2 型糖尿病外来患者の経口管理に関する看護師の知識・態度・実践：糖尿病教育認定看護師を対象とした全国調査

Nurses' knowledge, attitude, and practice regarding oral management for outpatients with type 2 diabetes: a national survey on certified diabetes educators.

抄録

糖尿病教育認定看護師の経口管理に関する知識、態度、実践の関連はあまり検討されていない。本研究の目的は，日本国内の医療施設において糖尿病教育認定看護師が口腔管理を実践する際の変数として，知識と態度の関連を検討することであった．1277の医療施設に勤務する糖尿病教育認定看護師300名を対象に質問紙を実施した．口腔管理に関する知識・態度・実践に関する項目は，糖尿病と歯周病に関するガイドライン・報告書・書籍の項目と先行研究の網羅的な知見から評価した．7 割以上が十分な口腔管理を実践していなかった．ロジスティック回帰分析の結果，すべての項目が看護師の口腔管理への自信と負の相関を示した（因子 1： オッズ比 [OR]=0.55；95% 信頼区間 [CI]0.37-0.83； 因子 2：OR=0.35；95% CI 0.18-0.70； 因子 3：OR=0.38；95% CI 0.24-0.61； 因子 4：OR=0.29；95% CI 0.18-0.49）．口腔管理の実践と糖尿病合併症としての歯周病に関する説明（OR=2.67，95% CI 1.01-7.02），複数の診療科との連携支援（OR=2.65，95% CI 1.24-5.65 ）は看護師の教育と正の相関があった．これらの結果から，口腔管理実践の重要性を理解し，患者の口腔管理に関する知識，態度，自信を向上させるために，看護師の教育についてより多くの戦略が必要であることが示唆された．

The association among certified diabetes educator nurses' knowledge, attitudes, and practices related to oral management has not been well examined. The aim of this study was to examine the association between knowledge and attitude as variables for nurses' practice of oral management as certified diabetes educators at medical facilities in Japan. The questionnaires were administered to 300 certified diabetes educator nurses from 1277 medical facilities. The items regarding knowledge, attitude, and practice of oral management were assessed using items from the guidelines, reports, and books on diabetes and periodontal disease, as well as the exhaustive findings of previous studies. More than 70% of the participants did not practice adequate oral management. Logistic regression analysis revealed that all the items were negatively associated with nurses' confidence in oral management (Factor 1: odds ratio [OR] = 0.55; 95% confidence interval [CI] 0.37-0.83; Factor 2: OR = 0.35; 95% CI 0.18-0.70; Factor 3: OR = 0.38; 95% CI 0.24-0.61; Factor 4: OR = 0.29; 95% CI 0.18-0.49). The practice of oral management coupled with an explanation regarding periodontal disease as a diabetic complication (OR = 2.67; 95% CI 1.01-7.02), and supporting collaboration with multiple medical departments (OR = 2.65; 95% CI 1.24-5.65) were positively associated with nurses' education. These results suggest that more strategies for nurses' education are needed to understand the importance of oral management practices and to improve knowledge, attitudes, and confidence in patient oral management.