Home care nursing in Japan: a challenge for providing good care at home

Home care in Japan has developed over the past 30 years. Nurses have taken leadership in promoting home care and at the same time have expanded their roles. The roles of Japanese nurses in the field of home care are presented in the context of the historical perspective and view for the future. Home care nurses have performed care management for their community as well as for individual older clients living in their community. Currently, nurses work as high-tech and personal care providers and are developing a new role in health care enterprises. The number of nurses working as clinical nurse specialists will increase consistently with the rapid increase of master's programs. In the future, nurses should take a lead in developing health policy. The purpose of the article is to describe the current situation of home care clients and home care nursing in Japan. In addition, four issues of home care in Japan are described related to home care for older persons, high-tech home care, terminal care, and home care for psychiatric patients.     

肥胖症患者减重代谢手术后居家护理需求的研究进展

对肥胖症的危害、居家护理的概念、减重代谢术后居家护理的现状、居家护理需求测量工具、居家护理需求及患者术后居家护理需求干预研究现状进行综述,提出我国可以采取制订居家营养方案、促进形体恢复、重建心理等措施满足肥胖症患者术后患者的居家护理需求,并探索适合我国国情的减重代谢术后患者的居家护理模式。     

尿毒症患者对家庭病床服务的意愿及影响因素

目的调查尿毒症患者对家庭病床服务的需求意愿,分析其影响因素。方法选择2007年4月至2009年10月某院收治的275例尿毒症患者对家庭病床服务意愿调查,并统计分析影响尿毒症患者对家庭病床服务意愿的因素。结果尿毒症患者是否需要家庭病床服务与是否听说过家庭病床服务、是否知道家庭病床服务具体内容、是否接受过家庭病床服务、是否需要上门的医疗卫生服务等有关,差异均有统计学意义（均P〈0.05）。不同年龄、文化程度、婚姻状况、职业、家庭经济收入等尿毒症患者的家庭病床服务意愿差异均有统计学意义（均P〈0.05）。不同日常生活能力、不同主要照顾者的尿毒症患者的家庭病床服务意愿差异均有统计学意义（均P〈0.05）。医疗费用来源不同的尿毒症患者的家庭病床服务意愿差异有统计学意义（P〈0.05）。年龄、文化程度、家庭经济情况、日常生活能力、是否知道家庭病床服务的具体内容、是否接受过家庭病床服务是患者家庭病床服务意愿重要影响因素。结论影响尿毒症患者家庭病床服务意愿的因素很多,应针对这些因素加大宣传教育,积极推进家庭病床服务。     

社区护士的家庭护理安全相关知识与行为研究

目的:了解社区护士的家庭护理安全相关知识与行为,探讨家庭护理中存在的安全隐患。方法:采用自设问卷,对94例社区护士的家庭护理安全知识与行为进行调查。结果:社区护士的家庭护理安全知识得分为(23.50±3.26)分,家庭护理安全行为得分为(66.31±7.54)分,均处于偏低的水平;多元线性回归结果显示,社区护士的护理安全知识对其护理行为有一定影响(P0.05)。结论:要加强家庭护理安全的培训,完善各项家庭护理规章制度,规范家庭护理人员从业资格,以保证病人护理安全,提高护理质量。     

Bringing children home: bridging the gap between inpatient pediatric care and home healthcare

Pediatric home care is an emerging need. Eleven years ago, six community-based, not-for-profit home care agencies in New Hampshire and Vermont took action by progressively forming the Visiting Nurse Association Health System of Northern New England, Inc. (VNAHSNNE) workgroup to improve pediatric home care. The focus of a pediatric home care initiative called Bringing Children Home was created to provide enhanced training for pediatric nurses and bridge the gap between inpatient pediatric care and home care, thus improving home care for children with complex medical needs. The goal of the workgroup is to enhance the transition from hospital to home, ultimately providing improved quality care to the patient and the family.     

There really is a difference: home care competencies

BACKGROUND: More nurses are turning to home care agencies as sources of employment because of mergers, alliances, and increased emphasis on outpatient services. The unique differences in the home care nursing role necessitate adequate orientation and ongoing competency validation. METHOD: A review of relevant nursing literature was conducted. The author also relied on her experiences as a home care educator. RESULTS: Nurses who enter the specialty of home care nursing can expect to learn specific competencies that are unique to home care. CONCLUSION: Specific competencies unique to home care are proposed. There is scant published research regarding home care competencies to date.     

Family Caregiver's Satisfaction with Home Care in the Taipei Metropolitan Area

Abstract This research was designed to evaluate the quality of home care by examining family caregiver's satisfaction with home care services received. The sample for this study were 110 families using home care from the Taipei Metropolitan Area. Data were collected from interviews of the family members. The degree of satisfaction with each attribute of services was measured using a Likert scale with 5 responses. The degree of general satisfaction with home care was averaged across 19 attributes. More than 91.0% of the family caregivers believed that the respect, consideration, concern for questions, and acceptance for suggestions from home care workers did not need any improvement. In contrast, at least two-thirds of the family caregivers felt the speedy provision of services in an emergency and the degree of ease of contacting home care workers by telephone needed improvement. The number of desired attributes that were received was a significant determinant of general satisfaction with home care services received. Family caregivers who received at least 14 attributes tended to be more satisfied with home care services than the respondents who received fewer than 14 attributes of home care services. Overall, subjects receiving home care services were satisfied. The more desired attributes of home care received, the higher the satisfaction with home care.     

深圳市社区老年人家庭护理供需调查及其影响因素分析

目的 调查分析深圳市社区老年人家庭护理服务供需现状及影响因素.方法 采用自行设计的调查问卷随机对深圳市6个社区216名老年人和78家社区健康服务中心进行调查,了解老年人家庭护理服务的供需现状及相关影响因素.结果 84%老年人对家庭护理有需求,接受过家庭护理服务者占38.1%.32项家庭护理需求项目中,居前6位的需求项目依次是血压监测、血糖监测、健康咨询、照顾者指导、心理护理、服药指导.78家社区健康服务中心有48家提供家庭上门服务,开展家庭护理服务的中心有44.0%提供10个以上项目,67.0%的中心提供5个以上项目,17.0%提供2个以下项目,30家不提供家庭上门服务.影响社区家庭护理服务开展的主要原因是护理人员配置不足、风险系数大、医疗环境及设施受限.结论 老年人对家庭护理服务有较大需求,社区健康中心提供的家庭护理服务相对滞后,家庭护理服务供不应求,当务之急是增加社区护理人员数量,建立和完善社区家庭护理行业规范,促进家庭护理的稳定发展.     

深圳市社区老年人家庭护理供需调查及其影响因素分析

目的调查分析深圳市社区老年人家庭护理服务供需现状及影响因素。方法采用自行设计的调查问卷随机对深圳市6个社区216名老年人和78家社区健康服务中心进行调查,了解老年人家庭护理服务的供需现状及相关影响因素。结果84％老年人对家庭护理有需求,接受过家庭护理服务者占38．1％。32项家庭护理需求项目中,居前6位的需求项目依次是血压监测、血糖监测、健康咨询、照顾者指导、心理护理、服药指导。78家社区健康服务中心有48家提供家庭上门服务,开展家庭护理服务的中心有44．0％提供10个以上项目,67．0％的中心提供5个以上项目,17．0％提供2个以下项目,30家不提供家庭上门服务。影响社区家庭护理服务开展的主要原因是护理人员配置不足、风险系数大、医疗环境及设施受限。结论老年人对家庭护理服务有较大需求,社区健康中心提供的家庭护理服务相对滞后,家庭护理服务供不应求,当务之急是增加社区护理人员数量,建立和完善社区家庭护理行业规范,促进家庭护理的稳定发展。     

老年家庭护理服务的卫生经济学评价

我国人口年龄结构已进入老年型,高速发展的人口老龄化使得卫生资源的供需矛盾日益突出.如何合理配置老年家庭护理资源,优化家庭护理成本效益,促进我国家庭护理的进一步规范和发展,须从经济学角度对老年家庭护理进行卫生经济学评价.为了使人们对老年家庭护理的卫生经济学评价有更深入的理解和认识,对国内外卫生经济学评价方法以及该方法在老年家庭护理领域的应用等进行了综述.     

Forgotten resources of older home care clients: Focus group study in Finland

In this qualitative focus group study, the resources available to older home‐dwelling people, particularly incoming and existing home care clients, are described from the viewpoint of home care professionals (n = 32). The data were analyzed using inductive content analysis. There were three categories of older people requiring resources from the viewpoint of interviewers: home‐dwelling people, incoming home care clients, and existing home care clients. Based on the analysis, the resources of older home‐dwelling people were categorized in terms of support, meaningful life, everyday activities, and environment. Incoming home care client resources were support, out‐of‐home activities, in‐home activities, and environment. Existing client resources were described in terms of support, everyday activities, and environment. Home care professionals described the resources of the older home‐dwelling people in diverse ways, but those of the perspective of existing clients were reduced. The biggest difference was in everyday activities. Psychological and social resources, including meaningful life and social relationships, seemed to be forgotten. All available resources must be taken into account, especially in the everyday home care services for existing home care clients.     

Home care personnel's perspectives on successful discharge of elderly clients from hospital to home setting

The successful discharge of elderly patients from hospital to home care is a process requiring co-operation between health and social care personnel in addition to their commitment and skills. During the discharge process it is important that health and social care professionals have a shared view of the health and mental status and needs of the patient so that appropriate plans for meeting these needs can be made. The aim of the study was to investigate home care personnel's (health and social care workers) views of which practices between the discharging hospital and home care are associated with the successful discharge of clients. Home care personnel in 22 Finnish municipalities (n = 1890, response rate 63%) received a questionnaire in spring 2001. When the respondents' background factors were standardized, the best predictors of successful discharge from the home care personnel's point of view were adequate information received about the treatment of the patient's illnesses and their functional ability and cognitive potentials, timely information about the discharge, and good co-operation between the discharging hospital, and the home care, social care and health care workers working in home care. There were differences in the opinions of social care workers and health care workers working in home care. From the home care personnel's point of view the most important correlates of an elderly client's discharge from hospital to a home setting were factors associated with how they can best plan their work. Their perspective on the discharge process may diverge from clients and their informal care givers point of view. To ensure the successful discharge process we must take them all into account.     

Factors predicting home death for terminally ill cancer patients receiving hospital-based home care: the Lyon comprehensive cancer center experience

This study aimed to determine factors favoring home death for cancer patients in a context of coordinated home care. A retrospective study was conducted among patients followed up by the home care coordinating unit of the cancer center of Lyon. The main endpoint was place of death. Univariate analysis included general characteristics (age, gender, rural or urban residence, disease), Karnofsky Index (KI), type of care at referral (chemotherapy, palliative care, or other supportive care), and coordinating medical oncologist (MCO) home visits. Significant factors were used in a logistic regression analysis. Of 250 patients, 90 (36%) had home death. Low KI and MCO home visit were correlated with home death (odds ratio, respectively, 2.1 and 3.1). These results indicate that health care support favors home death. A hospital-based home care unit is effective for bridging the gap between community and hospital. MCO home visits offer concrete support to health care professionals, patients, and relatives.     

Cost-effective potential for home health care

This article discusses the cost-effective potential of home health care. A forward-looking managed care system might find home health care an increasingly cost-effective bargain. Why is home health care evolving into a better locus for patient care? The home health care facilities are reducing costs and prices in response to new pressures from consumers and new methods of prospective payment.     

近10年国内外老年居家护理研究热点的对比分析

目的探讨国内和国外老年居家护理研究热点的差异,为我国老年居家护理研究提供参考。方法基于CNKI、Web of Science核心合集,检索2010年1月1日—2020年7月8日收录的国内外老年居家护理相关文献,采用SPSS、COOC等软件对检索结果进行可视化分析。结果近10年国内和国外老年居家护理共同研究热点为健康教育、家庭照顾者、生活质量、老年痴呆、社区护理、长期护理。国内和国外学者对老年痴呆、长期护理研究的侧重点不同。近10年国内外老年居家护理研究热点差异体现在护理模式、家庭功能、老年人身心健康管理等方面,国内学者多关注老年人躯体疾患管理,国外学者在居家老年人疾病管理上更注重老年人健康管理、尊严等高维度需求的满足。结论近10年国内外老年居家护理研究热点差异主要集中在护理层面,国内注重疾病护理,国外更注重高维度的心理需求与健康水平管理;提示我国学者可以开展老年人高维度需求方面的现状调研,以及满足策略的相关研究。     

美国家庭护理模式及其付费体系对我国老年家庭护理的启示

通过介绍美国家庭护理服务的定义、服务内容、服务提供者,分析家庭护理需求评估体系和费用支付系统,学习美国较为完善的家庭护理服务模式为构建我国特色的老年家庭护理服务制度提供借鉴.     

Home care nursing: professional and political issues

Concern for quality, cost, and access dominate the health care system in the eighties. State and national actions, demographic changes, and technological advances are converging to create many changes in the home care delivery system. Knowledgeable nurses can influence the evolution of home care services to assure that patients receive appropriate acute and long term home care services. Concern for quality care, changing patient needs, and availability of care are the major issues facing home care nursing in the eighties, and will continue to be into the nineties. Reimbursement policies of third party payers, medicare/medicaid regulations, state licensing, employer benefit programs, state health programs, home health care providers, professional/trade associations, and consumer advocacy groups are some of the key forces reshaping the practice of home health nurses. Knowledge of these factors will enable nurses to influence effectively the design of institutional and governmental policies which affect the care nurses deliver to patients at home.     

Information Needs in Home Care: A Review and Analysis

Before prospective payment can be implemented in home care, providers and administrators in home care agencies require information in a variety of areas. This article reviews the literature on several factors likely to influence the market for home care services, including hospital use trends, the response to diagnosis-related groups by home care agencies, proposed reimbursement patterns, patient disease and demographic profiles, and patient needs. Research must be conducted in several areas before prospective payment can be implemented in home care.     

Consistency Between Preference and Use of Long-Term Care Among Caregivers of Stroke Survivors

ABSTRACT Effective arguments have been made for the importance of expanded attention to understanding how family preferences influence decisions to choose long-term care. The effects of preference on the utilization of long-term care deserve further research, especially on a longitudinal basis. The family members of 582 first-time stroke patients from the neurology departments of four teaching hospitals in Taiwan were categorized into two groups based on their attitudes toward type of long-term care, i.e., a preference for nursing home care (n₁= 324) or a preference for home care (n₂= 258). The consistency rate between preference and utilization of the type of long-term care was estimated by the division of number of families preferring one type of long-term care by the number of families actually utilizing the services preferred. Results indicated that the consistency rate for those with nursing home preference was 8.3% while the consistency rate for those with home care preference was 94.2%. Accessibility of nursing home facilities near family residences was significantly associated with whether those preferring nursing home services actually utilized them, and the odds ratio was 20.8. The family manpower available for caregiving at home was tremendously associated with whether families utilized home care when home care was preferred; the odds ratio was 33.3. The preference for the type of long-term care was a strong predictor of the utilization when home care was preferred, yet not when a nursing home was preferred. The low consistency between preference and utilization for nursing homes preferred is due to the low accessibility of nursing home facilities in Taiwan. How to provide sufficient support to families for caregiving at home, and how to deal with the barrier of accessibility to nursing home services should be two major concerns for those who are planning and operating the long-term care system and for those trying to design institutional services and noninstitutional services as alternatives.