認知症高齢者の生活の継続を見据えた急性期病院における看護の構造―開放型病床での看護実践の質的分析

Structure of Nursing Practice in an Acute Care Hospital Considering Continuous Living of Elderly People with Dementia: Qualitative Analysis of Nursing Practice in an Open Ward

抄録

　本研究は，急性期病院の開放型病床における認知症高齢者への看護の構造を明らかにした．開放型病床に勤務する看護師4人を対象にグループインタビューを行い，逐語録をデータとして質的に分析した．その結果，開放型病床に入院した認知症高齢者への生活の継続を見据えた看護は【認知症高齢者の早期退院に向けた理念と使命の共有】と【盤石なケア体制】の2カテゴリーを支持基盤として，時間軸を踏まえた【認知症高齢者の入院生活への適応に向けた調整】【認知症高齢者の自立支援と介護負担の軽減】【認知症高齢者の自宅退院に向けた査定】【退院に向けた家族の整え】【他職種・他部門・多機関との協働】【退院前の認知症高齢者・家族，専門職者の合意形成】の6カテゴリーの実践から構成されていた．開放型病床の看護師は，院内外の専門職と連帯性ある立ち位置で認知症高齢者の生活の経過を俯瞰して，認知症高齢者を生活者としてとらえ，継続的な情報収集と院内および多機関の多職種との対話を繰り返し，認知症高齢者の全身状態の回復と心身の自立に向けて取り組んでいると示唆された．

　The present study clarified the structure of nursing practice for elderly people with dementia in an open ward of an acute care hospital. Group interviews were conducted with four nurses working in an open ward. The interviews were recorded and transcribed verbatim, and then subjected to qualitative analysis. As a result, in addition to time, nursing for elderly people with dementia who were admitted to an open ward was classified into two fundamental and supporting categories, [Sharing of philosophy and mission for the early discharge of elderly people with dementia] and [Solid care system], and six practice categories, [Adjustment for adaptation to hospital life among elderly people with dementia], [Support for the independence of elderly people with dementia and the reduction of family care burdens], [Assessment of elderly people with dementia for home discharge], [Preparation of family for discharge], [Collaboration with other professionals and divisions and multiple institutions], and [Consensus between elderly people with dementia, family members, and professionals]. Nurses working in open wards regarded the elderly with dementia as living people by observing their progress as stable in solidarity with professionals inside and outside of the hospital. These findings suggest that information gathering and dialogue with multiple institutions having multiple specializations was carried out continuously, and that this promoted a good general condition and independence of the mind and body among the elderly with dementia.