小野 博史

This study aimed to identify the current state of nursing theory development among Japanese scholars by analyzing the syllabi of doctoral nursing programs in Japan to examine the educational content relating to nursing philosophy and theory and by reviewing the related literature. Only 17.2% of the doctoral-level nursing programs in Japan offer courses in philosophy or theory. Florence Nightingale was the most frequently discussed figure in the literature. Middle-range and situation-specific theories originating in Japan have emerged relatively later than those introduced by Western theorists. Recently, the development of nursing theories, particularly situation-specific theories, has begun in Japan, showing promising prospects for advancement in the field.

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．

Introduction Various stressors have been identified in patients in the intensive care unit (ICU), including postoperative pain, ventilatory management, and nursing care. However, sedated patients are less responsive, and nurses have difficulty capturing their stressors. Objective To investigate patient stress caused by nursing care performed in the ICU on sedated patients based on changes in physiological indices. Methods We observed nursing care performed on patients with postoperative esophageal cancer under sedation in the ICU. This included endotracheal suctioning and turning, the time required for the care, and the patients’ behavioral responses. Information on arousal levels, autonomic nervous system indices, and vital signs were also obtained. The changes in indicators before and after care were then compared and analyzed. Results There were 14 patients in the study. The mean age of the patients was 68 years. Ninety-nine scenes of nursing care were observed, and in six of these, additional bolus sedation was administered because of the patient's significant body movements. In endotracheal suctioning, no significant changes were observed in all indicators. In turning, vital signs changed significantly, and when both were continued, all indicators changed significantly. Conclusion Our study found that different types and combinations of nursing care may cause different stresses to the patients. Moreover, the autonomic nervous system indices may be more likely to react to stresses in a variety of nursing care, while arousal levels may be more likely to react to burdensome stresses. If the characteristics of these physiological indicators can be understood and effectively utilized during care, it may be possible to better identify and reduce patient stress during sedation management.

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.

This study evaluated the effectiveness of a life-enhancement program designed to focus on dining conditions in welfare facilities for seniors living in Japan. Effectiveness was specifically evaluated based on whether improvements were achieved in (1) nutritional status, (2) oral health, (3) frequency of fever, and (4) vitality of appetite across three sites. As part of a comprehensive-care initiative that began with dining support, the program consisted of two main components: (1) a 3-month intensive program comprised of (a) collective experiential learning for residents and staff (including nutritionists, nurses, and physiotherapists) and (b) a tailor-made individual program for residents followed by (2) a 3-month continuation program. Participants included 168 individuals (31 males and 137 females) from a total of three facilities (average age was 85.9 [60-104] years). Results showed that the intensive program significantly improved nutritional status (e.g., BMI, caloric intake, and water intake; P < 0.000-0.005) and tongue movement (P < 0.000) while significantly reducing dental-plaque and tongue-coating indices (P < 0.000). Significant improvements were also achieved for degree of appetite and vitality indices (P < 0.000-0.001). However, incidences of fever were not reduced. These findings indicate that the program effectively improved nutritional status, oral health, vitality, and appetite. However, these effects did not sufficiently remain once the program was finished, thus suggesting the need for a continuous intervention.

【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。

【目的】看護学の発展のためには研究や実践と密接にリンクする理論が必要であることから， Situation Specific Theory（状況特定理論 以下，SST）という新しいタイプの理論が提案され，20年が経った。本研究では文献レビューを通して，SSTに関する論文数や内容の変遷，構築手法や活用された情報源を分析することを通じてSST構築の発展経過を明らかにするとともに，SST構築の今後の展望を得ることを目的とする。【方法】CINAHL，PubMed，医学中央雑誌を用い，国外誌には"situation specific theory" situation specific theories"をキーワードとし，国内誌にはさらに「状況特定理論」を加えて検索を行い，88件の論文が抽出された。スクリーニングを経て得られた50件の論文を対象とし，論文の発行年や論文内容で分類を行った。さらにSSTを構築した論文に対して，理論の構築手法と活用した情報源の分析を行った。【結果】英語論文は47件あり，理論構築，概念分析，理論の下位レベル概念の明確化，理論検証，理論を枠組みとした研究，総説・解説の6種類に分類された。また，論文の公表数は年代を経るにつれて増加していた。SSTとして構築された理論が検証され，研究の枠組みとして使われ，看護学の知の構築に貢献している状況が明らかとなった。SSTの構築が行われた論文は23件で，いずれも特定の領域や対象に限局された現象を取り扱っていた。構築手法としては統合的アプローチが最も多かったが，それ以外の手法を用いた論文も認めた。構築の情報源として，既存の理論，研究データ，文献レビューが多く活用されていた一方で，実践経験の活用は少なかった。【結論】SSTは数を増やし続けており，理論検証やSSTを枠組みとした研究もおこなわれ，これから看護学領域内での認識が拡大していくものと予想される。また，統合的アプローチ以外の構築手法も出現していることから，今後はより多様なアプローチを通して，より多くのSSTが生み出されていくことが期待される。