Construction of a terminal care training system for nursing-care workers under the Long-term Care Insurance System

在这项研究中，我们进行了三项基本调查。首先，在长期护理保险制度即将修改之前，我们调查了N县所有特殊老人护理院的工作人员对临终护理的态度。其次，我们在老年人医疗机构进行了类似的态度调查，以比较特殊的老年人护理之家。超过50%的人员回答说，他们对护理设施的临终关怀持积极态度，他们对临终关怀的态度与工作类型、年龄、死亡人数、工作经验和设施的位置有关。在特殊老年人护理院的工作人员比在老年人医疗机构的工作人员更具侵略性。第三，我们调查了两个县的护士面临的终端护理相关的困境。调查结果显示，护理人员面临的困境主要是照顾老年人和赡养家庭的困难，而不是设施系统或团队合作的问题。调查结果显示，护理人员的培训重点是（1）老年人临终阶段的身体评估和（2）赡养家庭的方法，因此制定了培训计划。第二年，我们沿着正在进行的调查，对护理管理人员进行了临终护理基础知识和支持方面的培训，作为老年人医疗护理机构临终护理培训计划的一部分，并作为对家庭护理的支持。这些培训项目让受训者深入了解了临终关怀，但也在如何支持家庭方面造成了一些混乱。根据这些结果，我们认为，重要的是开发培训计划，采用讲习班或其他手段，使护理工作者可以建立经验（或增加经验知识）。

In this study, we conducted three basic investigations. First, immediately before the Long-term Care Insurance System was amended, we surveyed the attitude of personnel working at all special elderly nursing homes toward terminal care in N Prefecture. Second, we conducted a similar attitude survey at healthcare facilities for the elderly for comparison with the special elderly nursing homes. Over 50% of personnel responded that they felt positive toward the care of the dying at nursing facilities, and their attitude toward terminal care was associated with the types of jobs, age, the number of deaths the worker has attended so far, years of work experience, and locations of facilities. Workers at special elderly nursing homes were more aggressive than their counterparts at healthcare facilities for the elderly. Third, we surveyed nurses in two prefectures facing terminal care-related dilemmas. Their dilemmas were found to stem mainly from difficulties caring for elderly people and supporting their families rather than from the facility system or working as a team.The results of the surveys showed the priority of training nursing-care workers in(1) physical assessment of the elderly in the terminal phase and(2) ways to support their families ; a training program was thus prepared. In the second year, along with ongoing surveys, we trained care managers in the basics and support of terminal care as part of a terminal care training program in medical nursing-care facilities for the elderly and as support for in-home care. Those training programs gave trainees insight into terminal care but also created some confusion regarding how to support families. Based on these results, we think it is important to develop training programs employing workshops or other means so that nursing-care workers can build experience(or increase empirical knowledge).