在宅看護における訪問看護内容の検討 ―病院を基盤とする訪問看護ステーションの事例調査―

病院を基盤とした在宅看護提供機関における在宅看護の現状を調査し,在宅看護の現在の問題点を明らかにするとともに,在宅看護に携わる看護婦の役割について検討した｡本調査の結果,一人暮らしの患者は,家族に介護者のいる患者に比べ明らかにADLが高い場合も訪問看護を受けていることが分かった｡また,高齢者夫婦二人暮らしの患者と2世代以上家族の患者のADLに差はなく,このことは,高齢の介護者に相当の負担がかかっていると言える｡訪問看護内容としては, 日常生活自立度の低い患者への日常生活援助の実施率は高く,精神的支援や指導的看護技術の実施率は低かった｡在宅看護に携わる看護婦は, 日常生活援助に追われがちであるが,一次予防に焦点を当てたケア,患者や介護者の精神的支援,指導,ケアマネジメントを行うことは緊急の課題である｡

We investigated the present status of home health nursing in a Japanese hospital-based home health care agency, to clarify present problems in home health nursing and to assess the roles of home health nurses. Based on our results, ADL of care recipients who lived alone were clearly independent compared with care recipients who lived with family care-givers. The level of ADL of both care recipients who lived with their spouses and those who lived with more than 2 family members were not different. It indicates that aged family care-givers assume great responsibility. In cases of bedridden recipients,daily life care was performed at a high rate, but mental care or teaching care was performed at a low rate. Home health nurses should focus on primary preventive care, mental care for recipients and care-givers, and teaching care or management of a care plan.