長期目標の方向性とは

第31回介護福祉士国家試験問題より

次の事例を読んで、問題６６、６７について答えなさい。

〔事例〕
　Jさん（７１歳、男性）は２０歳から造園業を営んでいた。２か月前に脚立から転落して、右大腿骨頸部骨折で入院した。骨折部位は順調に回復し、下肢機能訓練により杖歩行も可能であると診断されている。しかし、訓練への参加は消極的であり、入院中は車いすで過ごしていた。退院後は自宅で過ごしたいという希望から、下肢筋力に対する機能訓練で５日前に介護老人保健施設に入所した。
　入所後のJさんは、日中ほとんどをベッド上でテレビを見て過ごしている。排泄に関する移乗を依頼する以外に職員に話しかけることはなく、食事をしていても他社との会話はみられない。Jさんの表情が穏やかな時に歩行訓練に参加を促すが、「ああ、うん…」と言うだけで訓練に参加していない。
　面会に来た妻によると、Jさんは、「施設で訓練しても歩けるようになるはずはない」と話していたということだった。また、妻は、「仕事が大好きで、仕事ができないことに相当落ち込んでいるようだ」と話した。

問題6６
　Jさんに対する長期目標の方向性として、最も適切なものを1つ選びなさい。

1 　病院で機能訓練をすること
2 　施設での生活に慣れること
3 　造園業に再び携わること
4 　話し相手を見つけること
5 　新しい趣味を見つけること

正解は↓

答え　３
　造園業を営んでいた利用者に対する長期目標の方向性に関する設問です。

１　×　機能訓練はあくまでも手段であり、なぜ機能訓練を行うのか、その機能訓練の先にある目指すべきものを目標に設定する必要があります。Jさんは「施設で訓練をしても歩けるようになるはずはない」と話しており、介護老人保健施設での機能訓練の効果に疑いを抱いていることが推察できるものの、病院での機能訓練が長期目標とはならなりません。仮に機能訓練の場を病院に移したとしても、それは目標を達成するための手段であり、目標とはなりません。
２　×　Jさんには「退院後は自宅で過ごしたい」という希望があります。その希望を叶えるために介護老人保健施設に入所して杖歩行訓練を行うことになっており、施設での生活の継続を望んでおられるとはいえません。ですから、施設での生活になれることは必要であるものの、それをJさんの長期目標にするのは不適切といえます。
３　〇　Jさんには「自宅で過ごしたい」という思いがあります。その理由として増減業の仕事が好きで、造園業の仕事を続けることがJさんにとっての生きがいになっていることが考えられます。そのことは「仕事ができないことに相当落ち込んでいるよだ」という妻の発言からもわかります。ですから、Jさんが好きな造園業に再び携わることを長期目標の方向性として設定することが最も適切と考えられます。
４　×　利用者が自分らしい生活を実現するためには、利用者の思いや意欲、能力、嗜好等、利用者の強みや長所といったストレングス（strength）を重視する必要があります。食事をしていても他社との会話がないため、話し相手を見つけることも大切ですが、それ以上に「退院後は自宅で過ごしたい」「仕事が大好き」というJさんの思いや嗜好を重視して長期目標の方向性を検討する必要があると考えられます。　
５　×　新しい趣味を見つけることも大切ですが、Jさんからは直接、そのような要望はお聞きできていません。また「仕事が大好きで、仕事ができないことに相当落ち込んでいるようだ」と妻がJさんのことを話していることからも、新しい趣味ではなく、長年営んできた造園業に関する取り組みができるように支援することが求められます。

英訳

From the 31st National Examination Question for Care Workers

Read the following case and answer questions 66, 67.

[Case]
Mr. J (71 years old, male) has been in the landscaping business since he was 20 years old. He fell from a stepladder two months ago and was hospitalized for his right femoral neck fracture. His fracture site has recovered steadily, and it has been diagnosed that he can walk with a cane by training his lower limbs. However, his participation in training was reluctant and he spent his time in a wheelchair while in the hospital. Since he wanted to spend his time at home after his discharge, he entered the Long-Term Care Health Facility five days ago for functional training on lower limb muscle strength.
After moving in, Mr. J spends most of the day watching TV on his bed. He does not talk to staff other than asking for a transfer regarding excretion, and he does not have conversations with other companies even if he is eating. When Mr. J’s facial expression is calm, he encourages him to participate in walking training, but he just says “Oh, yeah …” and does not participate in the training.
According to his wife, who came to his visit, Mr. J said, “Training at the facility shouldn’t make you able to walk.” Her wife also said, “I love my job and seem to be quite depressed about not being able to do it.”

Problem 6６
Select one of the most appropriate directions for your long-term goals for Mr. J.

1 Perform functional training at the hospital
2 Get used to life at the facility
3 Re-engaged in the landscaping industry
4 Finding someone to talk to
5 Finding a new hobby

The correct answer is ↓

Answer 3
This is a question regarding the direction of long-term goals for users who were engaged in the landscaping industry.

1 × Functional training is just a means, and it is necessary to set the goal of why functional training should be done and what should be aimed at beyond the functional training. Mr. J said, “Even if you train at the facility, you should not be able to walk,” and although it can be inferred that there is doubt about the effect of functional training at the Long-Term Care Health Facility, it is a function at the hospital. Training is not a long-term goal. Even if the place of functional training is moved to the hospital, it is a means to achieve the goal, not a goal.
2 × Mr. J has a desire to “want to spend time at home after discharge”. In order to fulfill that wish, we are supposed to enter the Long-Term Care Health Facility and conduct cane walking training, and we cannot say that we want to continue living at the facility. Therefore, although it is necessary to be able to live in a facility, it is inappropriate to make it a long-term goal for Mr. J.
3 〇 Mr. J has a desire to spend time at home. The reason for this is that I like the work of increasing / decreasing work, and it is thought that continuing the work of landscaping is what makes Mr. J’s life worthwhile. That can be seen from his wife’s remark, “I’m pretty depressed about not being able to work.” Therefore, it is most appropriate to set the direction of the long-term goal to be re-engaged in the landscaping industry that Mr. J likes.
4 × In order for the user to realize his or her own life, it is necessary to emphasize the strength such as the user’s strengths and strengths such as the user’s thoughts, motivation, abilities, and preferences. It is important to find someone to talk to because there is no conversation with other companies even if you are eating, but more than that, we emphasize Mr. J’s thoughts and tastes such as “I want to spend time at home after discharge” and “I love work”. It is necessary to consider the direction of long-term goals. It was
5 × It is important to find a new hobby, but Mr. J has not heard such a request directly. Also, as my wife talks about Mr. J, “I love work and I seem to be quite depressed because I can’t work,” so that I can work on the landscaping industry that I have been doing for many years, not a new hobby. Is required to support.

d for shopping on behalf of Mr. G, but Mr. G said, “I am. I don’t feel like I bought it if I didn’t pay for it. “Mr. G’s satisfaction is low. Therefore, it can be said that environmental factors should be taken into consideration, including the response of long-term care and welfare workers, such as lining up at a vacant cash register so that Mr. G can pay by himself. It was
5 × Activities include ADL (Activities of Daily Living) such as movement, meals, excretion, bathing, oral care, and changing clothes, as well as IADL (Activities of Daily Living) such as cooking, cleaning, laundry, shopping, money management, and medication management. Operation) is also included. Since it is an activity for Mr. G to shop at a familiar store, instead of reviewing Mr. G’s activity itself, care and welfare such as lining up at an empty cash register so that Mr. G can shop by himself including payment. It is necessary to consider environmental factors, including how to deal with jobs.