急性期病院の認知症高齢者の退院支援過程において退院支援専任看護師が行う倫理的意思決定支援  [in Japanese] ETHICAL DECISION-MAKING SUPPORT FOR DISCHARGE PROCESS FOR OLDER PEOPLE WITH DEMENTIA AT AN ACUTE HOSPITAL  [in Japanese]

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Abstract

[要旨] 【目的】急性期病院の退院支援専任看護師が行う認知症高齢者への退院支援過程の倫理的意思決定支援を明らかにする。【方法】急性期病院に入院する認知症高齢者及びその家族に退院支援専任看護師が実施した援助過程を記載したフィールドノートとプロセスレコードの内容を分析データとし,『本人の意思表出の能力を最大限に引き出し,その意思をくみ取るために本人と話し合い,尊重する支援』(分類1)と『本人の意思決定を基にして家族および医療ケアチームが合意する方向へ向かうための支援』(分類2)に分類した。【結果】小テーマ(計66テーマ,19テーマ)に分類・統合された。そして各々の分類の詳細を適切に表現するテーマが導きだされた。さらに分類2の中に合意へ向かうために家族や医療者が直接話し合う以外の支援が浮かび上がり分類2aとし,直接的な話し合いで合意へ向かう支援を分類2bとした。【結論】急性期病院に入院する認知症高齢者の退院支援過程において分類1『高齢者の能力の適切な見極めと意思表出ができる環境を整え,意思表出能力を最大限に引き出し,その能力を維持する支援』を基盤に,分類2『本人・家族及び医療ケアチームが合意する方向へ向かう支援』の中に分類2a『本人の意思を間接的に支えることで合意へと向かう支援』と分類2b『本人の意思決定を基にして家族,院内・院外関係者と話し合いを重ね共有することで合意へ向かう支援』が明らかとなった。

[SUMMARY] This study aimed to reveal the details of ethical decision-making support for discharge process for older people with dementia at an acute care hospital. Methods: The researcher, a discharge support nurse, provided decision-making support to older people with dementia for discharge process, recorded field notes and maintained process records. The analysis of this data is predicted to guide the ethical decision-making support in this study. Support was classified into two types Group I and Group II. Group I ? involved support for understanding their expression of intent, using their maximum ability, conversing with them, and respecting them. Group II ? involved support for agreement and discussion with family and medical professionals. Small themes (66, 19 themes) were derived from the classified data. The final analysis was described relatively and arranged into small themes of support during discharge process. Results: Through analysis of seven case studies, Group I was determined as support for-ascertaining older people's ability, creating a facilitative environment-, and using and maintaining maximum ability. Group II ? included support for family members on whom the person can rely; recognizing medical professionals' sense of value, and ? attempts to understanding that the person is important. It also included support for agreement with family members regarding supporting the person's intention. Conclusion: Ethical decision-making support for discharge process for older people with dementia at an acute hospital was clarified that these are structure of classification II based on the support of classification I.

Journal

  • 千葉看護学会会誌

    千葉看護学会会誌 25(1), 47-56, 2019-08

    千葉看護学会

Codes

  • NII Article ID (NAID)
    120006774934
  • NII NACSIS-CAT ID (NCID)
    AA11354292
  • Text Lang
    JPN
  • Article Type
    journal article
  • ISSN
    1344-8846
  • NDL Article ID
    029987364
  • NDL Call No.
    Z19-B794
  • Data Source
    NDL  IR 
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