[Findings from Actual Situation of Cooperation between Discharge Nurses and Home-Visiting Nurses from Shifting to Home Care through Terminal Phase in Terminal Cancer Patients].

We conducted questionnaire surveys focusing on the"actual situation of cooperation between discharge nurses and homevisiting nurses etc. from transition to home-care through the terminal phase in terminal cancer patients."As a result,discharge nurses were employed at acute-stage hospitals to practice discharge adjustment. Medical staff in home care and home care workers continuously supported the patients and their families in managing difficulties such as changes in pathological conditions and care-related anxiety after the patient was discharged. Amidst these efforts,over 80% of home-visiting nurses thought that there was some disagreement about the understanding of pathological conditions between the hospital medical staffs and the patients/their families while shifting to home care(immediately after shifting to home care). It was also clarified that the informed consent for and instructions regarding discharge according to individual patients and families were insufficient.

[Ways to make cooperation between hospital nurse and home visiting nurse in treating a final stage cancer patient at home].

Due to a payment system based on Comprehensive Medical Evaluation has been adopted, both a shorter hospitalization and the use of home nursing care have been increasing. A good cooperation between hospital and home visiting nurses is desired in order to transfer continued nursing. Regarding a home nursing care service for the most terminal cancer patients, we conducted a survey of 459 home visiting nurses with twelve questions in five categories: (1) Before transferring to home care, (2) Right after the transfer to home care, (3) Patient in a stable period, (4) Time of near death and (5) Other (Requests to hospital nurses). The following issues became clearer in terms of how hospital and home visiting nurses should be cooperating with the handling of last stage terminal cancer patients: (1) A home visiting nurse should have a coordinating role with a hospital nurse when the patient is discharged from the hospital. (2) A participation of home visiting nurses on the coordination guidance at the time of a patient discharge is influenced by a manpower of the nursing station. (3) Even though home visiting nurses found a discrepancy between the hospital information and what patients and their families were getting from the hospital, home visiting nurses have learned through the job to clarify what patient and family needs were, and they responded accordingly. (4) A coordination between hospital and home visiting nurses was needed quite often when the patient's time has come to die at home.

[Questionnaire survey for doctors in the area of cooporation efforts when a terminal cancer is transformed to home medical care].

In order to smoothly transform a terminal cancer patient from hospital to home medical care, we surveyed based on questionnaires to examine doctor's roles of each primary and regional hospitals and its cooperation among the hospitals. We established two types of questionnaires for two groups, a primary doctor group and a regional doctor group, and distributed and collected them. A total of 123 doctors (35 primary doctors and 88 regional doctors) responded out of 185 doctors, and the collection rate was 66.5%. The survey result indicated that there were significant differences among the primary and regional doctors in evaluating patient's family members for understanding of the patients disease at the time of discharge, how to give a treatment to the patient, alleviating patient's disease conditions and a mental support given by doctor to family members from the hospital. Meanwhile, about 70% of regional doctors answered that family members had some sort of anxieties during a night and at the time of emergency to care the patient. It also revealed that about 70% of regional doctors had experienced troubles in coordinating with a primary hospital. On the other hand, 62% of primary doctors answered that they always provided necessary care to the patient at the time of emergency. In providing a safe and a high degree of QOL in home medical care settings, it is important to have specific common purposes among the two groups of doctors and patients. Furthermore, the primary and regional doctors have to be cooperative, specify duty roles when the patient is transformed to home medical care, and to have ways to accomplish mutual common goals for patients.

[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.