認知症高齢者の足趾の爪切り実施時における介護老人福祉施設スタッフの困難と工夫に関する基礎的研究

Difficulties Experienced by Staff at Welfare Facilities for the Elderly Requiring Long-term Care when Cutting the Toenails of Residents with Dementia and Related Strategies

要旨

　本研究は、今後実施予定の足趾の爪ケアの量的探索的集団調査の構造化質問紙の内容を検討することを目的に、特養における介護士5名と看護師3名を対象として、認知症高齢者に対する足趾の爪切りにおいて感じている困難と工夫の内容を質的記述的に明らかにした。対象者が感じている困難の内容は、①ケア行為の特殊性によって助長される認知症の行動と心理症状（Behavioral and Psychological Symptomsof Dementia；以下，BPSD）への対応や、②予測不能な状況や危険性への対応に関すること、③業務が忙しく手が回らない、裁量権が限られているなどやりたくてもやれないジレンマが明らかとなった。BPSDへの対応や、リスクマネジメントに関する意識の高さが伺われ、様々な工夫がなされていたが、職種役割や裁量権に関係するジレンマについては、積極的な対応は確認できなかった。

　以上をもとに、高齢者のフットケア教育のあり方を検討していくための構造化質問紙の内容を考察した結果、①足趾の爪ケアに影響を及ぼすケア提供環境、②ケア技術やリスクマネジメントの教育背景との関連、③職種役割や裁量権が足趾の爪ケアの実施に及ぼす影響の3点が考えられた。

Abstract

　In the present study, we qualitatively and descriptively clarified the difficulties experienced by 5 care workers and 3 nurses at welfare facilities for the elderly requiring long-term care(special nursing home for the elderly) when cutting the toenails of residents with dementia, and the details of related strategies, with the objective of investigating the contents of a structured questionnaire for a quantitative exploratory population survey on toenail care scheduled to be implemented in the future. Difficulties comprised 1) dealing with behavioral and psychological symptoms of dementia(BPSD) provoked by the characteristics of care activities; 2)dealing with unpredictable and dangerous situations; and 3)the dilemma of being unable to cut the toenails even if willing to due to factors such as being too busy and the limited discretionary power of care workers and nurses. High levels of awareness were observed regarding dealing with BPSD and risk management, and various strategies were employed. However, the dilemma between job role and limited discretionary power were not proactively handled.

　The contents of the structured questionnaire for investigating methods of education on foot care for elderly individuals were considered based on the above findings, and the following three points were identified: 1)the care provision environment affecting toenail care; 2)the relationship between care techniques and educational background regarding risk management; and 3)the effects of job role and limited discretionary power on the implementation of toenail care.