認知症の人の日常生活・社会生活における意思決定支援ガイドライン研修（組み込み型研修（改訂版））【介護職研修向け】

I am Toshihiko Mizushima, a lawyer at the Saetama Law Office, which is in charge of training and coaching for nursing homes, a guideline for decision-making support for people with cognitive disorders in daily life and social life. Thank you for your cooperation. What do you think is important for decision-making support for people with cognitive disorders?

This is because it is very important for each of us to form our own will, express it, and respect it, and decide our daily lives and social lives. This means that we can say the same thing to people with cognitive disabilities. Of course, people with cognitive disabilities have various cognitive disabilities.

It is difficult to remember the necessary information, it is difficult to see through, it is difficult to concentrate, it is difficult to understand the words, and it is difficult to grasp the atmosphere of the expression and place. There are such situations. Therefore, it is important that the supporters actively support the people with cognitive disorders. This training is a short training of about 15 minutes.

Therefore, we have prepared a 3-hour training for you to learn more about the guidelines and the examples. Therefore, we will explain the purpose and the outline of the guidelines in this training. Please join us for the training of independent practice. What the guidelines aim for

This is a guideline for the patient's life to be reflected appropriately. This person with cognitive disorder is not only diagnosed with cognitive disorder, but also has a disability, and is not only diagnosed with cognitive disorder, because he or she is suspected of the decrease in cognitive function and has insufficient ability to make decisions.

We have defined various processes and points of reference for those who are involved in the decision-making of those with cognitive disorders to carefully assemble the will of those with cognitive disorders as much as possible. From now on, please watch one of the videos. It is the voice of the person with cognitive disorder. Please take a look at how the person with cognitive disorder thinks about decision-making.

Haruko Sunohara, who lives in Ueda City, Nagano Prefecture, works as a volunteer at a restaurant run by the local community. She has been concerned about forgetting things for about two years, and was diagnosed with dementia at a hospital last year. She lives alone now, and her son and wife live nearby. I suddenly forgot things.

I was very anxious about everything. I looked at my calendar many times to see which members had to go to which event, and I looked at my notes. I have three different notes, but I checked them before going to the event.

I have to play it three times to remember. I'm anxious. I used to know what I was going to do, but now I'm worried about it again. I have to check it again and check the notes again. I think that's really good. The most important thing is cooking.

I didn't have the feeling of making anything. I just cut and ate what I had. I mixed and mixed a lot.

I can't do the same thing as I used to do. I just cut and eat what I have. I can do it easily.

I want to do more of what I can do. But I want to make sure that others understand that I can't do it anymore. I don't know if the word "period" is good, but I want them to understand that I can't forget things and that I can't do it anymore.

I think that's the most important thing. I'm glad that you understand, but if you feel like you're cheating or you don't want to do it anymore, that's a problem. I think you need to explain that well and understand it.

I've been doing a lot of things, so I have a few of my favorite choral songs and dance songs. I'm going to keep doing that. If I'm convinced that I can decide on my own, I won't be able to keep up with it.

I have a lot of things I want to do in my life, but I think it's best to do it for a long time. But if I can't do it, I'll be in a hurry and say, "I can't do that anymore." I want to decide and be convinced by myself and quit.

I think it's important to decide for yourself. I don't think it's because I was told to do so. I understand what I'm doing. I know that I can continue to do this, and I know that I can't do this. I want to decide for myself. There are several points in this video. Earlier, you talked about the importance of deciding for yourself, not for others.

We need to support the decision-making process based on the premise that both people with cognitive disabilities and those with disabilities have the same will and emotions, and have the power to think and decide on their own. For this, we need to understand the consciousness reform and decision-making support of the supporters and the method and process.

Also, the position of the decision-maker in the decision-making support, the position of the decision-maker, the person's opinion, and the way of thinking, and the way of seeking hope from the heart, are required. In other words, the decision-maker decides on behalf of the person who thinks it is good, and this is not decision-making support. From this support of thinking it is good,

We are now looking for a change in the support for decision-making, the hope and values of the person, and the support for searching for such things. In this guideline, we will explain the points of decision-making support in the context of daily life and social life. In daily life, it is assumed that the participants will participate in meals, bathing, and outdoor activities and daily programs.

In the case of social life, for example, changes in the person's home or the disposal of property are expected. In addition to the guideline, various guidelines are issued. Please pay attention to these guidelines. The guidelines are available in each area of the decision-making support, the mutual aid, non-daily income compensation, daily and daily life.

In this guideline, we will discuss how to respect the person's will and how to support the decision-making activities of the person who decides the will. This guideline is specialized in this decision-making activity. The structure of the guideline is: 1. The basic rules for the decision-making of people with dementia. 2. The manual when practicing decision-making. 3.

and the important details of the case. This is the structure. What I want you to be especially aware of this time is the basic principle of decision-making support. The person's will to be respected, the consideration of the person's decision-making ability, and the continuous support from the team in the early stages. Especially, the ability to make the person's decision. This is not to say that it is only the person's ability because it is written as ability.

Please note that the ability of the patient to make decisions will change depending on the support of your decision-making support. Let's also be aware of the status of decision-making support. We would like you to think about the meaning of respecting the patient's will.

The main target of this guideline is decision-making support. In other words, it is called decision-making support, where the person is the main target and supports the person to make decisions. The basic stance of this decision-making support is to ask the person what they want, where their heart is, and to seek the hope from their heart.

"It's hard for the person to decide, so there's no one else to decide for them." Or, "We're worried, so we're not going to decide for them, but we're going to do everything for them." We hope you will understand that we are not making a decision based on the best interests of the people, focusing on objective aspects. This slide shows the process of decision-making.

The most important thing is the maintenance of human and material environment. We need to pay attention to the attitude of the decision-makers as I explained earlier. Furthermore, the elements of "Protection of the Will", "Representation of the Will", and "Service of the Will" are divided into elements. We should be aware that they overlap in reality and are always in the same place.

Whether the patient is considering the place where the patient is accustomed to or the time when the patient can concentrate, whether the participant is sufficiently considered, or whether the record is sufficiently considered. I think that it is necessary to seek for decision-making support after considering this area in advance. As for decision-making support,

We call this support for the formation of a doctor based on appropriate information, recognition, and environment. There are points to be checked for each. The important thing is whether the doctor is provided with the necessary information to form a doctor in the first place.

Also, we need to pay attention to whether the information is explained to the patient in an easy-to-understand manner, rather than to the patient himself. We also need to pay attention to whether the patient's will is properly expressed and expressed. This is called "will expression support." We also need to pay attention to whether the patient's will is properly expressed.

For example, if you are in a hurry and don't say what you don't want to say. Or, if you have a particularly important will, it is possible that your will may change. Whether you are properly attached to such a changing will is the point. And support for reflecting your will on your daily life and social life. This is called will fulfillment support.

It is not that the support team will take the person out of the team and proceed with everything, but that the person will work as a member of the team to realize this will. This kind of attitude is important. Also, it is not decided whether the support team will support the person by judging whether it is rational from the perspective of the other party.

If you are trying to make a decision based on your own values or preferences, you need to be in a position to approach this. There are also meetings like the decision-making support team and the decision-making support meeting. The important point here is not a meeting for the purpose of intervening or solving problems,

We need to have a common understanding of how the person has a certain sense of value and how they make decisions and how they make decisions. Thank you for watching. In order to provide support, we need to consider the person's will, their ability to make decisions, and the appropriate support based on their ability.

and support based on the team's process. I hope you will take part in the independent practice-based training if you want to learn more about the guidelines. Here are some reference materials. Please use them for your practice. This concludes the training. Thank you for listening.