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Ａ県Ａ圏域の病院看護師の退院支援への取組みの現状や自己評価，退院支援に関する病棟看護師の役割認識等を調査し退院支援の実態を明らかにすることを目的に，Ａ圏域の総合病院４か所の病棟看護師400名を対象に質問紙調査を実施した（有効回答299名，有効回答率74.8%）．退院支援病棟評価では13項目中10項目において，70% 以上が「いつもできている」または「ときどきできている」と回答し，退院支援自己評価の尺度全体の得点± SD は20点満点中13.90±2.44と共に概ね高評価であったが，院内外他職種との連携，役割分担等に課題があることが推察された．また病棟看護師の役割として，患者・家族の意思決定支援を重要視している一方，療養環境や社会資源の調整まで病棟で完結しようとする認識が窺えた．今後，他職種との関わりやカンファレンスの持ち方，他職種との役割分担を再確認し，病棟における退院支援のあり方を整理する必要があると考える．This study aims to elucidate the state of discharge support by investigating initiatives for discharge support by hospital nurses, their self-evaluation, and their role awareness regarding discharge support in District A, Prefecture A. We conducted a questionnaire survey on 400 ward nurses at four general hospitals in District A. Of 299 respondents (valid response rate: 74.8%), by 10 item in 13 items of the discharge support ward evaluation, "It's always done" or "It’s sometimes done" was answered more than 70 % , and the total score ± SD for discharge support self-evaluation was 13.32 ± 2.33, respectively, suggesting generally high scores for both. However, issues associated with items such as coordination with other professionals inside and outside of the hospital, and role allocation were noted. Although several subjects gave the highest priority to patient and family decision-making support in their role as a ward nurse, they most likely felt that they had to complete everything up to the recuperative environment and social resource adjustment at the ward. Furthermore, it appears imperative to reconfirm involvement and conferences with other professionals, the acquisition of assessment and communication methods for decision-making, and role allocation with other professionals to determine how to implement discharge support at wards.

当院では, 2006年にインシデントの影響度分類を, 旧分類のレベル０～８から国立大学附属病院安全管理協議会のレベル０～５の分類(以下現分類) に変更した. そこで2004～2009年度分の転倒・転落を遡及的に分析し, 現分類の意義を検討した.2004～2005年度分を, 現分類に変更するため, 内容を精査してレベル分けしたところ, 消毒や止血などを実施したにも関わらず結果的に健康被害が無い場合は, 旧分類レベル３ ｢エラーが起こり患者に実施され様子観察や検査を必要とした. 健康被害はないかすぐ回復するものであった｣ではなく, 旧分類レベル２ ｢エラーが起こり患者に実施されたが, 健康被害はなかった｣に分類されていた. これは, 旧分類では, 抽象的表現での処置内容と健康被害の有無が混在していたため, 健康被害がないことに重きを置いて分類していたものと考える. 現分類は, 具体的な処置内容が明記されているため実態に即した分類が可能となっていると考えられた., In Akita University Hospital, the influence rate classification of incidents was changed in 2006 from former levels 0-8 to current levels 0-5 of the classification made by the Safety Management Council of National University Hospitals. We examined the value of the current classification by analyzing retrospectively stumbles and falls experienced from 2004 to 2009. To transfer the incidents from the old classification into the current one, we examined the details of incidents in 2004 and 2005 thoroughly and reclassified them into the new levels. Where there was ambiguity in the old classification, incidents without health aftereffects despite performance of disinfection and hemorrhage control, were classified to the oldlevel 2 (No aftereffects even though errors needing treatment occurred), not to the old level 3 (No aftereffects, or quick recovery even though errors needing treatment, observation, and examination occurred). We speculate that this incorrect level assignment might have happened because we classified the incidents with emphasis on "no aftereffects." Practical classification is now feasible under the current classificationbecause specific treatments have been described explicitly.

膵癌の治療成績は不良であり, 現在においても, 膵頭部癌切除例の生存期間の中央値は12.3ヶ月, ５年生存率は13.0％と低値である. 浸潤性膵管癌は膵癌の大多数を占めるものであるが, 同診断により手術を受けたのち, 19年が経過したサバイバーに, 病気との向き合い方についてインタビューする機会を得た.１) 疾病の理解, ２) 病気に対する自分自身の構え, ３) 病気への対処行動と予防行動について, その語りを健康生成論的視点で分析したところ, 首尾一貫して健康のベクトルを健康軸に向けるよう, 自分はこれでは死なないと信じて, 病名告知がない状況で自ら文献を調べて疾患を理解し, 回復手段を考え, 便秘やガス貯留が無いように代替療法を取り入れるなど, 主体的かつ積極的に過ごしてきたことが分かった. また, 入院中の生活で感じたさまざまな不合理や, 職業的背景や価値観を尊重した対応がされなかった際に感じた疎外感については, 今後のケアで留意すべき示唆となった.\nThe prognosis of invasive ductal pancreatic cancer is not satisfactory even at present. The median survival is reportedly 12.3 months, and 5 year survival rate is as low as 13.0％ in patients who underwent pancreatoduodenectomy.We interviewed a pancreatic cancer patient who survived for more than 19 years following pancreatoduodenectomy, with regard to the way he coped with the disease. We have analyzed the interviewfrom a salutogenic standpoint such as 1) understanding of the disease, 2) his own preparedness, 3) manageability and preventive approach to the disease.As the result, we realized that he maintained a proactive and positive attitude : he had a strong sense of coherence to maintain his health, he believed that he would not die from the disease, he examined the literature to comprehend the disease (since informed consent had not been achieved sufficiently in those days), and he managed constipation and abdominal distension well by resistance training, special supplements and devised abdominal massage. Furthermore, he sometimes felt irrational and alienated during his hospitalization, because his value judgment fostered through his long career of journalist was not respected during his treatment. This should be given consideration in future.