デルファイ法を用いた急性期脳梗塞患者の初回機械浴の可否判断項目の検討

Study of Items to Determine Whether or Not to Perform First Machineassisted Bathing in Patients with Acute Stroke Using Delphi Method

【抄　　録】

　目的：本研究の目的は、脳卒中リハビリテーション看護認定看護師（以下；認定看護師）が認識する急性期脳梗塞患者の初回機械浴の可否判断項目について明らかにすることである。

　方法：全国の病院に所属する認定看護師182名を対象にデルファイ法を用いた自記式質問紙調査を郵送法で行った。調査は3回実施し、それぞれ前回の回答結果を添えた質問紙を送り、回答を求めた。コンセンサスを示す同意率はは80%に設定した。

　結果：同意率が80%以上を示した項目は、〔循環動態〕で9項目、〔呼吸状態〕で7項目、〔感染兆候〕で5項目、〔神経学的所見・症状〕で8項目、〔血液データ〕で2項目、〔その他（個人、環境・治療要因）〕で7項目の38項目であった。

　結論：認定看護師は急性期脳梗塞患者の初回機械浴の可否判断には、安全な入浴が実施できるよう、身体面だけでなく環境面も併せて判断することが必要だと認識していた。

【Abstract】

　Objective: The purpose of this study is to identify the decision items for whether or not to perform an initial mechanical bath for patients with acute stroke as perceived by nurses certified in stroke rehabilitation (hereinafter, “certified nurses”).

　Methods: We mailed a self-administered questionnaire to 182 certified nurses working at hospitals/institutions across Japan to conduct a survey using the Delphi method. Certified nurses were requested to complete the questionnaire three times: the second and third questionnaire forms were mailed with the results of responses to the first and second questionnaires, respectively. Additionally, similar types of items were added to the questionnaire during each round. For each item, an agreement rate of ≥80% was considered as a consensus.

　Results: The agreement rate was ≥80% for a total of 38 items: 9 hemodynamics-related items, 7 respiratory condition-related items, 5 infection sign-related items, 8 neurological findings/symptomrelated items, 2 blood test data-related items, and 7 other items (individual, environmental, and therapeutic factors).

　Conclusion: Certified nurses were found to consider that both physical and environmental factors are necessary in assessing the safety before starting machine-assisted bathing for patients with cerebral infarction.