医療施設で認知症高齢者に看護を行ううえで生じる看護師の困難の構造

Patterns of Difficulty Experienced by Nurses Caring for Elderly Patients with Dementia in Medical Facilities

　本研究では，医療施設に勤務する看護師が，認知症高齢者の看護を行ううえで困難と意味づけている体験の共通概念を抽出し，構造化を行うためにグラウンデッド・セオリー・アプローチにより，質的記述的研究を行った．病院・介護老人保健施設・介護療養型医療施設の看護師27名に半構成的インタビューを実施した結果，中核カテゴリーとして【目が離せない人に対する許容】，主要なカテゴリーとして【目が離せない人との遭遇】【見守りの必要性】【看護業務の緊迫化】【家族からの応じられない要望】を抽出した．構造として，【目が離せない人との遭遇】と【家族からの応じられない要望】を契機に，【見守りの必要性】と【看護業務の緊迫化】が生じ，患者を受け入れるためには看護師側の内面のプロセスとして【目が離せない人に対する許容】が必要であり，認知症高齢者の危険で予測がつきにくい状況を許容していくプロセスが認められた．また，【見守りの必要性】から，看護業務上の負担による倫理的課題が起こりやすい状況であることも示唆された．

　The purpose of this study was to describe and clarify nurses' experience of difficulties with institutionalized elderly patients with dementia in medical facilities. This study was a qualitative study using grounded theory guided data collection and analysis. Twenty-seven registered nurses （RN） who care for elderly with dementia in medical facilities were interviewed. Retrospective audio-taped narration provided the data for analysis. The semi-structured interviews were transcribed. Finally, a core category emerged following the refinement of categories and diagrams. Dimensions of Accepting patients and their situation was the core category and four categories were identified : An encounter with demented patients, necessity to watch, the tension of the routine work, and conflict between families and nurses. Antecedent conditions were an encounter with demented patients and conflict between families and nurses. These two conditions lead to several categories, necessity to watch and the tension of routine work. Between these two states nurses struggled to find ways to accept patients' situation. Dementia patient's behaviours are risky and unpredictable for nurses, but the most difficult problem was to accept their patients during their tension of routine work （becoming accustom to the situation）. These patterns suggested that there was marked tendency of ethical problems to emerge resulting from watching patients and the burden of labor in medical facilities. It is necessary to support nurses in accepting patients through education, and reduce the tension in routine work. Further research is necessary to clarify watching patients （“Mimamori” in Japanese） and nurse's accepting patients and their situation.