意思疎通不可能な高齢者の終末期ケアに取り組む看護職を対象にしたよりよい終末期ケアを目指すための教育プログラムの開発―態度形成に向けた介入効果の評価

Development of an Education Program for Nurses to Improve End-of-life Care for Older Adults Who are Unable to Communicate: Assessment of the Intervention Effect on Attitude Formation

抄録

　本研究は，意思疎通不可能な高齢者の終末期ケアに取り組む看護職を対象にしたよりよい終末期ケアを目指すための教育プログラムを開発し，その介入効果を評価することを目的とした．教育プログラムの構成要素である「死生観」「ケア意欲」「ケアの意義」「感情処理」を評価指標とし，既存の尺度を用いて測定した．全4回の教育プログラムのすべてに参加した療養病床の看護職40人を分析対象とし，介入前・介入中・介入直後・介入2か月後の測定値について反復測定分散分析を行った．「死生観」を評価する「看護師の死生観尺度」（岡本ら，2005）の第Ⅱ因子「死の不安」（p＝.030）と第Ⅲ因子「身体と精神の死」（p＝.010），および「ケア意欲」を評価する「看護師の仕事意欲尺度」（佐野ら，2005）の下位尺度「現在の仕事に向ける意欲」（p＝.005）で有意な変化がみられ，死生観の深化とケア意欲の向上において，教育プログラムの有効性が示唆された．

　This study aimed to develop an education program for nurses to improve end-of-life care for older adults who are unable to communicate, and to assess the intervention effect on attitude formation. Components of the program, namely, “Views of life and death”, “Motivation for care”, “Meaning of care”, and “Emotional processing”, were set as performance indexes and assessed using existing scales before intervention, during intervention, and immediately and 2 months after intervention. Data from 40 nurses working on long-term care wards who participated in all 4 program sessions were analyzed using repeated-measures analysis of variance. Significant effects were found for “Anxiety about death” (p = .030) and “Death of the body and mind” (p = .010) on a scale measuring views of life and death in nurses (Okamoto et al., 2005) in assessment of “Views of life and death” and for the subscale “Motivation for current work” (p = .005) on a scale measuring work motivation in nurses (Sano et al., 2005) in assessment of “Motivation for care”. These results suggest that this education program was effective in deepening views of life and death and facilitating positive changes in nurses' motivation for care.