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

在本研究中，我们进行了三项基本调查。首先，在长期护理保险制度修订前，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。第二，我们在老人医疗机构进行了一项类似的态度调查，以与特殊的老人疗养院进行比较。超过50%的人员表示，他们对护理机构临终关怀的态度是积极的，他们对临终关怀的态度与工作类型、年龄、到目前为止参加过的死亡人数、工作年限和设施位置有关。特殊养老院的工作人员比老年保健机构的工作人员更具攻击性。第三，我们对面临临终关怀困境的两个县的护士进行了调查。调查发现，他们的困境主要源于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困难。调查结果表明，护理人员在(1)老年后期体检评估和(2)如何赡养家庭方面的培训是优先的；因此制定了培训计划。在第二年，随着正在进行的调查，我们对护理经理进行了关于临终关怀的基本知识和支持的培训，作为老年医疗护理设施的临终关怀培训计划的一部分，并作为对居家护理的支持。这些培训计划让学员对临终关怀有了深入的了解，但也造成了一些关于如何支持家庭的困惑。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，使护理人员能够积累经验(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).