看護の経験年数別にみた病院の老年看護の実態

Educational Needs of Clinical Nurse Specialists for the Elderly

　病院における老年看護の実態を把握し，老年看護専門看護師教育を検討する目的で自記式質問紙を用い調査を実施した．調査対象は，3つの総合病院の65歳以上の患者30％以上を占める病棟の看護婦279名．有効回答245名．分析は，看護経験年別，経験3年以下群，経験3〜10年群，経験10年以上群の3群に分類し検討し，以下のことが明らかになった．（1）日常生活援助で,「一定時間ごとの排泄」「義歯の手入れ」に対し「よく行う」の回答は，経験10年以上群が最も高率，各経験年群間に有意差を認めた．(2)「褥瘡の予防法」では,「皮膚の清潔・乾燥」に，経験10年以上群は最も高率を示す回答，各経験年群間に有意差を認めた．(3)「老人の接し方で注意すること」では，「個人の価値観・人生観を大切に」の回答は，経験10年以上群が最も高率，経験3〜10年群は低率を示し，両群間に有意差を認めた．（4）「老人の精神安定になること」では，「家族の面会」の回答は，経験10年以上群が最も高率，3〜10年群との間に有意差を認めた．(5)「福祉情報提供状況」では，情報を「時々提供している」の回答は，経験10年以上群が最も高率，一方「あまり提供していない」と「まったく提供していない」を合わせ，経験3年以下群が高率，各経験年別群間に有意差を認めた．(6)「老人ケアで困ること」では，「家族の受け入れが悪い」の回答は，経験10年以上群は最も高率，他経験年群間と有意差を認めた．（7）「老人のケアで嫌なこと」では，嫌なことは「ない」の回答が経験10年以上群は最も高率，3年以下群は低値であったが有意差はなかった．10年以上の経験は専門職としての役割，使命感がつちかわれ「嫌なこと」と捉えていないのであろう．（8）「老年看護で深めたいこと」では，経験10年以上群は「老人のQOL」と「ADL援助」の2項目のみであったが，経験の少ない群は，学びたい項目が多かった．各経験年群間に有意差を認めた．以上，10年以上の経験者は老年看護の実践面で，熟練者に相応しい対応，専門職者の責任感，考え方などが，経験少ない者と相違を示した．老年看護専門看護師には，スタッフの教育，管理，医療福祉，人間理解など多面的な教育が必要である．

　The purpose of this study is to assess nursing care among nurses engaged in the care of the elderly in general hospitals. The subjects of the study were 245 nurses in three general hospitals (279 responses; inactive nurses were excluded, leaving 245 registered nurses who were the subjects of this analysis). Three groups were classified among the nurses: A group with less than 3 years experience, B group with 3 to 10 years experience and C group with more than lOyears experience. The self-administered questionnaire-survey took place from October to December in 1994 and the following results were obtained: (1) Regular Time Given to Bedpan and Dental Care: Significantly higher results were recorded by C than for A and B. (2) Bed Sore Prevention: Care by keeping the skin clean and dry; results were significantly higher among C than A and B. (3) Patients Welfare: Giving the elderly attention and encouraging their family to visit them in order to support their emotional stability; recorded significantly higher with C than B. (4) Social Welfare: Informing the patient and family about welfare procedures was significantly higher among C than A and B. Recommending the offices of a social worker was common to all. (5) Leaving Hospital: Non-acceptance of discharged patients as the worst problem was reported more significantly among C than A and B group. (6) Nurses' Attitude to Care: Most answered that while there were many difficulties these were not serious obstacles. (7) Further Training: C group wants further instruction in the two categories, the quality of life for the elderly and ADL care, and A and B groups want instruction in many kinds of categories. The results of this questionnaire show that group C (more than 10 years experience) proves that nursing skills are higher with experienced professionals. The necessity to train nurses to be specialists in the many aspects of nursing the elderly, e.g., management, law, coordination, as teaching-staff ,etc. is readily observable from the questionnaire answers.