一般病棟の看護師が実施している認知症高齢者の痛みのアセスメント

Pain Assessment for Elderly Patients with Dementia Performed by General Ward Nurses

抄録

　本研究は一般病棟の看護師が実際に行っているアセスメントの内容を明らかにすることを目的とした．一般病棟の看護師7人に半構成的面接を行った結果，8カテゴリーと30サブカテゴリーが抽出された．看護師は【認知症高齢者の表情や言動の変化の把握】【認知症高齢者の身体状況の変化の把握】【認知症高齢者の日常生活活動の変化の把握】【認知症特有の行動症状の有無や程度の把握】といった本人の状態に着目しアセスメントしていた．また，【声かけやタッチングによる痛みの部位や程度の把握】【鎮痛剤の使用による痛みの変化の評価】といったアセスメント方法を用いるだけでなく，【認知症高齢者が信頼する身近な人との情報共有による痛みの評価】【看護師間の情報共有による痛みの評価と発現の予測】といった情報共有によりアセスメントを行っていた．これらの結果は認知症高齢者の痛みをアセスメントするうえで活用できると思われる．

　The present study aimed to clarify the details of pain assessment of elderly patients with dementia performed by general ward nurses. Semi-structured interviews with seven general ward nurses were conducted, and as a result, 8 categories and 30 subcategories were identified. In performing assessments, the nurses focused on the state of the individual concerning: (1) identifying changes in the expressions, speech, and behavior of the elderly patient with dementia, (2) identifying changes in the physical condition of the elderly patient with dementia, (3) identifying changes in activities of daily life of the elderly patient with dementia, and (4) identifying the presence or absence, and extent of behavioral symptoms specific to dementia. Furthermore, the nurses made assessments by using assessment methods such as (5) identifying the site and extent of pain by using verbal interactions and techniques of touching, and (6) evaluating changes in pain with the use of analgesics. The nurses also used information sharing for the assessment, such as by (7) evaluating pain by sharing information among individuals who are close to and trusted by the elderly patient, and (8) evaluating pain and predicting the development of pain by sharing information among nurses. It was suggested that these results are useful for the assessment of pain in elderly patients with dementia.