保険制度外の訪問看護の実態に関する調査研究

Research and Study on Actual Situation of Visiting Nursing Outside of the Insurance Benefits

要旨

目的：本研究は，保険制度外の訪問看護の実践を把握し，その実践をする訪問看護ステーションの特性を明らかにする．

方法：多職種が協働する場への参加がある5地域の訪問看護ステーション145カ所に，保険制度外の訪問看護の実態，事業所の体制に関する自記式質問紙を郵送した．分析は保険制度外の訪問看護実践の有無の2群に分けて，事業所の体制の属性を比較検討した．

結果：有効回答は58カ所，そのうち20件に保険制度外の訪問看護の実践があった．その実践は，利用者が看護を受けたい，家族が家庭内の役割を担いたい，という理由が多かった．保険制度外の訪問看護の実践は，職員の実人数，利用者の人数や延べ訪問回数，保険制度外の訪問看護の自費設定をしていた事業所が多かった．両群では多職種協働する場への参加に差はなかった．

結論：保険制度外の訪問看護は，規模の大きい事業所が利用者や家族からのニーズを汲み取り，実践に組み替えていた．

Purpose: The aim of this study was to clarify the actual situation and characteristics of visiting nursing agencies providing visiting nursing outside of the insurance benefits.

Methods: A self-administered questionnaire survey was distributed by mail to 145 visiting nursing agencies in five municipal districts working to participate in multidisciplinary collaboration situation regarding the actual situation they were providing nursing services outside of the insurance benefits as well as the characteristics of their visiting nursing agency. The visiting nursing agencies were then divided into two groups according to whether they practiced visiting nursing outside of the insurance benefits and compared.

Results: Responses were received from 58 of the 145 visiting nursing agencies, among which 20 practiced visiting nursing of the insurance benefits. The reason they were providing visiting nursing outside of the insurance benefits was because of the following aspects: the users require professional nursing care, the families wish to fulfill their roles. These 20 agencies had high numbers of users and staff members, performed a significantly higher frequency of home visits, and had set up a payment system outside of the insurance benefits for visiting nursing. No significant differences were seen between groups regarding participation in multidisciplinary collaboration.

Conclusions: Large visiting nursing agencies understood the needs of users and families rearranged their schedules to accommodate visiting nursing outside of the insurance benefits.