佐藤 幹代

Objective: We retrospectively assessed the clinical incidence and risk factors for ICU-attributable muscle weakness by surveying the medical records of patients admitted to the emergency ICU. Materials and methods: We investigated the medical records of patients who required mechanical ventilation between 2006 and 2007. Muscle weakness was determined as Medical Research Council (MRC) score of <48, manual muscle test (MMT) level of <4 evaluated by nurses in at least one extremity, or medical recordings that indicated abnormal activities. Clinical factors and laboratory data that could influence the onset of muscle weakness were collected from the medical records. Results: Out of 916 patients admitted to the ICU who required mechanical ventilation over the 2-year study period, 495 were evaluable. Among these, 82 (16.6%) had muscle weakness. The incidence of muscle weakness was 47 (34.1%) among 138 patients who required ≥7 days of mechanical ventilation. Independent predictors of muscle weakness were duration of mechanical ventilation, use of muscle relaxants, neurological disease and blood urea nitrogen (BUN). Conclusions: ICU-attributable muscle weakness was some degree of feature in critically ill patients who required mechanical ventilation. The duration of mechanical ventilation, muscle relaxants, neurological disease and BUN was associated with ICU-attributable muscle weakness.

本研究の目的は、基礎教育課程の学生が、成人看護学概論の外来演習において、初対面の成人外来患者との間にどのようにして対人関係を形成したのか、その過程から学生がどのような学びを得ていたのかを明らかにすることである。方法は、成人看護学の学習導入期にある看護学生10名に半構成的面接を行った。その結果、対人関係形成を築いた経過では、【受け入れられ感覚】【人間的関心】【課題達成のへの思い】【自信のなさ】【方略を用いる】の5つのカテゴリーが抽出された。またその過程から有効なコミュニケーション方略やその果たす効果・必要性、関心を持つことの必要性、対象や疾患を理解することの大切さ、関係性のあり方、困難さの実感、自己への気づきなどを学んでいた。