Reiko Sakashita

The process by which stroke survivors move toward health while facing various difficulties can be construed as a "transition." Importantly, nurses need to understand and support this state of transition effectively. This study developed a situation-specific theory to explain post-stroke transition by integrating the findings of a qualitative study that explored the rehabilitation experiences of stroke survivors with dysphagia with a scoping review of qualitative studies using the theoretical framework of transition theory. This theory will help understand the transitions that stroke survivors with dysphagia undergo during recovery and provide a framework for exploring nursing care to support healthy transitions.

Introduction: The purpose of this study was to clarify the relationship between the available service information on small-scale multifunctional in-home nursing care (KANTAKI) and its operational status via text mining. Methods: We obtained nationwide textual information on KANTAKI from the Nursing Care Service Information Disclosure System and the Ministry of Health, Labour, and Welfare, and analyzed the characteristics of the word usage using KH Coder. The number of users and employees and the implementation of services were compared among the facilities that used terms relating to medical dependency and end-of-life care, which are KANTAKI characteristics, and with other facilities. Results: The facilities that used terms relating to medical dependency and end-of-life care showed significantly more users requiring nursing care level 5 and more full-time nursing staff than those not using such terms. Moreover, regarding service provision, the rate of procedures was significantly higher in 11 of 12 items, except for stoma. Conclusion: The facilities that use terms relating to medical dependency and end-of-life care in their information have more users and provide a greater variety of services. In the future, educational support is required to enable facility managers to understand the services and translate them into their work.

背景・目的:本研究では,先行研究において抽出された看護小規模多機能型居宅介護(以下,看多機)で働く看護師に求められるコンピテンシーの内容と,実際に看多機で働く看護師の優れた看護実践から,コンピテンシーの内容妥当性を検討することを目的とした.方法:看護師や施設管理者11名を対象にフォーカスグループインタビューを2回実施し,コンピテンシー評価指標(大項目・小項目)案の内容妥当性を検討した.結果:その人の希望に沿いながら「生きる」ための支援を重視するという意見から【看取りを支える】は【最期まで「生きる」を支える】に修正された.また【その人を支えるチームをつくる】は,平時から地域資源を活用する必要性の指摘を受けて【その人を地域で支えるチームをつくる】に修正された.家族の介護負担を軽減する支援の重要性から【家族を支える】が新たに追加された.変更のなかった【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】【その人の居場所をつくる】と合わせ,大項目は8つとなった.小項目の妥当性についても検討と修正した結果,37項目から48項目となった.考察:フォーカスグループインタビューでは利用者だけでなく家族支援が望まれていた.本調査を経て,看多機で働く看護師のコンピテンシーが精錬され,内容妥当性は確保された.(著者抄録)

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.

【目的】本研究では,2型糖尿病が強く疑われる人とそうでない人の生活習慣の比較を行うことを目的とした。【方法】A市において2008年度から2019年度までに国民健康保険の健康診査を受診した30歳以上の男女のうち,解析項目に欠損がある人,既に生活習慣改善に取り組んでいる人を除く10,401名を解析対象とした。糖尿病が強く疑われる人を「HbA1c(NGSP値)が6.5%以上かつ/または血糖値を下げる薬の服薬ありの人」と定義し,χ2検定を用いて糖尿病の疑いの有無の2群間で生活習慣の比較を行った。その後,糖尿病が強く疑われる/それ以外を従属変数,各生活習慣項目を独立変数,性別と年齢で調整した二項ロジスティック回帰分析を行った。解析は65歳未満と以上で行った。【結果】二項ロジスティック回帰分析の結果,65歳未満の対象者においては,日常生活において歩行または同等の身体活動を1日1時間以上実施していない人,他の人と比較して食べる速度が速い人,就寝前の2時間以内に夕食をとることが週に3回以上ある人は,そうでない人と比較して糖尿病が強く疑われる人のオッズ比がそれぞれ1.69倍(95%信頼区間:1.22-2.32),1.31倍(1.01-1.72),1.52倍(1.12-2.07)であった。一方,お酒を時々あるいは毎日飲み,かつ1日当たり1～2合飲む人では,ほとんど飲まない・飲まない人と比較して糖尿病が強く疑われる人のオッズ比が0.65倍(0.46-0.92)であった。65歳以上の対象者では,日常生活において歩行または同等の身体活動を1日1時間以上実施していない人,ほぼ同じ年齢の同性と比較して歩く速度が速くない人,他の人と比較して食べる速度が速い人は,そうでない人と比較して糖尿病が強く疑われる人のオッズ比がそれぞれ1.41倍(1.18-1.70),1.21倍(1.01-1.45),1.29倍(1.09-1.53)であった。【結論】本研究より,糖尿病予防のためには65歳未満,65歳以上の人に共通して身体活動を行うこと,早食いをしないことが重要であり,加えて65歳未満の人では就寝前2時間以内の夕食摂取に注意すべきことが示唆された。(著者抄録)