DSpace コレクション: 2006-03-312006-03-31https://usprepo.office.usp.ac.jp:443/dspace/handle/11355/152023-10-26T20:32:03Z2023-10-26T20:32:03Z下肢の支持性が低下した人に対する移乗動作の身体的・心理的負担の評価伊丹, 君和安田, 寿彦豊田, 久美子石田, 英實久留島, 美紀子藤田, きみゑ田中, 勝之森脇, 克巳https://usprepo.office.usp.ac.jp:443/dspace/handle/11355/612019-04-21T16:30:26Z2006-03-30T15:00:00Zタイトル: 下肢の支持性が低下した人に対する移乗動作の身体的・心理的負担の評価
著者: 伊丹, 君和; 安田, 寿彦; 豊田, 久美子; 石田, 英實; 久留島, 美紀子; 藤田, きみゑ; 田中, 勝之; 森脇, 克巳
抄録: 背景 高齢化が進む中で人間の基本的な生活行動に看護支援が必要な人々が増加するとともに、看護者の腰痛も多発する状況にある。前報では、下肢の支持性が低下した人に対する移乗サポートロボットを用いての立ち上がり動作実験を行い、サポートを受ける人の身体負担が少ないロボットの動きについて検証を行った。その結果、深く前傾しロボットに伏臥して立ち上がる方法で筋疲労は比較的低く、胸部や腹部など身体に密着する側に改善を加えれば有効にロボット活用できる可能性が示唆された。研究目的 本研究では前報に引き続き、下肢の支持性が低下した人を対象とした移乗動作実験を行い、看護者が移乗動作をサポートする場合に、サポートを受ける側とサポートする側の両者にとって安全・安楽・自立を考慮した方法について検証することを目的とした。方法 1.対象および研究方法2004年10月、以下の実験および調査を実施した。被験者は、健康な平均的体格の20歳代の女子4名とした。実験は、看護現場で移乗方法として広く用いられている患者の両足の間に看護者の片足を入れて移乗する方法(「中足法」とする)と、前報で比較的有効な移乗サポートロボットであると検証されたロボットの動きに近い患者を前傾にして看護者の背部に乗せて移乗する方法(「背負い法」とする)を取り上げて移乗動作を行った。分析は、表面筋電図測定装置(SX230)を用いて各被験筋について筋積分値を算出して両者の比較を行った。また、同被験者に対して、安全・安楽・自立の観点から主観的反応調査を行った。2.倫理的配慮 対象は研究の趣旨に同意した者のみとし、研究参加に同意した後でも、いつでも辞退可能であること。また、プライバシーの保護についても文書と口頭で伝えた。結果 移乗サポートを受けた患者側の実験・調査結果をみると、中足法を用いた場合では、特に上肢に苦痛を感じており、動作時6秒間の筋積分値を比較しても上肢の筋活動が高いことが明らかとなった。一方、背負い法を用いた場合では、苦痛は比較的感じていないものの安全性・安心感・自立性の面では低値を示していた。また、移乗サポートを行った看護者側の結果では、中足法を用いた場合に腰部への負担が大きく、背負い法を用いた場合に上肢・下肢に負担が大きいことが認められた。結論 以上より、下肢の支持性が低下した人に対する移乗動作では、看護現場で広く行われている中足法はサポートを受ける側とサポートする側の両者において身体的負担は大きいものの、安全性・安心感・自立性の面からは有効であると考えられた。一方、背負い法では身体的負担は比較的低いものの、サポートを受ける患者側の安心感は低いことが明らかとなり、それぞれの移乗法の課題が示唆された。; Background Japan's population is graying rapidly. The increase in the number of people seeking assistance to carry out some of the basic everyday activities has resulted in an increased incidence of low back pain among nurses. In our previous study, electromyographic (EMG) activity in patients with reduced lower limb strength was measured during robot-assisted standing transfer in order to assess the usability of a robotic transfer aid in terms of user safety and comfort. The results of this previous study suggested that muscle fatigue associated with robot-assisted standing transfer can be reduced by allowing patients to bend their upper body forward over the robot before raising them to a standing position, and with a few modifications to the part of the robot which comes into contact with the user's chest and abdomen, the robot may have a potential to become a useful tool for assisting individuals in a standing transfer. Objective In the present study, EMG activity in patients with reduced lower limb strength was measured to identify the methods of transfer and lifting that are safe, secure, and convenient for both the provider and the receiver of support. Method 1. Subjects and Methods: The survey was conducted in October 2004. Subjects were four healthy women with average height and build aged in their 20s. The following transfer techniques were examined: 1) placing one leg between the legs of a patient in order to safely lift the patient to a standing position (Technique A), and 2) having a patient bend his/her body forward onto the nurse's back to lift him/her to a standing position (Technique B). Technique A is a customary lifting technique widely used by nurses in Japan, while-according to our previous study - Technique B proved to cause minimal patient discomfort. Muscle activity of the subjects was measured to compare the two lifting techniques. A surface electromyograph called SX230 was used to calculate the integral of the electromyogram signals (EMG integral) for each tested muscle. Subjects were interviewed regarding their perceived comfort and discomfort in terms of safety, sense of security, and convenience. 2. Ethical Consideration All subjects were fully informed of the purpose of the study before consenting to participate, and were fully aware that they could withdraw from the study at any time. They were also fully informed both orally and in writing about their right to privacy. Results Standing transfer using Technique A caused pain in the upper limb in the support receiver, with the EMG integral for the upper limb during the first 6 seconds of a standing transfer indicating relatively intense muscle activity. With Technique B, the support receiver experienced less pain but indicated an increased level of perceived discomfort in terms of safety, sense of security, and convenience. On the other hand, while Technique A caused the support giver much strain on the low back, Technique B inflicted excessive stress on both the upper and the lower limb muscles of the support giver. Conclusions The results obtained from the present study showed that both Techniques A and B have their merits and demerits. Technique A is a customary lifting technique which is widely used by nurses in Japan to raise individuals with reduced lower limb strength to a standing position. Although this technique inflicted relatively intense physical strain on both the support giver and the receiver, it gave the support receiver increased sense of safety and security. On the other hand, Technique B involved less physical strain but provided less sense of security to the support receiver.2006-03-30T15:00:00Z分娩時および産褥入院中の看護時間調査岩谷, 澄香高橋, 里亥白井, やよい志田, 映子玉里, 八重子宮田, 久枝勝又, 浜子篠塚, ひとみhttps://usprepo.office.usp.ac.jp:443/dspace/handle/11355/562019-04-21T16:30:26Z2006-03-30T15:00:00Zタイトル: 分娩時および産褥入院中の看護時間調査
著者: 岩谷, 澄香; 高橋, 里亥; 白井, やよい; 志田, 映子; 玉里, 八重子; 宮田, 久枝; 勝又, 浜子; 篠塚, ひとみ
抄録: 背景 わが国における急速な少子化の進展は、どのような対策も効を示さず、留まる様子は見えず、2004年の出生数は1110835人(合計特殊出生率1.288)と1899年に統計を取り始めて以来の最小を更新した。このような中、平成14年の全国の分娩場所の状況は病院52.3%、診療所46.5%と病院が半数以上を占めている。本県においては病院41.8%、診療所57.6%と全国とは逆の状況で診療所が過半数を占めているが、分娩介助および周産期ケアの専門家である助産師の就業状況は、病院62.8%、診療所22.6%と病院に集中している状況である。これらより妊娠・出産への安全性・快適性を確保する必要性が高まり助産師の適正配置に関する検討会が設置された。目的 より安全・快適な出産が行える体制を整備するための助産師の適正配置検討の基礎的資料とするため、助産師が分娩時および産褥入院中に提供する看護時間を把握することを目的とした。方法 妊婦が分娩目的に入院してから分娩後退院するまでの期間中に、助産師および看護師が、全勤務時間帯において妊産褥婦に提供した看護時間を測定した。時間の測定方法は、測定表に基づき、ケアの項目毎の看護の関わりをポイント化し、点数の記載を求めた。調査票への記載は、直接看護を提供した助産師および看護師に依頼した。結果 分娩時の看護時間の平均は6.2±3.8時間であった。病院と診療所別にみると病院は5.6±2.4時間,診療所は6.7±4.4時間で、両者間に有意な差は認められなかった。産褥入院中の看護時間の平均は13.5±4.9時間であった。これを病院と診療所別にみると、病院は13.3±6.7時間(助産師9.5±5.8時間,看護師3.8±4.7時間)で、診療所は13.6±3.2時間(助産師4.4±2.6時間,看護師9.2±3.4時間)であり、施設間における助産師および看護師の看護時間に有意な差を認めた(p<0.01)。分娩時の看護時間と産褥入院中の看護時間を合計すると、病院は18.8±8.2時間で診療所は20.3±5.6時間で、平均19.7±6.8時間であった。結論 助産師および看護師の看護行為を量的に測定し、分娩時および産褥入院中に助産師が提供する看護時間は12.8±6.4時間で、助産師と看護師が提供する総看護時間は19.7±6.8時間であることが把握できた。助産師・看護師の看護時間は、病院と診療所の間において有意な差を認め、病院では助産師の方が長く、診療所では看護師の方が長いことが明らかとなった。; Background Any preventive measures against the rapid decline of the birth rate in Japan have failed to stop the persistent tendency and return it to an increasing birth rate. The childbirths in 2004 accounted for 1,111,000 (the birth rate: 1.2888), the lowest number in terms of the annual statistical record started in 1899. Under present circumstances, it is reported that the institutional choice for delivery throughout Japan in 2004 was 52.3% in hospitals and 46.5% in clinics. These data show that hospital deliveries account for more than half of the total number of deliveries in Japan. However, research in Shiga Prefecture shows a reverse result on the above data. Delivery in clinics accounts for 57.6%, while delivery in hospitals shows 41.8%. Consequently, midwives, specialists in the interventions for delivery and post-natal care, have been largely employed both by hospitals and clinics: 62.8% and 22.6% respectively. A study committee for a proper reshuffle of midwives was established with the increasing interest and necessity towards making childbirth safer and more comfortable. Purpose In order to establish a better system to enhance the safety and comfort of childbirth, this research was aimed at clarifying the hours for interventions provided by midwives at the time of delivery and post-natal care in hospitals and clinics as the basic date for a proper reorganizing of midwives. Method The interventions for an expectant mother, given by a midwife and a nurse after her hospitalization for childbirth, are measured on the basis of hours provided by them on duty. The method for measuring hours is based on a report card of points explained in a list with item by item care. For this a specified "time table" is used for counting points. Both a midwife and a nurse are asked to enter the points they obtained in the card. Results The hours for delivery, on average, were 6.2±3.8 hours. Observing the differences between hospital and clinics, the hours for delivery in hospital were 5.6±2.4 hours, while the hours for it in clinics were 6.7±4.4 hours. There was no significant difference between them. The hours for post-natal care, on average, were 13.5±4.9 hours. Observing the difference between hospital and clinics, the former spent 13.3±6.7 hours (midwife spent 9.5±5.8 hours and nurses spent 3.8±4.7) hours. The latter spent 13.6±3.2. hours (midwife spent 4.4±2.6 hours and nurses spent 9.2±3.4 hours). The significant difference of the hours for post-natal care was recognized between midwife and nurse and between hospital and clinics. (p<0.01). The total hours of the interventions for delivery and post-natal care, on average, were 19.7±6.8:18.8±8.2 in hospital and 20.3±5.6 in clinics. Conclusion According to the research, the hours for the interventions given by a midwife during delivery and post-natal care were 12.8±6.4. The total hours for the intervention given by a midwife and a nurse were 19.7±6.8. Considering the institutional difference in the hours for interventions given by a midwife and a nurse, there was a significant difference in favor of a midwife in hospital, while there was a significant difference in favor of a nurse in clinics.2006-03-30T15:00:00Z看護におけるinvolvement概念の構成要素に関する文献研究 (研究ノート)牧野, 耕次比嘉, 勇人甘佐, 京子松本, 行弘https://usprepo.office.usp.ac.jp:443/dspace/handle/11355/572019-04-21T16:30:26Z2006-03-30T15:00:00Zタイトル: 看護におけるinvolvement概念の構成要素に関する文献研究 (研究ノート)
著者: 牧野, 耕次; 比嘉, 勇人; 甘佐, 京子; 松本, 行弘
抄録: 背景 わが国の看護において、巻き込まれやかかわり(関わり)、関与などと訳されているinvolvementは、職業倫理および科学的客観性などの視点から問題視されていたが、近年、involvementに関する研究が行われ始めている。しかし、看護におけるinvolvementの概念分析は行われていないため、involvementの様々な側面に焦点が当てられ看護の中心的な概念と認識されながら、その概念を共通認識することは難しいのが現状である。目的 本研究では、看護におけるinvolvementに関する過去の文献を用いて、involvement概念の構成要素を抽出することを目的とする。方法 文献検索は、看護に関連したデータベースを用い、involvementとnurse-patient relationshipがキーワードである文献を検索した。検索された文献からinvolvement概念に関する記述を抜粋し、抽象化しカテゴリー化を行い、看護におけるinvolvement概念の構成要素を抽出した。結果 上記の方法により、看護におけるinvolvement概念の構成要素として、「経験の共有」「感情の投資」「絆の形成」「境界の調整」を抽出した。結論 考察の結果、「経験の共有」「感情の投資」「絆の形成」「境界の調整」というinvolvement概念の構成要素に沿った振り返りの必要性が示唆された。; Background In the past, involvement in nursing was considered to be a difficult issue in Japan from the employment ethics and objective scientific perspectives. Following the recent reviews of the evaluation of involvement in other countries, studies on involvement in nursing are gradually becoming more common in Japan. Although various aspects of involvement have been investigated and the importance of this concept has been recognized, it has not been analyzed; therefore, it remains difficult to obtain widespread recognition of the concept of involvement in nursing. Objective The present study aimed to extract components of the concept of involvement from published literature regarding involvement in nursing. Method A literature search was conducted and manuscripts containing the keywords "involvement" and "nurse-patient relationship" were retrieved from the PubMed and CINAHL databases. From the selected literature, components of the concept of involvement in nursing were extracted by excerpting descriptions regarding the concept of involvement, abstracting them, and categorizing them. Results Four extracted components of the concept of involvement in nursing, were "sharing experiences," "investing emotions," "forming bonds," and "negotiating boundaries." Conclusion Further investigation of nursing practice based on the components of the concept of involvement in nursing identified by the present study is required.2006-03-30T15:00:00Z足浴が排尿に与える影響に関する基礎的検証豊田, 久美子https://usprepo.office.usp.ac.jp:443/dspace/handle/11355/582019-04-21T16:30:26Z2006-03-30T15:00:00Zタイトル: 足浴が排尿に与える影響に関する基礎的検証
著者: 豊田, 久美子
抄録: 背景 足浴は入浴することができない患者のための重要な看護ケアの一つである。足浴の効果は多くの研究者によって調査、実証されており、睡眠パターン、自律神経機能、精神神経免疫機能への効果が報告されている。これらの結果から、足浴はその副交感神経系への効果により、リラクゼーション、睡眠、循環を促進する可能性があることが示唆されている。看護師はしばしば排尿困難のある患者に、水の音や流水、手浴などのケアを用いているが、それらのケアはエビデンスに基づいておらず、また広くリサーチも行われていない。また、足浴が排尿を促す効果の有無についても未検証である。足浴は副交感神経を優位にし、心地よさを提供し、また循環を改善する効果が期待され、その効果が排尿困難を改善することが予測される。目的 本研究は、足浴ケアが排尿に与える影響を明らかにし、その効果を今後の介入研究の一助とすることを目的とした。方法 研究協力の得られた健康な成人11名(男性3名、女性8名)を対象とし、41℃の湯を用いて20分間密封式足浴法を施行し、自律神経の活動、尿量、バイタルサインの変動、主観的反応を評価した。結果 足浴中後60分間において、11名中5名に顕著な尿量の増加がみられ、この5名の交感神経活動(LF/HF)は増加した。一方、他の参加者においては緩やかな尿量の増加が見られ、またHFで示される副交感神経活動量が増加していった。また、全ての参加者が足浴に心地よさを感じ、足浴の温度刺激が指尖温度を改善することも明らかとなった。結論 足浴に対する反応には2つのタイプがあることが、この研究から示唆された。足浴による温熱・湯という刺激によって、気持ちよさや指尖部温の上昇をみるが、交感神経を優位にし尿量の顕著な増加をみるタイプと、そのような効果は認めないが、副交感神経への効果により、心地よさ、リラクゼーションを感じ、短時間での急激な尿の増加をみないという二つのタイプがある可能性が示唆された。; Background Foot bathing is one of the important nursing care for patients who cannot take a bath by themselves. Many researchers examined and verified the effects of foot bathing on people. It was revealed that foot bathing affected participants' sleep pattern, autonomic nervous system, and mental, physical and immunological status. They concluded that foot bathing might facilitate participants' relaxation, sleeping and circulatory system because foot bathing might affect their parasympathetic nervous system. Nurses often use water sound, running water or hand bathing as the care for patients with difficulties in urination; however, the care is not evidence-based and well researched. Furthermore, few researchers examined whether or not foot bathing could facilitate people's urination. Foot bathing could provide comfortable feelings to people and improve their circulatory system; therefore, it was expected that the difficulties in urination might be improved by foot bathing due to its effect on the parasympathetic nervous system. Objective This experimental study aimed at revealing how foot bathing affected urination, and developing the results obtained in order to use them for the next research project. Method Eleven healthy adults (3 males and 8 females) agreed to participate in the study. The participants were provided with closed style foot bathing in water heated to 41℃ for 20 minutes. The researchers checked the activities of the participants' autonomic nervous system the amount of their urination, and changes in their vital signs during the experimentation. Then the researchers evaluated the participants' subjective reaction to the foot bathing. Results It was found that 5 in 11 participants had a marked increase in the amount of urination, 60 minutes before and after the foot bathing. The numerical values of activities of their sympathetic nervous system (LF/HF) were being increased during and after foot bathing. Other had a slow increase in the amount of urination, and the activities of their parasympathetic nervous system, which was measured and shown as HF, were stimulated, and the values were being increased during and after foot bathing. In addition, it was also revealed that the comfort of all participants and the temperature of their toes were improved by the warmth and stimulus of foot bathing. Conclusions The researchers suggested that there might be two types of participant reaction to foot bathing. Some people may feel comfortable and the temperature of their toes may be improved by the warmth and stimulus of foot bathing, but they also may get a marked increase in the amount of urination due to the dominant effect of foot bathing on the sympathetic nervous system. Others may feel comfortable and relaxed by foot bathing because of its effect on the parasympathetic nervous system but may not get a marked increase in the amount of urination in a short term.2006-03-30T15:00:00Z