The Development of a Care Model for Elderly Patients with Delirium-like Symptoms in General Hospitals

这项研究的目的是为住院的老年患者建立一种急性护理模式，这些患者都有类似的妄想症。这项研究是与一家私立综合医院的护士合作进行的。在1996学年，我们总结了一项关于私立综合医院精神错乱患者实际情况的研究结果(从1995学年开始)。我们分析了影响妄想症状出现和消失的主要因素。我们还对160名护士进行了问卷调查，了解他们对精神错乱的看法和他们所提供的护理。这项调查显示，护理妄想症患者的重要因素包括安全、沟通、观察、刺激和日常生活节奏。研究结果在1996年1月举行的日本老年护理学会科学会议上公布。在1997学年，我们查阅了有关精神错乱的评估和护理计划的文献。在研究的基础上，我们考虑了护理模式的内容和结构。我们开发了《妄想的护理模式的建议》，以阐明如何确定妄想的严重性，以及如何处理和区分妄想的原因。这项建议包括一个精神错乱分级表，关于原因的信息，以及急性和预防性护理的指南。该模型旨在为临床环境中的护士制定决策和采取行动的指南。为了提高护理模式的内容效度，我们分析了实际使用该模式的案例，并从专家和临床护士那里获得了对该模式的评价。根据以上研究结果，我们对模型进行了修正，并设计出了“妄想症护理模式”。

This research aims at developing an acute care model for elderly patients hospitalized with delirium-like symptoms. The research was carried out in cooperation with nurses in a private general hospital.In the 1996 academic year, we summarized the results of a study (from the 1995 academic year) on the actual conditions of patients with delirium in a private general hospital. We analyzed the primary factors in the appearance and disappearance of symptoms of delirium. We also conducted a questionnaire survey of 160 nurses on their perception of delirium and the care they are delivering. This survey showed that important factors in the care of patients with delirium include securing safety, communication, observation, stimulation and the rhythm of daily life. The results were presented at the 1^<st> Scientific Meeting of the Japan Academy of Gerontological Nursing (January, 1996).In the 1997 academic year, we examined the literature on the assessment of and care plans for delirium. We considered the content and structure of a care model based on our studies. We developed "a Proposal for a Care Model of Delirium"to clarify how to determine the pressence of delirium, and how to deal with and distinguish the causes of delirium. This proposal includes a delirium rating scale, information on causes, and guidelines for acute and preventive care.The model is intended as a guideline for nurses in a clinical setting for making decisions and taking action. In order to increase the content validity of the care model, we analyzed case studies in which the model was actually used, and obtained evaluations of the model from specialists and clinical nurses. We revised the model based on the above results and devised the "Care Model for Delirium".