回復期リハビリテーション病棟における看護職の高齢者排尿ケアの実践に関連する要因

Factors Related to the Implementation of Voiding Assistance for Older Adult Patients by Nursing Staff in Rehabilitation Wards

抄録

　本研究は，回復期リハビリテーション病棟（以下，回リハ病棟）における高齢者排尿ケアの実践と排尿ケアの知識，態度および職場環境との関連を明らかにすることを目的とした．中国・四国地方の回リハ病棟に勤務する看護職を対象に無記名の自記式質問紙調査を行い，375人から回答を得た（回答率46.2％）．高齢者排尿ケア実践は，独自に作成した項目を因子分析して抽出された3因子，「アセスメントに基づくケア」「排尿日誌の活用」「高齢者を尊重したケア」を用いた．重回帰分析の結果「アセスメントに基づくケア」には排尿ケアに対する態度と職場サポート（R²＝0.160），「排尿日誌の活用」には排尿ケアに対する態度，排泄ケアチームや委員会の有無と研修会で得られた情報の活用の有無（R²＝0.173），「高齢者を尊重したケア」には排尿ケアに対する態度（R²＝0.128）が関連していた．回リハ病棟における高齢者排尿ケア実践には，看護職の排尿ケアに対する態度のみではなく，職場環境の整備の必要性が示唆された．

　The objective of this study was to determine the relationship between the implementation of voiding assistance for older adult patients in rehabilitation wards (abbreviated “rehab wards” below) and knowledge and attitudes regarding voiding assistance as well as the relationship between the implementation of voiding assistance and the work environment. An anonymous, self-administered questionnaire survey was conducted of nursing staff at rehab wards in the Chugoku and Shikoku regions. Responses were obtained from 375 patients (response rate, 46.2%). In terms of the implementation of voiding assistance for older adult patients, the following 3 factors, which were extracted in a factor analysis of the independently prepared questionnaire items, were used: “care based on assessments,” “utilization of bladder diaries,” and “care that shows respect for older adult patients.” A multiple regression analysis showed that the nurses' attitudes toward voiding assistance for older adult patients and workplace support for such assistance were related to “care based on assessments” (R² = 0.160). Related to “utilization of bladder diaries” were the nurses' attitudes toward voiding assistance for older adult patients, whether a continence support team or committee was present at the organization, and whether information obtained in training workshops was utilized (R² = 0.173). Related to “care that shows respect for older adult patients” were the nurses' attitudes toward voiding assistance for older adult patients (R² = 0.128). The results suggested that not only the attitudes of the nursing staff regarding voiding assistance but also the establishment of an appropriate work environment as an organization were needed to implement individualized voiding assistance in rehabilitation wards.