放課後等デイサービスにおける医療的ケア児を受け入れる体制整備の現状と課題に対する認識—看護師5名のインタビューから

Recognition of Current Situation and Issues in Establishing a System to Accept Children Requiring Medical Care into After-School Daycare: From Interviews with 5 Nurses

要旨

　目的：放課後等デイサービスでの医療的ケア児の受け入れの現状と課題に対する看護師の認識を明らかにする．

　方法：探索的研究であり，質的記述的研究デザインである．医療的ケア児を受け入れている放課後等デイサービスの看護師5名を対象に半構成的面接を実施した．

　結果：現状は，医療安全面と人的体制面に，課題は1つのテーマに分類した．医療安全面は「家庭でのケア方法の共有」，「予防の視点を持った観察」，「体調管理に関する役割分担の明確化」，「危機管理」があった．人的体制面は「継続したケアの構築」，「他職種との連携」，「看護師への支援体制の構築」であり，課題は「安全な事業所運営のための人員確保」，「経営の難しさ」，「受け入れが困難な子どもがいる歯がゆさ」，「退院時の在宅療養の視点の欠如」，「長期的な療育の視点の欠如」があった．

　結論：看護師は感染・災害・医療安全対策，急変時の対応等について事業所の体制整備の必要性を認識されていた．人員確保や経営の難しさを課題として捉えていた．

　Objective: To clarify nurses' recognition of the current situation and issues surrounding the acceptance of children requiring medical care at After-School Daycare.

　Methods: This was an exploratory study with a qualitative descriptive research design. Semiconstructive interviews were conducted with five nurses at After-School Daycare that accepts children requiring medical care.

　Results: The current situation was categorized into medical safety and human resource management, and the problems were categorized into one theme. The medical safety aspects included “sharing care methods at home,” “observation from a preventive perspective,” “clarifying the division of roles regarding physical condition management,” and “crisis management.” The human resource system included “establishment of continuous care,” “cooperation with other professions,” and “establishment of a support system for nurses,” while the issues included “securing personnel for safe operation,” “difficulties in management,” “frustration that some children are difficult to accept,” “lack of a perspective on home care upon discharge,” and “lack of a perspective on long-term medical care and education.”

　Conclusion: The nurses at After-School Daycare that accepts children requiring medical care, recognized the need to establish a system for infection control, disaster management, and medical safety measures, as well as for responding to sudden changes in medical conditions. They recognized the difficulty of securing personnel and management as issues.