長期ケア施設に入所する高齢者の転倒の予防を目的とした施設スタッフへの教育的介入の効果─スタッフの転倒予防に対する認識とケア実践の変化に焦点を当てて

Evaluation of Fall Prevention Education for Nursing Home Staff : Staff's Recognition about Preventing Falls and Caring for Fall Prevention

　本研究の目的は，転倒予防のためのスタッフ教育プログラムを開発し，長期ケア施設で介入を行い，スタッフの転倒予防に対する認識やケアの変化を記述し，その効果を評価することである．

　教育プログラムは学際的チームの育成と，転倒予防に関する知識の習得を目的とし，講義とアクティビティを組み合わせた手法により90分間で実施するものである．都内4か所の長期ケア施設に勤務し，教育効果を評価するための質問紙に対して有効回答が得られたスタッフ162名（介入群93名，非介入群69名）の調査結果を二要因反復測定分散分析等を用いて分析した．その結果，介入後における転倒予防策の立案等の負担感と学際的チームアプローチの実践の有意な改善は認められなかった．しかし，介入後には転倒の第一発見者が他職種と連携しながら反復転倒者への予防策を立案する場面がみられ，学際的チームアプローチに対する基盤形成がすすみつつあることが観察された．以上から，本プログラムは転倒予防におけるスタッフの学際的チームアプローチに対する認識の改善に寄与する可能性があるのではないかと考えられた．

　The purpose of this study was to evaluate the effects of staff education by comparing the recognition and caring for preventing falls between the intervention group of nursing homes' staff and the control group of nursing homes' staff. The two program goals were to: (1) enhance knowledge about fall prevention and (2) further develop the interdisciplinary team. The intervention for staff was one educational session using the researcher's lecture program.

　Four nursing home administrators consented to participate in the study. Intervention group consisted of 93 staff and the control group consisted of 69 staff for a total of 162 staff. To assess effectiveness of the educational program for staff in nursing homes, data were analyzed by two way repeated-measures ANOVA. No, significant interaction effects between intervention and time of measurements were seen in four items of staff's burden about fall prevention. In addition, since the interdisciplinary team approach provided little improvement after the implementation of the program, the influences that this program gave to reduce staff's burden about fall prevention and improvement of the interdisciplinary team approach were not clear. However, in nursing homes receiving the intervention, the interdisciplinary team approach for fall prevention in caring indicated confirmation of improvement after the intervention. From this finding, the program may help to develop the interdisciplinary team in the intervention nursing homes. And, if the educational program for staff is able to improve the interdisciplinary team approach, it may be presumed that effectiveness of fall prevention also becomes increasingly effective.