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Supports Provided to One-year-old Children Undergoing Blood Sampling and Their Parents
Get PDFP(論文)背景 小児看護領域において, 子どもの権利条約の批准後, プレパレーションの概念が広まった. しかし, 小児専門病院の看護師に比べ, 総合病院の看護師のプレパレーションの認識は低く, プレパレーションの実践の普及がされていない実態がある. さらに, 採血を受ける子どもに関する研究は多いが, 自己の思考により物事をみることができない発達段階である2歳未満の年少の子どもを対象とした研究は少ない. 目的 採血を受ける1歳の子どもとその親への援助内容を明らかにする. 方法 全国の小児外来を標榜する総合病院131施設の外来に勤務する看護師のうち, 子どもの採血に関わる786名を対象に質問紙調査を行い, 自由記述の内容を分析しカテゴリー化した. 結果および考察 282名 (回収率35.8%) から回答が得られた. 看護師のプレパレーションの認知は, 知っている51.1%, 知らない45.0%であり先行研究より認識が高まっていた. しかし, 親の付き添いがないと回答した看護師は66.5%であり, さらに子どもの姿勢は寝かされ, 身体の抑制を受けながら採血を受けていたことが明らかとなった. 自由記述の内容分析では, 1歳の子どもと親への援助内容から看護師は, 子どもの発達段階に応じた援助ができていたが, 親が付き添う採血のケアモデル提示が少ないことが明らかとなった. 結論 看護師が, 1歳の子どもの発達段階に応じた援助を行うために, 子どもの権利およびプレパレーションの概念を学習する機会の提供が必要である. さらに, 親が付き添う採血のケアモデルの提示をする必要があることが示唆された.Background Nurses' awareness of preparation at general hospitals is lower than that of nurses at specialist pediatric clinics, which has impeded the spread of preparation being put into practice throughout Japan. Although many studies have investigated children undergoing blood collection, few have examined young subjects aged less than two years.Objective This study aimed to clarify the state of blood collections conducted on one-year-old patients and support offered to parents.Methods A questionnaire survey targeting 786 outpatient nurses who routinely collected blood from pediatric patients at 131 general hospital facilities nationwide was conducted. Free comments were analyzed and content was categorized.Results/Discussion Answers were received from 282 nurses (recovery rate: 35.8%). It was found that nurses' awareness of preparation had increased from that reported in previous studies to 51.1%. However, 66.5% of nurses reported that parents did not accompany children during blood collection. Analysis of free comments revealed that although nurses were offering parents support in accordance with children's developmental stage, few care models incorporating parental attendance during blood collection had been presented.Conclusions Opportunities to study the concepts of child rights and preparation need to be provided so that nurses can give support in accordance with the developmental stage of one-year-old children undergoing blood collection. Results also suggested that a care model incorporating parental attendance during blood collection needs to be presented
The Effect of the Number of Years' Experience Held by Home-Visiting Nurses on Rehabilitation Nursing Practice Content
Get PDFP(論文)背景 訪問看護師はリハビリテーション看護において, 自らの実施内容に不安を持っている. しかし, 一般的に看護師の経験年数が5年以上の者は, セルフエフィカシーが高いことから, 経験年数が実施内容に影響を及ぼしていると考えられる. これまで, 訪問看護師の経験年数によるリハビリテーション看護における実施内容は明らかにされていない. 目的 訪問看護師経験年数が及ぼすリハビリテーション看護の実施内容への影響を明らかにする. 方法 訪問看護師を対象に半構成的面接を実施し, 内容分析を行った. 分析にあたっては, 3名の看護研究者で行い, 妥当性の担保に努めた. 結果および考察 対象者は, 訪問看護師の経験年数5年未満の5名と5年以上の5名の計10名であった. カテゴリー, サブカテゴリーの数は, 5年未満8カテゴリー, 25サブカテゴリー, 5年以上9カテゴリー, 29サブカテゴリーであった. 共通する実施内容は,【心身の状態に合わせたリハビリを判断する】【療養者のニーズを把握する】【リハビリを継続できるように支援する】【身体機能低下の予防や, 維持向上の訓練を実施する】【家族への支援を行う】【環境を整える】【精神的な支援をする】であった. 特徴として, 5年未満は, 【他職種と連携する】, 5年以上は【多職種と協働する】【生活意欲を向上させる】が抽出された. 結論 5年未満は【他職種と連携する】し, 5年以上は,【生活意欲を向上させる】【多職種と協働する】ことで経験年数が長いほど訪問看護師として自律した実施内容を実施していた.Background Home-visiting nurses feel anxious about performing the self-practice aspect of rehabilitation nursing. However, because nurses with more than 5 years of experience generally have high self-efficacy, it is thought that the number of years' experience they have affects their practice content. To date, practice content according to the number of years' experience held by home-visiting rehabilitation nurses is not well understood.Objectives To determine the effect of the number of years' experience held by home-visiting nurses on the practice content of rehabilitation nursing.Methods A semi-constitutive interview was conducted with home-visiting nurses as subjects of the study, followed by content analysis. An analysis was conducted by 3 nurse-researchers in order to ensure the validity of the study.Results / Discussion The subjects were 5 nurses with less than 5 years' and 5 nurses with more than 5 years' home-visiting nursing experience. There were 8 categories and 25 subcategories extracted for nurses with less than 5 years' experience, and 9 categories and 29 subcategories extracted for nurses with more than 5 years' experience. The common practice contents included creating 【rehabilitation judgment adjusted to mental and physical state】,【understanding the needs of the patient】,【providing support to allow for continuous rehabilitation】, 【prevention of reduced bodily function and practice of maintenance improvement training】,【providing support for family】,【creating a good environment】, and【providing psychological support】. With respect to characteristics,【collaborating with other medical professionals】was extracted for nurses with less than 5 years' experience, while【collaborating with multiple colleagues】and【improving life motivation】were extracted for nurses with more than 5 years' experience
What Causes the Worker in Care Facilities to Become Depressed and Stressed
Get PDFP(論文)背景 施設職員のストレスが高いことが指摘されている.高齢者介護施設では,認知症ケア施設のユニット化,障害者自立支援法の施行による障害者支援施設職員の勤務環境が変化した.高齢者介護施設の介護職のストレスに関する報告はあるものの,障害者支援施設職員を対象とした研究や施設職員全体のストレス,抑うつに関する報告は見られない.目的 障害者支援施設,特別養護老人ホーム,認知症ユニットケア施設職員の異なった施設環境にある施設職員を対象とし,抑うつ・ストレス状態と関連要因を明らかにすることである.方法 特別養護老人ホーム,認知症ユニットケア施設職員,障害者支援施設,272人を対象として,Zungの自己評価式抑うつ尺度(Self-rating depression scale 以下SDS)を用いた.本調査の信頼性係数(α係数)は0.82であった.また,職場のストレス判定には,原谷(1998)のNOIOSH(National Institute for Occupational Safety and Health)職業性ストレス簡易調査票を用いた. 調査項目毎のSDS平均値の差にはWelchのt検定,一元配置分散分析を実施し,多重比較分析は,Tukey-kramer検定を実施した.SDSは40点をカットオフポイントとし,40点未満を健康群,40 ～ 49点を軽度抑うつ,50点以上を中等度以上の抑うつと判定した.抑うつと関連要因の比較においては,健康,軽度抑うつ,中等度以上の3群に分け,カイ二乗検定を行った.職業性ストレス簡易調査票は,リスクA,B,Tを職場別,職種別に算出し,比較した.結果 回収数は,184人(回収率74.8%)で,SDS及び職業性ストレス簡易調査票のデータに欠損の無かった169人(有効回答率62.1%)を分析対象とした.SDSの平均値は,42.1(SD=9.1)で,軽度抑うつ以上が,55.0%と抑うつの割合が高かった.抑うつ状態には,年齢,職種,仕事の満足度,相談者の有無が関連していた.職業性ストレス評価の総合健康リスク値では,従来型特別養護老人ホームが129,障害者支援施設が124で高く,職種別では介護職,役職者が高かった.考察 介護施設は他の事業場よりも抑うつ傾向にあることが推察された.また,施設によって,職業性ストレスに違いが見られ,各施設の環境に合わせたラインケアの体制づくりが必要である.若い介護職と役職者の抑うつやストレスが高い傾向にあり,ハイリスク群であると考えられ,相談支援体制を強化する必要がある.結語 施設に合わせた相談支援システムとハイリスク群への介入の必要性が示唆された.Background Care facilities for elderly people are transitioning to the unit care system.With the law supporting the independence of people with disabilities enacted in 2006,the employee compensation structure and work environment of care facilities for such people has changed.Previous studies have reported that the workers in care facilities experience high levels of stress.However,the factors responsible for their stress have not been clarified.Aim This study attempts to determine what causes the worker in care facilities to become depressed and stressed.Method A survey was administered to 272 workers of a special elderly nursing home,a dementia unit care facility,and a support care facility for people with physical disorders.Depression was assessed using the Zung Self-Rating Depression Scale(SDS; Cronbach's alpha=0.82),and job stress was assessed using the Brief Job Stress Questionnaire(National Institute for Occupational Safety and Health,NIOSH).Welch's t-tests,one-way analyses of variance,and Tukey-Kramer post-hoc tests were used to examine how SDS scores differed with respect to age,job characteristics,work satisfaction,and the presence of a mentor.Scores over 100 on the Brief Job Stress Questionnaire indicate high risk of job stress.I analyzed whether job stress levels differed with respect to the type of facility and job classification.Results/Discussion From the 184 responses(response rate : 74.8%)received,a total of 169 valid responses(valid response rate : 62.1%)were subjected to analysis.The mean SDS score was 42.1±9.1,and 55% of the respondents had symptoms of depression.Depression was found to be related to age,job classification,work satisfaction,and the presence of a mentor.The mean scores on the Brief Job Stress Questionnaire were 129 for special elderly nursing homes and 124 for facilities providing care to persons with physical disorders; this indicates that workers of these two facilities were at high risk for excessive job stress.Care workers and managers also had scores indicating a high risk of job stress.Conclusions On the basis of these findings,we suggest that consultation support systems should be provided for personnel at high-risk facilities and individuals found to be at a high risk for depression and job stress
Literature Based Research and Review on Rehabilitation Nursing Provided by Home Care Nurse
Get PDFP(論文)背景 わが国の高齢化率は2012年23.3%と年々上昇傾向にある.急速な高齢化の進展に伴い,介護保険サービスに対するニーズは増大しつつあり,中でもリハビリテーションのニーズは高い.そこで,リハビリテーションに特化した専門職ではない訪問看護師に着目し,在宅におけるリハビリテーションの実施状況について調査した.目的 本研究は訪問看護師が提供しているリハビリテーションの内容と現状を,これまでに報告された論文より明らかにすることを目的とした.方法 リハビリテーション看護の現状を読みとくために,1997年12月から2012年8月までに特定非営利法人医学中央雑誌に報告された4,399件の論考を精読した.結果 リハビリテーション看護に関する論文は,1997年から年々増加傾向にあり,当事者研究が少なく,ほとんどが看護師の実践報告であった.訪問看護師におけるリハビリテーションは,身体機能訓練を中心に実践されており,実施する看護師も訓練計画や評価に対して不安を抱いている現状が明らかになった.結論 訪問看護師が行うリハビリテーションは,健康問題や生活面をトータルにアセスメントし提供している.訪問看護師と理学療法士等の専門職とが協働していくことで,療養者の生活に則した質の高いリハビリテーションの提供が可能となる.Background Care preventive payment became the start in 2006,and,as for a lot of requests of the rehabilitation,needs is high in offer contents of the temporary nursing at home. Purpose This study was intended that I clarified it than an article reported contents and the present conditions of the rehabilitation that a visit nurse offered to so far. Method I read 4,399 studies that were reported to specific nonprofit undertaking corporation medicine center magazine by August,2012 from December,1997 I read,and to untie the present conditions of the rehabilitation nursing carefully. Result A tendency to increase included the article about the rehabilitation nursing year by year from 1997, and there were few person concerned studies,and most were the practice reports of the nurse,and the rehabilitation in the visit nurse was practiced mainly on body function training,and the present conditions that the nurse who carried it out held uneasiness in for training program and an evaluation became clear. Conclusion An offer of the high quality rehabilitation that met the life of the person of medical treatment because I make assessment for total,and the rehabilitation that a visit nurse performs provides a health problem and an aspect of living,and the employment such as a visit nurse and the physical therapist collaborates is enabled
