看護師が認識するせん妄患者への不適切な対応

Nurses' Recognition of Care Patients with Delirium

《要旨》

　本研究は、看護師のせん妄患者へのケアの質を高めるために、せん妄患者への対応において看護師自身が不適切であると認識している内容を明らかにすることを目的とした。対象者は、A県内の看護師・准看護師で、無記名自記式の質問紙調査を行った。有効回答1,755名のうち、せん妄患者への対応が不適切であると回答した対象者は、1,015名（57.8％）であった。内容について自由記載のあった対象者は946名で、自由記載のテキスト分析を行った。出現頻度の高かったキーワードと出現頻度は、“抑制（204）”、“尊敬語・丁寧語（163）”などであった。キーワードをカテゴリ化した結果、《乱雑な言動》《すぐに抑制する》《否定的》《感情的》《冷淡》《見下す》《嘲笑》《説明をしない》《家族に委譲する》が見出された。看護師はせん妄患者に対して、抑制や態度、言葉遣いなど多岐にわたり不適切な対応であると認識しており、温かみと尊厳をもった対応が必要であると考えていることが推察できた。

《Abstract》

　Delirium is an impairment of cognitive function manifesting a lack of concentration, disturbance of consciousness, and alteration of sleep wake cycle, which occurs an abrupt onset and develops within a relatively brief duration. The purpose of this study was to investigate what nurses consider as inappropriate when they care of patients with delirium. This study was carried out an anonymous self-entry questionnaire delivered and returned by mail. Nurses were asked to indicate whether or not they had encountered any inappropriate ways while dealing with delirium patients in their experience, and to specify any such inappropriate ways. The answers in the free entry column were analyzed using the IBM SPSS Text Analytics for Survey. 1,755 nurses who returned their valid responses, 57.8% answered that they had encountered some inappropriate ways of care patients with delirium in their experience. The key words of the answers frequently made in the free entry column were "suppression (204 cases)," "honorific/polite words(163 cases)," "way of speech(126 cases)," "roughness(40)" and so on. When the key words were categorized, the most frequent were "rough speech," "quick suppression," "denial," "emotional," "indifferent," "contempt," "ridicule," "lack of explanation" and "relying on family members." The key words contained the negative emotions of nurses, suggesting the necessity of establishing a system to cope with the negative emotions held by nurses when they care of patients with delirium.