急性期病院における臓器提供の意思確認を実施するための終末期医療の質改善を目的とした教育プログラムの開発と評価

抄録

Although public opinion polls reported that over 40% of Japanese people want to donate their organs at death, the number of organs remains low (=< 1 donor/million population). This low donation rate is supposed to be due to the lack of an in-hospital system to confirm patient desires to donate organs to patients at hospitals. The purpose of this study is to develop and evaluate the educational program to improve the quality of terminal care at acute care hospitals in the form of a QM (quality management) seminar at emergency departments, focusing on management methods and quality management to facilitate and establish an in-hospital system.
From 2013 to 2015, there were 94 participants. Pre- and post-program test showed that the improvement rate was 15.9% for transplantation medical care, 6.9% for skills, and 10.5% for the management method. By the educational method, the improvement rate was 10.1% for lecture and 10.2% for group-work exercise (+ lecture). Compared with doctors, nurses had a lower improvement rate in the domain of management methods. A questionnaire survey showed that the participants evaluated that management method was difficult and their understanding level was low, but they highly recommended participation.
To improve the quality terminal care, the role of nurses is important because they are the major players in patient care, and revision to improve the educational program is necessary to provide outcomes similar to those doctors produce. Other supporting methods, such as the provision of educational tools and sharing success cases, should be considered to facilitate in-hospital system development.