『保健医療科学』 2021 第70巻 第5号 p.569-578（2021年12月）
＜原著＞
透析施設の災害対策の推進要因:先進事例の分析
清水由美子 1)，熊谷たまき 2)，杉澤秀博 3)，篠田俊雄 4)，宍戸寛治 4)，馬上和久 5)
1)東京慈恵会医科大学
2)国際医療福祉大学
3)桜美林大学大学院国際学術研究科
4)日本透析医会
5)全国腎臓病協議会
Factors promoting disaster preparedness in dialysis facilities: Qualitative analyses of advanced preparedness
SHIMIZU Yumiko 1), KUMAGAI Tamaki 2), SUGISAWA Hidehiro 3), SHINODA Toshio 4), SHISHIDO Kanji 4), MAGAMI Kazuhisa 5)
1) The Jikei University School of Nursing
2) International University of Health and Welfare
3) International Graduate School for Advanced Studies, J. F. Oberlin University
4) Japanese Association of Dialysis Physicians
5) Japan Association of Kidney Disease Patients
抄録
目的：災害対策が相対的に進んでいる透析施設を対象とした質的調査に基づき，災害対策の推進要因を明らかにすることである.
方法：1) 対象施設の選択:日本透析医会の会員施設全数を対象に行った災害対策に関する量的調査では，患者対策，職員対策，透析設備/備品対策，地域組織とのネットワーク対策(以下，ネットワーク対策)，一般的管理対策の区分の中で，患者対策とネットワーク対策の実行度が相対的に遅れていたことが明らかにされた.そのため，量的調査で，患者対策とネットワーク対策それぞれについて実行度が高く，さらに質的調査に協力する意向を示した施設(各15施設，しかし両対策とも実行度が高い施設が4施設あったため合計26施設)を対象とした. 2) 調査対象と方法:選択した施設の災害担当 責任者を対象に半構造化インタビューを実施した.インタビューの項目は，上記の2区分の対策に加えて，実行度が比較的低かった職員対策，および施設全体の災害対策の工夫・進め方で構成した. 3) 分析方法:逐語録に基づき質的記述的分析法で行った.
結果：調査の結果，患者対策，ネットワーク対策それぞれ12施設(両方の実行度が高い施設が4施設)，計20施設の調査が完了した.災害対策を先進的に行っている施設では，対策を前進させるため以下のようなことを行っていた.患者対策については，現実に役立つ連絡体制の構築，患者のニーズに合わせた事前の情報周知，実践重視の避難訓練，職員対策に関しては，職員目線の対策，日常業務の活用，主体性を引き出すスタッフ教育，ネットワーク対策については，実践的な組織的連携，手段・目的を明確にした連携，顔の見える関係を築く，であった.災害対策の全体的な推進要因には，災害対策へのニーズの自覚，災害対策の意識を持ち続ける，震災対策の機運の高まりがあった.
結論:透析施設の災害対策を推進させるためには，患者・職員の主体性を引き出す，日常業務の中に組み込む，さらに施設全体としてはキーパーソンを育てることの重要性が示唆された.
キーワード：透析施設，災害対策責任者，質的記述的分析，患者対策，地域のネットワーク対策
Abstract
Objectives: This qualitative study explored factors promoting disaster preparedness (DP) in dialysis facilities by investigating facilities with relatively advanced preparedness.
Methods: (1) Choice of advanced facilities: A quantitative survey on DP in dialysis facilities was conducted on all the facilities operated by members of the Japanese Association of Dialysis Physicians. Questionnaires inquired about their accomplishment of five DP targets: Patients, Staff, Equipment/Infrastructure, Cooperation with community organizations (Cooperation), and General management. Results indicated that DP accomplishment in facilities participating in the survey regarding Patients and Cooperation was lower than for the other targets. We selected 30 facilities in the descending order of accomplishing each target (15 facilities for Patients and 15 facilities for Cooperation) with five facilities being selected for both targets. We finally conducted interviews in 25 facilities. (2) Survey methods: Semi-structured interviews were conduct- ed with the staff in charge of DP. Interview items included methods of advancing DP for each target, DP for the staff (a target of relatively low accomplishment scores), and DP for the entire facility. Twenty facilities (8 facilities for Patients, 8 facilities for Corporation, 4 facilities for Patients and Corporation) participated in the interviews. (3) Analytical method: A qualitative descriptive analysis of verbatim interview records.
Results: Facilities with high DP accomplishment for Patients (1) developed methods showing practical benefits in communicating with patients, (2) disseminated DF information according to patientsʼ demands, and (3) conducted practical evaluation drills. Facilities with high DF performance by Staff (1) conducted measures from the staffʼs perspectives, (2) conducted drills utilizing daily tasks, and (3) conducted education for promoting spontaneity. Facilities with high DF accomplishment for Cooperation (1) developed practical cooperation, (2) established Cooperation with a clear purpose and meaning, and (3) developed face-to-face relationships with the staff of other organizations. DP promotive factors in an organization as a whole included (1) awareness of DP needs, (2) maintaining awareness of DPʼs crucial role, and (3) increasing the momentum for DP through experiences of large natural disasters.
Conclusion: It is suggested that developing the spontaneity of patients and staff, incorporating DP into daily tasks, and nurturing key DP personnel in facilities are essential for developing DP in dialysis facilities.
keywords：dialysis facilities, disaster preparedness managers, qualitative and descriptive analyses, disaster preparedness for patients, community-based disaster preparedness networks
