Introduction and Theorization of Risk Management on Users with Dementia at Long-term Care Insurance Facilities

通过文献研究、访谈和学术会议上的信息交流，我们对2002-2003财年长期护理保险机构中痴呆症患者的风险现状和风险管理进行了全国性调查，并在了解实际状况和创建干预理论框架后，在2004-2005财年对四个机构进行了干预研究。虽然干预的细节因每个设施的情况而异，但我们提供了以下共同的支持：1)通过增加照顾者的手头信息（包括知识和方法）来增强工作人员之间的相互理解；2)通过分享支持性案例分析和事件报告，支持提高对用户安全、舒适、满意度、能力发挥和护理之间关系的理解；3)支持风险管理体系的制定。这些支持是作为c的基础提供的。干预的一个效果是减少事故，如跌倒，误吸和/或窒息，和感染。即使没有观察到减少，工作人员也意识到他们可以防止此类事故；他们可以在发生这种事故时采取措施，这种事故不再是无法解决的问题。护理人员的意识也发生了变化，他们更积极地承诺“实施与风险管理相关的护理”、“照顾痴呆症患者”和“成为推动团队的代理人”。我们认为，研究人员所期望的变化是通过干预带来的。研究人员的每项干预措施及其效果之间的关系被分析、回顾，并作为风险管理理论（FY2005）加以说明。我们认为，设施管理可以有意地实施此类干预，因为针对痴呆症患者的风险管理活动和此类干预将有助于提高风险管理质量。少

We performed a nationwide survey based on documents study, interviews, and information exchange at academic conferences concerning actual status of risks and the risk management related to users with dementia at long-term care insurance facilities (in FY2002-2003), and implemented intervention study in four facilities (in FY2004-2005) after understanding actual status and creating a theoretical framework for the intervention.Though details of the intervention vary depending on the conditions of each facility, we provided following common supports : 1)support to enhance mutual understanding among the staffs by increasing on-hand information (including knowledge, and methodology) of care takers ; 2)support to improve understanding of the relationship between users' safety, comfort, satisfaction, ability exertion and care provided by sharing support case analysis and incident reports, and 3)support for the development of a risk management system. Such supports were provided as basics of c … More aring.One effect of the intervention was reduction of accidents such as falls, aspiration and/or asphyxiation, and infection. Even when no reduction was observed, the staffs realized that they could prevent such accidents ; they can take measures in the event of such accidents, and such accidents are not insoluble issues any more. Changes in care takes' awareness were also observed, with more active commitments to "implementation of care related to risk management", "care for users with dementia", and "becoming an agent to drive the team". We believe that the changes intended by the reserchers were brought about through the interventions.The relationship between each intervention of researchers and its effect were analyzed, reviewed, and illustrated as risk management theory (FY2005). We believe that facility managements can intentionally implement such intervention, as risk management activities for users with dementia and such intervention will contribute to improve risk management quality. Less