介護老人保健施設における看護師の認知症高齢者ケア場面のとらえ方とケア行動の特徴

How to Perceive the Scenes of Caring for Elderly with Dementia and the Characteristics of Caring Behaviors of Nurses at Care Health Facilities for the Elderly Requiring Care

抄録

　本研究の目的は認知症高齢者と看護師相互のケア場面に焦点を当て，看護師が認知症高齢者の言動をどのようにとらえ，どのようなケア行動をしているのかを明らかにすることである．方法は介護老人保健施設で働く看護師10人を対象に，半構成的面接調査を行い質的記述的研究方法で分析した．看護師が認識するケアがうまくいったと思う場面での言動のとらえ方は≪その人には強い思いがある≫≪その人の言動にはなにか理由がある≫≪人として当たり前の思いをもっている≫≪その人のもてる力を発揮していない≫≪楽しみが必要≫であり，そのケア行動は≪その人の意に沿った対応≫≪その人を気遣う対応≫≪その気になるように対応≫≪生きる意欲につなげる対応≫のカテゴリーに分類された．ケアがうまくいかなかったと思う場面では≪その人の言動にはなにか理由がある≫≪その人の思いがある≫≪認知症の人は相手の思いを察知する≫ととらえながらも≪認知症だから分からない≫ととらえ，そのケア行動は≪その人の意に沿わない対応≫≪その人は認知症だからという対応≫≪人としての尊厳を欠く対応≫のカテゴリーに分類された．この結果から，どのようなケア場面においても，認知症ケアへの倫理感を育む必要があることの示唆を得た．

　The purpose of this research is to clarify how nurses perceive the words and behaviors of the elderly with dementia and how nurses behave to care for them, by focusing on the caring scenes and the relationship between nurses and the elderly with dementia. The research was conducted by performing a semi-structured interview survey with 10 nurses working in health care facilities for the elderly requiring care and analyzing the results by qualitative and descriptive research method. The words and behaviors of the elderly in the scenes where nurses recognized that caring was successfully performed, were categorized into “he has strong feelings,” “there is some meaning in his words and behaviors,” “he has a mind common to human beings,” “he does not fully exercise his ability,” and “he needs amusement.” The caring behaviors of nurses who responded to the above were categorized into “response in complying with his will,” “response in caring manner,” “response in making him incline to,” and “response in leading his will to live.” The words and behaviors of the elderly in the other scenes, where nurses recognized that caring was unsuccessfully performed, were categorized into : “there is some reason in his words and behaviors,” “he has some feelings,” and “persons with dementia can sense others' thinking.” Whereas, their words and behaviors were recognized as : “he cannot understand because he has dementia.” The caring behaviors of nurses responding to the above were categorized into : “response not complying with his wish”, “response by saying he has dementia,” “response lacking the sense of dignity as a human being.”

　In the environments where individual needs are observed, such as symptoms of the elderly with dementia, requirements during the night, and not fully respondent in the morning, it is sometimes difficult to react to each of them with respect, thinking that he will forget because he has dementia. In any case, this research suggests the need to cultivate an ethical sense for dementia care.