特別養護老人ホームにおいて認知症高齢者への食事ケアを協働することについての看護・介護職の認識

Recognition of the Necessity of Cooperation in Dietary Care among Nursing and Care Staff for the Elderly with Dementia at a Special Elderly Nursing Home

抄録

　本研究の目的は，特別養護老人ホーム（以下，特養）において，認知症高齢者の食事ケアを協働することについての認識を看護・介護職双方の視点から明らかにすることである．特養に勤務する看護師と介護福祉士を対象に，認知症高齢者の食事ケアを協働して行っている経験について面接調査を行い，得られたデータから協働することに関する認識を質的に分析した．その結果，両職種とも食べられないことへの対応を，協働する状況として挙げており，看護師は≪看護職の医療的なアセスメントに基づいて，食事摂取量の減少や誤嚥に対する予防の援助方法を助言する≫等，協働の必要性を意図していた．一方介護福祉士は，≪食事行動がとれないことや誤嚥がみられるため，看護職の医療的な判断に基づいてケアをする≫等の必要性だけでなく，≪食事ケアは介護職の守備範囲なので協働する必要はない≫等の意図も示していた．認知症高齢者の個々のニーズに沿ったケアには看護・介護職の協働が必須となるが，そのためには双方の認識を理解したうえで協働のあり方を検討することが重要であると考える．

　The purpose of this study was to clarify how nursing staff and care staff recognize the necessity of cooperation in dietary care for the elderly with dementia at a special elderly nursing home (hereinafter called “Tokuyo”). We conducted a survey by interviewing nurses and certified care workers at Tokuyo about their experiences in cooperatively performing dietary care for elderly residents with dementia, and performed qualitative analysis based on the obtained data. Both nurses and certified care workers agreed that cooperation between the two job categories was necessary when working with elderly people who are unable to eat. Nurses recognized the necessity of cooperation by saying, “Care staff members should be advised based on medical assessment by the nursing staff on how to help prevent such problems as aspiration and decreased dietary intake.” Meanwhile, some certified care workers indicated the necessity of cooperation by saying, “Those who are unable to eat or sometimes experience aspiration should be cared for based on medical assessment by the nursing staff,” but others expressed the opinion that “Since the care staff assumes responsibility for giving help with eating, the nursing staff need not assist them on this job.” Cooperation between nursing and care staff is essential for providing care according to the individual needs of elderly residents with dementia, and it is also important to discuss methods of cooperation, based on the mutual understanding of each profession's perception of the issues.