重症脊髄損傷者の在宅療養におけるケアマネジメント : ニーズに合わせることの重要性

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筆者は在宅療養で問題を抱えていた重度脊髄損傷者、ADL全介助の男性を対象に在宅支援サービスを提供した。支援を継続していく中でQOLの向上が推察された。これらの過程は何を意味しているのだろうか。筆者は、本対象のケアマネジメント過程から分析検討したので報告する。対象：脊髄損傷の男性（Ｋ氏） 25歳　独身支援期間：1996年１月～1998年9月及び1999年11月～2000年6月迄の期間。方法：１）分析に使用した資料は訪問看護記録、会議録等２）支援経過を3期に分類、QOL評価を上田のQOL総合評価基準(50点満点)を用いた。倫理的配慮：研究目的をK氏に十分に説明し同意を得た。プライバシー保護のためケースの紹介にあたっては骨子に支障がない程度に筆者の方で修正を加えた。結果：第１期：ADL全介助。年末年始の外泊から引き続き退院となり、訪問看護を提供したが変化なく経過、家族の介護参加もみられず支援方法に疑問を感じ、Ｋ氏のニーズ把握目的のため傾聴に務めることでニーズが引き出された。この期のQOL総合評価は25点。第２期：次第に支援サービスが導入され、Ｋ氏の能力に適したコンピュータの改造やIADL(手段的ADL)介助の機器の開発を行い、ハガキや名刺印刷業を始める。Ｋ氏は自らバーベキュパーティを企画し仲間との交流を楽しむ。この期のQOL総合評価は32点。第３期：介護に家族が参加し、IADL介助の機器の再改造で電話受信や窓の開閉が可能となる。Ｋ氏は他の障害者支援を目指し始めた。QOL総合評価は34点。結論：本事例において(1)対象のニーズを引き出しニーズに合わせた支援が展開された。(2)ニーズに合わせた支援が対象のQOLの向上をもたらしたと推察される。(3)上田の｢新しい人生を建設する｣という対象の行動変容がみられた。以上、これらのことから対象のニーズに合わせる支援の重要性が確認できた。Background and Objective: we provided an at-home support service targeting the man of the ADL with all cares aimed at of the serious spinal cord injury patient who had a problem with the at-home treatment life. While him support was continued to begiven, it suggested that the improvement of QOL became apparent. What do these processes mean? We report that the analysis examination of the care management process that was provided for this object was achieved. Design: Case study. Object: 25 years old, single, male patient with spinal injury Period of providing home care services: From Jan. 1996 to Sep. 1998 and From Nov.1999 to June 2000. Method:1) The materials used for the analysis are such as the visit nursing records, and the minutes.2) Support progress was classified in 3 terms, and Evaluation of QOL used Ueda's Synthetic Evaluation Standard for QOL (50 points top grades). Ethical Consideration:We showed and explained Mr. K a research purpose fully, and got his agreement. As there was no hindrance in the main point, we added modification by the case introduction for the privacy protection. Results: First period: ADL of Mr. K were under total care. It continued from staying out overnight of end of the year New Year's Day, until he was discharged from the hospital. Though he received visit nursing, there was no change in the treatment life. And, the care of the family to him wasn't apparent. We felt a doubt about the way of supporting it, and acted in over to grasping the needs of Mr. K by listening to him attentively, and the needs of Mr. K were drawn. Synthetic Evaluation Standard for QOL of first period is 25 points. Second period: Gradually, a support service was introduced. Remodeling of the computer that is suitable for the ability of Mr. K and the development of the help machine of IADL (Instrumental Activities of Daily Living) are done, and a postcard and a card printing industry are being undertaken by him. Mr. K plans a barbecue party, and enjoys the interaction with the company. Synthetic Evaluation Standard for QOL of second period is 32 points. Third period: A family participates in the care, and telephone reception and opening and closing of the window have become possible by re-remodeling of the help machine of IADL. Mr. K began to give hands to aim at other handicapped persons. Synthetic Evaluation Standard for QOL of third period is 34 points. Conclusion: In this case,(1)The needs of the object were drawn, and the support fitted to the needs was developed.(2)It suggested that the support fitted to the needs brought up the improvement of QOL of the object.(3)We could confirm the behavior transfiguration of the object of Dr.Ueda's "A new life is built." As mentioned above, the importance of giving support to fit the needs of the object from these things could be confirmed.
沖縄県立看護大学の論文

重症脊髄損傷者の在宅療養におけるケアマネジメント : ニーズに合わせることの重要性

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