Factors Associated with General Hospital Nurses’ Self-evaluations of End-of-life Care Practices for Non-cancer Patients

Purpose: To elucidate the factors associated with self-evaluations of end-of-life care (EOLC) practices for non-cancer patients experienced by nurses in general hospitals. Methods: A questionnaire survey was conducted involving 1161 nurses from general hospitals. Results: Comparing the realities of 648 cancer cases with those of 306 non-cancer cases in terms of end-of-life care practices, it was found that significantly lower EOLC self-evaluation scores (on a 10-point scale), fewer instances of eliciting patients’ intentions or wishes, and fewer team discussions related to EOLC practices were observed in the non-cancer cases. (p<0.001). For each disease, pneumonia and heart disease tended to be lower. Self-evaluation of EOLC practices was consistently associated with eliciting patients’ intentions and wishes (β=0.21 for cancer, β=0.16 for non-cancer), and team discussions (β=0.25 for cancer, β=0.35 for non-cancer) for both cancer and non-cancer cases. Conclusion: General hospital nurses’ self-evaluations of EOLC practices for non-cancer patients were lower compared to those for cancer patients. It is necessary to enhance their skills in eliciting patients’ intentions and wishes and to implement a system of care for team discussion.

Integrative Review of Advance Care Planning Research in Japan

Purpose: To review the current state and discuss future direction of research related to advance care planning (ACP) in Japan. Methods: We have conducted literature search in the Ichushi, CINAHL, and Medline database between January 2011 and November 2017 using Advance Care Planning (ACP) as a keyword. Extracted research articles were further selected using the definition of ACP by Sudore et al., and reviewed using integrative review approach. Results: Majority of selected 39 articles was descriptive studies exploring general knowledge and interests about ACP and end-of-life decision making. Although the number of studies examining prevalence or strategies to implement ACP gradually increased in later years during the search period, detail information about the definition of ACP and strategies were lacking and generalizability of the studies were limited. Conclusion: ACP research in Japan is in the burgeoning phase. Clear definition of ACP in Japanese context that will guide the research and robust and scalable research examining strategies to implement ACP is urgently needed.

End-of-life care by expert clinical nurses for non-malignant chronic illness patients in genelral hospitals

This study clarified practices in end-of-life care for non-malignant chronic illness patients by expert nurses in general hospitals. Interviews with 7 chronic illness specialist nurses on practice cases were conducted, and final labels were elicited using a qualitative synthesis method（KJ method）. As patients’ conditions deteriorated, nurses defined the necessary interactions to support patients’ decision-making for living their own way of life and accompany patients and families based on their experience, and using patients’ restoration of self-esteem, sense of satisfaction, and acceptance as indices. In general hospitals, measures to cope with pain for patients not receiving life-prolonging treatment were insufficient;and while it was difficult to agree on care between medical professionals and to maintain care in other facilities, expert nurses grasped patients’ wishes on a daily basis and made arrangements for them to permeate through family and community care systems. In end-of-life care in treatment settings, it is necessary to be supportive so that the family and medical professionals can continue the patient’s care. Medical professionals who have been involved from the initial diagnosis stage need to improve their awareness and support skills as medical professionals to be involved purposefully from an early stage to the final stage.