Abstract
Purpose: Patients with neurological diseases who receive care at home may require a variety of services provided by community resource organizations. This study aimed to describe the coordination efforts of public health nurses (PHNs) who help these patients receive good care from the relevant organizations. Method: Six PHNs who had experience in supporting home care patients with neurological diseases participated in a semi-structured interview. Interview data were analyzed qualitatively and quantitatively. Results: Coordination activities by PHNs were extracted from the interview data and divided into 4 categories and 28 subcategories. The categories identified skills used by PHNs: 1) to facilitate mutual understanding between patients, their families, and resource organizations, to make base of support-network; 2) to introduce patients to appropriate organizations when they need support; 3) to support the coordinators from outside the framework of the system; and 4) to support relevant organizations in continued care by keeping their strong ties. Discussion: PHNs worked with patients and their families to determine the necessity of care by community organizations, and worked with community organizations to better understand patients. PHNs recognized the importance of key persons who lead to the necessary support. Other important roles of PHNs were to support organizations in the continued care of patients and to support the independent work of the coordinators. If PHNs are given the resources to develop these activities, they can network and liaison to improve the environment and accessibility to services for patients with neurological diseases who receive care at home.
