在宅の利用者アウトカムに影響するケア項目と実施度  [in Japanese] Care Items and Degree of Implementation as It Affects Client Outcomes in Home Care  [in Japanese]

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Author(s)

    • 島内 節 Shimanouchi Setsu
    • 東京医科歯科大学大学院保健衛生学研究科 Division of Comprehensive Health Nursing, Sciences Graduate School of Allied Health Sciences, Tokyo Medical and Dental University
    • 友安 直子 Tomoyasu Naoko
    • 東京医科歯科大学大学院保健衛生学研究科 Division of Comprehensive Health Nursing, Sciences Graduate School of Allied Health Sciences, Tokyo Medical and Dental University
    • 森田 久美子 Morita Kumiko
    • 東京医科歯科大学大学院保健衛生学研究科 Division of Comprehensive Health Nursing, Sciences Graduate School of Allied Health Sciences, Tokyo Medical and Dental University
    • 川上 千春 Kawakami Chiharu
    • 東京医科歯科大学大学院保健衛生学研究科博士前期課程 Master Student of Tokyo Medical and Dental University
    • 内田 陽子 Uchida Yoko
    • 東京医科歯科大学大学院保健衛生学研究科博士後期課程 Doctoral Student of Tokyo Medical and Dental University

Abstract

目的:在宅ケアにおける利用者アウトカムに注目し,アウトカム改善をもたらしやすいケア項目,ケア実施度,ケア実施内容を明らかにした.方法:(1)在宅ケアにおいて利用者アウトカム23領域に対応した119のケア項目の精選を目指した.2000年10月に全国訪問看護ステーションの開設主体別に訪問看護ステーション数を算出し,500のステーション所長に調査依頼し220の回答を得た.統計的解析によって60項目に精選した.(2)2000年11月にこの60のケア項目について7か所の訪問看護ステーションの40歳以上の利用者でターミナルを除く2か月間のケア継続者527事例にケア実施度を,必要時いつも実施,必要時時々実施,必要だが実施せず,非該当,で調査した.(3)利用者アウトカムは看護職のアセスメントにより,同年9月と11月の2時点においてADL,IADL,症状等健康状態のアウトカム23領域41項目を用いて2か月間の変化を測定した.(4)アウトカム改善群と非改善群に区分し,上記各ケア項目の実施度との関係をt検定により比較し,アウトカム改善に影響したと考えられるケア項目と実施度を分析した.結果:全体的にアウトカムはケアの「実施が必要時いつもなされる」ほど向上すること,特にケアの評価が有効であることがわかった.ケア効果をみるためのアウトカム23領域のうち改善事例群は非改善事例群と比べて13領域に有意にケア実施が多く,「必要時いつもケアを実施する」ほどアウトカムは向上していた.アウトカム改善をもたらしやすい利用者本人のアウトカム領域は,(1)ADLではJABC自立度・移動,(2)IADLでは食事の準備・交通機関利用・鍵・火災・水道の安全性・冷暖房管理,(3)意欲レベル,(4)尿失禁であった.介護者のアウトカム領域は,(1)身体的疲労感,(2)精神的疲労感,(3)介護知識・技術,(4)介護者の時間的余裕,(5)介護継続意志であった.また,アウトカムの多くに影響していたケア項目は,意欲への働きかけ,飲水の確保と確認,尿失禁等排泄ケア,服薬,睡眠であった.ケア項目ごとのケア実施内容についてみると,アセスメント・プラン・ケア実施・ケア評価のうち,ケア評価が改善群では,非改善群と比較して32項目のうち1項目を除くすべてにおいて有意に高く行われており,評価はアウトカム向上の重要な条件であることが明らかになった.すなわちケア実施度の量的なものとケア提供における評価行為が統合されてアウトカム向上を確実にできるといえよう.一方,実施頻度が第1に高い転倒(予防)ケア,第2の排泄ケアは改善群も非改善群にも同程度なされており,アウトカムに差は見られなかったが,重視されているといえる.これらによってアウトカム改善群も非改善群も転倒の危険から安全を守り,排泄へのケアによって基本的な生活が強く支えられていると考えられる.

Purpose: We focused on client outcomes in home care, and identified influential care items, achievement of care implementation and care processes in outcome improvement. Methods: (1) We aimed to refine 119 care items for 23 client outcome areas in home care. The number of visiting nursing stations were calculated by types of organizations across the country in October 2000, and based each on the proportional distribution ratio. We asked the directors of 500 stations for their participation in this survey, and received 220 replies. We refined the number of care items to 60 for statistical analysis. (2) We carried out the survey on these 60 care items for 527 clients, who were 40 or over and continued: to receive care services for two months, of 7 visiting nursing stations in November 2000. Terminal cases were excluded., Achievement of home care was weighted by : it was "always," "sometimes," and "not" implemented when necessary. (3) Client outcomes were measured at two points, September and November, 2000. We measured Changes using 41 assessment items in 23 outcome areas of health conditions including ADL, IADL and symptoms during a period of two months. (4) We classified the cases into improvement and non-improvement groups in outcomes. It was compared with the achievement degrees of each care item using t-test, and we studied the care items influencing the improvement of outcomes, and the degrees of implementation. Results: In 23 outcome areas for care effectiveness, there was a significantly higher, achievement degree of care in 13 areas in the improvement group over those in the non-improvement group. The more cases that "it was always implemented when it was necessary," the more their outcomes were improved. The areas likely to improve outcomes of clients were: (1)JABC independence and locomotion in ADL, (2)meal preparation, safety of key, fire and water, management of air conditioning and heater in IADL, and urinary incontinence. The outcome areas of caregivers were : (1)physical fatigue, (2)psychological fatigue, (3)the knowledge and technique of caregiving, (4)free time for caregivers, and (5)willingness to continue caregiving. The care items that influenced many of the outcomes were encouragement, securing water, urinary incontinence, medication and sleep. When looking at the care processes in care items, of assessment, planning, care implementation and care evaluation/record, many items in care evaluation/record were significantly higher in the improvement group than, in the non-improvement group. Evaluation and record were identified as an important factor for outcome, improvements. Conclusion: This study found that client outcomes were more improved when there were more cases that "it is always implemented if it is necessary," and care evaluation was especially effective in the reprocess.

Journal

  • Journal of Japan Academy of Community Health Nursing

    Journal of Japan Academy of Community Health Nursing 4(1), 26-33, 2002

    Japan Academy of Community Health Nursing

Cited by:  2

Codes

  • NII Article ID (NAID)
    110009864566
  • Text Lang
    JPN
  • Article Type
    Journal Article
  • ISSN
    1346-9657
  • Data Source
    CJPref  NII-ELS  J-STAGE 
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