セルフマネジメントプログラムを適正に機能させる運用システムの開発—看護師の適正な援助行動に対する強化

Developing an Operational System to Ensure Proper Functioning of the Patient Self-management Program: Reinforcing Nurses' Helping Behaviors

要旨

　目的：患者のセルフマネジメントプログラムを機能させるために，看護師に対する強化の原理を活用した運用システムの効果を検討した．

　方法：運用システムは，患者にプログラムに基づく判断の正否を看護師がFeedbackする行動（以下，FB行動）をリーダーが分化強化する．セルフマネジメントプログラムに運用システムを組み込み，病院A・Bに導入し，Standard-care期（S期），Intervention期（I期），Follow-up期（FU期）を設定した．

　結果：I期に看護師のFB行動実行率は増加し，FU期で維持され，患者の判断実行率も増加した．病院A・Bで看護師のFB行動適正率は78.0％，70.9％に増加し，患者の判断適正率が69.5％，74.7％に増加した．

　結論：運用システムは，セルフマネジメントプログラムに基づく看護師の適正なFB行動を増加させ，患者の適正な判断を増加させた．

　Aims: This study aimed to develop an operational system based on the reinforcement principle for nurses to ensure proper functioning of the patient self-management program.

　Methods: In the operational system, leader nurses provide differential reinforcement to the nurse's feedback behavior on the correctness of the patient's judgment. The system was incorporated into the self-management program and introduced to hospitals A and B, with Standard-care phase, Intervention phase (I phase), and Follow-up phase (FU phase) settings.

　Results: During the I phase, the nurses' feedback behavior execution rate increased and was maintained during the FU phase. The patient's judgment execution rate also increased during the I phase. The feedback behavior adequacy rate of nurses at hospitals A and B increased to 78.0% and 70.9%, respectively, while the patient's judgment adequacy rate increased to 69.5% and 74.7%, respectively.

　Conclusions: These results demonstrate that this system increased not only the appropriate feedback behavior of nurses based on self-management program but also the patient's appropriate judgment.