手術部看護師の適正数に対する新たな算定式の提案∗ - 一橋大学国際 ...

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A (2.40)×A/B× (A:1B:)() 10 A 2

.................................. 51.1 ............................................................................... 51.1.1 ........................................................................................................... 51.1.2 ............................................................................................... 51.2 ............................................................................... 91.2.1 .................................................................................. 91.2.2 ................................. 91.3 ....... 10 2 .................................................. 122.1 ........................................................... 122.1.1 ...................................................................................................................... 122.1.2 ................................................................................................................. 122.2 .............................................. 142.2.1 ............................................................................................. 142.2.2 .......................................................................................................................... 14 3 .................................................................. 193.1 .................................................................... 193.1.1 .................................................................................... 193.1.2 .................................................................................... 193.1.3 ........................................................................ 203.2 ................................................. 203.2.1 ..................................................................................................... 213.2.2 ..................................................................................................... 23 4 A ...................... 274.1 ................................................................................ 274.1.1 ................................................................ 274.1.2 .............................. 304.2 ................................................................. 324.2.1 ............................................................................................................. 324.2.2 ..................................................................................................... 324.3 .................................................................................... 344.3.1 ................................................................................................................. 344.3.2 ............................................................................................. 344.3.3 ............................................................................................. 354.4 .............................................................. 363

5 ..................................................... 385.1 ................................................................. 385.2 ....................................................................................... 39 .................................................................................................. 41......................................................... 43................................ 444

4 1 1 3.31 2.94 3 () 1 5000 1 3 12.3 7.5 5 10 3 1 37.364 12.212 3.06 41.250 12.000 3.44 43.265 12.657 3.42 19.000 7.091 2.68 24.067 8.009 3.00 23.077 7.367 3.13B-6 5, 6 B-1B-6B-1 5() 6() B-6 2007B-1 ( 2007) 7 8 7

1.2 1.2.1 1.2.2 () 2 24 4 ()()()() 1 15 1 13 1 10 1 7 1 4 7 1 7 1 18 4 9

(2008)71 ()71 9 1 7:1 :1 19 1,55510:1 10:1 21 1,30013:1 13:1 24 1,092 20101.3 “” 2006 1967 8 22 10

4 2005 7 48 2010 9 5 4 5Vol.6 No2 (2010) p148 11

2 (2.1)(2.2)2.1 2.1.1 101 10 1 30 8 3 1 24 9 3 3 6 7 2.1.2 10 A 2 B 3 1 71 2010 101 1 5 6712

10 71 13

71 2.2 2.2.1 () 1 10 10 ()1. 2 3 4 4 8 4 11 2012 8 2.2.2 8 8 7 14

12 12 2012 8 7 8 3 3 13. 13 8 8 15

3 14 3 2 6 14()() 13 8 2 ()() 8 3 8 8 16

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x a x a 16/5 17 16 1 a1 16a 5 16a 5 16a/5 1.09 104 15 3 5 1 365 238 20 238/(238-20) 1.091 1.09 3 2010 ( 18)( 19) 18 2010 132010 31 3 p19619822

19 1 () 4.4 10 44.5 42 32 1 0.6 1 3.8 4.4 10 44 44.5 3.2.2 23

2.AORN 2007 AORN(Association of perioperative Registered NursesInoperative Staffing Formula Step1~ Step6 Step7,Step8 ) 23 ) 1 1 2 Step1 1 21 1 22 Direct staff patient care calculationStep1: Total hours to staffed per weekStep2: Total working hours per weekStep3: Basic fulltime equivalentsStep4: Basic relief per employeeStep5: Relief fulltime equivalentsStep6: Total minimum direct care staff membersStep7: Indirect care staff membersStep8: Call relief(Step1) (Step2) 40 ( 1 1 8 ×5 ) (Step3) 1 1 (Step4) 2080 (40×52 )(Step5)Step3(1 )Step5()(Step6)(Step7)(Step8) Step6 Step7 Step8 16 Association of periOperative Registered Nurses (2007), Standards, recommended practice, and guidelines2007 edition, AORN.25

21 8 AM7 PM3 8 PM3 PM6 2 PM6 AM7 1 AM7 PM6 1 21 / Step1 AM7 PM3 8 8 5 8 ×8 ×5 320 2×3×5301×13×7911×11×222463 22 3 2.5 3 4 2.5 Step1 22 () Step2 2007Edition 1 2.5 463 ×2.51,157.5 23(orientation FTEs) 4 () 12 4 ×40 /×12 1,920 1,920 2080 (40 ×52 )1,920÷2,0800.9 ()2007edition 24 24 26

4 A () A A ()(4.1)(4.2)(4.3)(4.5)4.1 ()A 2 4.1.1 23 12 8 12 22 2 51 36 ( 70.6) 123454 3 2 12 24 33( 24)5 (3 /12 ) 12 ( 4 ) 10 2 5.9 27

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55 55 2.41 2.00 2 (3.6) 2.00 53 (96.4%) 2.00 () 2 () 55 ()()() 3.00 3 (5.5)1 2.23 2.40 0.17 28 29 28 29 1 31

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B ( 2 ) A C B B B C 53 () 4 3 2 4 3 2 24 8 33

24 1 2483 3 54.3 (4.3.1)(4.3.2)(4.3.3)4.3.1 1 311h22m/465m40.18...41 2 2 41(22)=37 2 14228 2.38 142.3833.32...34 33h22m 465m() 4.305 2 AORN 4.3.2 22 30 1 22 1/2() 3034

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(4 11 8 ) W 5 5 32 W 4 12 () 1 1 32 10 11 (0.75 10 )12 8 32 1 32 8 10.8750.750.6250.50.3750.250.125120.375 1 0.375 5 0.37551.875 2 0.37537

5 4 (5.1)()(5.2)5.1 331 33 1 2.40 1 2.40 1 (A)1 1 (B) 4.3.3 2 33 (2.40)×A/BA:1 B:A A/B 34 1 (241)(124) 14 1 (A)(B)7 45 (221) 24 34A/B 38

A A/B 1.65 2.41.651455.44 56( 57 )(53)(3~5)A B A/B A/B 5.2 ()5 3 (NSP)1990(1996)(2005)(Subproblemcentric Approach), 1818 39

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(1990)4 8 11, 3 p363(2005)53 2 p231259(2008) III 4 2 p134(2009) 30 2 p116121 25 8 p94962010(2009) http://www.ohno.mgmt.waseda.ac.jp/Thesis/2009m/ukai.pdf(2008) 136 11 p2248(2009) 30 2p1221261996 (2007) 28 4 p284291(2008) II 4 2 p131(2009) 30 2 p111115(2010) 31 3 p196198 25 8 p90932010 6 2 p14820106 2 p1482010Association of periOperative Registered Nurses (2007), Standards, recommended practice, andguidelines 2007 edition, AORN. 7 200741

2012 8 20122010http://www.aorn.org/PracticeResources/AORNPositionStatements/Position_RegisteredNurseCirculator/http://www.nurse.or.jp/nursing/practice/housyu/pdf/2010/tebiki.pdf http://www.mhlw.go.jp/shingi/2010/02/s0205-7.html 166http://sites.google.com/site/shinryoutensuu2010/ 22 web http://www.jstshingi.jp/abst/p/10/1038/ritsumei1.pdf 42

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