Journal Article 急性期病床から医療療養病床に移行した高齢患者への転入時ケア実践モデルの開発
Development of a care practice model for post-acute elderly patients transferred to long-term care wards

丸山, 優

23 ( 2 )  , pp.21 - 30 , 2018-02-28 , 千葉看護学会
[抄録] 本研究は,急性期病床から医療療養病床に移行した高齢患者に適用する「転入時ケア実践モデル」(以下“モデル”とする)の開発を目的とし,転入時ケア実践行動の抽出と関連する状況の整理,“モデル”草案作成,草案の検討に基づく修正の3段階からなる。調査は,関東圏内1ヶ所の医療療養病床において,高齢患者の急性期病床からの転入に関連して看護師や家族を対象としたインタビュー調査や転入した高齢患者の実態調査など5つの調査と作成した草案について老年看護の専門家および実践家へのインタビュー調査を実施した。“モデル”の構成要素は,〔円滑な療養生活開始に向けた環境・関わり方の準備〕,〔高齢患者・家族に関するリスクアセスメント〕,〔高齢患者のもつ運動機能・潜在機能の発揮を目指したケア〕,〔高齢患者・家族のコンフォートを目指したケア〕の4つに集約された。その構造は,転入前からの準備に加え,転入後早急にリスクアセスメントを行い,高齢患者のもつ機能の発揮を目指したケアと高齢患者および家族のコンフォートを目指したケアが同時進行的に実施される構造を示した。本研究で開発した“モデル”は,医療療養病床における急性期病床からの移行時のケアを明確に示し,高齢患者に対する先入観による不適切なケアの予防,意図的なケア実践,急性期病床と継続した支援の促進に寄与するものと考える。
[ABSTRACT] The objective of this study was to develop a practical care model applicable to elderly patients transferring from acute care to long-term care wards. This study consisted of the following three stages: identification of behavior and arrangement of the relevant circumstances, creation of a draft model, and investigation-based revision of the draft model. The survey included five surveys covering the questioning of nurses and relatives involved in the transfer of elderly patients from acute care to a long-term care wards in the Kanto region and a fact-finding survey related to these patients. And also interview surveys with geriatric nursing specialists and practitioners about the draft model were conducted. The model was consolidated into the following four components: preparation of an environment and interactions aimed at a smooth start to life under long-term care; risk assessment for the elderly patient and their family; care with the goal of maximizing motor and latent functional capabilities of the elderly patient; and care with the comfort of the elderly patient and their family in mind. In addition to preparations starting prior to transfer, this framework provided for immediate post-transfer risk assessment and simultaneous progress of care aiming to stimulate the patient’s motor functions and latent faculties and care aiming to comfort the patients and their families. The model developed in this study clearly indicates the care to be provided to elderly patients when they transfer from an acute care bed to a long-term care bed. This model contributes to the prevention of any inappropriate care arising from preconceptions about the patient concerned, the provision for practical implementation of intentional care, and the promotion of continuous support starting from the acute care phase.

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