Departmental Bulletin Paper 療養病床を有する医療施設の看護師が実践する退院支援スクリーニング
The Current Status and Challenges of Screening Tests for Discharge Planning by Nurses in General Hospitals which Provide Long-term Care

小松, 純子  ,  佐々木, 真紀子  ,  KOMATSU, Junko  ,  SASAKI, Makiko

23 ( 2 )  , pp.145 - 156 , 2015-10-31 , 秋田大学大学院医学系研究科保健学専攻
本研究の目的は療養病床を有する一般病院で働く看護師が行う退院支援スクリーニングの現状と課題を明らかにすることであった.東北6県の療養病床を有する500床未満の病院で退院支援担当の看護師256名に調査票を郵送した。189名から回答が得られ, これら全てを分析対象とした(有効回答率:73.8%). 退院支援部門の有無と看護師の属性, スクリーニングの状況, プロトコルの有無などの関連をχ2 検定および残差分析で検討した.その結果, 退院支援部門の設置は23.3%であった. 退院支援部門がある病院では退院支援プロトコルがある割合が有意に高かった. また退院支援部門がない病院ではプロトコルがなく, 病棟看護師が独自の判断でスクリーニングを行う割合が有意に高かった. 看護師に必要な支援としてはアセスメントやコミュニケーション, コーディネート能力を高めるための支援が最も多かった. これらの結果から, 今後は退院支援に関わる看護師の能力向上のための支援を病院で組織的に取り組むこと, また多職種や家族との連携体制を円滑にするためには退院支援機能を備えた部門の設置の必要性が示唆された.
The objective of the present study was to clarify the current status of and the challenges associatedwith discharge planning and the administration of discharge screening tests by nurses in general hospitalsthat provide long-term care. A questionnaire survey was conducted among 256 nurses in charge ofdischarge planning. The nurses were employed in general hospitals with fewer than 500 beds, includinglong-term care beds, in six prefectures in northern Japan.A total of 189 respondents were analyzed (response rate : 73.8%). We attempted to determine therelationship between the presence or absence of a discharge planning department, the basic characteristicsof the nurses, and the statuses of the protocols and the screening tests for discharge planning using aχ2-test. A follow-up residual analysis was also performed. Twenty-three percent of the hospitals in ourstudy had a discharge planning department. At the hospitals which had a discharge planning department,the ratio of respondents who reported using a discharge planning protocol was significantly high. On theother hand, in the hospitals without a discharge planning department which had no discharge planningprotocol, the ratio of nurses who reported screening patients for discharge according to their ownjudgment was significantly high. Nurses need support in improving the competence of nursingassessments, as well as improving communication and coordination with the medical team and patients family members.From these findings, it is suggested that hospitals with long-term care beds need to make anorganizational effort to improve their nurses' competencies in relation to discharge planning and toestablish a discharge department to promote smooth communication between nurses, the medical team andpatients' family members.

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