撫養 真紀子

目的：看護小規模多機能型居宅介護（看多機）に特徴的なサービス情報の発信と運営状況との関係を明らかにする． 方法：介護サービス情報公開システムに公表された全国の看多機のテキスト情報を厚生労働省から入手し，KH Coderを用いて語の使われ方の特徴を分析した．看多機に特徴的である医療依存度や看取りに関する語を使用していた事業所とそれ以外に分け，利用者数や従業員数，サービスの実施状況を比較した． 結果：医療依存度や看取りに関する語を使用していた事業所は，使用していない事業所よりも要介護5の利用者数，看護職員の常勤人数が有意に多く，処置の実施率も人工肛門の1項目を除く，12項目で有意に高かった． 結論：医療依存度や看取りに関する語を発信していた事業所は，より多くの利用者を確保し多様なサービスを展開していることが示唆された．今後は事業所管理者が看多機サービスの理解を深め，運営に反映できるような支援が求められる．

Background Japan is a superaging society unparalleled in the world. Elderly people who need medical care do not receive adequate support in the community. As a new service to address this issue, a small-scale multifunctional in-home care nursing service called Kantaki was created in 2012. Kantaki, in collaboration with a primary physician, operates 24 hours a day and provides various nursing services (home visits, home care, day care, and overnight stays) to older people living in the community. The Japanese Nursing Association is working hard to promote this system; however, its low utilization rate is an issue. Objective This study aimed to determine factors influencing the utilization rate of Kantaki facilities. Methods This was a cross-sectional study. A questionnaire on the operation of Kantaki was sent to all administrators of Kantaki facilities operating in Japan from October 1 to December 31, 2020. A multiple regression analysis was used to determine factors associated with a high utilization rate. Results Responses from 154 of the 593 facilities were analyzed. The average utilization rate for all valid responding facilities was 79.4%. The average number of actual users and the break-even point were almost equal, resulting in little surplus profit from facility operations. A multiple regression analysis showed that factors that had a significant impact on the utilization rate included the break-even point, a surplus of users relative to the break-even point (ie, the margin of revenues), the number of months in office of the administrator, the type of corporation (ie, nonprofit), and Kantaki’s profit from operating home-visit nursing offices. The break-even point, a surplus of users relative to the break-even point, and the number of months in office of the administrator were robust. In addition, support for reducing the burden on family helpers, a service sought by the system, significantly and negatively affected the utilization rate. In the analysis that removed the most influential factors, the cooperation of the home-visit nursing office, Kantaki’s profit from operating the home-visit nursing office, and the number of full-time care workers were significantly related. Conclusions To improve the utilization rate, managers need to stabilize their organization and increase profitability. However, a positive relationship was found between the break-even point and utilization rate, suggesting that simply increasing users did not contribute to cost reduction. Moreover, providing services that meet the needs of individual clients may result in lower utilization rates. These results, which are inconsistent with common sense, reflect the divergence between the assumptions underlying the system’s design and actual conditions. To solve these issues, institutional reforms, such as an increase in nursing care fee points, may be necessary.

Objectives: In order to cope with a rapidly aging national population, the Japanese government promotes the use of a comprehensive community care system known as Kantaki, which was established in 2012. Aimed at older populations, Kantaki offers a variety of services, including home-visit nursing care, day care, and overnight care. This study clarified the factors that affect the estimated revenue of Kantaki services through a secondary analysis of detailed information released by the Ministry of Health, Labour and Welfare (MHLW). Our goal was to provide information that may facilitate the stable management of Kantaki operations across Japan. Methods: We conducted a secondary analysis of official statistics data and detailed information released by the MHLW in April 2020. As such, we calculated the estimated revenue for Kantaki services. We then conducted a logistic regression analysis with estimated revenue set as the dependent variable in order to assess the magnitude of each influencing factor. Results: A total of 594 multifunctional in-home long-term care services were established. Of these, 506 met the requirements for Kantaki set in this study’s analysis. The logistic regression analysis showed that items with large odds ratios included tube feeding (2.59), enhanced working conditions for care workers (I) (2.58), and colostomy/ileostomy care (1.76). Conclusion: To achieve stable management practices for Kantaki, it is important to handle at-home medical needs through the use of skilled care workers, who must be properly trained and ensured stable employment.

目的：看護小規模多機能型居宅介護（以下，看多機）で働く看護師の行動特性を明らかにする． 方法：看多機の施設長から推薦された看護師29名を対象に行動結果面接法を参考に半構造的面接を行い質的記述的に分析した． 結果：看多機で働く看護師の成果は，【利用者・家族の生活の質の向上】【利用者・家族に提供するケアの質の向上】の2カテゴリーと8サブカテゴリー抽出された．これら成果につながる行動特性として【その人の生活の中で歩み寄りを続ける】【その人や家族の強みを引き出し生活に取り入れる】【個々に合わせ臨機応変にケアを創造する】【命をまもる】【看取りを支える】【その人の居場所をつくる】【その人を支えるチームをつくる】の7カテゴリーと37サブカテゴリーが抽出された． 結論：今回抽出された看護師の行動特性によって，最期まで住み慣れた自宅や地域で暮らし続けていくという看多機の役割が促進されることが期待される．

【背景】高齢化率の進展に伴い，地域包括ケアシステムが推進されている。2012年より，複合型サービス（現在名称は，看護小規模多機能型居宅介護，以下看多機）が創設され，訪問看護・訪問介護，通所，宿泊を組み合わせて包括的な生活支援ができるサービスが展開されているが，全国規模での開設・運営状況の情報は明らかにされていない。【目的】全国の看多機に関する情報や人口動態に関する情報を用いて，看多機の運営状況や開設地域の特徴を明らかにすることである。【方法】「介護事業所・生活関連情報検索」のウェブサイトを用いて，2018年12月31日の時点で登録されている全看多機を対象とし施設属性，運営状況，従業員情報等を抽出した。また，同ウェブサイトから都道府県別の看多機数，小規模多機能型居宅介護数（以下，小多機数），訪問看護事業所数を抽出した。「国勢調査」等から都道府県別の高齢化率，人口密度，人口の情報を収集した。分析は度数分布・記述統計分析，スピアマンの相関係数を用いた相関分析とした。【結果】全国の看多機数は479であった。都道府県別の看多機数は平均10.19±10.51であった。市町村別でみると，1724の市町村のうち233（13.5％）に看多機が所在した。看多機数と有意な相関（相関係数ρ）を認めたのは，小多機数（.765），訪問看護事業所数（.747），人口（.703），人口密度（.513）が正の相関，高齢化率（-.442）が負の相関であった。【考察】地域別の看多機数には大きなばらつきがみられ，高齢者の割合の高い地域ではなく，人口の多い地域や人口の密集した地域に多く開設されていた。過疎地では職員確保やサービス供給コストが影響する可能性があると考えられる。今後，どの地域でも安定して看多機が運営され，拡大するためには，現在生じている運営課題を明らかにしていくことが重要であると考えられる。

AIM: This study attempts to develop a scale measuring job satisfaction in Japanese hospital nurses. METHODS: The authors developed items for a new scale measuring job satisfaction and determined the scale's internal and external validity. Based on this analysis, the authors then modified the scale after conducting two surveys. In Survey 1, the scale was tested on 600 nurses from two hospitals and items were selected based on item and factor analyses. In Survey 2, items were further refined based on responses from 800 nurses from four hospitals. Using these responses, the authors determined the reliability and validity of the scale. RESULTS: A 37 item job satisfaction scale was developed through examination of internal and external validity and based on the results of item analysis. Through factor analysis, four factors - "positive emotions toward work", "appropriate support from superiors", "perceived significance in the workplace", and "pleasant working environment" - and 28 items were extracted. The cumulative contribution rate was 43.9%. Cronbach's alpha coefficient was 0.91. The correlations found between sense of satisfaction with work, burnout, and self-esteem supported the scale's concurrent and construct validity. CONCLUSION: The authors were successful in developing a scale measuring hospital nurses' job satisfaction. The surveys conducted using this scale identified factors associated with work achievement and capability development, including "positive emotions toward work" and "perceived significance in the workplace", neither of which have been covered by existing scales.