北海道内における在宅重症心身障害児(者)の実態調査 : 親が子どもを介護する実態

本研究は在宅で暮らす重症心身障害児(者)の実態と保健医療福祉サービス利用状況を明らかにし、介護者への支援について示唆を得ることを目的とした。重症心身障害児(者)を介護している主たる介護者(家族に限る)102 名を対象に無記名自記式質問紙調査票を用い調査した。主たる介護者は全員母親であり、年齢は50 歳台が最も多かった。1 日の介護時間は12 時間以上が76.5 %を占め、介護期間は19~29 年が最も多かった。重症心身障害児(者)は男性52 %、女性48 %であり、年齢は1 歳~42 歳であった。通園・通所以外の保健医療福祉サービス利用者は77.5 %であり、短期入所の利用が最も多かった。保健医療福祉サービス利用状況と1 日の介護時間との間には、有意な相関が認められた(r=0.29,p< 0.01)。重症心身障害児(者)と家族が共に在宅生活を続けていくためには、障がいの程度に対応した保健医療福祉サービスの更なる充実が示唆された。With the aim of identifying ways to support caregivers, this paper reports on the status of homebound children and adults with profound mental and motor disabilities and their use of health, medical and welfare services. A self-administered questionnaire survey was conducted involving 102 main caregivers (limited to family members) caring for children and adults with profound disabilities. All subjects were mothers, the majority of whom were in their 50s. Among the respondents, 76.5% gave care for 12 hours or more every day, and the majority had been providing care for between 19 and 29 years. The age of children and adults with disabilities ranged from 1 to 42. Users of health, medical and welfare services accounted for 77.5%, the majority of whom were using short-stay services. A significant correlation was observed between the use of health, medical and welfare services and the hours of care per day. It was suggested that further improvements in health, medical and welfare services according to levels of disability will be necessary for children and adults with profound mental and motor disabilities to enable them to continue living at home with their families

A地域の高齢者が考える自らの終末期

本研究の目的は、終末期ケアを検討するための知見として、高齢者自身が終末期における「生死」に関してどのように考えているかを明らかにすることにある。10例の対象者へ半構成的面接を行い、データを質的に分析した結果7カテゴリーを抽出した。高齢者は〈痛みの回避〉や〈傍にいてほしい〉等《苦痛緩和》を望んでいることがわかった。《死の準備》では〈妻と対話〉〈身辺整理〉や〈遺言〉等を考えていた。《延命は望まない》では〈高度の医療は不要〉等をあげていた。《終の棲家》では、〈できれば自宅〉〈住み慣れた地域〉とする一方、〈病状悪化時病院〉とし、その裏には家族への遠慮もある。《平安なる死》では〈眠るが如き〉や〈自然死〉等を希求していた。《死の恐怖感》では、〈死への恐れ〉を抱き、それを抱く一方、〈死と共に〉生死は表裏一体と考えている。《死後の世界》には〈信じる〉〈肉親に会える〉等、死後の世界を希求していると考えられる。以上のような高齢者の気持ちを汲み取り尊厳・尊重した終末期の《苦痛緩和》ケアが重要であることが示唆された。The purpose of this study is to clarify how senior citizens consider"life and death"at their end-of-life stage, which would be useful for end-of-life care. Semi-structured interview was conducted, targeting 10 subjects, and data was analyzed qualitatively and then 7 categories were extracted. It was found that senior citizens hope"to avoid pain"and "someone will be around them,"etc. to alleviate their agony. To prepare for death, they thought about"conversation with their wives,""putting their affairs straight,"and"testaments,"etc. Those who do not want life-prolonging treatment felt that advanced medicine is unnecessary. They wished to die"at home"or"in a place where they have lived, but they hoped to stay"at a hospital if their symptoms worsen,"caring about their family members. For peaceful death, they wished to"die as if they fell asleep"or"naturally."As for the fear of death, they consider that life and death are two sides of the same coin, while fearing death. They believe in the afterworld and think that they will be able to meet their parents there. This indicates that they dream of the afterworld. This study indicates that it is important to alleviate their agony at the end-of-life stage, by considering the abovementionedfeelings of senior citizens and respecting them

基礎看護学実習I における学生の学び : 実習アンケートの分析から

基礎看護学実習Iにおける学生の学びや気づき、達成感などを把握するために実習終了後にアンケート調査を行っており、2年間の調査から以下のような結果を得た。実習到達度には年度差がみられたが、患者とかかわる体験を通して「看護への学びを深めていく動機づけとなる」目的は達成されていた。実習に対する満足感は看護あるいは看護師に対する関心を強化し、学習への動機づけを促進していた。今後の課題として(1).基礎看護学実習1での学生の状況を教員が共有し、次の段階の教育に生かすことができるようにすること(2).演習の効果を向上させるために、グループワークのルールや役割についての指導を行い、グループワークの作業過程を評価すること(3).初めて行う看護体験の個人差を少なくすること(4).体験が成功体験となるような支援の必要性が示唆された。In order to better understand what students learn and perceive, and the sense of achievement they gain from Basic Nursing Practicum I, a yearly study is conducted in the form of a self-reported questionnaire of nursing students after completion of this course. This paper looks at results from the past two years. Although there were differences in course achievement levels between the two years, through their experience of interacting with patients, students were able to achieve the goal of "motivation to learn more about nursing". Students found satisfaction in experiential learning in a clinical situation, which reinforced their interest in nursing and nurses, and strengthened their motivation to learn. The results of the present study suggest as follows: 1) All teachers should share student\u27s state of the basic nursing practicum I, and use it to next stages of various education. 2) In order to improve the effectiveness of nursing practice, it is necessary to give students more guidance about the rules of group work and their individual roles, and to assess group work tasks. 3) Efforts should be made to reduce initial disparities in individual performance due to in experience. 4) It is important to provide enough support so that students have a successful first experience in nursing practice

嫁が高齢者を自宅で看取る意味

戦後60年を迎えた今年,高度医療の技術などの進展によって,わが国は世界一長寿国となった。その一方で高齢者の介護問題が大きな課題となっている。その背景には,核家族の問題,つまり家族機能の外部化と家族の個人化へとなった。従来家庭内で出産や死亡という人間の基本的営みが家庭の中で行われていたが,ほとんど病院や施設で行われるようになっている。このような社会情勢の中で,多くの高齢者は最期の棲家を自宅で過ごしたいという願望が90%いる。しかし,現実には在宅死が20%である。特に北海道では8%である。そこで,道内の2町の農村地域で嫁が自宅で看取りをした9例を対象とした。 データ収集は自記式アンケートを作成し,面接聞き取り調査を行った。分析は,データから,自宅で看取りを可能とした資源を,介護者自身の資源,家族資源,社会的資源にさらに,嫁の看取り後の反応を分析した。その結果,生前から高齢者との人間関係が良好である。そして高齢者を看取りたいという意識が9例全員にあり,高齢者の希望を尊重したことも自宅で看取りを可能にしていた。同居者がおり,家業が農業8例,自営業1例という環境から家庭内での介護力があったこと。医師の往診を定期的・必要時受けて,高齢者の健康管理をしていた。また2例が訪問看護も利用していた。主介護者の嫁は,高齢者を自宅で介護をしていく過程で様々な葛藤が生じ,また介護経験から老いや死について考える機会を得ていた。ln the 60th year after the end of world war 2, Japan now has the world\u27s highest longevity rate thanks to the progress of advanced medical technology. However, at the same time, nursing care for the aged is becoming a serious problem. This situation stems from problems with nuclear families, that is, the outsourcing of family functions and individualization of family members. Births, deaths and other basic human activities that formerly took place at home, are now generally taking place in hospitals and other facilities. Despite these social circumstances, 90% of elderly persons hope to spend their last days at home. ln reality, however, the rate of people who die at home is 20% in across Japan and only 8% in Hokkaido. With these conditions in mind, we chose to study nine cases in which daughters-in-law provided in-home hospice and palliative care for the parents of their spouses in two rural Hokkaido towns.To collect the data, self-entry-style questionnaires and interview surveys were conducted. From the data, resources that made caring at home possible were classified as resources of the care-givers themselves, family members and society. ln addition, the reactions of daughters-in-laws after deaths of the elderly persons were analyzed. Through this study, we were able to determine that,for the nine study subjects, their personal relationships, with the elderly persons were good before their deaths. The fact that all nine daughters-in-law were willing to take care of their elderly parents-in-law and respected their wishes helped to make these specific instances of homecare possible.They were also capable of caring for their parents-in-law at home because of their family structure, the number of family members family business (8 in farming and l in a family-operated business) and other conditions. The health and well-being of the elderly persons was managed by doctors who visited regularly or whenever necessary.Home-visit nursing care service was also used in two cases. As the main caregivers, the daughters-in-law faced a variety of difficulties in taking care of their parents-in-law at home and had opportunities to think about aging and death as a result of their nursing experiences

糖尿病患者への外来看護研究の動向と今後の課題

専門外来・特殊外来の開設が進むなか、外来看護の機能や専門性が注目されている。糖尿病患者への外来看護研究における動向と課題を明らかにする目的で、検索した国内研究文献32件のレビューシートを作成し、研究内容を研究者3名で検討した。外来看護の活動に関する研究は16件で、他の16件は外来に通院する糖尿病患者の実態やニーズおよび行動や認識について調査した研究であった。外来看護研究のうち、患者個別指導・教育やフットケアなどの看護介入成果を患者対象に調査した研究は8件、外来の看護活動状況を看護師に調査した研究は5件、プライマリナーシング追う乳のようなシステム成果の研究は3件であった。糖尿病外来での相談・指導ニーズが高まるに伴い、外来看護実践の成果検証とともに、運営システムや人員配置、担当看護師の資質や教育に関する実証研究の必要性があると考える。In the trend of establishing professional and specialized outpatient care,the function and specialty of outpatient nursing has been the subject of some attention. With the purpose of clarifying the current status and problems pertaining to outpatient nursing study for diabetic patients,three researchers studied 32 papers written by domestic reserchers,created a review sheet for them, and examined the contents. The cases reserched for outpatient nursing numbered 16. The remaining 196researched cases focused on investigating the actual conditions,needs, and behavior and awareness regarding diabetes diagnosed outpatients. Eight of the studies on outpatient nursing were on nursing intervention factors, such as patient individual consultation,education,and foot care. Five of the studies were on the nursing activities for outpatients and three of the studies were on the system results such as the introduction of primary nursing. As the needs for consultation and guidance for outpatients with diabetes becomes higher, it is thought that the experimental study concerning the management system, staff assignment,and the competence and education of nurses,as well as result verification of the outpatient nursing practice is needed

深夜帯勤務が看護者に及ぼすストレスの検討

深夜帯勤務で看護者が受けるストレスを明らかにするために、勤務前後での血圧、代液分泌量、精神的ストレスの指標である唾液中クロモグラニンA(CgA)レベルを比較した。血液と唾液分泌量は深夜帯勤務で変化しなかった。一方、唾液へのCgAレベルは勤務に入る前に高く、勤務後には低下していた。また、勤務によるCgAの変化量と勤務前の休養度、勤務時の忙しさ、緊張度、および疲労度との間には相関関係は見られなかったが、勤務前のCgAレベルとの間には有意な負の相関関係が見られた。本研究の結果は、看護者は深夜帯勤務に入る前に強いストレスを感じていること、また勤務後にはストレスから解放されることを示唆している。ln order to evaluate the stress of nurses induced by overnight work, before-and after-work levels of blood pressure,saliva excretion and salivary chromogranin A (CgA)excretion,an indicator of psychological stress, were compared. Blood pressure,as well as salivary excretion, did not change after overnight working. Salivary excretion of CgA was high before work,and decreased significantly after work. There was a negative relationship between differences in before-and after-work salivary CgA levels and initial levels of it, but not when these differences were compare to any of the following: the condition of rest before work, and degrees of busyness,psychological tension and tiredness during work hours. The present results indicate that nurses felt strong stress before starting overnight work, and were released from the stress after finishing work