愛媛県における特別養護老人ホームの看取りに関連する要因

Factors Related to the End-of-life Care at Special Nursing Homes in Ehime Prefecture

抄録

　本研究の目的は，愛媛県内の特別養護老人ホーム（以下，特養）における，看護職と他職種との連携および看取りの事前意思確認状況の実態を把握するとともに，看取りに関連する要因を明らかにすることとした．調査対象者は愛媛県内の特養（94施設）に勤務する看護職で，アンケートによる質問紙調査を行い，37施設より回答を得た．看取りに関する意思確認が実施される時期は，最も高率なのは状態が悪化したときで91.9％，ついで入所時が70.3％であった．入所時の意思確認に看護職が参加している施設は24.3％と少なかった．看取りとの関連では，医師の看取りに対する態度，看護職間の連携，看護職の勤務形態で有意差が認められ，看取りが高率な施設では，医師が看取りに積極的であること，看護職間の意見交換が活発であること，看護職が遅出勤務をしていることが明らかになった．特養の看取りを促進するためには，看護師が医師との連携をとり夜間の介護職をサポートすることが重要であることが示唆された．

　The objective of the present study was to elucidate the actual conditions of cooperation between nurses and other professionals and the support for confirmation of intention regarding end-of-life care, as well as whether these factors are related to end-of-life care, at special nursing homes in Ehime prefecture. A questionnaire survey was conducted on nurses working at 94 special nursing homes in Ehime prefecture, and responses were obtained from 37 facilities. The most common timing of confirmation of intention regarding end-of-life care was following worsening of condition (91.9%), followed by the time of admission (70.3%). Nurses participated in the confirmation of intention at the time of admission at only 24.3% of facilities. As for relationships to end-of-life care, significant differences were observed based on physicians' attitude toward end-of-life care, cooperation among nurses, and working arrangements of nurses. Specifically, at facilities with a high rate of end-of-life care, physicians had a positive attitude toward end-of-life care, nurses actively engaged in exchange of opinions among each other, and nurses worked late shifts. These results suggest that in order to promote end-of-life care at special nursing homes, it is important for nurses to cooperate with physicians and to support night-time care workers.