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修改之前，我们调查了N州所有特殊养老院工作人员对临终关怀的态度。其次，我们在老年人保健机构进行了类似的态度调查，并与特殊养老院进行了比较。超过50%的工作人员回答说，他们对护理机构对临终者的护理感到积极，他们对临终护理的态度与工作类型、年龄、工作人员迄今参与的死亡人数、工作经验年数和设施地点有关。特殊养老院的工作人员比老年人保健机构的工作人员更具攻击性。第三，我们调查了两个县面临临终关怀相关困境的护士。他们的困境主要来自照顾老人和养家糊口的困难，而不是来自设施系统或团队合作。调查结果显示，护理人员培训的重点是(1)对老年人的身体评估和(2)如何支持他们的家庭；于是编制了一个培训方案。第二年，随着调查的进行，我们对护理经理进行了临终关怀的基础知识和支持培训，这是老年人医疗护理机构临终关怀培训计划的一部分，也是对家庭护理的支持。这些培训项目让学员对临终关怀有了深入的了解，但也在如何支持家庭方面造成了一些困惑。基于这些结果，我们认为重要的是制定培训计划，采用研讨会或其他方式，使护理工作者可以积累经验（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).