Asunto(s)

RESUMEN

The purpose of this study was to identify the characteristics of home care of patients with intractable neurological diseases. A survey was conducted of members of Tokyo Medical Association who were home visit doctors. They responded to questions about their patients who have suffered from either Parkinson's disease (PD), spinocerebellar degeneration (SCD), or amyotrophic lateral sclerosis (ALS), and whose home care have been supported by the care system for at least three months. Of 205 survey questionnaires collected, 198 were effective to be analyzed. The sample consisted of 105 patients with PD (53.0%), 63 patients with SCD (31.8%), and 30 patients with ALS (15.2%). The mean age of the PD was 75.5 years with a range of 53 to 90, SCD was 66.5 years with a range of 39 to 88, and ALS was 58.7 years with a range of 42 to 86. The major findings in this study were as follows: 1) The patients who had one or more medical equipment installed at the beginning of home care were 30% of ALS, 9% of PD and 18% of SCD. As time elapsed, patients who needed to have some medical equipment installed increased in ALS greater than in PD and SCD. 2) The home doctors predicted that the condition of 37% of ALS patients, 9% of PD, and 8% of SCD would probably be deteriorating within one month. 3) Of the 30 patients with ALS, 47% experienced hospitalization three times or more compared to 27% of PD and 21% of SCD. The most prevalent reason for hospitalization for ALS was respite of caregivers, PD and SCD, however, were hospitalized for control of prescription, a change for the worse, or treatment of other diseases. 4) Ninety percent of ALS caregivers felt extremely tired or slightly tired. Their home doctors responded that 83% of ALS caregivers did their best in caregiving. 5) ALS patients utilized social resources such as volunteers, care workers, services of supply and maintenance of medical equipment, and emergency care for 24 hours more than SCD and PD. In the conclusion, ALS patients experienced the highest hospitalization of the three diseases and respite of family caregivers was necessary. They showed a higher utilization of various social resources than other diseases. It is important to consider these characteristics of home care patients by diseases in order to prepare and develop the necessary support system of home care for the intractable neurological patients.

Asunto(s)

RESUMEN

The high prevalence of 'bedridden elderly' in Japan is at least three times higher than that of any other industrialized country. To decrease likelihood of being bedridden, it is important to cultivate and maintain the willingness of older disabled patients for rehabilitation, and to preserve functioning in activities of daily living (ADL). The purpose of this study was to identify the factors facilitating and inhibiting the willingness of institutionalized disabled older adults for rehabilitation with respect to physical, goal-attainment, psychological and cultural aspects. The convenience sample consisted of 71 disabled older adults (45 in Japan and 26 in the USA). 46 subjects (64.8%) were identified as 'willing for rehabilitation', whereas 25 (35.2%) were 'unwilling for rehabilitation'. The data were gathered using structured interviews to subjects and administering questionnaires to the nurses. The data were compared between the 'willing' and the 'unwilling', and between those from Japan and from the USA by cross-tabular and correlational analyses. The major findings in this study were as follows: (1) Factors found to facilitate willingness of older persons for rehabilitation included: high independence level in ADL, generalized endurance/stamina, lack of pain, mutual goal agreement between old people and care staff, and no presence of regressive behavior. (2) Factors found to inhibit willingness of older persons for rehabilitation included: lower independence in ADL, presence of pain, generalized little stamina, depression, presence of regressive behavior, and dementia, and expectation of another person's help all the time. Healthcare workers need to be aware of patients who are subject to factors inhibiting willingness, and to promote factors facilitating willingness, in order to prevent the elderly with disabilities from becoming bedridden. In addition, the implications of this study are for a multidimensional functional assessment to be part of the rehabilitation intake in order to better understand each individual and motivate his/her optimum level of functional ability.

RESUMEN

Because of the rapid growth and changes occurring in home health care, nurses have a need for acquiring additional education and nursing skills. Post-RN (registered nurse) education in home health care, however, has not been developed yet. The purpose of this study was to identify the significant educational needs of the home health care nurses in order to upgrade nursing skills. A survey was conducted of members of the nursing society for intractable-diseases and other home health nurses introduced by some of the members. The survey questionnaires were sent to 172 subjects and the response rate was 79.6%. Practical nurses and inactive nurses were excluded to leave 125 registered nurses who were subjects of this analysis. The major findings in this study were as follows: a) The mean age of the respondents was 42.1 years old. The average length of clinical nursing experience was 17.0 years. b) Among fifty home care nursing skills indicated higher implementation percentage than high-technology nursing skills. c) The personal care skills as well as high-technology nursing skills showed low difficulty, while interviewing and counseling skill and communication skill showed high difficulty. d) The respondents showed high educational needs for mastering high-technology nursing, communication and counseling skills. e) Clinical nursing experience of hospital service was found to be significantly useful means for the respondents to perform most of the home care nursing skills. Reference books were utilized as supplementary to the clinical experience. f) When asked about their desire for educational resources to provide high quality home health care nursing, approximately 80% responded that they wanted to obtain up-to-date information, and opportunities for clinical practice training courses. On the basis of our findings, the following skills could be crucial for the home health nurses and should be included in continuing educational programs; interviewing and counseling, interpersonal communication, high-technology home health care nursing, and independent decision-making.

Asunto(s)

RESUMEN

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.

Asunto(s)