老人保健施設における介護事故予防の現状—安全管理体制と看護職員の安全意識に影響する要因

Current Status of Prevention of Care Accidents in Geriatric Health Care Facilities: Factors Influencing the Safety Management System and Safety Awareness of Nursing Personnel

要旨

　目的：老人保健施設で働く看護職員の安全に対する認識の現状と影響因子について明らかにし、老人保健施設の介護事故防止に必要な対策について検討した。

　方法：A県下老人保健施設165施設の看護職員2300名を対象に、無記名自記式質問紙調査を実施し、761名（回収率33.1％・有効回答率33.0％）を分析対象とした。

　質問紙は、職場の安全管理体制と個人の安全意識について佐藤ら（2003）ならびに、松原ら（2004）が作成した調査項目を一部改変して用いた30項目である。分析は、記述統計後、30項目については因子分析を行い尺度の信頼性と妥当性について検討した。その後、抽出因子と属性等との関連についてt検定ならびに一元配置分散分析と多重比較（Tukey）を用いて比較した。

　結果・考察：質問項目の信頼性としてCronbach αは約0.7〜0.8を示し、妥当性については、Kaiser-Meyer-Olkinは0.71を示した。抽出因子は5因子で＜職場の雰囲気＞＜安全確認行動＞＜人間関係＞＜事故予防対策＞＜事故予防行動＞と命名した。

　老人保健施設で働く看護職員は、年代が40代以上で看護職の経験年数が15年以上、現在の職場の勤続年数は1年〜5年未満の者が多いことが特徴であった。また、職場の安全管理体制と個人の安全意識については、年代・職位の高い者、経験年数・現在の職場従事年数などが長い者のほうの安全意識が高かった（p＜.05）。さらに、定員100人以上の施設で働く看護職員や研修の内容に関らず3回以上の研修を受けた者に安全意識が高い（p＜.05）ことが明らかとなった。年代・経験年数が高い者が多い集団であることから、安全に対する高い意識を持ち合わせた集団であることが推測できる。しかし、ベテラン特有の事故や定員100人以上で事故のリスクが高い入所者の増加による介護事故のリスクを予測した安全管理体制が必要と考える。以上から介護事故予防には、安全に関する研修会を開催するなど学習機会を有効に利用しながら施設で働く看護職員全員が同様な安全意識を持って業務を遂行できるような体制づくりが必要と示唆された。

Abstract

　Purpose: Current safety awareness of nursing personnel who work in geriatric health care facilities and factors influencing their awareness were determined to consider necessary measures to prevent accidents during nursing care for elderly people.

　Method: An anonymous self-completion questionnaire was administered to 2300 nursing personnel working at 165 intermediate care facilities in Prefecture A, Japan. Analysis was performed in 761 persons (collection rate 33.1%, valid response rate 33.0%). The questionnaire, composed of 30 items, was partially adapted from the survey items that were prepared by Sato et al. (2003) and Matsubara et al. (2004) for safety management systems in the workplace and personal safety awareness. Factor analysis was performed for 30 items to determine the reliability and validity of the scale after descriptive statistics. Additionally, the association between extracted factors and variables including attribution was tested and compared using the t-test, one-way analysis of variance, and a multiple comparison(Tukey).

　Results and discussion: The Cronbach alpha for the reliability of questionnaire items was approximately 0.7 to 0.8. Validity measured by the Kaiser-Meyer-Olkin value was 0.71. Five factors were extracted and these were "workplace atmosphere," "safety-checking behavior," "personal relationship," "accident prevention measures," and "accident prevention behavior." Characteristically, nursing personnel working in geriatric intermediate care facilities were likely to be in their 40s or older; most of them had more than 15 years' nursing experience and had been in service for one year to less than five years. The awareness of the safety management system in the workplace and personal awareness of safety were likely to be higher for those in older age brackets and those with high positions, many years of experience, or service years(P＜.05). It was also demonstrated that nursing personnel in facilities with a capacity of more than 100 and those who were trained more than three times irrespective of the type of training had a higher awareness of safety(P＜.05). A large percentage of the personnel was in higher ages and had many years of nursing experience, which suggests high awareness of safety in this population. However, the safety management system is required to predict risks in these geriatric health care facilities, such as veteran-specific accidents and nursing care accidents that can be caused by the increasing numbers of high-risk residents in facilities with a capacity of more than 100. The results of the study suggest that, to prevent care accidents, geriatric intermediate care facilities should establish a safety management system where all nursing personnel can provide service with the same level of safety awareness, making use of learning opportunities such as on-site safety training courses.