急性期病棟における認知障害高齢者に対するパーソン・センタード・ケアをめざした看護実践に関連する要因

Factors Related to Nursing Practice for Elderly Patients with Cognitive Impairment with the Aim of Person-centered Care on Acute Wards

抄録

　本研究は，急性期病棟に勤務する看護師の認知障害高齢者に対するパーソン・センタード・ケアを目指した看護実践に，看護師の基本属性や経験，個人特性，看護労働環境が，どのように関連し，影響しているかを明らかにすることを目的とした．急性期病棟に勤務する看護師329人を対象に，自記式質問紙調査を実施した．認知障害高齢者に対する看護実践を従属変数，看護師の個人特性と看護労働環境を独立変数として重回帰分析を行った．その結果，看護実践と関連がみられたのは，影響の強い順に，道徳的感受性，看護に対する自分自身での振り返りの頻度，看護労働環境，認知症やせん妄に関する研修や勉強会への参加経験の有無，専門職チームや老人看護専門看護師・認知症看護認定看護師等への相談経験の有無，認知症の人に対する認識，看護に対する他者との振り返りの頻度の7要因で，分散の30.7％が説明された．看護師への倫理教育の質の向上，看護師自身が意欲をもち自身の看護実践の省察を継続的に行う必要性が示唆された．さらに，看護師の意欲と行動を支え専門性を発揮できるような労働環境の調整などを組織的に行うとともに支え合うケア文化を醸成することの重要性が示唆された．

　The purpose of this study was to investigate how several factors—nurses' attributes and experiences, individual characteristics, and practice environments—relate to nursing practice for elderly patients with cognitive impairment with the aim of person-centered care on acute wards. A multiple regression analysis was performed on data obtained from a questionnaire administered to 329 nurses working in acute wards at general hospitals. The dependent variable was nursing practice for elderly patients with cognitive impairment and on acute wards. The independent variables were nurse attributes, experiences, individual characteristics, and practice environments. The results revealed seven factors which related to nursing practice :moral sensitivity, followed by the frequency of self-reflection on nursing practice, nursing practice environment, experience participating in dementia or delirium training or study groups, experience consulting with a professional team, Certified Nurse Specialist in Gerontological Nursing or Certified Nurse in Dementia Nursing, frequency of reflecting on their nursing care with others, and recognition of persons with dementia. These variables explained 30.7% of the variance. These findings suggest the necessity of improving the quality of nurses' ethics education and encouraging nurses to continuously reflect on their level of motivation and nursing practice. Furthermore, it suggests the importance of managing the organizational work environment that supports nurses' motivation and positive behaviors which allow them to demonstrate their professional abilities, as well as nurturing a supportive and caring culture.