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

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.

Factors influencing decision-making ability of the patient receiving home medical care.

BACKGROUND: Patients' decision-making ability is a substantial barrier to end-of-life conversations with doctors. This study aimed to examine factors influencing this ability. METHODS: Altogether, 914 doctors from Japanese home care supporting clinics providing home medical care as of February 2019 participated in this study. Data were collected through an anonymous mailed survey between April and May 2019. RESULTS: Stepwise multiple linear regression analysis of factors influencing patients' decision-making ability revealed the following significant factors: (a) independence level in the daily life of older adults with dementia (B: -0.52), (b) disease name (B: 0.20), and (c) family structure (B: 0.12). CONCLUSIONS: Patients' decision-making ability regarding conducting end-of-life conversations with doctors was characterized; thus, (a) they did not have cognitive impairment, (b) they had cancer, and (c) they lived with a spouse.

Qualities required for new graduate visiting nurses: A qualitative study.

BACKGROUND: The qualities required for new graduates to become visiting nurses remain unclear. The present study aimed to clarify the qualities required for new graduate visiting nurses. METHODS: Semi-structured interviews were conducted with nine home-visiting nurses. Content analysis was conducted by the transcribed data collected from visiting nurses. RESULTS: Years of nursing experience were ranged from 16 to 50. In total, 23 attributes were extracted and categorized. CONCLUSION: Our findings indicated that the qualities required for new graduate visiting nurses were as follows: basic knowledge and skills required as professionals and appropriate attitudes as members of society.

[Medical Home-Care Support Activities by Clinics in Japan: Developments Since 2008].

The purpose of this study is to investigate the comparative changes over time of the home care supporting clinics(HCSCs) in each of the 4 Secondary Medical Areas within Mie Prefecture. There were 129 HCSCs activity reports in 2008, and 170 in 2014. The number of patients and the number of deceased patients have increased in Mie Prefecture. These findings suggest that improvements in the home-care staff recruitment system should be further expanded throughout Mie Prefecture and, in particular, the quality improved in the Higashi-Kishu area.

[Perspectives of Japanese home care supporting clinics in Tokyo on the conditions needed to continue home care].

We examined the conditions that had to be met to continue home care according to Japanese home care supporting clinics from Tokyo's perspective. Aspects of the conditions for continuing home care were as follows: 1) enhanced partnerships with the hospital and home-visit nursing stations, 2) a reduced burden on 24-hour-a-day home care, 3) promotion of training and education of medical personnel in the home care setting, 4) training and education of caregivers to provide direct care to the patient, and 5) reduced caregiver burden.

[Analyses of the activities of home care supporting clinics in Tokyo from the standpoint of place of death].

We examined the activities of home care supporting clinics (HCSC) in Tokyo, Japan, from the standpoint of the place of death. The number of HCSCs in Tokyo was 1,246 in 2010. Fifteen HCSCs cared for > or = 50 patients who died at home in a year. In contrast, the 19 HCSCs in the top 10 percentile for the number of patients (> or = 176) did not have any patients who died at home. Their patients died at hospitals or facilities. These results suggest that the activities of HCSCs in Tokyo are diverse.

[Applicability of the scale for measuring the quality of end-of-life home-care services provided by home-care supporting clinics in Japan(HCSC-J)].

We examined the applicability of the home-care supporting clinics in Japan(HCSC-J)scale to measure the quality of home-care services provided by HCSC. We conducted an anonymous mailed survey of 349 bereaved family members who received home-care services in 23 wards of HCSC in Tokyo, Japan. Of 143 responders, 77(clinic A: 44; clinic B: 33)were finally evaluated. The total scores of the HCSC-J subscale revealed a significant correlation with the overall assessment of home care. Our results suggest that the HCSC-J scale is effective for measuring the quality of home-care services of HCSC in Japan.

Trends associated with Home Care Supporting Clinics (HCSCs) in Japan.

AIM: HCSCs were introduced in Japan in April 2006 with the aim of playing a central role in providing end-of-life care at home. However, it is unclear how the HCSCs are operated because statistical data regarding their activities have not been disclosed to the Japanese public. The purpose of this study was to describe the trends associated with the HCSC activity in Tokyo, Japan. METHODS: We submitted an application to the relevant government ministry to disclose the annual activity reports from 2008 to 2010 of the HCSCs located in Tokyo. Reports from each HCSC contained information on the number of patients, the number of deceased patients, their place of death and the number of home visits by physicians and nurses. RESULTS: The number of HCSC activity reports for each year was 1166 (2008), 1209 (2009) and 1246 (2010), while the total number of patients for each year was 67,765 (2008), 67,094 (2009) and 83,486 (2010). Patients who died at home each year under the care of HCSCs was 4431 (2008), 4786 (2009) and 5234 (2010). It is of note that in 2010 about 87% of patients were cared by HCSCs that cared for >50 patients a year and as many as 26.9% of patients who died at home utilized clinics that cared for >50 deceased patients a year. CONCLUSION: The advent of HCSCs caring yearly for >50 patients and deceased patients has led to a shift in the location in which patients receive end-of-life care.

[Yearly change of the relationship between the place of death and activity of home care supporting clinics in Tokyo, Japan].

We examined a yearly change of the relationship between the place of death and the activity of home care supporting clinics(HCSC)in Tokyo, Japan. The number of HCSCs by the Japanese Ministry of Health, Labor and Welfare has edged up slightly from 1, 166 in 2008 to 1, 246 in 2010. The number of total patients provided the care by HCSC has increased by 24. 4% from 2009 to 2010. There was a 9. 3% increase in the patients provided the care by HCSC, and died at home from 2009 to 2010. These results suggested that the home care support system has proceeded gradually in Tokyo, Japan.

Factors influencing home death in a Japanese metropolitan region.

To examine factors influencing home death, an anonymous survey was mailed to 998 home care supporting clinics (HCSCs) in the 23 wards of Tokyo, Japan. We classified the HCSCs into two types (single physician practice and multiple physician practice) and identified factors of each type of practice that predict home death. The factors associated with a greater probability of dying at home were as follows: in the multiple physician practices, collaboration with hospitals and teaching coping skills to the family members and, in the single physician practices, collaboration with clinics. Our findings suggest that home end-of-life care services are unlikely to be achieved without cooperation among service providers and without improvement of the family members' coping skills.

Characteristics of home care supporting clinics providing home care for frail elderly persons living alone in Japan.

To explore the characteristics of home care supporting clinics providing home care for frail elderly persons living alone (EPLA), a self-administered questionnaire was mailed to 998 home care supporting clinics in the 23 wards of Tokyo, Japan between July and August 2009. Clinics providing home care for the frail EPLA significantly collaborated with 4 or more home visit nursing stations (42.5%) and 4 or more care managers (58.7%) and had sufficient medical care equipment, such as an oxygen inhaler, ventilator, and intravenous hyperalimentation. Sixty-one percent of the clinics which provided care for the 18 patients who died at home collaborated with 4 or more care managers. Our findings suggest that the factors enabling home care for frail EPLA are as follows: (1) collaboration with care managers, (2) collaboration with home visit nursing stations, (3) sufficient medical care equipment.

[Relationship between the activity of home care supporting clinics and the place of death in Tokyo, Japan].

We examined the relation between the activity of home care supporting clinics and the place of death in Tokyo, Japan. Of 1,209 clinics certified home care supporting clinics by the Japanese Ministry of Health, Labor and Welfare, 9.1% were not functioning for a year and 34.7% of them did not deal with patient's home death. Of patients who died at home, 64.3% utilized home care supporting clinics which dealt with 11 or more patient's death at home per year.

Importance of end-of-life support to minimize caregiver's regret during bereavement of the elderly for better subsequent adaptation to bereavement.

This study examined whether the quality of end-of-life home medical care affected caregiver's psychological recovery from bereavement. We analyzed survey responses from an anonymous self-administered questionnaire from 147 bereaved family members (caregivers). Questionnaire content included information on the quality of end-of-life home medical care, feelings during bereavement and present feelings. Results showed that caregiver regret during bereavement was significantly associated with present feelings about loss regardless of the length of time after death of a loved one. Aspects of end-of-life support that were statistically significant at minimizing regret during bereavement were: (1) fulfilled home medical care service system, (2) peaceful death of the patient, and (3) providing direct care by the caregiver. These findings suggest that end-of-life support to minimize caregiver regret during bereavement was crucial for better subsequent adaptation to bereavement.

Factors enabling home death of the elderly in an institution specializing in home medical care: analysis of apprehension of the bereaved family.

AIM: To determine the factors enabling home death despite caregiver apprehension about home medical care. METHODS: This study was an anonymous mailed survey of bereaved family members (the caregiver) of patients who died in a home medical care setting provided by an institution specializing in home medical care in Japan (home death rate, approximately 80%). We analyzed the relationships between caregiver apprehension about home medical care, overall satisfaction with home medical care and the place of death. RESULTS: Higher caregiver apprehension about home medical care and lower overall satisfaction with home medical care were significantly associated with dying in a hospital. In addition, the home death group with apprehension about home medical care significantly rated higher overall satisfaction with home medical care than the hospital death group. Meanwhile, there was no difference in the overall satisfaction with home medical care between those with or without apprehension about home medical care in the home death group. Factors influencing overall satisfaction with home medical care in the home death group with apprehension about home medical care were: (i) being free from pain or symptoms (partial regression coefficient: 0.83); and (ii) fulfilled medical care service system (partial regression coefficient: 0.40). CONCLUSION: These results suggest that caregiver satisfaction with home medical care is an essential factor to enable home death of the patient despite the caregiver apprehension about home medical care.

[Factors influencing the death of the elderly at home in an institution specializing home medical care--analysis of survey of the bereaved family].

AIM: To determine factors influencing on the death of the elderly at home in an institution specializing in-home medical care (home death rate: about 80%). METHODS: This study was an anonymous mailed survey of bereaved families of patients (the caregivers) who died using the home medical care setting provided by an institution specializing in home medical care in Japan. We analyzed the relationship of demographics of the patients and the caregivers with such factors as the anxiety of the caregiver and eventual death at home, and that of such factors as perceived quality of home medical care by the caregiver, and satisfaction with home medical care, satisfaction with death bed nursing, regret for death bed nursing. RESULTS: The most significant determinant factor associated with home death was that both patients and caregivers preferred death at home (OR=19.42). Determination coefficients (R(2)) in the multiple linear regression analysis of caregiver's satisfaction with home medical care, satisfaction with death bed nursing and regret for death bed nursing were as high as 0.68, 0.55 and 0.62, respectively. Significant influential factors were: peaceful death, psychological consistency of the caregiver, a good relationship with one's physician and fulfillment of the care service system. CONCLUSIONS: Important components of home medical care and death bed nursing for the realization of death of the elderly at home are 1) peaceful death, 2) psychological consistency of caregivers, 3) a good relationship with one's physician, 4) fulfillment of the care service system.