急性期病院におけるせん妄ケアチームの構築プロセス

Development Process of Interdisciplinary Delirium Care Teams in Acute Care Hospitals

抄録

　本研究の目的は，急性期病院のせん妄対策における多職種チームの構築プロセスを明らかにすることである．関東および関西地区の一般病院のせん妄ケアチーム8チームを対象に，チームメンバーへの半構造化インタビューを行い，質的帰納的に分析した．

　分析の結果，55サブカテゴリー，17カテゴリーが抽出され，4つの局面に分類された．せん妄ケアチームの構築プロセスは，せん妄対策の【チームの立ち上げ】を契機に【チームの組織化】と【チーム活動の推進】が進み，波紋が広がるように組織内にチーム活動が浸透し，【チーム活動のアウトカム】が生じていた．このプロセスには，臨床のせん妄対策のニーズと，そのニーズを認識し行動する複数の人材が存在し，トップと交渉し支援を取りつけ，チームの内部と外部の組織化を進め，チーム活動のコスト回収方法を検討することが含まれた．また，せん妄ケアに関するスタッフ教育とケアプロセスのシステム化が組織全体のせん妄ケアスキルの向上に寄与し，チーム回診がスタッフレベルでの連携・協働の促進につながることが示唆された．

　The aim of this study was to describe the development process of interdisciplinary delirium care teams in acute care hospitals. Semi-structured interviews were conducted with eight delirium care teams in general hospitals in the Kanto and Kansai areas of Japan. The interview data were then analyzed qualitatively and inductively.

　A total of 55 sub-categories in 17 categories related to the development process of delirium care teams were extracted and then classified as follows into four phases: initially, a “launching team” for delirium care brought about the “organization of team building,” which improved through mutual interaction and the “promotion of team activities”, thereby improving the “outcomes of the team activities”. This development process included the following components: the clinical staff had a clear need for a delirium care team; multiple key members understood this need and took appropriate actions; key members negotiated with and got support from hospital administrators; team members built the delirium care team through simultaneous organization both within and outside the team; and administrators examined possible options and resolved any issues regarding the costs of team activities. These findings suggest that systematizing the delirium care process and facilitating staff education contributes to the improvement of overall delirium care skills. Activities such as team rounds within the hospital are effective for improving collaboration and cooperation among hospital staff members.