This study aimed to elucidate the relationship between continuity of nurses’ job and practice of dementia care at long-term care health facilities (L-HFs). A questionnaire survey was conducted with five nurses each from 255 facilities in four prefectures of the Tokai region. A total of 384 responses (30.1%) were analyzed using a covariance structure analysis, the Nursing version of the Duty Satisfaction Rating Scale for L-HFs, and the Support Standards for the Behavioral and Psychological Symptoms of Dementia (BPSD). The following results were obtained: (1) “wages” were related to overall job satisfaction, intention to change the workplace, and intention to resign; (2) regarding nurses’ fidelity to the assumed model, the goodness of fit index (GFI) was .922, the adjusted goodness of fit index (AGFI) was .887, the comparative fit index (CFI) was .934, and the root mean square error of approximation (RMSEA) was .076; GFI ≥ AGFI. Subsequently, the categories of “care for elderly people with BPSD,” “nurses’ job satisfaction at L-HFs,” and “continuity of nurses’ job” were extracted. These findings suggest that, for nurses to continue their job, it is important to cultivate their ability to cope with the elderly with BPSD.

抄録全体を表示

This study aimed to elucidate nurses’ dementia care practices at long-term care health facilities by following the perspective of the International Classification of Functioning, Disability, and Health (ICF) and to obtain suggestions for improving the role nurses play in healthcare. A survey was administered to 5 nurses each from 255 facilities in 4 prefectures in the Tokai region. The responses of 339 nurses (31.3%) were analyzed using covariance structure analysis. It was revealed that care practices that follow the perspective of the ICF comprised two factors: “making use of a comprehensive assessment of the minds and bodies” and “preparation of the human and physical environment to increase calmness in the daily lives.” The ability to practice care and to assess the minds and bodies of the elderly with dementia improved depending on the number of years of experience nurses had with dementia care. Regarding nurses’ fidelity indices for the model, the goodness of fit index (GFI) was 0.884, the adjusted goodness of fit index (AGFI) was 0.840, the comparative fit index (CFI) was 0.909, and the root mean square error of approximation (RMSEA) was 0.086; GFI ≧ AGFI. Although the assessment ability could be improved upon at any nursing site, the practice of preparing the human and physical environment differed according to the location of medical treatment. Therefore, planned training and education were suggested as requirements for nurses at nursing facilities.

抄録全体を表示

目的：特別養護老人ホーム（以下，特養とする）の職場環境評価尺度を開発し，信頼性と妥当性を検討することである．

方法：予備調査の後，全国の特養300施設の看護職と介護職の1,800名を対象に，質問紙調査を実施した．

結果：344名（回収率19.1%，有効回答率95.6%）の因子分析の結果，「上司の支援的役割」，「創造的業務改善」，「人事考課」，「施設長の任務」，「教育」，「介護職と看護職の協働」の6因子34項目で構成された．尺度の信頼性と妥当性を検討した結果，尺度全体のクロンバックα係数は，.956で，モデル適合度は，χ² = 1193.5，p < .001を示し，GFI = .837，AGFI = .812，CFI = .925，RMSEA = .059であった．また，外的基準との相関係数は，.204～.916であった．

結論：構成概念妥当性のデータへの当てはまりはやや劣るが，内的整合性，基準関連妥当性が一定の基準を満たした．特養の職場環境評価の指標として活用可能である．

抄録全体を表示

【目的】本研究の目的は，介護老人保健施設の看護職と介護職に対し，職種それぞれの職務満足の構成要素を明らかにしその信頼性と妥当性を検討することである。
【方法】職務満足度尺度などを用いて，質問紙調査を看護職384名（30.1％），介護職486名（38.1％）に実施した。職種ごとに，探索的因子分析で得られた各６因子を潜在変数として，確認的因子分析を行い，モデルの適合度を確認した。
【結果】探索的因子分析では，介護老人保健施設の看護職版職務満足度評価尺度（N-DS-HF）は６因子であり，モデル適合度はCFIは .837， RMSEAは .078であった。また，介護老人保健施設の介護職版職務満足度評価尺度（C-DS-HF）は６因子であり，CFIは .856， RMSEAは .071であった。
【結論】N-DS-HFおよびC-DS-HFともに，職務満足の指標としての信頼性が許容範囲であることが確認できた。

抄録全体を表示

介護老人保健施設の職務環境の改善に対する自由記述による質問紙調査を実施した。看護職159名（12.5%），介護職200（15.7%）の内容分析では，看護職の328記録単位は28サブカテゴリーに分類され，介護職の393記録単位は25サブカテゴリーに分類され，ともに7カテゴリーに類型化された。職務環境整備は，【国レベルでの制度改革】をすすめることで，【安心した生活が営める給与体制】を構築でき，【職員の確保と定着】ができれば，休みも確保しやすくなり，【ワークライフバランスの実現】になり〔職務継続意向〕につながる。それぞれの職種における更なる専門性を高めるためには，【キャリアアップの機会の確保】や【さまざまな職種・人との連携】も重要であり，職員のケアの実践力を高めるなど，【施設の営利を優先させない】方向性も求められる。それらのさまざまな要因が〔職務継続意向〕を強めると示唆される。

抄録全体を表示

　The purpose of this study was to clarify the factors related to the provision of nursing care to elderly patients with behavioral and psychological symptoms of dementia (BPSD) at hospitals for communitybased care (Hs-C-BC). A questionnaire survey was administered to 1,370 nurses at Hs-C-BC in four prefectures in the Tokai region. A multiple regression analysis with the stepwise method was performed, in which subscales of the support standards for BPSD (SS–BPSD) were used as dependent variables and either basic attribute or work environment (to assess the relationships among the nurses) was used as an independent variable. The valid response rate was 41.6% (N = 570). Results of SS-BPSD and each subscale indicated that there was no relationship between the provision of nursing care and nurses’ age, between the provision of nursing care and nurses’ educational background, and between the provision of nursing care and nurses’ years of experience. The multiple regression analysis revealed that work environment and exchanging opinions with people in other occupations were the two factors related to all the SS-BPSD. It is important for nurses to perform care while collaborating with people in other occupations as well as other nurses. The continuous practice of dementia care may strengthen nurses’ abilities to cope with patients suffering from BPSD.

抄録全体を表示