認知症を有する術後急性期患者における看護師の4点柵実施の判断に関連する要因

Factors Related to the Decision of Nurses to Use 4-point Bed-railing Restraints for Post-operative Acute Patients with Dementia

抄録

【目的】認知症の診断を受けている術後急性期患者に対して，看護師がどのような要因から4点柵の実施を判断しているのか，またその判断に影響を及ぼす看護師の背景を明らかにすることを目的とした．

【方法】外科病棟に勤務している看護師に，抑制の三大原則の認識および転倒・転落予防のための4点柵実施を判断する要因等について無記名自記式質問紙調査を実施した．

【結果】分析対象は547人であった．認知症の診断を受けている場合，4点柵の実施に同意できる者は170人（31.1％）であった．認知症の診断があり，かつ興奮状態や落ち着きのない行動がみられる場合でも，どちらともいえない，同意できないと回答した者が合わせて約4割であった．認知症の診断を受けている術後急性期患者の4点柵実施の判断に影響を及ぼしたのは，「ICUまたはHCUに勤務している」「3交替勤務」「看護倫理研修の受講」の3要因で，これらの群は有意に4点柵実施に同意する割合が高かった．

【結論】認知症の診断を受けている術後急性期患者に対する4点柵実施に同意するかどうかの判断は，職場環境の影響があることが明らかになった．

　Objective: The objective of the present study was to clarify nurses' decisions and the factors affecting their decisions regarding the use of 4-point bed-railing restraints for post-operative acute patients diagnosed with dementia.

　Methods: An anonymous, self-administered questionnaire survey was conducted on nurses working in the surgical wards of hospitals, regarding their understanding of the three major kinds of restraints and the main factors affecting their decisions to use 4-point bed-railing restraints to prevent falls.

　Results: Responses from 547 participants were analyzed. A total of 170 respondents (31.1%) were able to implement the use of 4-point restraints for patients diagnosed with dementia. About 40% replied that they could not decide and could not be sure when to use 4-point restraints for those diagnosed with dementia who exhibited states of excitement or restless behavior. Factors influencing decisions regarding the use of 4-point restraints for post-operative acute phase patients diagnosed with dementia were “employment in an ICU or HCU”, “three-shift system”, and “completion of nursing ethics training”, with a significantly higher proportion of respondents in these groups agreeing to the use of 4-point restraints.

　Conclusion: These results suggest that use of 4-point restraints for post-operative acute phase patients diagnosed with dementia varies according to each nurse's work environment.