急性期病院において認知症ケアを推進する看護師の活動上の障壁と克服過程

Obstacles Faced by Nurses in Care Activities for Dementia Patients at an Acute Care Hospital and the Process to Overcome Such Obstacles

要旨

　目的：急性期病院にて認知症ケアを推進する看護師（以下，推進者）の活動上の障壁と克服過程を明らかにする．

　方法：推進者11名を対象に3〜4名毎のフォーカスグループインタビューを行い，質的統合法（KJ法）にて分析した．

　結果：推進者は，急性期病院にて【葛藤しつつ身体拘束に頼る土壌】と【温度差による行き詰まり】の2つの障壁を認識しており，これらに通底していたものは病院組織の認知症ケアを後回しにしてしまう価値観であった．しかし【推進者の思いを基盤とした活動】と【チームを基盤とした活動】の両面からの活動の結果，【組織的な成果の実証】に至っていた．その支えに【活動継続のための原動力】があった．

　結論：推進者は障壁に対し，自身の信念の体現と全体へ波及するチーム作りという活動を継続し，原動力をもって長期的計画の段階的実施により成果を実証していた．この過程には組織による推進者への支援が不可欠である．

　Purpose: To identify obstacles faced by nurses (hereinafter referred to as promotors) in the promotion of care activities for dementia patients at an acute care hospital, and the process to overcome such obstacles.

　Method: Focus group interviews targeting 11 promoters were conducted in groups of 3-4 persons. Results were analyzed using the qualitative synthesis method (KJ method).

　Results: Promotors were aware of two obstacles, namely “conditions which relies on physical restraint to handle conflict” and “reaching a dead end due to varying degrees of enthusiasm” at the acute care hospital. This was due to an underlying sense of value of postponing dementia care. However, as a result of the activities that have the characteristics of both “activities based on the intentions of the promotor” and “activities based on the team”, “verification of organizational achievement” was eventually achieved. A support called “driving force to continue activities” was present in proof of the result.

　Conclusion: Regarding obstacles, promotors expressed their own conviction with a driving force, and continued activities called team formation that spread to all, and verified achievement through phased implementation of a long-term plan. In this process, support for the promotors through an organization was essential.