Awareness and Difficulties of Nurses in the Outpatient Setting of University Hospital A, Which Provides Advanced Acute Care / 日本プライマリ・ケア連合学会誌

Introduction: The purpose of this study was to clarify the awareness and difficulties of home care support in outpatient nursing at an advanced acute care hospital.Methods: An anonymous questionnaire survey of outpatient nurses at a university hospital was conducted using a detention method.Results: In total, 195 questionnaires were analyzed (effective response rate: 89.9%). The number of years of outpatient nursing experience was within 1 to 3 years for 40%, being the highest. Regarding the importance of outpatient care in supporting home care, approximately 97% of the subjects answered that they 'always think' or 'sometimes think' that it is important. On the other hand, approximately 50% of subjects answered that they 'always' or 'sometimes' perform home care support. Eight difficulties in outpatient home care support were identified: [insufficient manpower], [shortage of time], [difficulties in understanding which patients need home care support], [lack of knowledge], [difficulties in in-hospital and community collaboration], [support not keeping up with current medical change], [number of outpatients], and [time-consuming support].Conclusion: It is necessary to improve the individual skills of outpatient nurses in order to provide seamless medical care and systematically improve the outpatient nursing system, including streamlining work, and facilitating in-hospital and community collaboration.

Circumstances of Patients with Amyotrophic Lateral Sclerosis Transferred to Other Hospitals after Emergency Hospitalization and Challenges in Post-Discharge Support / 日本農村医学会雑誌

　　The purpose of this study was to elucidate the circumstances of patients with amyotrophic lateral sclerosis who were emergently admitted to hospital and to examine problems associated with discharge and transfer. We reviewed medical records for 3 years and identified 4 home discharged patients and 8 hospital transfer patients who had been urgently admitted to the neurology ward of Hospital A. Mean hospital stay was 77 days. All patients received 24-h noninvasive positive pressure ventilation immediately after hospitalization. After a mean 31 days of hospitalization, patients chose medical treatments and/or treatment facilities. Three patients changed to tracheostomy positive pressure ventilation and 2 patients opted for tracheostomy. Four patients had disagreements with their families and needed time to resolve their differences. Between 1 to 6 hospitals were asked to accept each patient for transfer. Decisionmaking about initiation of medical treatment for respiratory failure needs to done in the early stages of illness. Healthcare providers need cooperation between in-hospital and community services and must demonstrate excellent assessment skills to recognize the progression of illness and the patient’s acceptance of illness. In addition, it is essential that healthcare providers possess special support skills when patients are transferred from intermediate institutions to home care.

Circumstances and Challenges in Home Care-oriented Hospital Nurse Training: Using Group Interviews for Nurses Who Engage in Hospital Nursing Administration / 日本プライマリ・ケア連合学会誌

<p><b>Objective: </b>This study aimed to clarify the circumstances and challenges in home care-oriented hospital nurse training on the basis of results of hospital nurse self-evaluations of nursing activities implemented in preparation for home care.</p><p><b>Methods: </b>Group interviews were conducted with 13 nurses at 9 different hospitals, and the results were qualitatively and inductively analyzed.</p><p><b>Results and Discussion: </b>Six categories for actual nursing activities implemented in preparation for home care were extracted. These categories were "I leave home care to other medical professionals," "No form of inter-hospital cooperation has been established," "There is disparity in cooperation with home-visiting nurses," "Social resources are not being used due to a lack of knowledge," "Able to develop a perspective of home care through workshop participation, years of experience, and interest," and "Competency is lacking despite knowledge of home care." Home care was apparently not being utilized by hospital nurses due to a lack of knowledge of social resources and a lack of interdisciplinary cooperation.</p><p><b>Conclusions: </b>Challenges in nurse training implemented in preparation for home care included compensating for the lack of practical knowledge of social resources and devising a duty system and inter-facility exchanges to allow nurses to build experience in other areas and departments. The results of this study suggested the need for organizational training initiatives and for improvement of the quality of individuals in order to put acquired knowledge into practice.</p>

Challenges Based on Current Status with the Activities of Public Health Nurses Supporting Individuals with Intractable Neurological Disease in Prefecture A / 日本プライマリ・ケア連合学会誌

Objectives : Under the rapidly changing healthcare and social environments of individuals with an intractable disease, we identified the current status of supportive activities provided by public health nurses, and challenges in the implementation of seamless support and in the improvement of the quality of support provided by public health nurses. <br>Methods : A questionnaire survey was conducted by mail among public health nurses stationed at public health centers in Prefecture A, who work with patients with intractable diseases. <br>Results : The public health nurses surveyed had diverse experiences as to support and clinical care for intractable disease patients, and were in charge of a varying number of such patients within the territory covered by their respective public health stations. As far as knowledge and skill were concerned, not a few public health nurses answered that they were unfamiliar with home mechanical ventilation. They answered that they had experienced difficulties in most aspects of daily practice. Regarding mental health, 50-70% of the public health nurses had experienced difficulties in dealing with patients and their families, and with other healthcare professionals. <br>Conclusion : Our results suggest that the following main measures are needed to improve the quality of support by public health nurses for patients with intractable neurological diseases: (1) mutual support regarding knowledge and skill among nursing professionals; (2) care in maintaining the mental health of public health nurses; (3) a thorough review of the standard practices and methods of education for public health nurses; and (4) promotion of personnel development focusing on the cultivation of specialized nurses.

The effects of off–campus classes for students in a school of health sciences / 医学教育

In Japan, community–based education remains uncommon in undergraduate programs for students in schools of health sciences. The purpose of this study was to examine how students are affected by their participation in off–campus classes, which are considered as a main course of community–based education at the School of Health Sciences, Gunma University.<br>1)Reports submitted by students after participating in off–campus classes were broken down into sentences (with care being taken that each sentence made sense). The extracted sentences were carefully consolidated by means of the Kawakita Jiro method (affinity diagram).<br>2)A total of 972 sentences were extracted and were categorized into 3 categories: "enjoy going out to the community," "increased activity through experiences," "awareness of what one wants to be and one's insufficient abilities." Five middle–sized categories and 10 small categories were obtained.<br>3)Experiences in off–campus classes are expected to increase the activity of students and to have synergic effects with on–campus classes.<br>4)Community–based education might be effectively included in undergraduate programs for students in schools of health sciences.