老人保健施設における痴呆性老人とケアスタッフの相互作用にみられるずれの特徴

Characteristic Discrepancy in Interactions between Demented Elders and Care Staffs in Geriatric Health Service Facilities

　本研究は，老人保健施設に入所している痴呆性老人とケアスタッフの相互作用に見られるずれの特徴を明らかにし，そのずれに関連する要素を検討する目的で行った．グラウンデッド・セオリー・アプローチを用いて，痴呆性老人とケアスタッフの相互作用を観察し，両者の反応や言動から相互作用にずれを起こしていると判断した54場面の分析を行い，以下の知見を得た．

1）相互作用のずれは，ケアスタッフが痴呆性老人の行為の意味や思いにどのように添っているかによって影響を受け，次の3つのカテゴリーを見い出した．

　カテゴリー1は，相手に一貫して添っていこうとしながらも発生する相互作用のずれで，それには[手探り][引いて待つ][向き合う]という小カテゴリーが認められた．

　カテゴリー2は，相手に添っていけない相互作用のずれであり，それには[譲らない][離れる]が見られた．また，[譲らない]には（1）両者が譲らない，（2）痴呆性老人が譲らない—ケアスタッフが折れる，（3）ケアスタッフが譲らない—痴呆性老人が折れるという3つのタイプを見い出した．

　カテゴリー3は，相手に全く添っていこうとしない相互作用のずれであり，これには[動かす][抑え込む]が見られた．

2）相互作用の分析から，ずれに関連する要素として痴呆のレベル，集団的ケア・個別的ケアおよび看護職・介護職の相違が認められた．

　[手探り][引いて待つ]には，痴呆レベルが重度の人に特徴的であった．

　[譲らない]は，痴呆レベルが軽度〜中等度の人で，集団的ケア・個別ケア場面の双方に，また看護職・介護職の両者に見られた．

　[動かす][抑え込む]は集団的ケアの場面に多く，痴呆レベルは中等度〜重度の人に特徴的で，軽度の人には全く見られなかった．

　以上から，痴呆性老人とケアスタッフの相互作用に見られるずれの実態の一端を示し，望ましい相互作用の方向性を検討した．

　This study aimed to elucidate the characteristics of the discrepancy in the interaction between the demented elders and the care staffs in geriatric health service facilities and to investigate the factors related to the discrepancy.

　The interactions between the demented elders and the care staffs were investigated according to grounded theory approach. A total of 54 scenes which were judged to be discrepant interactions based on their words and actions along with thier responses were analyzed and the following results were obtained.

　1) The discrepancies in their interactions were influenced by the content of staff's responses to the implications of the actions and wishes of the demented elders.

　Category 1 was discrepancies in the interaction which developed even though one made efforts consistently to serve the other's wishes. This category was characterized with the behaviors such as [groping], [waiting with discretion] and [facing each other].

　Category 2 was discrepant interactions producing unsatisfactory result in the other. This included [not conceding] and [leaving the other].

　The behavior, [not coceding] was further divided into three subcategories ; (1) Both refused to concede each other (2) The staff conceded to the elder and (3) vice versa.

　Category 3 was the discrepancies which developed due to the lack of mutual helping. This category included [let to move] and [holding].

　2) Based on the analysis of these interactions, an investigation was made on the discrepancy in respects of the relationship with dementia level, as a possible factor causing such discrepancy and also, the differences between group care and individual one, and nurse and caregiver. The behaviors, [groping] and [waiting with discretion] were characteristically obserbed for the elder with severe dementia and [non concessive] attitude was specific to the elders with slight-moderate degree of dementia. The attitude was also seen in both scenes of group/individual care and in both nurse and caregivers.

　The behavior's, [let to move] and [holding] were found more frequent in the scenes of group care, and specifically noted in the elders with moderate to severe dementia, but not at all in those with slight one.

　These results showed a part of the actual states of the discrepancies in the interactions between demented elders and care staffs and pointed out the direction of favorable interaction between them.