在宅療養移行期のケアマネジメントにかかわる在宅介護支援センター所属の看護職ケアマネジャーの認識

本研究の目的は,要介護者が病院から在宅療養へ移行する際,在宅での生活を選択し準備し開始し継続していくためのケアマネジメント過程において,在宅介護支援センター所属の看護職ケアマネジャーは,その行動の背景にどのような認識をもつのかを明らかにすることである。データ収集は,看護職ケアマネジャーが過去に担当した事例を想起してもらい,退院前から関わり在宅療養が開始されるまでのケアマネジメント過程に対して半構成的インタビューを実施した。看護職ケアマネジャーの選定は,介護保険制度以前からケアマネジメント業務に専念していた在宅介護支援センターに所属する看護職ケアマネジャーへ依頼した。インタビュー内容は逐語録に起こしデータとし,質的内容分析を行なった。抽出された認識カテゴリーは,1.入院中の療養者の病状・ADL・精神心理状態の査定,2.外部支援導入の可能性を含めた在宅での介護力の査定,3.在宅療養に関して起こりうる問題の予測,4.看護専門職の判断への追認と留保,5.能動的態度による在宅介護実現の可能性の模索,6.在宅生活継続のための生命維持に必要な条件の判断,7.療養者(あるいは家族介護者)の望む生活への共感,8.外部支援サービスの調整と拡大のための工夫,であった。今回分析の対象となった看護職ケアマネジャーが語ってくれた6事例共に一貫して現れていた認識は,自分自身が決して感じたことのない他人の感情の只中へ,自己を投入する能力であるともいえる「能動的な態度で在宅介護実現の可能性を模索する」という認識であった。看護職ケアマネジャーは,看護専門職として査定した医療的ニーズを優先しようとする自分と,療養者の望む生活へ共感し,その

The present study aimed to clarify nursing care managers' awareness of the care management process for transition from hospital care to home care, namely the process of deciding, preparing for and maintaining home care. Subjects were six nursing care managers who worked at Home Care Support Center and have been working in care management before the enactment of The Long-term care Insurance System. Data were collected during a semi-structured interview, where they were asked to recall one of their cases in which they were involved prior to discharge in the transition to home care. Each interview was taped, transcribed, and then subjected to qualitative analysis. The following categories were extracted: 1. Assessment of the disease state, ADL and psychological state; 2. Assessment of the ability to provide home care, including the possibility of introducing outside assistance; 3. Prediction of potential problems associated with home care; 4. Ratification and reservation of patient needs as assessed by the nursing specialist; 5. Positively and actively work toward the possibility of home care; 6. Assessment of the necessary conditions for life support in home care; 7. Empathize with the life that each patient (or family members) wants to lead; and 8. Device to adjust and expand services provided. Common to all six situations recalled by the nursing care manger was "Positively and actively work toward the possibility of home care" , which is the ability of care managers to actively empathize with emotions that they themselves have never experienced. While nursing care managers were aware of the medical needs that they identified from the perspective of being a nursing specialist, at the same, they were sympathetic to the life that each patient wanted to lead. When faced with this type of conflict, at times, they withheld their judgements as medical specialists and respected the value system of patients as much as possible.

source:Journal of Chiba Academy of Nursing Science