Respecting the Wishes of Elderly Patients Living Alone with Dementia When Supporting Discharge from an Acute Care Hospital: Analysis of Narratives from Ward Nurses and Discharge Coordination Nurses

Objective：This study sought to determine how ward nurses and discharge coordinating nurses provide discharge support to elderly patients living alone with dementia following hospitalization in an acute care hospital, and in particular examining discharge support that respects the patients’ wishes.
Methods：A qualitative descriptive research design was used. Semi-structured interviews were conducted with four ward nurses and three discharge coordination nurses working in an acute care hospital. Their narratives were analyzed qualitatively.
Results：The five aspects of discharge support discussed by the participants were“support in line with patient wishes”,“support to achieve discharge home”,“assessment for safe living after discharge”,“support for safe living after discharge home,”and“activities to improve discharge support”.
Conclusion：In order to provide discharge support that respects the wishes of elderly persons with dementia who live alone, it is important to elicit the wishes of the elderly persons with dementia, to include support persons who support the elderly persons with dementia, to conduct assessments to ensure that the elderly persons with dementia can live safely after discharge, and to be involved in ensuring that support continues after discharge.

目的：急性期病院に入院した独居の認知症高齢者に対し、病棟看護師および退院調整看護師がどのような退院支援を行っているかを明らかにし、独居の認知症高齢者本人の意向を尊重した退院支援について検討することを目的とした。
方法：質的記述的研究デザインで実施した。急性期病院に勤務する病棟看護師４名、退院調整看護師3名に半構造化面接を行い、質的に分析した。
結果：対象者から語られた退院支援は、【患者の意向に沿った支援】、【自宅退院の実現に向けた支援】、【退院後、安全に暮らすためのアセスメント】、【自宅退院後、安全に暮らすための支援】、【退院支援の改善に向けた活動】の5つに分けられた。
結論：独居の認知症高齢者の意向を尊重した退院支援には、認知症高齢者の意向を引き出し、認知症高齢者を支える支援者を含めた支援や、退院後に安全に暮らせるようアセスメントを行い、退院後の支援が継続されるよう関わることが重要である。