急性期病院の退院調整看護師が感じている高齢者の退院支援における困難

Difficulties Experienced by Discharge Nurses Planning for the Discharge of Elderly Patients from Acute Hospitals

抄録

　本研究の目的は，急性期病院の退院調整看護師が高齢者の退院支援において感じている困難を明らかにすることである．11人の退院調整看護師を対象に個別面接調査を行い質的に分析した結果，困難には多様な高齢者とその家族の個別性をとらえた支援，関係職種との連携・協働，地域の資源や支援体制が不十分な状況での調整があった．さらに，短い期間での調整が困難の状況として示された．個別性が高い高齢者の退院支援には，これらの困難が複雑に絡みあいながら存在しているため，【これでよいという確信がもてない】ことが，急性期病院の高齢者の退院支援における困難の中心概念であると導き出した．高齢者にとってよりよい支援を探求し続けられるよう，事例の振り返りを通して，自己の行った支援の明確化や意味づけを行いながら，実践知を積み重ねることが重要であることが示唆された．

　The objective of this research is to shed light on the difficulties experienced by discharge nurses in acute hospitals when engaging in discharge planning for elderly patients. The results of qualitative analysis of the information gained in an interview survey conducted separately with 11 discharge nurses showed that the challenges they faced were attributable to: their inflexibility in responding appropriately to diverse requests from elderly patients and their families; insufficient coordination and collaboration between hospital staff members involved in the discharge planning process; limited availability of local resources in the community; and an inadequate organizational support structure. Furthermore, time constraints arising from the necessity to complete the discharge process in a short period also seemed likely to have added extra burden to the nurses. Through this research, the core concept underlying the sense of difficulty shared by the nurses in charge of discharge planning in acute hospitals when dealing with elderly patients whose conditions varied considerably from individual to individual was identified as “a feeling of uncertainty in what they were doing" that inevitably had grown from the complexly intertwined negative factors described above. The research suggests that, for these nurses to be able to continue pursuing better ways to care for elderly patients, it is important that they deepen their professional knowledge by acquiring more hands-on experience, as well as by clearly defining the efforts they have made in such work and evaluating how meaningful each of these efforts has been through a close review of past experiences.