医療療養病棟における看護職による便秘ケアの課題と工夫―横断質問紙調査

Current Issues and Contrived Practice of Constipation Care by Nurses in Long-term Care Wards: A Cross-sectional Questionnaire Survey

抄録

目的：長期療養を要する高齢者の便秘ケアのあり方を検討するため，医療療養病棟の看護職による便秘ケアの課題と工夫を把握する．

方法：全国1,180病院の医療療養病棟の看護職（看護管理者と看護スタッフ各1人）に質問紙調査を行った．病棟の便秘ケアの現状に対する認識を自由記載でたずね，回答を質的記述的に分析した．

結果：看護職は，【下剤使用のベストプラクティスがよくわからない】【治療や患者状態により複雑化する便秘ケアに対応しきれない】【病棟で醸成される画一化された便秘ケアからなかなか抜け出せない】【便性状のコントロール不良に付随するトラブルが生じる】現状に直面していた．便秘ケアの工夫として【刻々と変わる排便状況に合わせて患者ごとに下剤を調整する】【画一化された便秘ケアにプラスアルファの工夫を組み込む】【便秘ケアに関する多職種間コミュニケーションの敷居を下げる】を実施していた．

考察：医療療養病棟の看護職は下剤使用方法や，患者背景に応じた便秘ケアに困難を感じていた．一方，下剤の調整やコミュニケーションを図るなど，よりよい便秘ケアのための工夫も行われていた．おのおのの病棟で構築された便秘ケアの工夫を体系化し，医療療養病棟の入院患者に適した便秘ケア方法を確立する必要性が示唆された．

　Objective: This study explored how nurses and ward managers perceived the current issues and contrived practice of constipation care in long-term care(LTC) wards.

　Methods: This is a cross-sectional questionnaire survey of ward managers and staff nurses working in LTC wards. We asked free comments regarding current issues and strategies for the practice of constipation care. The descriptions were analyzed using qualitative content analysis techniques.

　Results: The subjects faced “being not sure about the best practices for laxative use”; “being unable to handle the complexity of constipation care because of patients' treatment and condition”; “being stuck in the uniformity of constipation care fostered on the wards”; and “Occurring trouble on account of poorly controlled fecal consistency.” For contrived practices, they tried “adjusting laxatives for each patient to accommodate the alternating bowel movements”; “incorporating extra ideas into standardized constipation care”; and “lowering the threshold for communication between interdisciplinary staff members regarding constipation care.”

　Discussion: Almost all nurses in LTC wards used laxatives for constipation care. However, they had difficulties in the use of laxatives and the practice of constipation care in the context of the patients' background. On the other hand, strategies for better constipation care, such as adjustment of laxatives and communication, were also implemented. Results suggest a need to establish a guide for constipation care in LTC wards.