医療観察法による通院医療患者に対する訪問看護ステーションからの訪問看護の実態―多職種カンファレンス実施率とその内容の特徴

Psychiatric Home Visits from Visiting Nurses Station for Out Patients under the Medical Care and Treatment for Persons Who Have Caused Serious Harm While Insane Act: The frequency of and issues in Team conferencing

抄録

　本研究では，訪問看護ステーションからの精神科訪問看護を利用している医療観察法の対象者71名とそれ以外の訪問看護対象者477名について，対象者の特徴とカンファレンス実施の状況について比較した。

　医療観察法の対象者では，気分障害の割合が高く，単身生活者が多く，ホームヘルプ利用が少なかった。またカンファレンスを実施している割合が高く，そのコーディネートを担当しているのは主に社会復帰調整官であった。医療観察法による訪問看護では，制度の特徴からカンファレンスで情報共有や診立てを丁寧に実施しやすいと考えられた。一方で，さまざまな社会資源とつながりにくくサービス提供に困難を生じやすい実態が明らかとなり，福祉サービスとの連携やサービス担当者のサポート機能の充実など今後検討が必要であると考える。

　This study compared the users of psychiatric home visit nursing under the act on medical care and treatment for persons who have caused serious harm while insane (n＝71) and users who are not under the act (n＝477). The rates of mood disorders and individual living were high among users under the act, while home help services were less used. Multi-disciplinary team conferences were held more frequently among users under the act, which were coordinated mainly by the community living coordinator designated under the act. Users under the act had more opportunities to share information and medical assessments among their healthcare providers through the conference. However, since it was suggested that the difficulty of utilizing social resources for users under the act is causing hardship for home visiting nurses, the provision of more collaborative and support systems for service providers is needed.