学術雑誌論文 摂食嚥下機能低下を認める特別養護老人ホーム入所者の経口摂取支援のための看護職役割行動指標の作成 : 看護-介護連携に着目して
Establishing indicators of nurses role behavior to support oral intake in dysphagic special elderly care home residents : From the viewpoint of nurse-care worker collaboration

清水, みどり  ,  吉本, 照子  ,  杉田, 由加里

23 ( 1 )  , pp.11 - 20 , 2017-08-31 , 千葉看護学会
ISSN:13448846
NII書誌ID(NCID):AA11354292
内容記述
[抄録] 目的:摂食嚥下機能低下を認める特別養護老人ホーム(以下,特養)入所者が,本人や家族の希望に沿って最期まで可能な限り安全・安楽に経口摂取できるよう,介護職との連携に着目した看護職の役割行動指標を作成する。方法:経口摂取支援に積極的に取り組む特養で,支援に責任を持つ立場の看護職7名,介護福祉士12名に半構成的面接を実施した。入所者や家族の希望に沿って最期まで安全・安楽な経口摂取を支援した事例を想起してもらい,支援行動,支援上の困難と解決のための工夫,多職種からの支援を質的・帰納的に分析し,指標案を作成した。次に摂食嚥下障害高齢者のケアを熟知した看護師,学識経験者等,6名から成る専門家会議で指標の内容妥当性を検証した。結果:中長期的に経口摂取の限界を見極めながら可能な限り経口摂取の可能性を探る行動,リスクに備えながら,その日の食事を安全・安楽に介助する行動,家族や介護職に入所者のハイリスクな身体状況を説明し,経口摂取の継続・中止の合意を形成する行動,介護・看護職が省察的実践により支援に必要な力量を開発する行動から成る看護職役割行動指標を作成した。考察:本指標は可能な限りの経口維持に向け,特養の看護職が中長期的に経口摂取の限界を見極めながら経口摂取の可能性を探る医療職の役割遂行をもとに,家族・介護職と連携して,ハイリスクであっても本人の希望を叶えるといった考え方と,その考え方を具現化するための行動を示したと考える。
[ABSTRACT] Objective: Many special elderly care home (SECH) residents experience dysphagia, and the role of nurses, they manage the residents’ oral intake safely and comfortably to the extent possible, in line with the wishes of residents and their families, until the terminal phase. Accordingly, this study aimed to establish indicators of nurses role behavior to support their oral intake. Methods: Semi-structured interviews were conducted with seven nursing staff and 12 certified care workers responsible for oral-intake support at SECHs with a proactive stance towards such support. Interviewees had provided relevant oral-intake support. Their collected recollections of these cases were subjected to qualitative-inductive analysis targeting support behavior, means of resolving support-related difficulties, and multidisciplinary support, to tentatively identify indicators. A specialist panel of six nurses and academic experts who are familiar with geriatric dysphagia care was then convened for detailed validation of the tentatively identified indicators. Results: Indicators for nurses role behavior were identified based on the following behaviors: exploring the residents’ potential oral intake to the maximum extent while ascertaining their limits in the medium-to-long term, assisting safe and comfortable consumption of daily meals while addressing risks, explaining the high risks associated with residents’ physical state to families and care workers and securing agreement for continuation/discontinuation of oral intake, and developing capabilities needed by nursing staff and care workers to deliver support based on reflective practice. Discussion: These indicators were focused on maximizing the residents’ potential for oral intake. We consider that behaviors and thinking were indicated as follows: SECH nursing staff accomplished their role as medical health professionals, by exploring the residents’ potentiality for oral intake while ascertaining their limits in the medium-to-long-term. Based on the findings, nursing staff, care workers, and residents’ families are collaborated, in order to meet the wishes of dysphagic residents even in a high-risk situation.
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http://opac.ll.chiba-u.jp/da/curator/104111/S13448846-23-1-P011-SIM.pdf

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