入所型介護施設の契約時に必ず説明されることが「終末期」の対応です。
入所契約なのに「なぜ？」と思われる方もいらっしゃると思いますが、特別養護老人ホームなどの人生の最後まで入所できる介護施設においては大切な話になります。
しかし、実際にその時期にならなければイメージも湧きにくいのではないでしょうか。
ここでは、施設に入所してからどのような経過をたどるのか解説いたします。
1.看取りケアとは
看取りケアとは、無理な延命治療をせず、身体的・精神的苦痛を緩和・軽減し、人生最後まで尊厳を持って、その人らしい最後を迎えられるように支援することです。
看取りとはどのような時になるのですか？
医師が状態を見て判断します。
施設に入所してから看取りまではどのような流れなのですか？
施設に入所してから看取りまでの流れを簡単に説明しますね。
2.施設入所から看取りまで
施設入所は、住み慣れた環境から知らない場所での生活になるので誰でも不安になりますよね。
看取りケアは、施設に入所した時から一定の時期やプロセスに応じた内容で実施しなければなりません。
施設入所から看取りケアまでの流れを解説します。
1.適応期
施設入所当初は、誰でも不安になるものです。
施設に入所してから1か月は「適応期」と言います。
「看取り」については、入所したこの時期から徐々に理解を深めていくことが大切です。
2.安定期
出典：SOYOKAZE
施設入所から半年ほどたつと「安定期」と呼ばれます。
施設にも慣れた頃で、意識の変化や今後の希望を把握することが大切です。
今後の希望は、入所者本人だけでなく、ご家族の意向も含めながら中長期的な目標を設定することです。
3.不安定期・低下期
出典：イラストAC
この時期には「食事が食べられない」、「体重が減少」などの衰弱傾向が現れ、進行していく時期になります。
状態の変化は、その都度ご家族へ連絡し情報を共有していきます。
4.看取り期
医師から「回復が望めない状態」であることを告げられ、ご逝去間近である時期になります。
どのような状態でも聴力は最後まで保たれていることはご存じでしょうか。
声をかけたりボディタッチなど行い寄り添うことで、心地よく安心できるのです。
5.看取り
出典：素材ライブラリー
最後に悔いのないひとときを持っていただけるように、ご家族で過ごせる環境を整えます。
希望されれば清拭や化粧など（エンゼルケア）を一緒に行うこともできる施設もありますので、施設職員へ事前に相談しておくことでスムーズに行えます。
3.ターミナルケア・緩和ケアとの違い
看取りケアと似たようなものとして、ターミナルケアや緩和ケアがあります。
この2つについて解説いたします。
1.ターミナルケア
ターミナルケアとは、最後の時を間近にした方の、心身の苦痛を和らげる事を目的とした医療的ケアの事を言います。
痛みの管理はもちろん、心理的なサポートも重要になります。
2.緩和ケア
緩和ケアとは、ターミナルケアの一部で、心身の苦痛を緩和しながら治療も行うケアのことを言います。
4.看取りケアの取り組み
実際、施設に入所してから職員の人たちは何をしているのかご存じでしょうか。
感染症の関係で入ることのできる範囲が限られたりして、見たり感じたりできない環境が続いています。
普段の生活環境はどのような感じなのか気になることだと思いますが、ここでは、看取り期に入ってからの施設の対応について解説いたします。
1.看取り期の日常生活を支援する視点の共有
看取り期のケア時には、以下の8項目について日常生活における観察力が重要になってきます。
①生活リズムの把握 ②食事・水分摂取量の把握 ③バイタルサインのチェック ④呼吸状態の把握 ⑤浮腫の有無 ⑥皮膚の状態 ⑦口腔の状態 ⑧排泄物の状態・量
日々の状態変化を見逃すことがないように、介護職員や看護職員、介護支援専門員など他職種が連携して取り組みがされます。
2.環境整備
「ベッドはその人の住まいである」という考えを持ち、思い出の物を飾ったり好きな音楽を流したり、心地よく安らかな気持ちで過ごしていただけるようにします。
3.コミュニケーション
看取り期になると孤立するように感じられるのではないでしょうか。
ご本人が不安にならないようにスキンシップを通じて、心で会話して気持ちを読み取ったり、伝えたりすることで「一人ではありませんよ。そばにいますよ」と安心できるようにします。
まとめ
看取りケアは、約8割の施設で取り組みがされています。
施設の職員は、少しでも安心した場所で最後まで過ごしていただけるよう寄り添います。
しかし、最後はやはりご家族の方の付き添いにより最後を迎えられることが一番の幸せではないかと思います。
看取りはその方に感謝を伝える最後の時です。
現実から目を背けず最後までしっかり向き合うことが、その方への最大の感謝ではないでしょうか。
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