A Prehistory Study of the Eldercare System : According to the geriatric treatment provided at the Yokufuen nursing facilities

浴風園は、1927年に恩賜財団浴風会によって設立された養老施設である。浴風園は、恩賜財団の豊富な資産をもとに内務省直轄の運営が行われ、当時としては質の高い養老施設とされていた。しかし、これまでの浴風園の評価は、社会福祉的視点からのものが多く、医療についての評価が不十分であった。今回の論文は、浴風園における、高齢者医療保障前史ともいえる医療を看護学的および経済学的に分析したものである。まず、浴風園がどのような社会的必然性によって設立されたかをふまえ、それによりどのような医療システムを作ったかを論じた。それから、医療の展開過程を分析した。すなわち、老人の医療ニーズおよび看護ニーズがどのように明らかにされ、それにどう対応したかについて論じた。また、尼子富士郎の老年医学研究の業績について論じた。そして、それらをふまえて、浴風園における医療活動を高齢者医療保障前史として位置づけた。The Yokufuen is a geriatric care setting established in 1927 under the Imperial Foundation. It was under the direct control of the Ministry of Internal Affairs, generously sponsored by the Imperial Foundation, and for those days was an outstanding care house. However, until nowadays a proper estimation of the medical treatment provided at the Yokufuen, especially from the social welfare approach was insufficient. This work represents a case study of the Yokufuen geriatric care setting with an analysis of medical treatment provided from the viewpoints of nursing and economics. Thus, the analysis has been performed in the following order. First, the social needs put on the base of establishment of the nursing facilities and the following development process of the health care system has been clarified. Second, an analysis of the medical development process has been done. In other words, the needs for the medical treatment and nursing sectors, and possible ways for its satisfaction have been clarified. Then, to summarize the above-mentioned it was analyzed how the Yokufuen geriatric care setting has managed to satisfy the social needs. As a conclusion, medical treatment system provided at the Yokufuen can be considered as a prehistory stage for development of the elderly care system

Bedsore Prevention in High-risk Patients : Evaluation of a 13-year Initiative

application/pdfBy adopting a historical research approach, we analyzed a 13-year effort at bedsore prevention, undertaken at a ward where no case requiring treatment has been reported for the last four years, although many of the patients were at high risk. Our analysis aimed at gaining an understanding of the development process of their nursing capabilities, and at identifying the indispensable prerequisites of the successful practice implemented at their ward. The analyzed items included the patient population, the methods used to support patient daily life (i.e., nurse observation and support techniques), the nursing devices employed, and nursing administration. The analysis revealed the following four points as essential factors for bedsore prevention:(1) bedsores can be prevented if depressurization is appropriate for the patient s individual condition; (2) location of that body position which achieves certain depressurization, it is necessary to observe sensitively, by both perceiving the situation as it is and making a conscious effort to grasp the perceived situation; (3) patient comfort is essential for the maintenance of successful depressurization; and, (4) nursing administration is necessary which ensures the administration of constant homogeneous care, throughout the team.ハイリスク患者が多いにもかかわらず、ここ４年間治療を要する褥瘡を発生させていない病棟を対象とし、褥瘡予防を可能にした看護力が整ってきた経緯から何が褥瘡予防の必須要件だったかを明らかにすることを目的に、過去13年間の褥瘡予防の取り組みを歴史研究の手法を用いて分析した。分析項目は、患者層、日常生活援助方法（観察と援助技術）、看護用具、看護管理である。 その結果、褥瘡予防の重要要素は以下の４点であると導かれた。①患者の個別状況に合わせた除圧すなわち体圧再分散ができれば褥瘡は予防できる。②確実に除圧できる体位を探るためには「ありのままに観ること」と「意識的に事実を把握すること」の両方が備わった細やかな観察が必要。③確実な除圧の継続には患者にとっての安楽が必須条件。④チーム全体で同質のケアが継続的に提供できるような看護管理が必要。journal articl

老人保健医療の制度体系に関する一研究

日本の医療保障は,1961年,国民皆保険体制の発足で大きな前進をしめした。しかし,その体系は,高齢者の医療保障を軽視したものであった。高齢者の受療機会を保障するために地方公共団体からはじまった肩代わり制度は,1973年,老人医療費支給制度としてスタートした。老人医療費支給制度は,医療保険に「足つぎ」し,医療保険を優先させたものであった。この制度体系は,高齢者の健康保障を1歩前進させはしたが,多くの課題を当然のこととして生み出した。また,老人医療費支給制度は,公費負担医療の性格をめぐる議論を再現させもした。本論文は,老人医療費支給制度の制度体系に注目し,その特徴を,仕組み,医療保険優先,肩代わり負担,出来高払い方式,疾病の特定化,対象の拡大について検討した。さらに,公費負担医療の性格などについて検討をくわえ,老人医療費支給制度を新しい公費負担医療として位置づけた。Medical security in Japan significantly increased with the start of a system of health insurance for the whole nation in 1961. However, health care coverage for the aged was treated lightly in this system. Thus, local public bodies adopted a system taking over elderly patients\u27 coverage. The government in 1973 started this system of provision for medical costs for the aged. The system of provision for medical costs for the aged was an addition to the system of health insurance and gave priority to medical care through medical insurance. Although the adoption of this system for the aged was certainly a great step for coverage, it also caused many problems. Additionally, it brought up a controversy over the role of medical care at public expense again. This study focused on the system of provision for medical costs for the aged and examined its structure, priority of health insurance, takeover of elderly patients\u27 pay, payment at piece rate, specification of diseases, and extension of objects. Furthermore, it studied the role of medical care at public expense and highlighted the system as another system of new medical care at public expense