術後床上安静期において認知症高齢者と看護師双方の安楽を促進するために高度実践看護師が実施している看護ケアの工夫

Nursing Care Strategies Employed by Advanced Practice Nurses to Promote Comfort During Postoperative Bed Rest for Both Older Patients With Dementia and Nurses

要旨

　目的：本研究の目的は認知症高齢者の術直後の床上安静期において，高度実践看護師（老人看護専門看護師・認知症看護認定看護師）が実施している患者・看護師双方に安楽をもたらす看護ケアの工夫について明らかにすることである．

　方法：急性期病院に勤務する高度実践看護師6名を対象に半構造化面接を実施し，質的内容分析を行った．

　結果：【興奮や混乱に繋がる予兆への初期対応】【床上安静に伴う苦痛の低減】【身体拘束に頼らない術後管理の工夫】の3つのカテゴリーが抽出された．これらの工夫は，認知症高齢者にとって術後安静に起因する不快感や苦痛の低減，せん妄や混乱の軽減のみならず，看護師にとってもケアの困難感を軽減するものであった．

　結論：安静に伴う不快症状を緩和し，薬の使用タイミングを見定め，疼痛緩和や術当日の睡眠の確保を図り，身体拘束の解除に力を注ぐことが患者・看護師双方に安楽をもたらす看護であることが示唆された．

　Aim：The purpose of this study is to elucidate the care innovations practiced by advanced practice nurses（geriatric nurses and certified dementia nurses）on elderly dementia patients during the postoperative bed rest period to provide optimal rest for both patients and nurses.

　Method：Semi-structured interviews were conducted with six advanced practice nurses working in acute care hospitals，and a qualitative content analysis was carried out.

　Results：The analysis also clarified the three categories [early response to signs that may lead to agitation or confusion]，[reduction of pain associated with bed rest]，and [innovations for postoperative management that do not rely on physical limitations] to achieve these categories. These innovations not only reduced the discomfort and pain caused by postoperative bed rest，delirium，and confusion in elderly dementia patients，but also reduced care difficulties for nurses.

　Conclusion：Nursing practices that address the discomfort associated with bed rest，determine the appropriate timing for medication，ensure pain relief and adequate sleep on the surgery day，and focus on removing physical restraints can provide comfort to both patients and nurses.