Falls among Hospitalized Patients in an Acute Care Hospital : Analyses of Incident Reports

Falls cause injuries such as fractures, skin lacerations, bleeding, and head injury, and could result in more severe medical conditions in hospitalized patients. We retrospectively investigated the incidence and characteristics of falls among hospitalized patients in an acute care hospital from incident reports by hospital staff between January and June 2013. There were 154 falls in 135 patients, 2 of which resulted in fracture. The average age of patients who fell was 63.9 (range 0 to 91) years. Many falls occurred at the bedside (68.2%). Approximately half of all falls were related to elimination (46.6%). The most common time of discovery of falls was 2 : 00-2 : 59 AM (14/154 ; 9.1%), followed by early in the morning when patients would actively move. Fall rates in our hospital were 1.39 falls per 1,000 patient days. The department of respiratory medicine and rheumatology had the highest fall rate (3.08 falls per 1,000 patient days), followed by the departments of neurosurgery and neurology (2.98 falls per 1,000 patient days). This study revealed the characteristics of falls in an acute care hospital, and suggests that their notification in the hospital might help reduce the incidence of falls in hospitalized patients

エキスパートナースが大切にする実践

To clarify the practical approaches of nurses in cancer chemotherapy, semi-structured interviews were conducted with 10 nurses certified for cancer chemotherapy in Tokushima Prefecture. The interview data were classified into the following categories : [not neglecting any step, as failure is unacceptable], [accurately predicting the symptoms of chemotherapy, rather than simply waiting for patients to report them], [making efforts to fulfill patients' desire to live], [bearing a heavy responsibility for handling toxic drugs], and [playing a role in generalizing chemotherapy]. The results suggest that the practical approaches of nurses in cancer chemotherapy three features place importance on “achieving positive effects while minimizing risks”, “not narrowing down the scope of life”, and “reducing resistance to chemotherapy”

認知症高齢がん患者の看護実践の関連要因

The purpose of this study was to clarify the current status of nursing practice for elderly cancer patients with dementia receiving treatment in acute care hospitals and related factors. An anonymous， self-administered questionnaire survey was conducted from May to July 2021， involving 400 people with experience of providing nursing care for elderly cancer patients with dementia. Factor analysis identified and as factors of self-evaluation of nursing practice for elderly cancer patients with dementia receiving treatment in acute care hospitals. Such evaluation was influenced by ， ， ， ， ， and

急性期医療を受ける患者の願い

目的：患者の地域での暮らしの希望と療養上の目標を中心に構造化した看護のプロセス”Nursing Care for Patient Goals”（NCPG）に患者の視点から示唆を得るため急性期医療を受ける患者が看護師に知ってほしい情報と療養の目標に対して求める看護を明らかにした． 方法：１特定機能病院において入院中または入院予定の20歳以上の患者を対象として質問紙調査を２回（2017年，2018年）に実施した．調査内容は基本属性，調査Ⅰ（2017年）は先行研究を基に抽出した患者情報23項目について看護師に知って欲しいと思う程度，最も大事と思う項目とその選択理由，調査Ⅱ（2018年）は自分の療養の目標について求める看護であった．統計分析は記述統計，因子分析，t 検定を用いた．自由記述によるデータは質的記述的分析を行った． 結果：調査Ⅰの有効回答数は448名で，看護師に知ってほしい自分の情報として【第１因子：社会的役割と環境】【第２因子：病気の理解・受け入れと心理】【第３因子：身体的状態と生活の仕方】【第４因子：暮らしの希望と自己決定】が抽出された．65歳未満と比較して65歳以上の対象者は第１因子が高い傾向にあった．また第４因子を最も大事と思う項目の選択理由について， “希望・目標がなきゃ生きていけない” という表現が特徴として出された．調査Ⅱの有効回答数は416名で，多数の対象者が自分の目標を医療者と共有することが重要だと感じており，受けたい看護として，傍にいて寄り添う看護，治療・症状への専門的な看護，地域での暮らしの自立への看護が抽出された． 結論：患者の視点から看護師に知ってほしい情報として４つの因子と自分の目標を分ってほしいとする対象者の願いは，希望と目標を基盤としたNCPG の考え方と一致しており，目標達成のために受けたい看護の３つの視点が示唆された．Objective : This study aimed to identify information on care of patients receiving acute care for life in community from the patientsʼ perspective and to obtain suggestions for “Nursing Care for Patient Goals”（NCPG）. Method : The subjects were patients receiving acute care and aged 20 years and above. They were given self-administered questionnaires. Survey Ⅰ（2017）consisted of a questionnaire that was based on previously collected qualitative data and comprised 23 Likert-scale questions and free descriptive questions on the reasons for selecting the most important item. Survey Ⅱ（2018）consisted of questionnaire that was comprised of three Likert-scale questions on goals and a free descriptive question on care for the achievement of goals. Statistical analysis included descriptive statistics, factor analysis, and t-test. Data from free-text descriptions were analyzed using qualitative descriptive analysis. Results : Survey Ⅰ : data from 448 valid responses were subjected to factor analysis to determine the factor structure. The following factors were identified from the patientsʼ perspectives: 1） social role and environment, 2） understanding/acceptance and psychological state, 3） physical condition and life, and 4） hope and decision-making for life. In addition, a qualitative and inductive approach was employed to analyze participantsʼ descriptive responses about the reason for selecting the most important item. The characteristic description of why participants selected “hope and decision-making of life” was “I cannot live without hope.” Survey Ⅱ : data from 416 valid responses were analyzed. The majority of participants felt it was important to share their goals with their healthcare professionals. A qualitative and inductive approach was employed to analyze the participantsʼ descriptive responses to care for goals achievement. The care desired by participants was categorized as “being with”, “professional care”, and “self-care support”. Conclusion : The factors that patients wanted nurses to know were consistent with the components of “NCPG.” The care that patients desire to achieve their goals was clarified

患者の希望を地域につなぐための患者状態とニーズ

目的：急性期医療を受ける患者の地域での生活を視野に入れた看護を展開するために患者の情報と看護の視点について明らかにすることを目的とした． 方法：特定機能病院に勤務する中堅以上の看護師３３名を対象に，地域での生活を視野に入れた患者の情報と看護の視点についてフォーカス・グループ・インタビューを行い分析した． 結果及び考察：急性期医療を受ける患者の地域での生活に必要な情報と看護の視点として，コアカテゴリー《地域での生活を可能にするニーズ》が抽出された．さらに地域での生活を可能にするための状態とニーズとして【身体・生理的な状態とニーズ】，【生活の自立と安全の状態とニーズ】，【病気の受け入れと心理的反応の状態とニーズ】，【社会的環境の状態とニーズ】，【医療・療養への自己決定の状態とニーズ】の５つのカテゴリーに分類された．これらより，患者の暮らしの希望，療養の目標，５つの視点の状態からニーズを導き看護を展開する看護の過程として，“Nursing Care for Patient Goals（” NCPG）を構造化した． 結論：地域包括ケアシステムの中において急性期医療を受ける患者の情報と看護の視点として地域での生活を可能にするための５つの状態とそのニーズが重視されていた．Objective : The aim of this study was to identify information and care perspectives of nurses for patients leaving an acute care hospital for life in the community, and to consider appropriate nursing care in the community-based integrated care system. Method : Focus group interviews were conducted with 33 nurses working in an acute care hospital. The data were analyzed using qualitative inductive analysis. Results & Discussion : The core category “Needs to enable patients to live in the community” was extracted as the information and care perspective necessary for patients receiving acute care to leave hospital for life in the community. The information and care perspectives were classified into five conditions : physical/physiological condition and needs, life independence and safety status and needs, acceptance of/emotions about illness and needs, social environment and needs, and decision-making and needs. “Nursing Care for Patient Goals” was structured as a nursing process. Conclusion : We identified five conditions and their needs that would enable patients receiving acute care to leave hospital for life in the community

Elderly aortic stenosis patients' perspectives on treatment goals in transcatheter aortic valvular replacement

Abstract Aims Transcatheter aortic valvular replacement (TAVR) is increasingly being performed for elderly patients with aortic stenosis (AS), and current guidelines acknowledge the importance of shared decision‐making in their management. This study aimed to evaluate elderly symptomatic severe AS patients' perspectives on their treatment goals and identify factors that influence their treatment choice. Methods and Results We performed a pre‐procedural cross‐sectional survey using a questionnaire at a single university hospital. The questionnaire included three primary domains: (i) symptom burden, (ii) goals and important factors related to treatment, and (iii) preferred place of residence after treatment. We investigated 98 symptomatic severe AS patients who underwent TAVR (median age 86 years, 26% men). None of the patients died during hospitalization, and most of them (94%) were discharged home. Prior to TAVR, the three most common symptom burdens were poor mobility (52%), shortness of breath (52%), and weakness (44%). The reported preferred treatment goals were symptom burden reduction (78%), independence maintenance (68%), ability to perform a specific activity/hobby (62%), and improvement in prognosis (58%). In total, 54% of the patients rated ‘in alignment with my values’ as the factor that affected their decision to undergo TAVR. Nearly all patients (95%) stated that they preferred to live at home after TAVR. Conclusions Among elderly AS patients with varying symptoms who underwent TAVR, symptom burden reduction was the most cited patient‐reported goal. Nearly all the patients preferred to live at home after the procedure. Encouraging patients to define their specific goals may improve the quality of shared decision‐making in such settings