高齢者施設での日常生活において認知症高齢者がアドボカシーを必要とする状況と看護師の支援内容

The Situations in Which Elderly with Dementia Require Advocacy in Daily Life and the Practice of Advocacy by Nurses at Elderly Care Facilities

抄録

　本研究は，高齢者施設で生活する認知症高齢者が日常生活を送るうえでアドボカシーを必要とする状況と，看護師が実践するアドボカシーの内容を明らかにすることを目的とした．高齢者施設に所属する認知症看護認定看護師9人に半構成的面接を実施し，得られたデータを質的に分析した．認知症高齢者は，【意思決定がむずかしい】【尊厳が尊重されにくい】【集団生活においてコミュニケーションが図りにくい】という状況でアドボカシーを必要としていた．看護師が実践しているアドボカシーには，【意思決定を支援する】【利益を保護する】【尊厳を守る】【集団生活の調整をする】ことがあった．認知症高齢者が権利の主体であるために，看護師は，高齢者施設という環境の特徴を理解し，認知症高齢者の意思決定支援と利益保護とのバランスをとりながら，アドボカシーを実践することが必要であると考えられた．

　This study aimed to clarify situations in which elderly individuals with dementia require advocacy in their daily lives and advocacy practices for them provided by nurses at elderly care facilities. After conducting a semi-structured interview survey with nine nurses certified in dementia-nursing at elderly care facilities, we performed a qualitative analysis. Situations in which the elderly residents with dementia require advocacy were “an inability to make decisions”, “a lack of respect for their dignity”, and “having difficulty communicating in a group living environment”. With regard to advocacy, the nurses practiced “support for the decision-making process”, “protection of residents' interests”, “respect for residents' dignity”, and “adjustments to improve group living”. Our results showed that the nurses practiced advocacy for elderly individuals with dementia in order to enable them to live with dignity. It is crucial for nurses to understand the various dimensions of the residents' environment while achieving an adequate balance between decision-making support and the protection of residents' interests.