統合失調症患者が地域生活において対処できない問題とその対処に向けた訪問看護師の支援

目的:統合失調症患者が地域生活において対処できない問題とその対処に向けた訪問看護師の支援を明らかにする.方法:A県内の精神科病院および訪問看護ステーションにおいて統合失調症患者を支援している訪問看護師を対象として面接調査を行い,Berelson,B.の内容分析を参考にして分析した.結果:訪問看護師が語った統合失調症患者が地域生活において対処できない問題は,【服薬自己管理ができないため薬を正しく飲めない】【入浴・洗髪・行為をできないため清潔が保てない】など11コアカテゴリが抽出された.統合失調症患者が地域生活において対処できない問題の対処に向けた訪問看護師の支援は,《服薬自己管理ができるように服薬確認や声かけを行う》など17コアカテゴリであった.結論:訪問看護師は,患者が地域生活において対処できない服薬,清潔,金銭管理,熱中症予防などの問題に対して,患者の状態に合わせて段階的に継続的な支援を行っていた.Purpose: To elucidate the problems in community living that patients with schizophrenia are unable to manage and the support provided by visiting nurses to address these problems. Methods : Interviews were conducted with visiting nurses caring for patients with schizophrenia at a psychiatric hospital or a visiting nurse service provider in Prefecture A. Interview data were analyzed according to Berelson's method of content analysis. Results : Results : Analysis of interview data extracted 11 core categories of problems in community living experienced by patients with schizophrenia, such as "medication errors due to inability to self-manage medication" and "cleanliness problems due to inability to bathe, shampoo and change clothing". The analysis also extracted 17 core categories of support that visiting nurses provided to address the problems, such as "checking medication and providing reminders to help patients manage self-medication." Conclusion : Visiting nurses provided continuous support to patients with schizophrenia living in the community in problem areas such as taking medication,cleanliness,money management and heat stroke prevention according to the condition of the patient.報

A県内の高齢者向け住まいのサービス提供体制と医療的ケア及び看取りの受け入れ意向との関連

目的：A県の高齢者向け住まいのサービス提供体制と医療的ケア及び看取りの受け入れ意向との関連を明らかにする． 方法：A県の高齢者向け住まい（463か所）に勤務する管理者等を対象とし，入居者の状況，サービス提供体制等の自記式質問紙調査を実施した．サービス提供体制と医療的ケア及び看取りの受け入れ意向の有無との関連について，χ2検定又はFisherの直接確率検定を行った． 結果：有効回答は130施設（有効回答率28.1％）であった．医療的ケアの受け入れ意向では，「施設に看護師が常駐」「夜間ケアを提供する職員の配置」等の11項目，看取りの受け入れ意向では，「施設に常勤の介護職員」「施設に常勤の看護師」「協力医療機関の24時間緊急往診要請への対応」「看取りのマニュアルの整備」等の14項目に関連があった． 結論：高齢者向け住まいにおける医療的ケア及び看取りの受け入れには，看護職員・介護職員の配置及び医療機関等との連携の必要性が示唆された．Objectives: To clarify the relationship between the service provision system of housing for the elderly in A prefecture and the intention to accept medical care and end-of-life care. Method: A self-administered questionnaire survey was conducted on residents’ status and components of the service provision system for managers working in residences for senior citizens in A Prefecture (463 facilities). The χ2 test or Fisher’s exact test was performed on the relationship between the service provision system and the intention to accept medical care and end-of-life care. Results: 130 valid responses were returned (effective response rate 28.1%). For the intention to accept medical care, 11 items were extracted, including “nurse resident in facility” and “allocation of staff providing night care”. For the intention to accept end-of-life care, 14 items were extracted, including“ full-time caregiver at facility”,“ full-time nurse at facility”,“ responding to 24-hour emergency visit requests with cooperating medical institutions” and“ maintenance manual”. Conclusion: It was suggested that the placement of nursing staff and cooperation with medical institutions are necessary for the acceptance of medical care and end-of-life care for the elderly.報

A村の特定健康診査受診者の非肥満者を対象とした健診結果の実態及び血糖と生活習慣の関連

目的：A村の特定健康診査受診者の非肥満者を対象とした健診結果の実態及び血糖と生活習慣の関連を明らかにする． 方法：A村の平成29年度特定健康診査受診者のうち，血圧や血糖等の服薬をしていない非肥満者533人を研究対象者とした．非肥満者533人を高血糖の有無による2群に分け，生活習慣との関連を分析した． 結果：健診結果では，非肥満者は，LDLコレステロールの平均値が特定健診受診者全体よりも高かった． 生活習慣では，非肥満者において高血糖群の方が定期的な運動をしている割合及び遅い時間の夕食をとっていない割合が有意に高く，生活習慣が良好な割合が高かった． 結論：非肥満者のうち高血糖の住民は，生活習慣には留意していると考えられた．今後は，詳細な生活習慣を確認し，その結果とともに健診結果に基づく指導が重要である．Objectives: The purpose of this study was to clarify the actual conditions of specific health checkups for non-obese individuals in A Village and the relationship between blood glucose and lifestyle habits. Method: The research participants were the 533 non-obese people who were not taking medication among of the all people who received a specific health checkup in A Village in 2017. We divided the 533 participants into two groups based on the presence or absence of hyperglycemia, and the relationship between blood glucose and lifestyle habits was analyzed. Results: Average LDL cholesterol was higher in the participants than in the recipients of specific health checkups overall. In terms of lifestyle habits, the proportion of participants in the hyperglycemic group who exercised regularly and those who did not eat dinner late at night was significantly higher than the non-hyperglycemic group, and the proportion of favorable lifestyle habits was higher. Conclusion: Non-obese people with hyperglycemia were considered to be aware of healthy lifestyle habits. It will be important for medical professional to ask more detailed questions about lifestyle during health checkups and to provide health guidance based on the results of blood test data.原

地域包括ケアシステムにおける訪問看護ステーションの経営状況と事業所特性及び地域特性，経営管理との関連―全国と群馬県の比較―

目的：全国及び群馬県の訪問看護ステーション（以下，ST）の経営状況と事業所特性及び地域特性，経営管理との関連を明らかにし，比較検討する． 方法：全国2,000人及び群馬県163人のST管理者を対象とし，自記式質問紙調査を実施した．有効回答は全国473人，群馬県55人で，経営状況と各項目との関連はχ2検定及びKruskal-Wallis検定を，さらに経営状況を目的変数とするロジスティック回帰分析を行った． 結果：全国では，看護師常勤・看護師非常勤・事務職員非常勤の従業者数，1人1日平均訪問回数，北海道・東北地域，収支のモニタリングが黒字に関連していた．群馬県では関連がみられず，全国に比して赤字のST割合が多く，経営管理の得点が低かった． 結論：経営状況の改善には，ST規模の拡大やST管理者の収支のモニタリングに焦点を当てた行動の有効性が示唆された．群馬県では，経営管理に関する分析の強化が必要である．Objectives: The financial status of home-visit nursing stations (STs) was analyzed in relation to business office characteristics, local community characteristics and business management, and the results between Gunma Prefecture and all prefectures in Japan were compared. Methods: A self-administered questionnaire survey was completed by 163 ST managers in Gunma Prefecture and 2000 ST managers from all over Japan. Valid responses were collected from 55 managers from Gunma Prefecture and 473 managers from all over Japan. The association between management status with each variable was analyzed by the chisquare test and Kruskal-Wallis test. In addition, logistic regression analysis was carried out with the status of management as the dependent variable. Results: For STs all prefectures in Japan, profitable business (black-ink balance) was associated with the number of employees (full-time nurses, part-time nurses and part-time clerical staff), the mean number of care receiver homes visited daily by each nurse, the district (Hokkaido/Tohoku) and revenue/expenditure balance monitoring. In Gunma Prefecture, the percentage of red-ink operation STs was higher and the score for business management was lower than in all prefectures in Japan. Conclusions: These results suggest that management actions focusing on expansion of the scale of STs and on revenue/ expenditure balance monitoring by ST managers are effective in improving the status of management. In Gunma Prefecture, reinforcement of how to analyze business management is needed.原