訪問看護師に対する高齢者総合的機能評価を活用した介護予防教育プログラムの効果

Effects of an Education Program for Frailty Prevention Using Comprehensive Geriatric Assessment among Visiting Nurses

抄録

　研究目的は，訪問看護師に対し高齢者総合的機能評価（CGA）を活用した介護予防教育プログラム（PGM）を実施し，訪問看護師の高齢者に関する知識，CGAの理解と活用意向，介護予防の意欲と自信，虚弱高齢者への支援方針に対する効果を検討することである．対象者は介入群40人，対照群41人の訪問看護師である．PGMは，①高齢者のフレイル，②CGAの評価項目，③CGAを活用した介護予防訪問看護，の理解を促す内容で構成した．介入前後の質問紙調査にて，高齢者に関する知識，CGAの理解と活用意向，介護予防の意欲と自信を把握し，介入後の事例検討会での対象者の発言内容から，虚弱高齢者への支援方針を把握した．介入後，CGAの理解と活用意向の得点は，介入群では上昇し群間に有意な変化の差を認めた（ともにp＜.001）．また，介護予防の意欲と自信の得点は，介入群では上昇し群×時間の交互作用を認めた（p＝.002，p＜.001）．虚弱高齢者への支援方針では，介入群は対照群に比べ，具体的な支援内容を提案していた．以上より，本PGMは訪問看護師のCGAの理解と活用意向，介護予防の意欲と自信，虚弱高齢者への支援方針に良好な効果があることが示唆された．

　The objective of this study was to evaluate the effects of a comprehensive geriatric assessment (CGA) education program on visiting nurses' knowledge of aging, understanding of CGA, intention to practice CGA, motivation for frailty prevention, confidence in executing frailty prevention measures, and care strategies for frail elderly adults. A total of 81 visiting nurses were non-randomly assigned to the intervention (IG: n = 40) or the control group (CG: n = 41). The education program covered (1) frailty, (2) components of CGA, and (3) nursing approaches to frailty prevention. Participants' knowledge of aging, CGA understanding, CGA intentions, frailty prevention motivation, and frailty prevention confidence were measured via self-report questionnaires before and after the intervention. The frail elderly care strategies they employed were determined through their responses in post-intervention group discussions that pertained to a vignette of a frail elderly patient. The IG scores on CGA understanding, CGA intentions, frailty prevention motivation, and frailty prevention confidence increased after the intervention. Pre-post intervention changes significantly differed between groups for CGA understanding and intentions (p < .001 for both), and significant group by time interactions were found in frailty prevention motivation and confidence (p = .002, p < .001, respectively). The IG participants' descriptions of care strategies were more specific than the CG participants'. The results indicated that the CGA education program could effectively improve visiting nurses' CGA understanding, CGA intentions, frailty prevention motivation, and frailty prevention confidence, as well as the quality of their frail elderly care strategies.