日本の病院における高齢者のエンドオブライフケア質指標の作成とその内容の妥当性の検討

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[要旨] 目的：日本の病院における高齢者のエンドオブライフケア（以下：EOLケア）質指標を作成し，その内容の妥当性を検討する。方法：既存の高齢者の終生期ケア質指標と文献検討によって，日本の病院における高齢者のEOLケア質指標を作成した。作成した質指標の内容の妥当性を，老人看護専門看護師８名，看護管理者20名，計28名を対象にした質問紙調査で検討した。内容の妥当性について，「重要性」「適切性」「実施可能性」「反応性」「実行可能性」は１～５段階のリッカート尺度の評価と記述より，「解釈可能性」は記述より回答を得た。結果：本質指標の内容の妥当性が確認できた。各項目の平均値は，「重要性」「適切性」はすべて4.0以上，「実施可能性」は９割の項目が3.0以上であった。項目全体としての平均値は，「反応性」は4.5，「実行可能性」は4.0であった。項目の平均値を参考にしながら，対象者の意見に基づき， 22項目を削除し，59項目を修正し，１項目を統合し，新たに１項目を作成した。その結果，本質指標は，（１）看護職の基本姿勢と態度（３項目），（２）高齢者の状況に合わせたケア（129項目），（３）組織の体制づくり（９項目）となった。考察：本質指標は，省察的なツールとして，日本の病院における高齢者のEOLケアの質を看護職が評価することに活用でき，高齢者のEOLケアに関する看護職の知識の確認と，看護職の認識，評価，行動の手がかりになる。今後の研究では，質指標の有用性を検討する。

[SUMMARY] Objective: To develop end-of-life (EOL) care quality indicators for older people in hospitals in Japan and verify their content appropriateness. Methods: Based on a review of literature and the existing EOL care quality indicators for older people, new quality indicators were developed. A survey, which included eight Certified Nurse Specialists in Gerontological Nursing and twenty nursing managers, was conducted to examine the content appropriateness of the indicators. They were asked to evaluate the indicators’ importance, validity, practicability, responsiveness, and feasibility on a 5-point Likert scale and provide comments regarding these aspects. Additionally, they were asked to provide comments on their interpretability. Results: The content appropriateness of the quality indicators was confirmed. The average values of items were found to be as follows: the importance and validity of each item was over 4.0; the practicability of 90% of all items was over 3.0; the responsiveness of all items was 4.5; and the feasibility of all items was 4.0. According to the evaluation and comments, 22 items were deleted, 59 items were modified, 1 item was integrated, and 1 new item was created. The quality indicators were revised as follows: (1) Basic attitude of nurses (3 items); (2) Care tailored to the situation of older people (129 items); (3) Creating an organizational structure (9 items). Discussion: The quality indicators can be used as a reflective tool for nurses to evaluate the quality of EOL care for older people in hospitals in Japan. It is essential in reinforcing nurses’ knowledge and aid in their recognition, assessment, and practice pertaining to EOL care for older people. Future research will verify the utility of the indicators.