医療型障害児入所施設Ｋの居室計画の有用性検証

<p> 1. Background</p><p> In 2012, the Japanese government revised the Child Welfare Act to improve support for children with severe disabilities. Previously, inpatient facilities were classified according to type of disability. However, after the law's revision, these facilities were merged into the category of 'medical-type facilities for children with disabilities'. Such facilities must adhere to standards for number of staff, room types, and room sizes, but not for floor plan or layout. Further, the facilities have not performed adequate verification of changes in facility usage and requirements. In a previous study 'Usefulness of the new layout at Center K', the results were as follows.</p><p> 1) It is useful for bedroom configurations and each bedroom to include oxygen and suction equipment.</p><p> 2) It is useful to have various bedroom configurations that can accommodate children with a high need for a single room. However, this previous study did not include an analysis on the actual use of each bedroom type (single room, twin room, and quad room) and the bedroom arrangement policy for children with various severities of disability.</p><p> </p><p> 2. Purpose</p><p> This study aimed to verify the usefulness of the bedroom configuration (single room, twin room, and quad room) for children with various severities of disability at Center K. We investigated the following five aspects:</p><p> 1) Children's severity of disability by bedroom type</p><p> 2) Children's usage rate of locations by severity of disability, need for medical care, and bedroom type</p><p> 3) Management policy and actual use of bedroom arrangement for children (number of placed children, change of bedroom, children who need medical care, children admitted for a short stay, and children with siblings)</p><p> 4) Differences in nurses' nursing actions by bedroom type</p><p> </p><p> 3. Methods</p><p> We selected Center K as the site for this case study. The center is a new medical-type facility for children with disabilities built in 2016 near the older facility for children with motional disabilities. We performed field research at the center in 2016.</p><p> 1) We recorded the size, position, and orientation of furniture and beds in each facility type.</p><p> 2) We collected resident demographics including age, sex, and primary diagnosis and severity.</p><p> 3) We observed and recorded locations, behaviors, and postures of nurses, doctors, nursery teachers, children, and families on a floor map using a tablet computer.</p><p> </p><p> 4. Results</p><p> We evaluated the usefulness of our planning proposal by analyzing four items by bedroom type: children's severity of disability, children's usage rate of locations by severity of disability, need for medical care, management policy and actual use of bedroom arrangement for children (number of placed children, change of bedroom, children who need medical care, children admitted for a short stay, and children with siblings), and nurses' actions by bedroom type.</p><p> Children with higher severity of disability were placed in single or twin rooms closer to the nurse station than the quad rooms. The needs for single rooms have been confirmed, and the current number of single rooms is insufficient. In order to accommodate siblings entering together, twin rooms, quad rooms, and adjacent single rooms are useful.</p><p> In conclusion, considering the increase in children requiring medical care or isolation, more single rooms are required near nurse stations and staff stations.</p>