Factors affecting the future employment of new graduate nurses as home-visiting nurses: a cross-sectional study in Japan / Journal of Rural Medicine

Objective: In Japan, home-visiting nurse (HVN) stations are at the frontline of providing home-based medical care and end-of-life care. The nursing authorities aim to establish an education program that allows new graduate nurses to become home-visiting nurses. However, previous studies have indicated gaps in education between new graduates recently employed as HVNs and experienced home-visiting nurses. The present study further investigates the factors influencing the recruitment of new graduates as home-visiting nurses.Methods: Self-administered questionnaires were sent to 2,000 HVN stations randomly selected from the 5,565 registered home-visiting nurse stations throughout Japan. The survey covered three main areas, namely, those concerning the respondent (6 items), the home-visiting nurse station (8 items), and the nursing services provided (12 items).Results: Four of the 26 items were statistically significant, and only one of these was determined by multivariate logistic regression analysis to be an independent factor for accepting new graduates as home-visiting nurses. This factor was undergraduate home-visiting nurse training for student nurses (OR=1.916, CI=1.124–3.267).Conclusion: To increase the recruitment of new graduates as home-visiting nurses, these findings suggest that nursing schools nationwide and home-visiting nurse stations should further cooperate with the specific aim of increasing the provision of practical training at home-visiting nurse stations for pre-graduation student nurses.

Daily Life Issues of Female Terminal Cancer Patients Who Are Parenting and Living at home, and the Current Practice of Providing Support for Them / 日本プライマリ・ケア連合学会誌

Introduction: The aim of this study was to identify daily life issues of female terminal cancer patients who are parenting and living in their own home, and the current practice of providing support for them.Method: Semi-structured interviews were conducted with three visiting nurses who had experience in providing support to female patients with terminal cancer who were parenting while living at home. The data collected were categorized using a qualitative and inductive classification approach.Results: Categories related to issues included: insufficient support systems; and lack of time to provide support to satisfy the needs of both the patients and their families because of rapid progression of the disease. Categories related to the current practice of provision of support included: assistance to make home care possible when time was limited and support services were unavailable; understanding the situation the parenting patients with cancer were in and assisting their decision-making; relief of the patients' emotional and physical pain; assessing how well the family, including the children, understood the situation, and to support the family in expressing their feelings.Conclusion: This study revealed issues specific to providing support to parenting patients such as insufficient support services. Furthermore, visiting nurses were found to provide support with an understanding of the fact that the patients were parenting children.

Perspectives of Home Health Nursing Care Users and Their Nurses on User Satisfaction in A Prefecture / 日本プライマリ・ケア連合学会誌

Introduction: To clarify the gap between user satisfaction with home-visit nursing services and nurses' recognition of such satisfaction.Methods: A questionnaire survey on user satisfaction with home-visit nursing services was conducted involving 716 users and 112 nurses in charge, and the obtained data were analyzed to calculate the agreement rate between the users' satisfaction and the nurses' recognition.Results: The response rate was 61.1%. In total, 438 respondents were analyzed. Many users chose <Provision of information regarding services other than home-visit nursing> as an unsatisfactory nursing point. The percent agreement for satisfaction was 93.2%. The prevalence- and bias-adjusted kappa was 0.863. The users were satisfied and deemed so by the nurses in 92.5% of all cases, the former were not satisfied and deemed so by the latter in 0.7%, and the former were not satisfied, but they were deemed satisfied by the latter in 1.6%.Conclusion: This survey clarified nursing points not satisfying home-visit nursing service users, and the gap between users' satisfaction with these services and nurses' recognition of such satisfaction.

Quality Evaluation of Agencies for Visiting Nurses: Perspectives by Quality Surveyors Employed by the Local Government / 日本プライマリ・ケア連合学会誌

Introduction: This study examined the perspectives of quality surveyors employed by the local government regarding the quality evaluation of agencies for visiting nurses.Methods: The participants were six surveyors. We carried out semi-structured interviews concerning the quality of agencies for visiting nurses. We conducted a qualitative analysis and derived several categories inductively.Results: The surveyors found little difference in the quality between for-profit and non-profit agencies for visiting nurses. In addition, they considered the following characteristics to represent good quality agencies: "availability of home-visit nursing 24 hours per day", "information disclosure and maintenance of quality records", and "the nurse manager understands and promotes an integrated community care system".Conclusion: Eleven categories were identified for the qualitative evaluation of agencies for visiting nurses. The present findings may be used useful for maintaining the quality of agencies for visiting nurses.

Disaster Preparation of Visiting Nurses in Public Health Centers / 한국간호교육학회지

PURPOSE: The purpose of this study was to identify the factors influencing personal disaster preparation and disaster nursing core competency among visiting nurses in public health centers. METHODS: A descriptive survey study was adopted. A convenience sample was taken from 277 subjects in three regions. Data were analyzed by descriptive statistics, t-test, ANOVA, correlation, Pearson correlation coefficient and multiple regression. RESULTS: The mean personal disaster preparation and disaster nursing core competency scores were 11.13 and 76.87, respectively. Personal disaster preparation was statistically significant by experience of disaster victims and disaster management guideline. Disaster nursing core competency was statistically significant by participation in future disaster recovery. As a result of multiple regression analysis, personal disaster preparation accounted for 14.9 of the variance by experience of disaster victims and disaster management guidelines; disaster nursing core competency accounted for 8.9 of the variance by perception of disaster nursing. CONCLUSION: Although visiting nurses are ill-prepared for disaster, global natural and man-made disasters can occur regardless of time and place. Disaster education and training should therefore be included in nurses' fundamental education.

Utility of Autism Spectrum Disorder Screening Tools Using Network of Community Home Daycare Center Visiting Nurses / 정신간호학회지

PURPOSE: The purpose of this study was to explore the utility of autism spectrum disorder (ASD) screening tools using community network of home childcare center visiting nurses. METHODS: The design of this study is multilevel survey to find the ASD using modified checklist for autism in toddlers (M-CHAT) for first screening by childcare teachers, checklist for autism in toddlers (CHAT) for secondary screening by nurses, Autism diagnostic observation schedule (ADOS) and Autism diagnostic interview revised (ADI-R) for final diagnosis by pediatric psychiatrists. RESULTS: In first screening by using M-CHAT, 61 subjects(0.56%) were detected among 8,926 subjects. Among the first screened 61 subjects, 13 subjects were exempted for normal finding in CHAT. 24 subjects consented participation for final diagnosis and 23 of them were diagnosed ASD. CONCLUSION: In conclusion, M-CHAT and CHAT were verified their utility as screening tools for ASD in the community and the community health networks as a childcare visiting nurses can be useful network in early detection and referral of ASD.

A Survey on Visiting Nurses' Management for Elders with Cognitive Impairment Living in a Community: Focused on Health Centers in a Metropolitan and Medium-sized Cities / 산업간호학회지

PURPOSE: The purpose of this study was to investigate the status and characteristics of visiting nurses' management for elders with cognitive impairment living in a community focused on health centers in a metropolitan city and five medium-sized cities. METHODS: Data were collected from 47 visiting nurses working in a metropolitan city and 47 visiting nurses working in five medium-sized cities from November to December 2012. RESULTS: There were no statistically significant differences in knowledge, attitudes, and nursing behaviors of cognitive impairment between two groups (F=2.13, p=.148; F=3.64, p=.060; F=0.28, p=.595). Among the elders referred to a physician in a metropolitan city by visiting nurses, 42.4% were diagnosed as mild cognitive impairment and 15.2% were diagnosed as severe dementia. The major intervention programs which visiting nurses currently applied for elders were medication and exercise intervention programs, and the intervention programs which they would want to apply in the future were playing, music and recall intervention programs. CONCLUSION: The cognitive impairment screening test can be done effectively by visiting nurses. This study also suggests to develop various kinds of intervention programs to improve cognitive function for elders living in a community.

A Survey on Visiting Nurses' Management for Elders with Cognitive Impairment Living in a Community: Focused on Health Centers in a Metropolitan and Medium-sized Cities / 한국직업건강간호학회지

PURPOSE: The purpose of this study was to investigate the status and characteristics of visiting nurses' management for elders with cognitive impairment living in a community focused on health centers in a metropolitan city and five medium-sized cities. METHODS: Data were collected from 47 visiting nurses working in a metropolitan city and 47 visiting nurses working in five medium-sized cities from November to December 2012. RESULTS: There were no statistically significant differences in knowledge, attitudes, and nursing behaviors of cognitive impairment between two groups (F=2.13, p=.148; F=3.64, p=.060; F=0.28, p=.595). Among the elders referred to a physician in a metropolitan city by visiting nurses, 42.4% were diagnosed as mild cognitive impairment and 15.2% were diagnosed as severe dementia. The major intervention programs which visiting nurses currently applied for elders were medication and exercise intervention programs, and the intervention programs which they would want to apply in the future were playing, music and recall intervention programs. CONCLUSION: The cognitive impairment screening test can be done effectively by visiting nurses. This study also suggests to develop various kinds of intervention programs to improve cognitive function for elders living in a community.

The Relation between Interpersonal Attitude and Communication Competence of New Visiting Nurses in Community Health Center / 한국직업건강간호학회지

PURPOSE: This study was to identify the relations of interpersonal attitude and communication competence of new community health nurses. METHODS: The research design was a correlational study. The data were collected from 136 visiting nurses using a structured questionnaire and analyzed using independent t-test, Pearson's correlation coefficient, and multiple regression with the SPSS/WIN 20.0 program. RESULTS: The type of interpersonal attitude in subjects was I+U+ and the score of communication competence was 3.6. Among 15 sub-dimensions, the highest score was responsiveness and the lowest was assertiveness. There were no significant differences in communication competence by general characteristics. Factors influencing on communication competence in new visiting nurses were interpersonal attitude I+(I am OK) (beta=.34) and I-(I am not OK) (beta=-.28). CONCLUSION: Education program, stressing the self-awareness, is necessary to increase positive interpersonal attitude and communication competence for reemployment of community health nurses. Furthermore, in order to reinforce assertiveness, institutional support should be accompanied with the efforts of individual level.

A Study on Occupational Satisfaction and Stress of Visiting Nurses at District Health Centers in Chungnam Province / 산업간호학회지

PURPOSE: The purpose of this study is to identify visiting nurses' occupational satisfaction and their stress who are working at district health centers in Chungnam province. METHODS: The subjects of the study were 109 visiting nurses of 16 district health centers in Chungnam province. The data were collected by self report questionnaires from March 1 to 31, 2010. The data were analyzed by Cronbach's alpha, t-test, ANOVA (Sheffe's test), and correlation coefficient using the SPSS program. RESULTS: The results of this study were as follows. The occupational stress level of the subjects was 46.7 and the level of subjects' occupational satisfaction was 2.46. There was a significant negative correlation between occupational satisfaction and occupational stress (r=-.627). CONCLUSION: The occupational stress level of the subjects, and stress levels of 'work environment,' 'job insecurity' and 'organizational structure' were higher than those of the Korean women workers' standard. The level of subjects' occupational satisfaction was lower than that of the nurse practitioners. There was a significant correlation among occupational stress and 'burden of workload' and 'visiting nurse career'. The study showed that occupational stress was correlated with occupational satisfaction. The results suggest that further follow-up study on visiting nurse is necessary to relieve their occupational stress and increase occupational satisfaction.

Cost-benefit Analysis of Home Visiting Care for Vulnerable Populations with Hypertension

PURPOSE: This study was to investigate the effect of home visiting care service and to evaluate the effect from the cost-benefit perspective. METHODS: Target participants were enrolled in 2007~2008 for home visiting care and provided with a home visiting nursing service for more than 18 months in J Ward of S City. Of 391 participants, 244 who satisfied the inclusion criteria were used in the final analysis. Cost-benefit analysis was done using the net benefit and benefit/cost ratio. RESULTS: After providing the home care nursing service, the blood pressure control rate increased from 50.8% to 75.4%. Of the subjects, 39.8% maintained their blood pressure level within the target range. As a whole, the net benefit of home visiting care per person ranged from 434,964.86 to 447,112.43 won and the benefit/cost ratio ranged from 2.82 to 2.84. CONCLUSION: Home visiting care for vulnerable populations with hypertension was effective in both maintaining blood pressure and reducing blood pressure to the target range. Therefore these results are especially useful for establishing the value of home visiting services for policy makers as well as for prioritizing vulnerable populations.

Cost-benefit Analysis of Home Visiting Care for Vulnerable Populations with Hypertension

PURPOSE: This study was to investigate the effect of home visiting care service and to evaluate the effect from the cost-benefit perspective. METHODS: Target participants were enrolled in 2007~2008 for home visiting care and provided with a home visiting nursing service for more than 18 months in J Ward of S City. Of 391 participants, 244 who satisfied the inclusion criteria were used in the final analysis. Cost-benefit analysis was done using the net benefit and benefit/cost ratio. RESULTS: After providing the home care nursing service, the blood pressure control rate increased from 50.8% to 75.4%. Of the subjects, 39.8% maintained their blood pressure level within the target range. As a whole, the net benefit of home visiting care per person ranged from 434,964.86 to 447,112.43 won and the benefit/cost ratio ranged from 2.82 to 2.84. CONCLUSION: Home visiting care for vulnerable populations with hypertension was effective in both maintaining blood pressure and reducing blood pressure to the target range. Therefore these results are especially useful for establishing the value of home visiting services for policy makers as well as for prioritizing vulnerable populations.

Effects of Low Intensity Exercise Program with Telephone Coaching on Physical Fitness in the Elderly Served Home Visiting Nursing Care / 기본간호학회지

PURPOSE: The purpose of this study was to determine the effects of low intensity exercise program with telephone coaching on the physical fitness of elderly people who are receiving home visiting nursing care. METHOD: This study was conducted using a non-equivalent control group pretest-posttest design. The participants were 61 elders. Elders (34) in the experimental group performed low intensity exercise and of these 16 received telephone coaching. The low intensity exercise program consisted of stretching, muscle strengthening with an elastic band, massage, and ball exercise, five days a week, for sixteen weeks. Data were collected from July 2007 to December 2007. chi-square-test, ANCOVA with SPSS WIN 11.0 program were used to analyse the data. RESULTS: There were statistical differences in the right grasping power in the right hand (p=0.021), Raising behind of right arm (p=0.006), Raising behind of left arm (p=0.007). CONCLUSION: These results indicate, that a low intensity exercise program with telephone coaching can help improve physical fitness in elders receiving served home visiting nursing care.

Evaluation of Cognitive Functions, Depression, Life Satisfaction among the Elderly Receiving Visiting Nursing Services / 간호학회지

PURPOSE: The purpose of this study was to examine cognitive functions, depression, and life satisfaction among the elderly receiving visiting nursing services. METHODS: The subjects of this study consisted of 221 elderly individuals who were receiving visiting nursing services from a public health center located in Gyeonggi-do. The Mini-mental State Examination Korea version (MMSE-K), Geriatric Depression Scale-short form-Korea version (GDS-K), and Life Satisfaction Scale were utilized to determine cognitive functions, depression, and life satisfaction. Collected data was analyzed by the SPSS PC Win 12.0 program. RESULTS: The prevalence of cognitive impairment (MMSE-K or =10) was 22.6%. Older age, lower education, and low income were associated with cognitive impairment, and low education, no religion, and low income were associated with depression. Cognitive function negatively correlated with depression. Life satisfaction level was fairly low and was not associated with any variables. CONCLUSION: The high prevalence of cognitive impairment and low life satisfaction status were determined among low-income elderly who were registered at a visiting health care center. Thus, in the future at visiting health care services, efficient and various programs for the elderly should be tried, to improve cognitive functions and reduce depression. Additionally, consistent evaluation studies for those programs will be required.

Economic Evaluation of Visitng Nurse Services for the Low-income Elderly with Long-term Care Needs / 간호학회지

PURPOSE: This study aimed to evaluate economic viability of public health center visiting nurse services for the low-income elderly with long-term care needs. METHOD: The sample consisted of 252 community dwelling elderly who enrolled in public health center visiting nurse services for three months or more. Data was collected on physical (ADL and IADL) and cognitive impairments of the elderly, contents and frequency of visiting nurse services, cost per visit, and costs of alternative services for long-term care. RESULT: The mean score of ADL and IADL levels of the elderly was 2.80.4904, which indicated these patients were mostly independent. Eighty four percent of the elderly subjects were cognitively intact. Among visiting nurse services supplied, providing assessment was 34%, followed by education and counseling 26%, medication 22%, and referral. The mean cost per visit was 17,824.1 won, which transformed into a total cost per person per year of 161,130.2 won. Comparing the cost of a visiting nurse service with those of other long-term care alternatives, the visiting nurse service was the least costly alternative, followed by an outpatient clinic, hospital based home care, and nursing home. CONCLUSION: Overall, the results of the study provide evidence of the economic viability of visiting nurse services for the low-income elderly among long-term care alternatives.

A Workload Analysis of a Visiting Nursing Service based on a Health Center in Seoul / 간호학회지

PURPOSE: This study focused on analysing the workload of visiting nurses based on a health center. METHOD: A Prospective descriptive analysis of self-records for workload data from 115 visiting nurses during 4 weeks was done. In addition, a cross-sectional analysis of linked data to grasp the priority of visiting nursing services from 155 visiting nurses at the 25 health centers in Seoul. RESULT: Time allocation that was performed on all nursing workload of visiting nurses was identified as follows: First, the inside workload of the health center took up 60% of all visiting nurse activities. Second, providing direct nursing care(caseload) took up 25%. Third, outside nursing activities excluding the caseload provided in the health center took up 15% of all working time. Fourth, the core works to have a high priority among visiting nursing activities were family health assessment, planning and evaluation of a visiting nursing program, personal health assessment, and so forth. CONCLUSION: The workload of a visiting nurse suggests that the caseload of visiting nurses in a health center needs to be increased. Also, our results will contribute to baseline data used to establish a proper visiting nurses infrastructure based on the demand of visiting nursing services.

Development of Database System for Community Based Home Care in Health Center / 대한의료정보학회지

The purpose of this study was to develop a database system for visiting nurses working in a community health center. The final goal of the system is for it to be used as a nationwide database-collecting tool over the Internet for community health services. Three unique systems were developed and trialed. The first system focused on the data warehousing technology as a research centered system for a theory based database construction. The second system was a local system, which has already been utilized in a proactive health center, and had the system interface revised according to the newly developed standardized framework of the service. The third system was part of the integrated community health information system, which had the goal of general dissemination. It is clear that these systems reflect the unique characteristics and goals of the test sites, and should be supported for the Systems Life Cycle to survive. The authors plan to move to the next stage of developing an integrated nationwide health information system for community health services.

Development of Database System for Community Based Home Care in Health Center / 대한의료정보학회지

The purpose of this study was to develop a database system for visiting nurses working in a community health center. The final goal of the system is for it to be used as a nationwide database-collecting tool over the Internet for community health services. Three unique systems were developed and trialed. The first system focused on the data warehousing technology as a research centered system for a theory based database construction. The second system was a local system, which has already been utilized in a proactive health center, and had the system interface revised according to the newly developed standardized framework of the service. The third system was part of the integrated community health information system, which had the goal of general dissemination. It is clear that these systems reflect the unique characteristics and goals of the test sites, and should be supported for the Systems Life Cycle to survive. The authors plan to move to the next stage of developing an integrated nationwide health information system for community health services.