身体疾患により急性期病棟に入院する認知症高齢者の日常生活援助における看護実践のプロセス—自律に焦点を当てて

Processes Related to Nursing Practices in Personal Care for Elderly People with Dementia and Who Are Hospitalized in the Acute Ward due to Physical Illness: Focusing on Autonomy

要旨

　目的：急性期病棟に入院する認知症高齢者への日常生活援助における自律に焦点を当てて看護実践のプロセスを明らかにすること．

　研究方法：急性期病棟にて認知症高齢者への日常生活援助場面の参加観察と看護師への半構成的面接を実施し，修正版グランデッド・セオリー・アプローチ（M-GTA）を用いて分析した．

　結果：研究参加者は2施設3病棟の看護師21名であった．急性期病棟における認知症高齢者の日常生活援助において自律の尊重に繋がる看護実践のプロセスとして【自律尊重への足掛かり】から【自律を保持する支援】へと向かうプロセスが捉えられた．一方で対極となる自律の尊重に繋がらない看護実践のプロセスとして，【認知症高齢者の意思軽視】から【置き去りになる自律】へと向かうプロセスが捉えられた．

　結論：自律の尊重に繋がる看護実践のプロセスは，認知症高齢者の尊厳を保った看護実践として急性期病棟でも活かせるものである

　Purpose: To capture the processes of nursing practices that focusing on autonomy in personal care for elderly people with dementia and who are hospitalized in the acute ward due to physical illness.

　Methods: Research design: Qualitative and inductive research using a modified grounded theory approach (M-GTA). Two types of data were used in the study: (1) field notes based on participant observations and (2) verbatim records of formal interview data.

　Results: Fieldwork took place at three acute wards in two hospitals. Participant observations and interviews were conducted with 21 nurses. The processes of nursing practices enable respect for the autonomy of elderly people with dementia in the acute ward leads from [A stepping stone to the respect for autonomy] to [Support for maintaining autonomy]. The process that does not lead to the respect for autonomy is a case where the nurse's <Prejudice against dementia> leads to [Ignoring autonomy] by [Paying little attention to the will of the elderly people with dementia].

　Discussion: The process of nursing practice enable respect for autonomy can be utilized in the acute ward as a nursing practice that maintaining dignity of the elderly people with dementia.