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2報）—12脳神経を除く全身に焦点をあてて

Delphi Study on the Required Physical-Assessment Level of Stroke Patients by Nurses Part 2: Focus on Examination of Entire Body Except 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12脳神経を除いた全身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SRN126名に郵送で質問紙調査を3回行った．内容的妥当性と信頼性を検討した上で診査98項目を調査し，コンセンサスを示す同意率は51％に設定した．

結果：参加同意者は126名で，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62項目・回復期56項目，アセスメントレベルでは急性期32項目・回復期34項目がコンセンサスを得た．

結論：実践レベルの実施到達度が必要とされる項目は，脳卒中の発症に伴う機能障害の有無と程度，セルフケア能力をその場で看護師が判断すべき診査項目であることが示唆された．

Purpose: The aim of this study was to clarify the examination skills required for whole-body physical assessment except cranial nerves of stroke patients, and the item-assessment level in the acute and recovery phases of stroke that is regarded as being essential by Certified Nurses 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 stroke-rehabilitation certified nurses, from whom an expert panel was organized. The questionnaire consisted of 98 items regarding physical examination except for cranial nerves during the acute and recovery phases of stroke. An established consensus was defined based on 51% agreement on the results of the third survey.

Results: Participants included consented candidates that totaled 126, with responses from 105 for the first round, 86 for the second round, and 87 for the third round. The nurses reached a practice-level consensus on 62 acute- and 56 recovery-phase items. Furthermore, an assessmentlevel consensus was reached for 32 acute- and 34 recovery-phase items.

Discussion: The selected skills of practice-level items suggested the physical assessment of stroke patients, and degree and presence or absence of dysfunction associated with stroke onset as fields of exploration to determine self-care ability.