並列タイトル等The efforts of facilities, including long-term care insurance facilities, for the abolishment of physical restraint, and its outlook. : Based on surveys of staff members at long-term care insurance facilities
一般注記We put together a list and conducted surveys in order to clarify the current situation and issues regarding physical restraint. We conducted the surveys with facility staff members on not only the long-term care insurance facility's internal regulations on restraint, but also on other items that they might regard as physical restraint and think need reviewing. In addition, we have investigated the recognition of verbal suppression (speech lock), which is considered a formof physical restraint. Based on these results, we will discuss how to perform care while respecting the resident's personality.The research consisted of the following two methods: one was literature research, including the background of the abolition of physical restraint and the situation after its abolishment. The other was a questionnaire survey targeting staff members who were taking care of the elderly in long-term care insurance facilities.The mail-in questionnaire survey was sent to 800 facilities all over Japan, and it regarded the situation of physical restraint and its recognition in 5 long-term care insurance facilities. We performed a chi-square test and residual analysis, and text mining.In addition, we conducted a mail-in questionnaire survey regarding staff members' recognition of verbal suppression (speech lock) in 2500 nursing care homes all over Japan. For the analysis,we performed simple aggregation using status recognition data, gave an initial code in the free description contents, categorized them based on the similarities of the contents, and examined any associations.The results showed the following points:1) The following correlations were found in actions that are considered to be restraint: the rate and necessity of the implementation of restraint, the rate and recognition of restraint, the recognition and the necessity of restraint. Since service is different in each facility, the implementation of physical restraint varies depending on the procedures of each facility.2) As "the current status of physical restraint and their initiatives", the following seven items were derived: emotional reaction and a proactive approach; the restriction of movement and countermeasures; risks on the bed and countermeasures; staff members' dilemmas and countermeasures; explanation, consent and cooperation; situations where abolishment is unsuccessful and individual attitude towards abolishment; and facility's philosophy and their creative efforts. Diverse efforts against restraint were shown.3) Regarding the recognition of nursing care home staff members of verbal suppression (speech lock), it was suggested that not only physical restraint, but also the compensation packages of the caregivers, abuse from caregivers, and staff member attitudes were also recognized as elements which were related to the wide range of the problems. In addition, we clarified the situations and the psychological states of staff members when "speech lock" was induced.In the future, it will be required to examine efforts for the abolishment of physical restraint, both in the facility and outside the facilities, depending on the situation of the facility and the residents. In order to provide better service, each facility will be required to show creative efforts and measures, including overcoming the lack of staff members, and encouraging cooperation among the staff, family members and the residents. Abolishment of physical restraint must be overcome in order to realize a better way of care, and it will be a step towards improving the quality of care.
平成27年度
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受理日（W3CDTF）2016-06-03T01:05:16+09:00
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