ศ┴❧┳ㆤ⛉ᏛᏛᏛ㝔 Ặ ྡ ᮡᮏࡍࡂࡶ ᆂ௨Ꮚࡅ ࠸ ࡇ Ꮫ ࡢ ✀ 㢮 ༤ኈ㸦┳ㆤᏛ㸧 Ꮫ グ ␒ ྕ ➨ 10 ྕ Ꮫᤵᖺ᭶᪥ ᖹᡂ 27 ᖺ 3 ᭶ 18 ᪥ Ꮫᤵࡢせ௳ Ꮫつ๎➨㸲᮲➨ 1 㡯ヱᙜ⪅ ┳ㆤᏛ◊✲⛉┳ㆤᏛᑓᨷ Ꮫ ㄽ ᩥ ྡ ᩆᛴ་⒪ᶵ㛵ࡢ┳ㆤᖌࡼࡿ⮬ẅᮍ㐙⪅ࡢᅗࣜࢫࢡࢭࢫ࣓ࣥࢺ㛵ࡍ ࡿ◊✲㸫ᅗ㜵Ṇࡢࢣྥࡅࡓ⤌⧊ࡋ࡚ࡢ‽ഛ╔┠ࡋ࡚㸫㻌
㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 Risk assessment of a suicide re-attempt by nurses working in the emergency room: systematic preparation for prevention
ᣦ ᑟ ᩍ ဨ ᙳᒣ㝯அᩍᤵ ఀᮾ᭸Ꮚᩍᤵ 㛵᰿๛ᩍᤵ ㄽ ᩥ ᑂ ᰝ ጤ ဨ ᰝ㸸▼⏣ె௦Ꮚᩍᤵ ᰝ㸸ᑠ㔝⨾႐ᩍᤵ ྜྷᮧᖹᩍᤵ ㄽ ᩥ ෆ ᐜ ࡢ せ ᪨ ࠙┠ⓗࠚᩆᛴ┳ㆤᖌࡣ⮬ẅᮍ㐙⪅ࡢ㌟యⓗࢣ௨እࠊᅗ㜵Ṇࡢࡓࡵࡢࢣࡀồࡵࡽࢀ࡚࠸ ࡿࡀࠊᐇ㝿ࡣᅇ㑊ⓗ࡞㛵ࢃࡾࢆࡋ࡚࠸ࡿࡇࡶከ࠸ࠋࡇࡢࢣࢆᬑཬࡍࡿࡣ┳ㆤᖌಶேࡢែᗘኚ ᐜࢆࡵࡊࡋࡓᩍ⫱ࡀ㔜せࡉࢀ࡚ࡁࡓࡀࠊࡑࢀࡔࡅ࡛࡞ࡃ⤌⧊ⓗ࡞‽ഛࡶᚲせ࡛࠶ࡿࠋࡑࡇ࡛ࠊᩆᛴ ┳ㆤᖌࡀ⮬ẅᮍ㐙⪅ᅗ㜵Ṇࡢࡓࡵࡢࢣࢆ⾜࠺ࡓࡵࠊ⤌⧊ࡋ࡚⾜࠺ࡁ‽ഛࡣࡢࡼ࠺࡞ ࡶࡢࢆ᫂ࡽࡍࡿࡇࢆ┠ⓗࡋࡓࠋ ࠙◊✲㸯ࠚᩆᛴ┳ㆤᖌồࡵࡽࢀࡿ⮬ẅᮍ㐙⪅ࡢᅗ㜵Ṇࡢࡓࡵࡢࢣࡘ࠸࡚ࢩࢫࢸ࣐ࢸࢵ ࢡࣞࣅ࣮ࣗࢆ⾜࠸ࠊᅜෆእࡢㄽᩥ ⠍ࡢᩥ⊩◊✲ࢆ⾜ࡗࡓࠋࡇࡢࢣࡣࠊᅗࡢࣜࢫࢡཬࡧᚰ⌮ ♫ⓗࢽ࣮ࢬࡢࢭࢫ࣓ࣥࢺࠊᏳࡢᥦ౪ࠊ㏥㝔ࡢᨭᵓ⠏ࡢ ࡘูࡉࢀࡓࠋࢣᐇࡢ㞀ᐖ ࡞ࡿせᅉࡣࠊ┳ㆤᖌಶேࡢㄆ㆑ࡸែᗘࠊᮍ㐙⪅ഃࡢᣄྰࡸᨷᧁⓗែᗘࠊᩆᛴࡢ≀⌮ⓗ࣭⎔ቃⓗせᅉ ࡛࠶ࡗࡓࠋࢣᐇࡘ࡞ࡀࡿせᅉࡣࠊᩍ⫱ࡸࢭࢫ࣓ࣥࢺࢶ࣮ࣝࡢά⏝࡛࠶ࡗࡓࠋ ࠙◊✲㸰ࠚ୍ᆅᇦࡢᩆᛴ་⒪ᶵ㛵⢭⚄⛉་⒪ᶵ㛵ࢆཷデࡋࡓ⮬ẅᅗ⪅ࡢᐇែࢆㄪᰝࡋࠊᅗࣜ ࢫࢡࢭࢫ࣓ࣥࢺࡢ୍㡯┠࡛࠶ࡿࠕṚࡠពᅗࠖࢆ☜ㄆࡋࡓྜࢆ☜ࡵࠊᅗࣜࢫࢡࢭࢫ࣓ࣥࢺ ࢆཷࡅࡃ࠸ᮍ㐙⪅ࡢ≉ᚩࢆ᳨ウࡋࡓࠋᩆᛴ㝔࡛ࡣࠊṚࡠពᅗࢆ☜ㄆࡋ࡚࠸࡞࠸ࡀ༙ᩘ㏆ࡃ࠶ ࡾࠊࡑࡢ≉ᚩࡣձ㹼 ௦߈ኪ㛫ᦙ㏦߉⮴Ṛᛶࡢప࠸ᡭẁմධ㝔ࡏࡎᖐᏯ࡛࠶ࡗࡓࠋᩆᛴ㝔࡛ࡣ Ṛࡠពᅗཬࡧᮍ㐙Ṕࡢ☜ㄆࡣ⢭⚄⛉㝔ẚ㍑ࡋ࡚ᐇ⋡ࡀపࡃࠊ⣔⤫ⓗ࡞ᅗࣜࢫࢡࢭࢫ࣓ࣥ ࢺࡀ⾜ࢃࢀ࡚࠸࡞࠸ࡇࡀ♧ࡉࢀࡓࠋ ࠙◊✲㸱ࠚᩆᛴ་⒪ᶵ㛵ࡢ⮬ẅᮍ㐙⪅ᑐࡍࡿᐇ㝿ࡢࢣᅗࢭࢫ࣓ࣥࢺࢶ࣮ࣝࡢ㛵㐃ࡘ ࠸࡚┳ㆤᖌ㉁ၥ⣬ㄪᰝࢆ⾜࠸᳨ウࡋࡓࠋᅇ⟅ࡋࡓ ྡ୰ࢭࢫ࣓ࣥࢺࢶ࣮ࣝࢆ⏝ࡋ࡚࠸ࡿࡢࡣ ྡ ࡛࠶ࡗࡓࠋᮍ㐙⪅ࢣࡢ⤒㦂ࡀᑡ࡞ࡃ࡚ࡶࢭࢫ࣓ࣥࢺࢶ࣮ࣝࢆ⏝ࡍࡿࡇ࡛ࠊࣜࢫࢡ ࢭࢫ࣓ࣥࢺࢆᐇ࡛ࡁ࡚࠸ࡿഴྥ࠶ࡗࡓࠋࡓࡔࡋࠊࢭࢫ࣓ࣥࢺࢶ࣮ࣝࡢ‽ഛࡔࡅ࡛࡞ࡃࠊࢶ࣮ ࣝࢆ⏝ࡍࡿࡓࡵࡢࡋࡃࡳࢆ⤌⧊ⓗᩚ࠼ࡿࡇࡶᚲせࡔ⪃࠼ࡽࢀࡓࠋ ࠙◊✲㸲ࠚᅗࣜࢫࢡࢭࢫ࣓ࣥࢺࢶ࣮ࣝࢆ⏝ࡋ࡚࠸ࡿ㝔ࡋ࡚࠸࡞࠸㝔ࡢ㛫࡛ࠊᅗࣜ ࢫࢡࢭࢫ࣓ࣥࢺࢆᐇࡍࡿ⎔ቃࡸࡋࡃࡳࡢ㐪࠸ࠊ┳ㆤᖌࡢᅗࣜࢫࢡࢭࢫ࣓ࣥࢺᑐࡍࡿㄆ ㆑ࡢ㐪࠸ࢆ᥈⣴ࡍࡿࡇࢆ┠ⓗࠊᩆᛴ㒊㛛ࡢ┳ㆤᖌ㠃᥋ㄪᰝࢆ࠾ࡇ࡞ࡗࡓࠋࢭࢫ࣓ࣥࢺࢶ࣮ࣝ ࢆ⏝ࡋ࡚࠸ࡿ㝔࡛ࡣࠊࢶ࣮ࣝ⏝ࢆ࣮ࣝࢳࣥࡋࠊ࡚ࡢ┳ㆤᖌࡀࣜࢫࢡࢭࢫ࣓ࣥࢺ࡛ࡁࡿࡋ ࡃࡳࡀࡘࡃࡽࢀࠊࢶ࣮ࣝࢆ࠸⥆ࡅࡿࡓࡵࡢᩍ⫱ࠊࡾ㏉ࡾࠊ⎔ቃࡢᵓ㐀ࡀ⾜ࢃࢀ࡚࠸ࡓࠋࢭࢫ ࣓ࣥࢺࢶ࣮ࣝࡀ࡞࠸㝔ࡢ┳ㆤᖌࡣࠊ⮬ẅᮍ㐙⪅ࡢࢣ㈇ᢸឤࢆឤࡌ࡚࠸ࡓࡀࠊ⏝ࡋ࡚࠸ࡿ┳ ㆤᖌࡣࠕ⮬ẅࡘ࠸࡚ࡓࡎࡡࡿࡇࡣᙜࡓࡾ๓ࠖ࠸࠺ㄆ㆑࡛࠶ࡗࡓࠋ ࠙⤖ㄽࠚᩆᛴ┳ㆤᖌࡀ⮬ẅᮍ㐙⪅ᅗࣜࢫࢡࢭࢫ࣓ࣥࢺࢆࡍࡿࡓࡵࡣࠊࢭࢫ࣓ࣥࢺࢶ࣮ࣝ ࢆ‽ഛࡋࠊᐇ㝿⏝࡛ࡁࡿࡼ࠺࡞ࡋࡃࡳࢆࡘࡃࡾࠊ⥅⥆ࡋ࡚⏝࡛ࡁࡿࡼ࠺⤌⧊ࡋ࡚㐠⏝ࡋ࡚࠸ ࡃࡇࡀ᭷ຠ࡛࠶ࡿ⪃࠼ࡽࢀࡓࠋ
ศ┴❧┳ㆤ⛉ᏛᏛᏛ㝔 $EVWUDFW
Objectives: Although emergency nurses need to provide suicide attempters the care to prevent their re-attempt, the nurses tend to avoid the suicide attempters. Not only personal education about the care, systematic readiness in their institutes is important. The aim of this study was to clarify the feature of systematic readiness for providing the care.
Study 1: Through the systematic review for 25 literatures about the care provided by emergency nurses for suicide attempters to prevent re-attempt. The care was categorized into assessment of suicidal risk and psychosocial needs, keeping safe, and building support at the time of discharge. The care is sometimes disturbed by their negative attitude toward patients, rejection and offensive attitude of the patients, and environment of emergency rooms. Education and assessment tools, however, promote the care.
Study2: The author examined the records of suicide attempters who were admitted to emergency hospital or psychiatric hospital in an area, in order to know how many patients were asked the "die intention", and to know the features of the patients who were not asked the intention. The features were being aged 10-39, visits at nighttime, less-lethal means, and going home without hospitalization. The intention was not confirmed particularly in emergency hospitals, compared with psychiatric hospitals, showing that systematic risk assessment is not carried out in emergency hospitals.
Study3: Questionnaire survey was carried out to know the actual care and use of assessment tools for re-attempt among emergency nurses. Among 399 respondents, only 17 (4%) used the assessment tools. It was suggested, however, that the tools can help the nurse with no experience to give care for suicidal attempters to assess the risk of re-attempt. Institutional effort to utilize the tool seems to be important.
Study4: To compare the environment and the system to assess risk of suicidal re-attempt in the
hospitals where the risk assessment is popular and those in the hospitals where it is not popular,
an interview survey was carried out to emergency nurses. In the former hospitals, it was a routine work to assess suicidal risk using tools, and all the nurses can assess the risk. For this purpose, education about using the tool, the discussion about patients, and structuring environment have been carried out. Even if assessment tool was not prepared in the former hospitals, the nurses recognized that asking suicidal risk is their work, in spite of burden to give care for suicidal attempters.
Conclusions: Making an institutional effort to prepare assessment tools for suicidal risk and to make the environment enabling continuous use of the tools is required for emergency nurses to assess suicidal risk in attempted suicide.
ㄽ ᩥ ᑂ ᰝ ࡢ ⤖ ᯝ ࡢ せ ᪨ ᮏㄽᩥࡣࠊᩆᛴ་⒪ᶵ㛵ࡢ┳ㆤᖌࡀࠊ⮬ẅᮍ㐙⪅ࡢᅗ㜵Ṇࢆ┠ⓗࡋࡓࢣࢆ⾜࠺ࡓࡵࠊ┳ ㆤᖌಶேࡢᩍ⫱ࡔࡅ࡛࡞ࡃ⤌⧊ࡋ࡚⾜࠺ࢣࡢ‽ഛ╔┠ࡋ࡚ࠊ ࡘࡢᇶ♏ⓗ᳨ウࢆ⾜ࡗࡓᡂᯝ ࢆࡲࡵࡓࡶࡢ࡛࠶ࡿࠋ➨୍ࡢ◊✲࡛ࡣᩥ⊩◊✲ࢆ⾜࠸ࠊࠕᅗࣜࢫࢡཬࡧᚰ⌮♫ⓗࢽ࣮ࢬࡢ ࢭࢫ࣓ࣥࢺࠖࠊࠕᏳࡢᥦ౪ࠖࠊࠕ㏥㝔ᚋࡢ㐃ᦠࠖࡀࠊᅗ㜵Ṇࡢࢣࡘ࡞ࡀࡿせᅉ࡛࠶ࡿࡇࢆ᫂ ࡽࡋࡓࠋ➨ࡢ◊✲࡛ࡣ㉁ၥ⣬ㄪᰝࢆ⾜࠸ࠊᅗࣜࢫࢡࢭࢫ࣓ࣥࢺ↔Ⅼࢆ⤠ࡾࠊࡑࢀࢆཷ ࡅࡃ࠸ᮍ㐙⪅ࡢ≉ᚩࢆ♧ࡍࡶࠊ⣔⤫ⓗ࡞ࢭࢫ࣓ࣥࢺࡢࡓࡵࡢࡋࡃࡳࢆᩚ࠼ࡿᚲせᛶࢆ᫂ࡽ ࡋࡓࠋ➨୕ࡢ◊✲࡛ࡣ㠃᥋ㄪᰝࢆ⾜࠸ࠊᅗࣜࢫࢡࢭࢫ࣓ࣥࢺ⤌⧊ⓗ‽ഛࡢ㛵㐃ࢆ᳨ウࡋࠊ ࢭࢫ࣓ࣥࢺࢶ࣮ࣝࡢ⏝ࡀᅗࣜࢫࢡࢭࢫ࣓ࣥࢺࡘ࡞ࡀࡿࡇࢆ᫂ࡽࡋࡓࠋ ᮍ㐙⪅ᨭࡣࠊ⮬ẅᑐ⟇࠾࠸࡚ᴟࡵ࡚㔜せ࡞ㄢ㢟࡛࠶ࡾࠊᮏㄽᩥࡣࠊᅗ㜵Ṇࡢࢣྥࡅࡓ⤌ ⧊ⓗ࡞ࡋࡃࡳ࡙ࡃࡾࢆ᥎㐍ࡍࡿ࠺࠼࡛᭷┈࡞▱ぢࢆᥦ౪ࡋ࡚࠸ࡿࠋᚋࠊᅗ㜵Ṇࡢࡓࡵࡢࢣࡢ ☜ᐇ࡞ᐇࠊࡑࢀࡼࡿᮍ㐙⪅ࡢᅗ㜵Ṇࡢ㈉⊩ࡀᮇᚅࡉࢀࠊ┳ㆤᏛࡢᏛㄽᩥࡋ࡚ࡩࡉࢃ ࡋ࠸ࡶࡢุ᩿ࡋࡓࠋ
