臨床判断プロセスを基盤とした認知症高齢者の転倒予防看護質指標の有用性─急性期病院と介護保険施設の比較による検討

Usability of Nursing Quality Indicator for preventing falls among the elderly with dementia based on processes in clinical judgment: Discussion of comparison between acute hospitals and long term care insurance facilities

抄録

　本研究の目的は，開発した転倒予防看護質指標の有用性を明らかにするために，認知症看護認定看護師が本指標を使用した評価をもとに，急性期病院と介護保険施設の特性を考慮して検討することである．本研究の対象者である全国の認知症看護認定看護師233人に自記式質問紙を送付し，回答があったのは105人（男性14人，女性91人），回答率45.1％，所属機関は急性期病院87人（82.9％），介護保険施設18人（17.1％）であった．「認知症看護の転倒予防の実践上重要な点が網羅されている」「認知症看護に関する院内の研修・教育やシステムの改善があれば実施できる」など肯定的回答が8割以上であった．実施の評価では【A認知症高齢者と行動を共にしてリスクを判断する】【B認知症高齢者のその人のもつ視点を重視しかかわる】に介護保険施設の8割以上は実施ありと回答し，とくに「B_3認知症高齢者の価値観を引き出し，その人の視点に合わせたケアを実施することで，転倒につながる行動を緩和する」などの5項目が有意に高かった．以上の結果から，本指標の有用性は高いが，院内の認知症に関する研修・教育の必要があり，介護保険施設における実施の割合が高い指標であることが明らかになった．

　The purpose of this study was to clarify the usability of the Nursing Quality Indicator for preventing falls as well as to evaluate their nursing teams by comparing the results between acute hospital and long term care insurance facilities by Dementia Nursing certified nurses. 233 Dementia nursing certified nurses as the subjects of this study were sent a self-administered questionnaire of this indicator. The subjects were 105 people (14 Males and 91 Females) with a response rate of 45.1%. Eighty seven (82.9%) of the subjects belonged to Acute Hospitals and 18 (17.1%) belonged to Long-term Care Insurance Facilities. More than 80% of the subjects agreed that, “This indicator covered important points in all practice of fall prevention for dementia nursing”, “If nurses would be able to attend trainings, have education about dementia nursing care in their hospitals/facilities and improvement of the system, they could perform nursing care using this indicator”. More than 80% of Dementia Nursing Certified Nurses in Long-Term Care Insurance facilities have already conducted the following indicators: [A:assess risk of falls concerning elderly with dementia], [B: consider the perspectives of elderly with dementia when taking care of them]. Five items such as “We draw the sense of values of elderly with dementia and care about the viewpoint of the person in order to reduce behaviors leading to falls” were significantly high. It was suggested that this indicator has a high usability when used in Long-Term Care Insurance Facilities. However, it needs training and education about dementia nursing.