[実践報告] 認知症看護認定看護師に求める資質能力を探る取り組み

本取り組みは、認知症看護認定看護師（以下、DCN）に求める資質や能力を明らかにし、認定看護師教育を検討することを目的とした。　ＤＣＮ26名によるグループワークの結果、認定看護師に求める資質能力は「多角的な対象理解」「ケアによる貢献」「スタッフとの高い親和性」「柔軟な対応力」「他者への説明」「自らの能力の把握」「現状に対する問題意識」「ピアレビューへの参加」「個性発揮能力」「高い知識技術による指導」「モデルとなる実践の例示」「スタッフへの良い波及効果」の12項目が抽出された。　ＤＣＮが認知症者に対するケアの方向性を統一し、スタッフの認知症者に対して抱くネガティブな感情のサポート、さらに多職種連携を行うにあたり「スタッフとの高い親和性」は重要である。今後の認定看護師教育において、DCNがスタッフとの関係性を向上させるような教育支援の検討が必要である。This study aimed to examine certified nursing education through clarifying the performance abilities and personal characteristics required for certified nurses who hold the Dementia Nursing Certification Nurse（called “DCN-certified nurses”）．Group work was conducted with 26 DCN-certified nurses, and based on their group work experiences, the following 12 items were extracted as performance abilities and personal characteristics required for certified nurses: “a multidimensional understanding of people with dementia,” “their contribution to care,” “a good relationship with staff members,” “the ability to be flexible in their response,” “the ability to provide explanation to other people,” “an understanding of their own abilities, “awareness of the existing situation,” “their participation in peer review,” “the ability to demonstrate originality,” “a high level of leadership knowledge and skills,” “the ability to effectively model practical examples,” and “positive spillover eff ects on staff members”. “A good relationship with staff members” is considered highly important in standardizing the direction of care for people with dementia, alleviating negative feelings of staff members towards people with dementia, and moreover collaborating with a variety of professionals. In the vision for certified nursing education in the future, it is necessary to examine educational support in which DCN-certified nurses can help improve relationships with staff members

Comparison of Moral Distress and Burnout Experienced by Mental Health Nurses in Japan and England : A Cross-sectional Questionnaire Survey

Aims: To compare moral distress and burnout experienced by mental health nurses in hospitals both in Japan and England. Methods: This is a cross-national study, and a cross-sectional design was adopted. An anonymous questionnaire containing 43 moral distress items, a 16 item burnout scale, and demographic data was administered to convenient samples; 391 nurses in Japan, and 460 nurses in England. Among the participants, 289 nurses (73.9%) in Japan, and 36 nurses (7.8%) in England responded. Results: The moral distress items which were commonly felt by nurses in both countries dealt with a lack of staff. Several differences, however, existed between the two, which reflected poor conditions such as long term social hospitalization in Japan. The nurses in England felt moral distress in a wider variety of situations, though they confront them less frequently than the nurses in Japan. Only in England was it found that the older nurses became, and the more experience they had accumulated, the less intensely they felt moral distress. The nurses in both countries felt the same levels of exhaustion, and cynicism, but as far as professional efficacy, the scores of the nurses in England were much higher than those of the nurses in Japan. Conclusions: If nurses feel no moral distress, there will be no improvements of care. Nurses should have moral sense, and do their best to improve the situations without being burned out

ショガイコク ノ ニンチショウ コウレイシャ ノ ユクエフメイ オヨビ コウツウジコ ノ ハッセイ リツ ニ カンスル イチ コウサツ

2012年の世界保健機関（WHO）の報告書によると、世界の認知症有病数はおよそ3,560万人に上り、2050年までに３倍の１億1540万人に増えるとされている。我が国の2050年の推計では、認知症の人は700万人、高齢者の５人に一人が認知症と推計される。本研究は、諸外国における認知症高齢者の行方不明および交通事故の発生率を明らかにし、認知症高齢者の行方不明および交通事故の早期発見につながるシステムの構築にむけての基礎データとすることを目的とする。医学中央雑誌WEB版とPubMedを用いて、1995年から2017年９月までに発行、掲載された原著論文について、「認知症高齢者　elderly people with dementia」、「警察　police office」、「交通事故　traffic accidents」、「行方不明　missing」をキーワードとして検索した結果32文献が抽出された。欧州で発表された行方不明及び交通事故に関する３文献と国内の１文献から得られた知見を報告する。１．国内外では認知症高齢者の行方不明及び交通事故に関する研究は少ない。２．認知症当事者や家族介護者等を対象とするインタビューによる研究が少ない。３．研究方法としてデンマークは個人識別番号を使用したデータを有効活用している。According to the report of the 2012 World Health Organization (WHO), the number of dementia prevalence in the world is up to approximately 35.6 million people, predicted to increase by 3 times to 115,000 thousand by 2050. According to Japan＇s 2025 estimate, 7 million people with dementia and 1 in 5 elderly people are estimated to be dementia. This research clarifies the incidence of missing and traffic accidents among elderly with dementia in other countries and makes it the basic data for establishing a system leading to early detection of missing elderly people with dementia and traffic accidents objective at. As a result of searching keywords,“ dementia elderly person＂,“ police office＂,“ traffic accident＂ and“ missing＂ from publication or placed original papers which were published in September, 1995 to 2017 using medical central magazine WEB version and PubMed, there were 32 documents. We report findings from three literature on missing and traffic accidents announced in Europe. 1. There are few studies on missing people and traffic accidents of elderly people with dementia in Japan and abroad. 2. There are few studies by interviews targeting dementia parties and family carer 3. As a research method, Denmark effectively uses data using a personal identification number

ニンチショウ サポーター ジギョウ ニ カカワル ゲンジョウ ト カダイ

先行研究と関係機関の公表データから、新オレンジプランの1つである認知症サポーターの活動状況と課題を検討した。現在、890万人を超す認知症サポーターが養成されているが、活発な活動がされているのは25～30%程度であった。認知症サポーター活動の課題として、60歳以上の高年齢層のサポーター参入を促すとともに、認知症サポーターが活動できる場の整備や地域住民への周知が必要である。また、認知症高齢者の介護家族のニーズをふまえて、情緒的サポートや徘徊に対する支援をする。認知症サポーター養成講座の課題としては、更に認知症BPSD（Behavioral and Psychological Symptoms of Dementia）の背景や対応方法、家族心理などの具体的な内容を加え、フォローアップ研修を行う事が有効である。また、認知症サポーターの要望を把握し、ボランティアとして負担なく活動できるような支援を進めることが必要である。We examined the activity status and issues of dementia patient’s supporter system, which was one of the New Orange Plans, by reviewing the previous research papers published by relevant organizations. Currently, there are more than 8.9 million dementia patient’s supporters，but the ratio of active supporters were approximately 25 to 30%. Since there are the problems of dementia patient’s supporter activity contents, it is necessary to promote the entry of supporters who are elder than 60 years old, and to develop a place where dementia patient’s supporters can work and send information to local residents. Also, based on the needs of caregivers for elderly patients with dementia, we should be able to provide emotional support and prevention of wandering. As to the task of dementia patient’s supporter training course, it is effective to add follow-up training by adding concrete content such as how to learn deal with Behavioral and Psychological Symptoms of Dementia (BPSD) and family psychology. By so doing, we will be able to grasp the psychological needs of dementia patient’s supporters, and promote the support system which is based on volunteers with less burden

セイシンカ ホウモンカンゴシ ガ ミル トウゴウ シッチョウショウ カンジャ ノ サイハツ チョウコウ

統合失調症患者における精神科訪問看護の目的の一つに、再発兆候の早期発見が重要な要素とされている。本研究では精神科訪問看護に携わる看護師が、統合失調症患者の再発兆候をどのようなところで観察し、捉えているかを明らかにするべく看護師への聞き取り調査を行った。結果、精神科訪問看護に携わる看護師は、統合失調症患者の病状悪化に、【生活様式の逸脱】【病的体験の増悪】【治療意欲の低下】【コミュニケーションの変調】が伴うことを経験的に体得しており、これらの局面から再発兆候をモニタリングしていた。Consulting itako [blind female mediums] is the spiritual practice found in the Tohoku region especially in Aomori Prefecture. In order to research how itako helped clients assuage guilt due to loss from suicide, our study interviewed suicide loss survivors who consulted an itako. Itako were believed to channel the soul of the deceased, allowing suicide loss survivors to learn why the family member committed suicide. Suicide loss survivors were comforted by learning how the deceased viewed life. In addition, suicide loss survivors felt “empathy for how the deceased had lived,” they “[believed] that the deceased is protected in the afterlife and [they felt] a connection to the deceased, and they “[felt] that the sins of the deceased and [his or her] family had been washed away.” having received a “divine revelation about life,” suicide loss survivors felt that “[their] soul[s] had been purified.

ニンチショウ カンゴ ニンテイ カンゴシ キョウイク カテイ ニオケル キョウイク ト ジュギョウ ヒョウカ ノ ブンセキ

認定看護師教育課程 認知症看護認定看護師コース(以下、本教育課程)の教育実践を振り返り、今後の課題を検討した。今回、授業評価を実施した研修生20名の認知症看護経験年数は平均10.4±4.45年であり、本教育課程を受講した理由の大半は自己の学習ニーズ(16名)であった。研修生の本教育課程に対する期待には「臨床実践に沿った講義内容」があり、修了生による臨床に即した実践内容を含んだ授業の工夫が必要であると考えられた。研修生は「認知症ケアを自己の言語で伝えられるようになりたい」という目標を持つ者が多く、本教育課程で看護過程の展開技術を重視した学習プログラムはニーズに一致していた。研修生は自己の目標達成において病院実習の有効性を高く評価していたが、満足度は低い傾向を示した。特に、受講理由が施設長等の勧めである研修生にその傾向が認められた。よって、入学前に研修生が自己を振り返る課題を課し、本教育課程での学びのイメージを高めさせ、認定看護師の研修の質の向上を図ることが課題に挙げられた。The purpose of the research was to look back upon the educational practice of the course for certified nurses in dementia nursing of the curriculum for of certified nurse education, (hereafter referred as to "this education course") and discuss tasks for future use. The average number of years of experience in dementia nursing for the 20 trainees of whom the class evaluation of this education course was implemented was 10.4±4.45, and the reason for attending this educational course was for the majority, a fulfillment of their own learning requirements (16 trainees). Their expectations for this educational course included the "contents of lectures consistent with clinical practice." Therefore, it was considered necessary to contrive the class in line with the clinical practice of those who have already completed this educational course. There were many trainees who had the target of "conveying dementia care in their own words," which showed that a learning program with emphasis on developing technology for the nursing process matched their needs. Although the trainees highly evaluated the eff ectiveness of hospital practice for their target achievement, they showed a low degree of satisfaction. This trend was significant among those who attended this educational course at the encouragement of the chief of their facility, in particular. Therefore, the benefit of indicating the tasks before they attend this educational course, in order to make them refl ect on themselves, enhance their image of learning in this educational course. Improving the quality of training for qualified nurses was also clarified

ジシ イゾク ノ グリーフワーク オ ソクシン スル ミンカン シンコウ ノ ジッタイ

自死遺族のグリーフワークにおいて、青森県の特徴的な民間信仰である「イタコ」の、どのような支えが喪失による悲嘆を乗り越えることができたかを明らかにすることを目的に、イタコを利用したことのある自死遺族で1年以上経過した30歳代～70歳代の女性７名に聞き取り調査を行った。遺族は、イタコの口寄せによって自殺の理由を聞かされたことで、故人の人生に対する価値を見出すことができ癒された。また遺族は、【故人の生き様への共感】、さらに、【故人の加護や繋がりの実感】【相互の赦免の獲得】を経て、【生きることへの託宣】を得て、【心の浄化】ができた。The early detection of relapse in patients with schizophrenia is considered an important objective for psychiatric nurses doing home health visits. In this study, interview surveys of home health psychiatric nurses were conducted to elucidate what they watched for when monitoring these patients for signs of relapse. The results showed that when monitoring for deteriorating health, through experience, they had learned to watch for deviations from usual lifestyle patterns, worsening of patient pathological experience, loss of interest in treatment, and abnormal communication

施設内老人と在宅老人の幸福感の相違 : 主観的幸福感と樹木像の形態指標を通して

今回我々は,PGCモラール・スケールとバウム・テストを用いて,施設内老人と在宅老人の主観的幸福感の相違や描画される樹木像の各形態指標の双方の相違から老人の一般的特徴とSuccessful agingの意義について考察した。結果は以下の通りである。1)モラール・スケールの各因子の得点結果から,第2因子の「若い時と同じように幸せに感じる」の項目は,在宅老人の方が高い。2)施設内老人と在宅老人が描いた樹木像の形態指標の比較において,(1)施設内老人は「陰影」を,(2)在宅老人は「一線枝」,「屈曲した枝」を多く描く傾向にある。3)モラール・スケールの低得点群の施設内老人と在宅老人に共通する形態指標は,「サイズ1/4以下」である。また,高得点群は,共通して「地平線」を描く傾向にある。We studied the differences of two groups of elders about the more of "Successful Aging" using Philadelphia Geriatric Center Morale Scale (PGC Scale) and Baum Test. Group A is elder living at home and group B is elders living nursing homes. The results are as follows ; 1) In the PGC Scale, Group A get a higher score than Group B in the question that "l feel happy as same as it used to be. 2) In Baum Test, "curve branch" and "a single branch" are more observed in group A than group B. "Shadow of the tree" are more observed in group B than group A. 3) In Baum test, the low scorer in PGC Scale of both groups tended to use below 25% of the space for drawing the tree. On the hand, the high scorer tended to draw "the horizon

精神科訪問看護師が見る統合失調症患者の再発徴候

統合失調症患者における精神科訪問看護の目的の一つに、再発兆候の早期発見が重要な要素とされている。本研究では精神科訪問看護に携わる看護師が、統合失調症患者の再発兆候をどのようなところで観察し、捉えているかを明らかにするべく看護師への聞き取り調査を行った。結果、精神科訪問看護に携わる看護師は、統合失調症患者の病状悪化に、【生活様式の逸脱】【病的体験の増悪】【治療意欲の低下】【コミュニケーションの変調】が伴うことを経験的に体得しており、これらの局面から再発兆候をモニタリングしていた。The early detection of relapse in patients with schizophrenia is considered an important objective for psychiatric nurses doing home health visits. In this study, interview surveys of home health psychiatric nurses were conducted to elucidate what they watched for when monitoring these patients for signs of relapse. The results showed that when monitoring for deteriorating health, through experience, they had learned to watch for deviations from usual lifestyle patterns, worsening of patient pathological experience, loss of interest in treatment, and abnormal communication.2