Journal Article 介護老人保健施設における肺炎の罹患予防,発見,治療開始後の取り組みと看護の課題
Prevention and detection of the start to treatment for pneumonia and clarification of the associated nursing challenges in the care of residents in healthcare facilities

小熊, 亜希子  ,  吉本, 照子  ,  杉田, 由加里

23 ( 1 )  , pp.63 - 70 , 2017-08-31 , 千葉看護学会
[抄録] 本研究は,老健職員の入居者に対する肺炎の罹患予防,発見,治療開始後の取り組みと結果を分析し,看護の課題を考察した。データベースに医学中央雑誌とMedline,CINAHLを用い,検索語を「介護老人保健施設」&「肺炎」,“health carefacilities”&“pneumonia”,“care facilities”&“pneumonia”として検索し,316件が該当した。これらから老健職員の取り組みと結果が書かれた31件を分析対象とした。老健職員の取り組みは,予防医学の一次予防から三次予防を用いて分類し,意図と行動の結果,看護師と老健職員間の連携の内容を分析し,看護の課題を考察した。結果,一次予防から三次予防の継続的な取り組みは見られなかった。また,一次予防から二次予防に向けて,肺炎罹患の予防と発見に向けた多職種からの情報収集と肺炎か否かの判断に至る看護判断,二次予防から三次予防に向けて,罹患した入居者の身体状態に即した治療や療養の場の意思決定支援,一次予防からの肺炎予防とADL維持に向けた支援,繰り返して肺炎に罹患する入居者に対する看取りケアにおける多職種協働に向けた行動は明らかではなかった。老健看護師は,入居者の肺炎ケアを継続して取り組む必要があり,肺炎の確実な予防と早期発見,治療内容や療養の場の選択,ADLの維持,看取りケアに向けた支援における,看護師の情報収集と分析,問題の抽出と入居者・家族,多職種との連携に向けた行動を明らかにする必要がある。
[ABSTRACT] Objective: The purpose of this study was to explore the prevention and detection of the start to treatment for pneumonia and to clarify the associated nursing challenges in the care of residents in healthcare facilities. Methods: Database searches of Ichushi-Web, Medline, and CINAHL were conducted using“ health care facilities” & “ pneumonia” and “ care facilities” & “ pneumonia” as keywords. Thirty-one articles corresponding to 316 articles were extracted, and staff activities and results were analyzed. Staff efforts were classified into primary and secondary prevention. In addition, cooperation between nurses and other staff on nursing issues was considered and analyzed. Results: No reporting nurses had an ongoing commitment from primary to tertiary prevention. Furthermore, no reporting nurses prevented or collected information for the detection of pneumonia or attempted to determine whether there was transfer of pneumonia from the first to the second period transfer. Nurses recognized and acted in accordance with the best choices for residents and their families when considering the preparation of family healing and decision making in the elderly. They considered the physical condition of residents on pneumonia treatment, and multidisciplinary teams conducted care to maintain the balance between rest and physical activity in the second to the third period transfer. Nurses maintained harmony based on the physical condition from primary-prevention activities and treatment and terminal care decisions. Discussion: It is important to clarify the perceptions and behaviors of nurses for the prevention and detection of pneumonia, including a resident’s physical condition for decision-making support, perceptions of benefits and treatment disadvantages, prevention of decline in activities of daily living, collection of information, analysis, and identify the problem by nurses, and communication with and actions of multidisciplinary teams, residents and their families.

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