分娩時および産褥入院中の看護時間調査

Abstract

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.