[Basic research in supporting the family who provides home care for their elderly people who need medical treatment at home--focusing on "uncomfortableness as judged by the utilization of the external human resource"].

The purpose of this study was to examine the use of external resource by the family caring for the elderly people who need medical treatment at home, and to discuss the methods of family support. An interview and the participatory observation were conducted to each of the 16 families, and the data were analyzed based on the Grounded Theory Approach. "Uncomfortableness as judged by the utilization of external resources" was found as a crucial factor to control the utilization of external human resources. The 3 factors that influenced the degree of uncomfortableness were also clarified. Those findings suggest that it is important to reduce the uncomfortableness stemming from the utilization of external support.

[Present situation of home care and roles of nurses at Tokyo Women's Medical University Hospital--through the 5-year home care support activities].

Diseases, details of interventions, medical cares provided and the condition of use and services of local medical institutions were investigated in the home care support activities during the period from November 1997 to March 2003. We intervened in 1,309 patients. 70% of them were terminal patients with malignant tumor. Interventions were mostly consultations about the life under medical care, guidance about HPN/tube feeding, consultations about nursing and coordination with local medical institutions. 422 of them were under care of family doctors. 502 of them used visiting nursing. 70% of the patients under care of the hospital required high-tech home care and home hospice care. The 5-year activities indicate that nurses who support home care at the hospitals providing acute medical care are expected to (1) serve as the consultation contact for patients and families, (2) support the life under medical care in consultation with internal and external related professionals, (3) use social resources, (4) serve as the contact for providing the logistic support under an emergent situation or under the lack of care-giving capabilities, (5) provide guidance for the safe use of high-tech home medical care by patients/families at the discharge, (6) communicate or coordinate with local medical institutions for continued care/nursing and (7) develop/support the flexible and convenient distribution system of medical equipment and medical materials/drugs or the 24 hour healthcare support system jointly with private enterprises.

[Present situation of home care and roles of nurses at Tokyo Women's Medical University Hospital--through the 5-year home care support activities].

Diseases, details of interventions, medical cares provided and the condition of use and services of local medical institutions were investigated in the home care support activities during the period from November 1997 to March 2003. We intervened in 1,309 patients. 70% of them were terminal patients with malignant tumor. Interventions were mostly consultations about the life under medical care, guidance about HPN/tube feeding, consultations about nursing and coordination with local medical institutions. 422 of them were under care of family doctors. 502 of them used visiting nursing. 70% of the patients under care of the hospital required high-tech home care and home hospice care. The 5-year activities indicate that nurses who support home care at the hospitals providing acute medical care are expected to 1. serve as the consultation contact for patients and families, 2. support the life under medical care in consultation with internal and external related professionals, 3. use social resources, 4. serve as the contact for providing the logistic support under an emergent situation or under the lack of care-giving capabilities, 5. provide guidance for the safe use of high-tech home medical care by patients/families at the discharge, 6. communicate or coordinate with local medical institutions for continued care/nursing and 7. develop/support the flexible and convenient distribution system of medical equipment and medical materials/drugs or the 24-hour healthcare support system jointly with private enterprises.

[Formulation of policies for promoting home medical care by a university hospital--report of planned and convened case review sessions].

It is no exaggeration to say that the linkage among the persons in various specialties, medical staff including the home doctors and visiting nurses, and those related to social welfare is essential for supporting and promoting the terminal care at home of the patients heavily dependent on medical care, as well as the patients and their families with problems in the nursing ability. Good understanding of other specialties and compensation for each other are considered to enable effective service to the patients. At our hospital, we have planned and convened case review sessions for the past two years. The sessions were proved to have the following merits that helped creation of teamwork for smoothly promoting medical care at home: 1. Persons in each specialty became able to play respective roles properly; 2. Measures to be taken were revealed, thereby inducing changes in the subsequent care; 3. The efforts made in the community could be understood and the problems to be wrestled within the hospital were suggested; 4. Smooth cooperation with visiting nurses and home doctors was achieved; 5. Nursing from a broader point of view became possible; and 6. A place for identifying problems and tasks under the present situation was provided.