Matsubasa Tadashi, Mitsubuchi Hiroshi, Kimura Akihiko, Shinohara Makoto, Endo Fumio
Department of Pediatrics, Kumamoto University Hospital, Kumamoto, Japan.
Kumamoto-Ashikita Institution for Developmental Disabilities, Kumamoto, Japan.
Pediatr Int. 2017 Jun;59(6):714-719. doi: 10.1111/ped.13256. Epub 2017 Apr 24.
Improvements in neonatal medicine and pediatric emergency medicine have led to an increasing number of children with severe disabilities requiring medical care, such as tracheal suction, on a daily basis. Most of these children, discharged directly from hospitals to their parents' homes, need home medical support. To provide data for the establishment of appropriate support systems, we analyzed the care for such children in a time study conducted at an institution.
A minute-by-minute time study of the work of 33 staff members in a ward for patients (medically dependent severe motor and intellectual disabilities [SMID]) requiring frequent medical care was carried out over 48 h. Data were compared with those from a ward for ordinary non-medically dependent SMID patients.
Time of life care for medically dependent SMID and ordinary SMID was almost identical, but the time for medical care for the former was 10-fold longer than that of the latter. Also, tasks involving information exchange and recording of the time of care were performed fourfold more frequently in the medically dependent SMID than in the ordinary SMID ward.
Medically dependent SMID children and adults, predominantly with tracheostomies, needed much more medical care and more concentrated involvement of the staff compared with ordinary SMID. This study provides valuable data for the development of support systems for medically dependent SMID children being cared for at home. In addition, it sheds light on the situation faced by non-SMID children requiring frequent medical care.
新生儿医学和儿科急诊医学的进步导致每天有越来越多患有严重残疾的儿童需要医疗护理，例如气管抽吸。这些儿童大多直接从医院出院回到父母家中，需要家庭医疗支持。为了为建立适当的支持系统提供数据，我们在一家机构进行的一项时间研究中分析了对此类儿童的护理情况。
对一个收治需要频繁医疗护理的患者（医学依赖型重度运动和智力残疾[SMID]）的病房中的33名工作人员的工作进行了为期48小时的逐分钟时间研究。将数据与一个收治普通非医学依赖型SMID患者的病房的数据进行了比较。
医学依赖型SMID患者和普通SMID患者的生活护理时间几乎相同，但前者的医疗护理时间比后者长10倍。此外，与普通SMID病房相比，医学依赖型SMID病房中涉及信息交流和护理时间记录的任务执行频率高出四倍。
与普通SMID患者相比，主要患有气管造口术的医学依赖型SMID儿童和成人需要更多的医疗护理以及工作人员更集中的参与。这项研究为在家中接受护理的医学依赖型SMID儿童支持系统的开发提供了有价值的数据。此外，它还揭示了需要频繁医疗护理的非SMID儿童所面临的情况。
