「長期療養高齢者の苦痛」の概念についての文献検討

A Literature Review on the Concept of Discomfort of Elderly People Receiving Long-term Medical Care

抄録

　本研究の目的は，Walker and Avant の概念分析の手法を参考に，文献検討により「長期療養高齢者の苦痛」の概念の構造を明らかにすることである．分析には，医学中央雑誌WEB版，Pub Med，CINAHL等により選定した32文献を用いた．結果，定義属性として，【身体的苦痛と苦悩の混在】【体験の多様性】【絶えず続く】【医療者による過小評価】【表面化されにくい】【存在への脅威】の6つが明らかとなり，先行要件として，【病気の進行や加齢に伴う心身の機能低下】【医療者の不適切な対応】【高齢者の否定的認識】の3つが明らかとなった．先行研究との比較から，「長期療養高齢者の苦痛」は，表面化されにくいために医療者に過小評価されやすく，医療者の不適切な対応の影響を受けることが特徴であると考えられた．本研究結果は，長期療養高齢者の苦痛を緩和するためのケア指針の開発に活用できると考えられ，高齢者の声にならない苦痛のサインをとらえる実践，高齢者の尊厳を守る実践が長期療養高齢者の苦痛を予防し緩和するうえで重要な看護実践に位置づくと考えられた．

　This study aimed to reveal the conceptual structure of discomfort of elderly people receiving long-term medical care by conducting a literature review based on Walker and Avant’s concept analysis. For the analysis, 32 articles were selected from ICHUSHI Web, PubMed, CINAHL, etc. The results revealed six defining attributes “mixture of physical discomfort and distress” “diversity of experiences” “constant continuation” “underestimation by healthcare providers” “unlikelihood of manifestation” “threat to existence” and three antecedents “mental and physical functional impairment associated with disease progression and aging” “inappropriate responses from healthcare providers” “negative perception of elderly people”. A comparison with previous studies suggested that the discomfort of elderly people receiving long-term medical care is unlikely to be manifested; thus, it characteristically tends to be underestimated by healthcare providers and is affected by inappropriate healthcare response. The results of this study are useful for the development of care guidelines for relieving the discomfort of elderly people receiving long-term medical care. The findings highlight the need for nursing practices geared toward detecting signs of discomfort undisclosed by elderly people and to protecting their dignity, to prevent and relieve the discomfort of elderly people receiving long-term medical care.