看護理工学会誌 4巻2号
目次
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【追悼】米田隆志先生を偲んで
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巻頭言
原著
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向老期皮膚熱傷モデルに対する初期局所療法での洗浄剤選択に関する研究向老期皮膚熱傷モデルに対する初期局所療法での洗浄剤選択に関する研究
- 佐賀大学医学部看護学科統合基礎看護学講座看護形態機能学領域
表皮は,加齢に伴い水分含有量が減少し乾燥傾向になる.また,創傷に対しても修復機能が低下してくる.一方,実験動物での皮膚の加齢変化を伴った場合の創傷からの治癒過程に関する研究は少ない.本研究では向老期における熱傷受傷初期の治癒過程に着目して局所療法に用いる洗浄剤による違いを検討した.今回,①市販アルカリ石けん,②市販弱酸性洗浄剤,③コールドプロセス製法石けん(100%オリーブオイル)洗浄ケアにおける水分含有率を比較検討した.5回洗浄処置では,水分含有率は対象群4.77%,①6.90%,②5.79%,③7.34%であり,統計学的に有意に③が高値であった(p<0.05).③では,ほかのケアと比較して,炎症性壊死組織や痂皮形成が少なく,表皮再生や創部の良好な外観を保持する傾向がみられた.以上の結果から,コールドプロセス製法石けん洗浄が保湿力の維持や皮膚の創傷治癒に有効であり,向老期の乾燥皮膚の創傷治癒にも好影響を与えることが示唆された.
向老期,皮膚熱傷,石鹸洗浄,保湿Selection of washing agents for acute topical therapy in an aging dermal burn study- Division of Morphology and Function for Nursing/Faculty of Medicine/Saga University
The water-content of the skin declines with age, resulting in drying of the epidermis. Moreover, wound repair ability decreases along with aging. The recovery process from wounds accompanying these age-related changes to the skin has been examined in a small number of animal studies. The present study considered differences arising from the washing agent used for topical therapy, with a focus on the recovery. The present study created an experimental mouse model of skin burns, and investigated the effects of the following agents on moisture retention of the affected area:1)commercial alkalinity(CA)soap;2)commercial mild acidic liquid(CMAL)soap;3)100% olive oil soap made with the cold process method(CP). The parameters assessed was water content as measured. After 5 time-treatment, there was statistical significance between moisture contents treated with CP and CA, CMAL or control(p<0.05). The treatment with CP tended to decrease inflammatory necrosis and scab formation, and to enhance epidermal regeneration and favorable cosmetic appearance than that with CA and CMAL, and control. The results showed that CP had the abilities to retain moisture and promote wound healing, suggesting that CP is effective in healing aging dry skin.
aging, burn skin, soap washing, moisture retention -
看護師が実施する末梢静脈カテーテル留置における静脈穿刺の不成功にかかわる要因看護師が実施する末梢静脈カテーテル留置における静脈穿刺の不成功にかかわる要因
- 大分県立看護科学大学
末梢静脈カテーテル留置は,看護師が行う技術のなかで最も侵襲が大きく難易度が高い医療行為の1つであり,患者の苦痛や合併症を最小限にするために1回の穿刺でカテーテルを留置させることが望ましい.今回,標的となった静脈血管の特徴から静脈穿刺の不成功にかかわる要因を検証した.看護師が標的とした皮静脈の駆血後の深さ,断面積,可視性,可動性,触知の有無を調査し,看護師に穿刺の難易度を0(やさしい)から10(むずかしい)の11段階で評価してもらった.調査した末梢静脈穿刺は65件で,成功率は69.2%であった.分析の結果,末梢静脈穿刺が不成功となる要因は,静脈血管が深い,細い,可視性がないであった.穿刺の難易度は,可視性がないあるいは触知できない場合に高く評価され,不成功群は有意に難易度が高かった.目視できない,また細い静脈血管に対しては可視化させる,静脈血管を拡張させるといった介入が有効である可能性が示唆された.
末梢静脈カテーテル留置,末梢静脈穿刺,看護師,不成功要因Factors related to failure of venipuncture conducted by nurses for peripheral intravenous catheterization- Oita University of Nursing and Health Sciences
The present study aimed to identify factors related to the failure of venipuncture conducted by registered nurses for peripheral intravenous catheterization. Sixty-five attempts were investigated. The depth and cross-section area of venous blood vessels were measured before venipuncture. Visibility, movability and palpability of veins were simultaneously evaluated. The nurse evaluated the difficulty of puncture on a Likert scale from 1(very easy)to 10(very difficult). The success rate of venipuncture was 69.2%. Veins in which venipuncture failed were significantly deeper and thinner than those in which venipuncture succeeded. Failed venipuncture was associated with increased difficulty resulting from vein characteristics such as being invisible. The nurses tended to judge that venipuncture was less likely to succeed when a blood vessel was invisible and not palpable. The findings suggested that nurses need to visualize and dilate invisible veins to increase the likelihood of successful venipuncture.
peripheral intravenous catheterization,peripheral venipuncture,nurse,factors of failure -
(英文論文)Identification and analysis of changes in patient behavior that lead to falls from the bed(ベッド上の患者の転落への行動の変化の抽出および分析)ベッド上の患者の転落への行動の変化の抽出および分析
- 東京女子医科大学・早稲田大学共同大学院共同先端生命医科学専攻
- 早稲田大学先進理工学部生命理工学専攻
- 東京女子医科大学先端生命医科学研究所
患者のベッドからの転落事故は頻度と重篤が高い重大な課題である.各院では各種ベッドセンサを設置しているが,偽陽性や偽陰性が多く信頼性が低い.先行研究は瞬時の行動検出の精度向上研究に止まっており転落防止の根本的対策ではない.われわれは,バイタルセンサ同様に常時患者の行動変化を測定し可視化,定量化することで看護師が患者行動を理解し必要なときに介入できるようになり,患者の危険な行動を減少させ結果転落を減少させると考えた.そこで非接触・非侵襲の患者の位置,動き,動きの方向を三次元の立体で測定できるシステムを開発し,臨床で患者行動を測定した.分析の結果,ベッド上の患者の転落にいたる行動の変化を抽出し,可視化,定量化できた.また,急性期の患者の行動が入院後数週間でどのように変化するかを定量化した.患者行動の可視化および定量化により,日常のケアや入院時の看護計画評価およびその後の看護計画策定へ有用であると考える.
医療安全,ベッド,転落,センサ,3次元計測Identification and analysis of changes in patient behavior that lead to falls from the bed- Cooperative Major in Advanced Biomedical Sciences, Joint Graduate School of Tokyo Wemen’s Medical University and Waseda University
- Faculty of Science and Engineering, Waseda University
- Institute of Advanced Biomedical Engineering and Science, Tokyo Wemen’s medical University
Patients fall out of their beds frequently in hospitals, and such incidents are a critical issue because they often lead to serious accidents. Accidents of patient falling out of beds have increased with increasing numbers of the hospitalized elderly. Although bed sensors are commonly used as a fall-preventive measure in hospitals, these sensors cannot prevent accidents. We hypothesized that if bed sensors can monitor patients’ behavioral changes continuously like vital sensors, nurses will be able to understand patient behaviors from the recorded data and provide appropriate care, thus decreasing patient falls. A three-dimensional measurement system was then developed. With this system, the position, movement, direction, and velocity of patients can be measured in a three-dimensional space in a non-contact, noninvasive manner. Using this system, we measured long-term behaviors of patients in bed. The analysis results allowed us to identify the behavior changes leading to a patient’s fall from bed. In addition, we quantified how behavioral changes in acute-phase patients change over several weeks after hospitalization. We believe that these quantified data will be useful in daily patient care and in evaluation of nursing-care plans.
medical safety,bed falls,sensor,three-dimensional measurement -
(英語論文)Detection of albumin using skin blotting as a measure of skin barrier function(皮膚バリア機能測定としてのスキンブロッティング法によるアルブミン検出)皮膚バリア機能測定としてのスキンブロッティング法によるアルブミン検出
- 東京大学大学院医学系研究科老年看護学/創傷看護学分野
皮膚バリア機能の代表的な評価方法に経皮水分蒸散量(TEWL)があげられる.しかし,臨床の場において安定したTEWLの値を得ることはむずかしい.本研究では,皮膚バリア機能の新たな評価方法として,スキンブロッティングによるアルブミン検出法を評価するために,動物と人におけるTEWLとスキンブロッティングによるアルブミン検出強度の相関を分析した.結果として,マウスの背部皮膚ならびに人の前腕皮膚のアルブミン検出強度はTEWLと有意に相関していた(マウス;r=0.56,p=0.02,人;r=0.73,p<0.01).以上より,スキンブロッティングによるアルブミン検出強度はTEWLの代替としての皮膚バリア機能評価として非侵襲・安定的な方法といえる.
アルブミン,スキンブロッティング,経皮水分蒸散量,動物実験Detection of albumin using skin blotting as a measure of skin barrier function- Department of Gerontological Nursing/Wound Care Management, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo
Measurement of transepidermal water loss(TEWL)is the gold standard for the evaluation of skin barrier function. However, it is difficult to obtain stable values in the clinical setting. In this study, we evaluated the use of albumin detection by skin blotting as a new measurement method for determination of skin barrier function. We analyzed the correlation between TEWL values and detected the intensity of albumin staining by skin blotting in animal models and humans. The albumin intensities were significantly correlated with TEWL values in samples of back skin from mice(r=0.56, p=0.02). In addition, the albumin intensities were also correlated with TEWL values in human skin(r=0.73, p<0.01). Thus, albumin intensity using skin blotting was a noninvasive and stable method for evaluating skin barrier function as an alternative to TEWL.
albumin,animal experiment,skin assessment,transepidermal water loss -
全方向歩行追従および床反力の制御に着目した新型移動式免荷歩行訓練器の提案と解析全方向歩行追従および床反力の制御に着目した新型移動式免荷歩行訓練器の提案と解析
- 豊橋技術科学大学機械工学系
- 松山リハビリテーション病院リハビリテーション部理学療法科
- 岐阜工業高等専門学校電子制御工学科
高齢化社会のなか,歩行障害をもつ高齢者が増加している.寝たきり予防や歩行機能回復のため,早期リハビリテーションが重要である.体重の一部を免荷するBWSTT(Body-Weight Supported Treadmill Training)は早期歩行訓練として有効な方法である.BWSTTの有効性に注目し,われわれは新型の免荷歩行訓練器NILTWAMORを開発した.NILTWAMORは,全方向移動機構と左右独立免荷が可能な体重免荷装置を有している.本稿では,効果的な歩行訓練を支援する2つのシステムについて提案する.第一に全方向歩行追従制御システムについての提案で,利用者の重心位置から利用者の意図する進行方向を推定し,利用者に対して歩行訓練器が全方向に追従する.第二に床反力一定制御システムについての提案で,利用者の姿勢から重心の偏心度合いを推定し,動的に免荷量を制御することで支持脚の床反力を一定に保持する.両システムについて健常者およびリハビリ患者を対象とした実機実験を実施し,提案システムの有効性を検証した.
歩行訓練,体重免荷歩行訓練,全方向歩行追従制御システム,床反力A novel mobile bodyweight-supported gait-training platform with systems for omnidirectional tracking and floor-reaction-force control- Department of Mechanical Engineering, Toyohashi University of Technology
- Department of Rehabilitation, Matsuyama Rehabilitation Hospital
- Department of Electronic Control Engineering, Gifu National College of Technology
The number of elderly people with gait disorders is increasing owing to population aging. Early rehabilitation is important for preventing such people from becoming bedridden and for facilitating the recovery of walking capability. BWSTT(BodyWeight-Supported Treadmill Training)is a valid early gait-training method. Noting the effectiveness of BWSTT, we have developed a novel gait-training platform called NILTWAMOR(Novel Intelligent Lift-Type Walking-Assist Mobile Robot). NILTWAMOR has an omnidirectional driving system using omniwheels and a bodyweight-supported system using two wires that can each independently hoist a harness. This paper proposes two systems to assist effective gait training. Firstly, an omnidirectional moving control system following human intention is proposed. This system estimates the user’s walking direction by identifying the user’s body center and controls the platform in order to track the user omnidirectionally. Secondly, a system that maintains a constant floor reaction force is proposed. This system estimates deviation of the user’s body center based on the user’s posture and maintains constant floor reaction force of the gait trainer’s supporting legs and the body center. In order to evaluate the effectiveness of the proposed gait-training platform, both systems were applied to healthy subject and patient undergoing gait rehabilitation.
gait training,body-weight supported training,omnidirectional tracking control,floor reaction force
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