RESUMEN
Reliable assessment instruments are essential for a new nursing care insurance system enacted in April 2000 in Japan, to ensure the quality of home care. We developed an assessment sheet based on a minimum data set and care assessment, previously developed by the Japan Visiting Nursing Foundation. This article describes the process of testing in practice, validation and revision of the assessment sheet and problem/need areas. One hundred and twelve subjects were initially visited in 48 home care agencies. The same nurse used the assessment sheet for the same client at the initial visit and one month later. After a refinement process, the assessment items and problem/needs areas were simplified. Documentation time for the assessment was significantly shortened. These assessment instruments help development of care plans by identifying client needs, utilization of social resources and evaluation of outcomes.
Asunto(s)
Servicios de Atención de Salud a Domicilio/normas , Evaluación de Necesidades , Evaluación en Enfermería , Garantía de la Calidad de Atención de Salud , Adulto , Anciano , Análisis por Conglomerados , Humanos , Japón , Persona de Mediana Edad , Reproducibilidad de los ResultadosRESUMEN
Incontinence is a common problem in the frail elderly. We conducted interviews focusing on urinary incontinence with 249 elderly clients in the home care setting, and studied differences of the needs among three (mild, moderate, and catheter) groups based on incontinence level. The mild group had the highest number of professional care needs, although their problems were not as serious as the other two groups. The moderate group required the highest amount of daily care by caregiver. A similar need pattern was shown in the moderate and catheter groups, while more diversified needs were required in the mild group. Portable toilet, rehabilitation, and short-stay services were frequently used in the mild group. The use of telephone consultation was the highest in the moderate group, and the use of doctor visit and bathing service were higher in the catheter group. The most important challenge was significantly different in each group: preventive efforts to maintain activities of daily living (ADL) in the mild group, interpersonal relationships in the moderate group, and infection control in the catheter group. Education was necessary for caregivers in all three groups. These findings help to project realistic care needs for each client based on his or her incontinence level.
Asunto(s)
Anciano Frágil/estadística & datos numéricos , Servicios de Atención de Salud a Domicilio/estadística & datos numéricos , Evaluación de Necesidades/estadística & datos numéricos , Incontinencia Urinaria/epidemiología , Actividades Cotidianas/clasificación , Anciano , Anciano de 80 o más Años , Análisis por Conglomerados , Femenino , Evaluación Geriátrica , Personas Imposibilitadas/clasificación , Personas Imposibilitadas/estadística & datos numéricos , Humanos , Entrevistas como Asunto , Japón/epidemiología , Masculino , Dinámica Poblacional , Enfermería en Salud Pública , Incontinencia Urinaria/clasificaciónRESUMEN
The purpose of this study is to develop "assessment guideline of family power for healthy life" aiming at expanding self-care power of family in community nursing practice. The subjects of this study covered those families in one hundred and fifty six instances that we had seized as subject for nursing care and study. The method of this study had constructed assessment guideline inductively out of each case, and modified it by applying to cases of families with health problems and others. As a result, we had formed nine items of "family power for healthy life" and three items of "conditions influencing family power for healthy life" for "assessment guideline of family power for healthy life".
Asunto(s)
Enfermería en Salud Comunitaria/métodos , Familia/psicología , Conductas Relacionadas con la Salud , Promoción de la Salud , Evaluación en Enfermería/métodos , Poder Psicológico , Autocuidado/métodos , Humanos , Investigación en Evaluación de Enfermería , Reproducibilidad de los Resultados , Autocuidado/psicologíaRESUMEN
Thanks to the advancement of medical technology, there has been a significant decline in stroke mortality in Japan. This means that many stroke victims could gain additional years of survival with several disabilities. It is necessary that nurses assist these disabled patients upon discharge for shifting smoothly from the hospital to the home. The purpose of this study was to clarify the factors of continuity of care for the disabled patients who has had a stroke, between hospital and community. The 504 patients who were discharged from the Kanagawa Prefectural Rehabilitation hospital and were in need of visiting nursing services upon their discharge were selected in this study. The survey was conducted through discharge summaries and visiting nursing reports. The data were compared at discharge with the first nursing visit with respect to the level of independence in activities of daily living (ADL) and their care needs. The results were summarized as follows: 1. As for the functional level of ADL, most patients remained unchanged. Feeding was improved; however, grooming (including bathing), using the toilet, and dressing were worse. Hence, hospital nurses should strongly educate the patients and repeat ADL so that dressing is a rehabilitation exercise itself. Also, nurses, prior to discharge, should consider dealing with the housing problems, especially in the bathrooms and washrooms, due to the patients' physical disabilities. Nurses should pay particular attention to the aged group upon the continuity of care since their level of independence in walking changed variously among individuals. 2. Hospital nurses identified nursing problems mostly in the physical aspects, whereas public health nurses did it in terms of family-caregivers and social resources rather than physical needs. The reasons why nursing problems did not correspond between hospital nurses and public health nurses were probably owing to the differences in their practice settings, job content, and working conditions between the hospital and community. Thus, both nurses should reciprocally provide one's information and introduce other's information in order to understand and employ the other's standpoints.