ASOURCE Times

The nursing care and rehabilitation capabilities of the ward
Holds the key to responding to people requiring nursing care

According to a survey by the Ministry of Health, Labor and Welfare, about 30% of people aged 75 and over and about 60% of people aged 85 and over need nursing care, and almost the same percentage of elderly people are hospitalized at our hospital. There are quite a few people who need nursing care after being hospitalized, and there is data that about 25% of hospitalized patients aged 75 and over at our hospital will require nursing care upon discharge. However, at present, it is the elderly who are already in need of nursing care even before they are admitted to the hospital that are putting pressure on the practice of medical care, including nursing work in acute wards.
　
Since several years ago, we have been reconsidering the way acute care is provided to people who require nursing care, as we are no longer satisfied with just treatment as an acute care hospital where lifesaving is the first priority. In many acute care hospitals, including our hospital, we have forced people requiring care to rest in order to give priority to treatment. It is required to prevent impairment of ADL (activities of daily living) as much as possible. The key to this is the nursing care and rehabilitation capabilities of the ward.
　
Therefore, in September 2022, we established the Nursing Department in order to strengthen our nursing care capabilities. As of May 2011, 43 nursing care workers belong to 10 wards, mainly community-based comprehensive care wards and convalescent rehabilitation wards. In the future, we aim to employ 100 caregivers and operate all wards, including night shifts.

as the patient's condition changes
The idea of alternating between nursing and nursing care

　看護部の中に介護部門を組み込み、介護職を看護助手として活用する急性期病院も少なくないですが、当院では看護のカウンターパートとして介護を位置づけ、組織上でも看護部長と介護部長は並列の関係にあります。なぜなら、看護師と同様に療養上の世話を担当していても、介護職の視点は看護とは異なるからです。「生活を支援する」ことが介護の目的であり、急性期病院でもその専門性を存分に発揮してもらうには一部門として独立させることがとても重要であると考えています。
　
　そもそも患者さんはある日を境に医療対象から介護対象に切り替わるのではなく、その看護・介護の必要度にはグラデーションがあります〈図参照〉。

For example, changing diapers with a tube in place immediately after surgery is a priority stage for treatment, so in order to ensure safety, it is appropriate for a nurse with medical knowledge to handle it. However, in order to maintain ADL, it is desirable for care workers who are good at promoting independence to provide excretion assistance at the stage when the patient's condition has recovered and rehabilitation has become the focus in anticipation of discharge from the hospital. In the nursing field, we try to separate nursing and nursing care into tasks such as diaper changing, meal assistance, and bathing assistance. We need the idea that jobs will be replaced. This separation not only improves medical outcomes (shorter hospital stay, rate of return to home, prevention of need for long-term care, etc.), but also improves patient satisfaction.

In addition, at our hospital, we break down the work related to nursing assistance work and environmental maintenance in detail so that these two occupations can concentrate on highly specialized work. are placed. When recruiting crew members, we also do this work unit, but when we were recruiting as nursing assistants, there were almost no applications, but when we narrowed down the work content and clarified it, many active seniors gathered in search of work.

Increased proportion of nursing care in the acute phase
Mixing long-term care fees should also be considered

To sum up, the strengthening of the nursing care capacity of the ward should not be entrusted only to the nursing department. The key to success is creating a system in which expertise is organically linked.

Positioning care workers as professionals has produced various effects, but on the other hand, they have to be treated as nursing assistants in terms of medical fees. However, when nursing care accounts for such a large proportion of acute medical care, it cannot be covered by medical fees alone, and long-term care fees should be included.

The Japanese Council of Hospital Organizations is requesting the government to evaluate nursing care workers in hospital wards in the revision of medical fees in 2024. At our hospital, we would like to focus on establishing the role of nursing care workers in acute care hospitals and creating evidence for this, so that it will lead to evaluation of compensation.