髙嶋正晴先生を偲んで

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介護老人保健施設におけるターミナルケアの満足度に関する検討-アンケート調査から-

近年介護施設でのターミナルケアが増加している.本研究は,介護老人保健施設でのターミナルケアの満足度からケアの評価を行い,課題を明らかにし質を高めることを目的とした.アンケートはターミナルケアを受けた全75家族に行い(回収率60.3%)課題を検討した.その結果,98%の家族が施設でターミナルを行い満足したと回答した.そして,ケアの実践内容の評価として90%以上が満足・やや満足の評価を得られた.その一方で,最期の迎え方について本人と話し合ったことがあるのは41%であり,医療内容まで話し合っているのは16%しかいなかった.本人の意志が反映されず,本人の意思を尊重したその人らしい最期を迎える看取りではなかった可能性があった.本人の意思決定能力がある間に話し合える機会を持ち,その人らしさを尊重しながら,穏やかに人生の最期を迎えるターミナルケアの向上をめざすよう繰り返し働きかけていく事が必要と示唆された.journal articl

Cognitive and Emotional Changes in Peer Educators of Type 2 Diabetes Patients After Starting Peer-Support Activities

Background: Diabetes self-management education through peer support has beneficial effects, especially in regions with limited medical resources. To ensure peer educators continue to provide peer-led education programs, it is important that they remain motivated to instruct patients. Here, to explore measures to enhance peer-educators’ motivation toward such programs, we examined the cognitive and emotional changes in Filipino type 2 diabetics after 7-month activities as peer educators. Methods: We individually performed semi-structured interviews with 13 peer educators with 20 years of age or above in August 2017 (immediately before starting their peer-education activities) and in March 2018 (7 months after the start). The first interview was performed after the peer educators had received 2-day training of diabetes self-management. In both interviews, we asked the peer educators about their feelings toward peer-led educational activities (e.g., satisfaction, difficulty, reward, confidence, and challenges). Their replies about their own cognition and emotions were interpreted and integrated, and then analyzed qualitatively. Results: Four and seven categories were extracted from the first and second interviews, respectively. The category “Cognition of patients’ active learning attitudes and of positive changes in patients’ physical conditions and behavior” observed in the second interview led to “Cognition of growth as a peer educator” and “Satisfaction with supporting patients as a peer educator.” These two feelings gave the peer educators’ “Increased motivation to continue the activities as a peer educator.” This motivation was also associated with “Active collaboration among peer educators,” which was affected by “Difficulties and concerns in working as a peer educator.” Conclusion: To sustain diabetic peer-led education programs, we suggest that interventions be implemented that increase peer educators’ motivation toward their activities and stimulate their awareness of the importance of collaborating with one another. Such collaboration should help to overcome the difficulties they may face in providing peer-led education.journal articl