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<title>終末期理学療法の実践（電子版のみ） | 株式会社文光堂</title>


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<meta name="description" content="対象者の終末期における理学療法について，介入場面別（緩和ケア病棟，訪問，特養施設）に，目標設定，理学療法評価，臨床推論，理学療法の実際を解説した．また，問題別（リンパ浮腫，がん性疼痛，呼吸，褥瘡，摂食・嚥下）に，理学療法の流れ，ポイント，コツ，注意点を解説した．終末期に向き合う姿勢や，チーム医療における役割など，理学療法士としての基本から現場で役立つ視点までまとめた実践書．　☆図版51点，表組60">

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		<h1 class="catchCopy">理学療法士が果たす役割とは何か？</h1>
		

		<h1 class="title titleWidth">終末期理学療法の実践（電子版のみ）<span class="version"></span></h1>
		

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					編集：日髙正巳（兵庫医療大学）
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					<span class="transparent">編集</span>　桑山浩明（上ヶ原病院）
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		<div class="headers"><h3 class="current content">内容</h3><h3 class="preface">序文</h3><h3 class="indexes">主要目次</h3></div><section class="current content">対象者の終末期における理学療法について，介入場面別（緩和ケア病棟，訪問，特養施設）に，目標設定，理学療法評価，臨床推論，理学療法の実際を解説した．また，問題別（リンパ浮腫，がん性疼痛，呼吸，褥瘡，摂食・嚥下）に，理学療法の流れ，ポイント，コツ，注意点を解説した．終末期に向き合う姿勢や，チーム医療における役割など，理学療法士としての基本から現場で役立つ視点までまとめた実践書．<br>☆図版51点，表組60点，カラー写真6点，モノクロ写真42点</section><section class="preface">序文<br><br>　「この人にとって，来年の花見はなかったと思います．ありがとうございました．」理学療法士の免許が届き，最初にかかわらせていただいた方の家族からいただいた言葉である．入院中から担当させていただき，退院後は訪問事業で継続的にかかわらせていただいた方である．ある年の4月に，町の事業で花見を計画し，花見の後，体調を崩され他界された方である．今でも生存時のかかわりを鮮明に思い出すことができる．その経験をもとに，訪問理学療法としてかかわらせていただくときには，遺された家族が対象者に対して，“精一杯のことができた” と思えるような環境を支えることを意識していた．そして，「生活している場がどこか」ではなく，「生活そのもの」に焦点をあてて理学療法を考えていくことが重要になってくる時代の到来を感じていた．地域理学療法は「community based physical therapy」といわれるが，これからの時代では「life based physical therapy」と呼ぶことが適当な時代に移行してきたと考える．<br>　本書は，終末期を冠としているが，単に「亡くなられる」ことを前提に理学療法を展開するということではなく，「死んでいない今は，生きている」という認識のもと，その「生」を支え続けていくための理学療法を意識したものである．第2部「介入場面における終末期理学療法」では，目標設定の共通性のもとで，緩和病棟，訪問，施設という場面ごとにおける臨床推論を含めた展開，第3部「終末期理学療法で向き合う諸問題」では，リンパ浮腫，がん性疼痛，呼吸，褥瘡，摂食・嚥下をとりあげ，具体的なアプローチ方法について紹介している．終末期理学療法にかかわる理学療法士は，超高齢社会・多死社会の到来を考えると増えてくることであろう．そして，終末期を支えることは理学療法士だけではできない．他職種がどのようなかかわりをしているのかを知ることも大切と考える．理学療法士もチームの一員として，他職種と協業し発展していければと考える．<br>　人の死は悲しいものである．しかし，人は他者の「死」によって自らの「生」を考える機会をいただく．それだけ「死」は尊く貴重なものである．理学療法士はそのかかわり方によって，対象者の人生を左右することすらありえる．だからこそ，自らの生き様にも目を向けていかなければならない．終末期理学療法は，まだまだ新しい領域であり，今後の発展が期待される領域である．一人一人の理学療法士が対象者の最期までの「生」に向き合い，貢献していくための一助に本書がなれば幸いである．<br>　最後に，冒頭でも触れたが駆け出しの私に人生の最後までかかわることを認めていただいたAさんならびにご遺族の皆様に感謝申し上げる．また，理学療法人生を通して，理学療法マインドとは何かを伝えご教示いただいた故篠原英記先生，故嶋田智明先生の両氏に捧げ序文とする．<br><br>平成27年4月<br>編者を代表して　日髙正巳</section><section class="indexes">I．総論<br>第１章　いわゆる終末期理学療法とは<br>　時代の変化<br>　死と終末期ケア<br>　死に向かう態度（人生観・死生観）<br>　終末期理学療法とは<br>　終末期に理学療法士がかかわる意義<br>第２章　終末期理学療法をどのように教えるか，そして学ぶのか<br>　終末期理学療法にかかわるための学習目標<br>　終末期理学療法を理解するための学習方略<br>　終末期理学療法の実践家としての熟達モデル<br>第３章　終末期を迎える方を理解するために<br>　終末期を迎える患者の一般的な心理的な反応<br>　対応・留意を必要とする心理的問題<br>　理学療法士自身のメンタルコントロール<br>II．介入場面における終末期理学療法<br>第１章　終末期理学療法における目標設定をどう考えるか<br>　目標設定<br>　理学療法評価<br>　臨床推論過程<br>　おわりに<br>第２章　緩和ケア病棟における終末期理学療法<br>　緩和ケアにおける理学療法の目的と役割<br>　目標設定<br>　理学療法評価<br>　終末期理学療法の実際<br>　ここがポイント<br>　これだけは気をつけよう<br>第３章　訪問における終末期理学療法<br>　在宅における理学療法評価<br>　終末期における訪問理学療法の実際<br>　終末期における訪問理学療法のポイント<br>　これだけは避けよう<br>　疾患別各論<br>　おわりに<br>第４章　施設ケアにおける終末期理学療法<br>　入所日から安定期の理学療法士のかかわり<br>　個別機能訓練計画のなかで<br>　経時的変化のなかで<br>　終末期を迎えた方の目標設定<br>　終末期を迎えた方の理学療法評価<br>　終末期理学療法推論過程<br>　これだけは避けよう<br>　施設における終末期理学療法の実際<br>　看取りのとき<br>　おわりに<br>III．終末期理学療法で向き合う諸問題<br>第１章　リンパ浮腫に対する理学療法<br>　浮腫の要因<br>　理学療法の流れ<br>　ここがポイント<br>　理学療法のコツ<br>　これだけはやめよう<br>第２章　がん患者の痛みに対する理学療法<br>　理学療法の流れ<br>　ここがポイント<br>　コツ<br>　これだけはやめよう<br>第３章　呼吸に対する理学療法<br>　呼吸困難の原因<br>　がん患者に発生する呼吸困難<br>　呼吸不全と呼吸困難<br>　低酸素血症の原因<br>　理学療法の流れ<br>　理学療法の実際<br>　酸素療法<br>　これだけはやめよう<br>第４章　褥瘡予防・管理<br>　褥瘡はこれでできる<br>　ここがポイント<br>　褥瘡予防・管理のコツ<br>　これだけはやめよう<br>　おわりに<br>第５章　摂食・嚥下機能に対する理学療法<br>　正常の嚥下のメカニズム<br>　終末期における摂食嚥下障害<br>　理学療法の流れ<br>　おわりに<br>IV．チームケアの展開に向けて<br>第１章　他職種の終末期の捉え方，そして理学療法士に対する期待<br>　A. チーム医療への期待<br>　　終末期を支えるチームとは<br>　　よりよいチームとなるために<br>　　リハビリテーションの理念を踏まえたチームケア<br>　B. 在宅医の立場から<br>　　ここを大切にしてかかわっています<br>　　ここは理学療法士に任せたい<br>　　これだけはやめてほしい<br>　　おわりに<br>　C. 緩和医療を行う医師の立場から<br>　　ここを大切にしてかかわっています<br>　　ここは理学療法士に任せたい<br>　　これだけはやめてほしい<br>　　おわりに<br>　D. 緩和ケアを行う看護師の立場から<br>　　社会情勢について<br>　　緩和ケアについて<br>　　チームケアについて<br>　　実践知について<br>　　ケアについて<br>　　終末期理学療法とは<br>　E. 終末期のリハビリテーション<br>　　終末期の苦痛症状への対処<br>　　非がんの緩和ケアについて：ALS の場合<br>　　がん患者の緩和ケアについて<br>　　在宅ホスピスケア<br>　　おわりに<br>　F. 作業療法士の立場から<br>　　ここを大切にしてかかわっています<br>　　ここは理学療法士に任せたい<br>　　これだけはやめてほしい<br>第２章　終末期を支える制度<br>　ケアマネジャーとして，ここを大切にしてかかわっています<br>　在宅でのリハビリテーション<br>　入院でのリハビリテーション<br>　施設入所でのリハビリテーション<br>　経済的な負担軽減<br>　終末期に特有の制度上の課題<br>　ここは理学療法士に任せたい<br>　ここは大事にしてほしい<br>第３章　終末期に対する関連療法<br>　A. 薬物療法<br>　　慢性心不全<br>　　慢性呼吸不全<br>　　がん緩和<br>　　糖尿病<br>　　褥瘡<br>　　慢性腎不全<br>　B. 栄養療法<br>　　栄養は何のために必要か<br>　　終末期の栄養管理<br>　　「食べる」ということ<br>　　胃瘻の適応を熟慮すべき<br>　　終末期の特殊な胃瘻活用<br>　　輸液の管理<br>　　栄養投与後の理学療法<br>　　終末期に優先すべきことは何か<br>　　終末期栄養管理に「答え」は存在しない<br>付表1　薬剤一覧<br>付表2　体験談1<br>付表3　体験談2<br>索引</section></article>
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