitation Nursing (SRN).

Method: The Delphi method was used for this quantitative descriptive study. A newly developed self-administered questionnaire was distributed by mail to 126 certified nurses in stroke rehabilitation nursing, with whom, the expert panel was organized. The questionnaire comprised 40 items regarding cranial nerve examination during the acute phase and recovery phase. An established consensus was defined by 51% agreement on the third survey results.

Result: The nurses reached a practice-level consensus on the 30 acute phase items and the 23 recovery phase items. Furthermore, an assessment-level consensus was reached for 8 acute phase items and 7 recovery phase items.

Discussion: The selected practice-level items suggested the necessity for nurses to make a clinical determination of normal or abnormal status. The selected assessment-level items suggested greater applicability for determining an appropriate nursing intervention and evaluating using multidisciplinary support.