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一般病院で身体拘束を受ける高齢者を対象に、看護師が身体拘束を必要と判断した理由と高齢者の特徴や治療などとの関連性を検討した。 / 1. 対象者は21病院180名で男性49％、平均年齢81.3±8.4歳、障害老人の日常生活自立度ランクA以下89％、認知症高齢者の日常生活自立度I以下85％であった。手術あり27％、安静の指示ありは46％であった。 / 2. 身体拘束の理由は点滴などの抜去64％、転倒・転落54％、安静が守れない40％などであった。 / 3. 「点滴などの抜去」の該当者ではランクC、指示が通じない、他者への意思伝達ができないが有意に多かった。「転倒・転落」ではランクB以上、転倒歴ありが有意に多かった。「安静が守れない」ではランクB以上、夜間の中途覚醒があり、指示が通じない、手術あり、安静の指示ありが有意に多かった。, This study investigated the reasons why nurses felt the need to use physical restraints on elderly restrained patients at general hospitals, and examined the relationship between these reasons and the characteristics and treatments of the elderly patients. / 1. The subjects were 180 patients at 21 hospitals, 49% males, mean age of 81.3±8.4 years, 89% with a Rank A and below in the 'independence degree of daily living for the disabled elderly' and 85% with a Rank I and below in the 'degree of independent living for the demented elderly' scale. A total of 27% of patients had a history of surgery and 46% were prescribed bed rest. / 2. The reasons for physically restraining patients were as follows : 64% for removal of intravenous lines, 54% to prevent overturning and falling, and 40% to maintain bed rest. / 3. Of the patients that required "removal of intravenous lines," a significantly large number of patients were Rank C or could not understand instructions or communicate their wishes. Among those who were at risk of "overturning and falling," a significantly large number of patients were Rank B and above or had a history of falling. Among those who could "not maintain bed rest," a significantly large number of patients were Rank B and above, experienced nocturnal awakening, could not understand instructions, had a history of surgery, or were prescribed bed rest.

Along with an increasing number of elderly people with dementia, many of them enter general hospitals due to physical complications. In this study, we interviewed 11 nurses who work at a general hospital ward to clarify and examine the process of care provided for elderly people with dementia who were hospitalized due to physical complications. As a result of our analysis of the interviews, we identified a “process leading to efforts to improve nursing”. This process was comprised of the following five categories : [composure], [experience and sense of care], [guess], [catering to the needs of patients], [awareness], and [efforts to improve nursing]. We observed that nurses with [composure] and [experience and sense of care] were able to [guess] the feelings of patients with dementia and [cater to the needs of patients]. The [awareness] of receiving and interpreting patients’ verbal and nonverbal messages acquired while [catering to the needs of patients] led to [efforts to improve nursing], and if it caused favorable changes to patients with dementia, it led to further [awareness] and [composure]. Thus, the results indicated the importance of communication based on [awareness] for the care provided at general hospitals to elderly people with dementia who were hospitalized due to physical complications.