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.     

Predicting Home and Community Walking Activity in People With Stroke

Fulk GD, Reynolds C, Mondal S, Deutsch JE. Predicting home and community walking activity in people with stroke.

Objective

To determine the ability of the 6-minute walk test (6MWT) and other commonly used clinical outcome measures to predict home and community walking activity in high-functioning people with stroke.

Design

Cross-sectional.

Setting

Outpatient physical therapy clinic.

Participants

Participants (N=32) with chronic stroke (n=19; >6mo poststroke) with self-selected gait speed (GS) faster than .40m/s and age-matched healthy participants (n=13).

Interventions

Not applicable.

Main Outcome Measures

Independent variables: 6MWT, self-selected GS, Berg Balance Scale (BBS), lower extremity motor section of the Fugl-Meyer Assessment, and Stroke Impact Scale. Dependent variable: average steps taken per day during a 7-day period, measured using an accelerometer.

Results

6MWT, self-selected GS, and BBS were moderately related to home and community walking activity. The 6MWT was the only predictor of average steps taken per day; it explained 46% of the variance in steps per day.

Conclusions

The 6MWT is a useful outcome measure in higher functioning people with stroke to guide intervention and assess community walking activity.     

Learning to Support Children With Complex and Continuing Health Needs and Their Families

PURPOSE: This paper reports on the evaluation of a pilot placement for preregistration child health nursing students focused on supporting children with complex needs in their homes. CONCLUSIONS: This type of placement can be beneficial in enabling students to develop practical skills, attitudes, and values that will assist them to provide appropriate support for this client group. The pilot placement clarified some of the major organizational and practical issues that must be considered. PRACTICE IMPLICATIONS: Developing opportunities for preregistration nursing students to learn to support children with complex needs and their families is possible and potentially beneficial.     

Evaluating Home Health Care Nursing Outcomes With OASIS and NOC

PURPOSE: To determine the sensitivity and responsiveness of the Outcome and Assessment Information Set (OASIS) and the Nursing Outcomes Classification (NOC) to the effects of home healthcare nursing interventions. METHODS: A quasi-experimental before-after study was conducted using a sample of 106 home healthcare participants referred to one of seven participating Midwest home healthcare agencies for treatment of a cardiac condition. Patient outcomes data were collected at home healthcare admission and discharge using OASIS and NOC. Nursing intervention data were collected at each visit using the Nursing Interventions Classification (NIC). Intervention intensity was calculated by totaling the number of NIC interventions provided over the episode of care. FINDINGS: Neither OASIS nor NOC were sensitive to the effects of home healthcare nursing as measured by intervention intensity. The OASIS was not responsive to clinically discernable changes in patient outcomes; while the NOC was responsive to patient status change in the outcome categories including activities of daily living, cardiopulmonary status, coping, and illness management behavior. CONCLUSIONS: Outcome measures that are more condition-specific and discipline-specific are more responsive to the effects of home healthcare nursing. Further research is needed to identify and refine outcome measures that are sensitive and responsive to the effects of nursing care in home health and other nursing settings. Clinical Relevance: The use of outcome measures that are more sensitive and responsive to nursing are more effective in guiding nursing practice.     

Two Different Primary Care Approaches for Caring for People With Dementia and Their Families

This study explored an established primary care–based dementia pathway in New Zealand (NZ) and nurse practitioner dementia diagnosis and care in 1 small United States state that has adopted a value-based delivery model. Central to the NZ model was the education of primary care providers, clear delineation of specialists’ support and referral pathways, and routine and predictable family carer respite. The US respondents reported that the essential resources necessary to support the diagnosis and management of dementia were lacking. The primary care of older adults may increasingly be provided by nurse practitioners in the US, and the structured NZ pathway offers a promising approach to adopt in the US. Potential strategies for implementation are detailed.     

Characteristics of patients who are violent to staff and towards other people from a community mental health service in South East England

Professionals working in the public sector in the UK report widespread violence towards staff working in areas such as health care, social services and education. This study compares the characteristics of patients with and without a history of violence in a large sample of patients attending a community mental health service in South East England. The data were taken from a study of comorbidity and cannabis use in a mental health trust covering a semi-rural population of 250,000 people in Harlow and the surrounding area of South East England. Key workers were interviewed using semi-structured questionnaires from the Comorbidity of Substance Misuse and Mental illness in Community Mental Health and Substance Misuse Services study. Rates of violence against health workers were more than 20 times higher among those patients with a history of violence (23.6% vs. 1%, P<0.001). Alcohol and drug use was more frequent in those who were violent. Prevalence of comorbidity, schizophrenia and personality disorders was high. Key workers' estimates suggested that there was no difference in aggression, engagement or adherence to care plan among those with a history of violence.     

外伤性截瘫病人家庭康复护理指导

通过对３５２例外伤性截瘫病人的护理，认为此类病人出院前应做好以下几方面的家庭康复护理准备：（１）加强心理护理，充分调动病人及家属的积极性，使其树立信心；（２）进行排尿机能和规律性排便训练；（３）指导功能锻炼；（４）制订家庭康复计划。     

Can the Experience of Caring at Home Affect Carers' Retrospective Evaluation of Community Care Services?

This paper investigates whether informal carers' experience of caring for their dying cancer patients at home affects their retrospective evaluation of the services received by these patients from community nurses, GPs, and the health and social services in general. Analysis was conducted on a sub-sample of the Regional Study of Care for the Dying (RSCD), a retrospective survey of family members and others who knew most about the last year of life of a random sample of people who died in 20 health districts in the UK in 1990. The sub-sample consisted of 1 858 carers of people who died from cancer (ICD, 140–208). The results showed statistically significant associations between carers' satisfaction with community nurses, GPs, and the health and social services in general and their perceptions that caring at home was a rewarding activity, and that their social activities were severely or fairly restricted. Carers' satisfaction with all providers was also more likely to have been reported by those who reported having had no need for more home help. All this suggests the importance of supporting carers to enable them to fulfil their caretaking role and to cope with caring at home. This in turn could lead to an increase in their level of acceptability of the services provided.     

The co-existence of psychiatric disorders and substance misuse: working with dual diagnosis patients

The co-existence of substance misuse and psychiatric disorders is often referred to by the term 'dual diagnosis'. The health-related problems associated with dual diagnosis has received growing attention by clinicians and researchers alike. Severely mentally ill patients who misuse drugs (prescribed and illicit) or alcohol have complex health and social needs. Mental health nurses have a key role to play in the early recognition and management of this group of patients. This paper examines the nature and extent of dual diagnosis and its implications for mental health nurses. It also addresses treatment strategies that are required to meet the needs of this cohort of patients.     

Paramedic-Initiated Home Care Referrals and Use of Home Care and Emergency Medical Services

Objective: We examined the association between paramedic-initiated home care referrals and utilization of home care, 9-1-1, and Emergency Department (ED) services. Methods: This was a retrospective cohort study of individuals who received a paramedic-initiated home care referral after a 9-1-1 call between January 1, 2011 and December 31, 2012 in Toronto, Ontario, Canada. Home care, 9-1-1, and ED utilization were compared in the 6 months before and after home care referral. Nonparametric longitudinal regression was performed to assess changes in hours of home care service use and zero-inflated Poisson regression was performed to assess changes in the number of 9-1-1 calls and ambulance transports to ED. Results: During the 24-month study period, 2,382 individuals received a paramedic-initiated home care referral. After excluding individuals who died, were hospitalized, or were admitted to a nursing home, the final study cohort was 1,851. The proportion of the study population receiving home care services increased from 18.2% to 42.5% after referral, representing 450 additional people receiving services. In longitudinal regression analysis, there was an increase of 17.4 hours in total services per person in the six months after referral (95% CI: 1.7–33.1, p = 0.03). The mean number of 9-1-1 calls per person was 1.44 (SD 9.58) before home care referral and 1.20 (SD 7.04) after home care referral in the overall study cohort. This represented a 10% reduction in 9-1-1 calls (95% CI: 7–13%, p < 0.001) in Poisson regression analysis. The mean number of ambulance transports to ED per person was 0.91 (SD 8.90) before home care referral and 0.79 (SD 6.27) after home care referral, representing a 7% reduction (95% CI: 3–11%, p < 0.001) in Poisson regression analysis. When only the participants with complete paramedic and home care records were included in the analysis, the reductions in 9-1-1 calls and ambulance transports to ED were attenuated but remained statistically significant. Conclusions: Paramedic-initiated home care referrals in Toronto were associated with improved access to and use of home care services and may have been associated with reduced 9-1-1 calls and ambulance transports to ED.     

Development and testing of the Family Caregiving Factors Inventory (FCFI) for home health assessment in Taiwan

Empathy, the ability to perceive and reason, as well as the ability to communicate understanding of the other person's feelings and their attached meanings, is held to be a core characteristic of a helping relationship. This paper examines some of the observations that motivated the authors' interest in how registered nurses learn how to offer empathy to clients. First, while empathy is crucial to all helping relationships, professional helpers do not normally offer much empathy. Second, while nurses are meant to provide helping relationships, they do not tend to show much empathy to clients. The relevance of empathy to clinical nursing and the potential consequences of low-empathy nursing for clients is considered. It will be shown that, in the past, a low level of empathy has been reported among the helping professions, including nursing, indicating that many professional helpers are not as helpful as they ought to be. While most studies of empathy in professional relationships are more than a decade old, more recent studies report similar results.     

Families, nurses and intensive care patients: a review of the literature

1. Nurses striving to give holistic care to provide quality care for their patients, need to recognize the importance of caring for patients' families. 2. A detailed review of the literature examining the relationships between nurses and intensive care patients' families was undertaken to examine its strengths and weaknesses as a basis for further study. 3. Studies show that although nurses are often in the best position to meet families' needs, their needs are not always met. 4. The building of good relationships with families is essential for nurses, and yet evidence shows that some nurses have difficulties in this area. 5. Good practice is identified and obstacles nurses face in forming relationships with families are explored. 6. Strategies for improving the interaction process between intensive care nurses and patients' families are systematically evaluated.     

Electronic Health Records in Danish Home Care and Nursing Homes: Inadequate Documentation of Care,Medication, and Consent

Background  Electronic health records (EHRs) are used in long-term care to document the patients'' condition, medication, and care, thereby supporting communication among caregivers and counteracting adverse drug events. However, the use of EHRs in long-term care has lagged behind EHR use in hospitals. In addition, most EHR research focuses on hospitals. Objective  This study gives a countrywide status of the documentation-related risks to patient safety in Danish home care and nursing homes, which are the two main providers of long-term care. Such a status provides a basis for national improvement efforts and international comparisons. Method  The study is based on the reports from 893 inspections of home care and nursing homes by the Danish Patient Safety Authority (Styrelsen for Patientsikkerhed [STPS]). Results  As much as 69% of the inspected institutions document inadequately to an extent that has led to demands (i.e., issues the institution is legally obliged to rectify) or requests (i.e., issues the institution is merely asked to rectify) from STPS. Documentation issues about the patients'' condition and care are present in nearly all institutions that receive demands (97%) and in the majority of those that receive requests (68%). Documentation issues about medication and consent to care are also common, but less so. The predominant risk to patient safety is incomplete documentation. It covers 72% of the documentation issues identified in the institutions that received demands; the remaining risks concern inconsistent (11%), nonexistent (7%), inaccessible (5%), and noncompliant (5%) documentation. The documentation inadequacies are similar for home care and nursing homes. Conclusion  Inadequate EHR documentation is a widespread problem in Danish long-term care. While previous research mainly focuses on how EHR documentation affects patient medication, this study finds that documentation issues about the patients'' condition and care are more prevalent and that issues about their consent are also common.