Purpose : The aim of this survey was to study related factors of prognosis and ADL (Activities of Daily Living) changes in clients with stroke, the leading cause of bedridden in Japan, in comparison to those with dementia, incurable disease and fall/fracture at home,and to explore care activities and method to prevent bedridden. Method : Subjects were 363 clients with stroke, dementia, incurable disease and fall/fracture in 527 home care clients (67.5%) and their families in S ward, Tokyo. The following data were obtained from nurses in charge : (1) clients' data including sex; age, primary disease, onset age, symptoms, ADL, and care needs, (2) caregiver's information, (3) provision of care including initial nurse visit, visiting period, and utilization of services. Result : 1. Stroke(48.2%) was most prevalent in 363 subjects. Of these, 65.2% needed help at home (Independence level B and C based on the standard of elderly with disfunction by National Ministry of Health and Welfare). The average duration between the onset of stroke and losing independence to level B, C, which was one of prognosis indicators of independence in clients with stroke, was 36.9 months and the bedridden rate within one year after the onset was high (64.0%). 2. The average bedridden period in clients with stroke was the second longest (45.6 months) following intractable disease (49.4 months), and the initial visit for stroke clients within one month after bedridden was the least (18.4%) compared with that for other diseases (p < 0.01〜0.001). 3. Significant related factors of ADL changes in client with stroke were the onset age of primary disease, duration between the onset and the initial visit, verbal ability, caregiver's burden and exhaustion, use of bathing service and physician's visit. Conclusion : Since there are more clients with stroke aged 40 to 64 years than those with other disease, earlier initiation of visit and rehabilitation are suggested to be important for clients in those ages as well as provision of care for those who do not have good verbal ability or family support even thought their ADL is high at the initial visit.

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The purpose of this study was to clarify the factors related to the level of satisfaction by parents concerning municipal health checkups for 18 months children. Questionnaires were given to 362 residents of City A in Hokkaido who had accompanied their children during a municipal health checkup at the age of 18 months between July and September of 1997. The subjects of analysis were 239 people from whom valid responses were obtained. The correlations of the following factors with the level of satisfaction felt by each subject were analyzed: the background of the subject, the burdensome feeling of taking of the child for the health checkup, the subject's expectations concerning the checkup, the degree of pleasantness felt concerning the manner in which the checkup was conducted, and benefits obtained from the checkup. The following results were obtained. 1) The level of satisfaction expressed by the subjects, all of whom were mothers of the children who underwent the checkup, were "very satisfied' in 12.6% of the subjects, "reasonably satisfied" in 79.5% of the subjects, "dissatisfied" in 7.5% of the subjects, and "very dissatisfied" in 0.4% of the subjects. 2) The results of univariate analysis showed the following factors to be correlated with the level of satisfaction: expectations before the checkup, awareness of the necessity of health checkup for infants, simplicity of the checkup procedure, attitude of the stuff, waiting time, and benefits obtained from the checkup. 3) The results of multivariate analysis showed that the factors correlated with the level of satisfaction were the acquirement of useful knowledge for child-raising and sympathy shown towards hardships of child-raising. The results showed that the factors related to a high level of satisfaction concerning health checkups for infants are good understanding by the parents of health checkups, simplicity of checkup procedure, good attitude. shown by stuff, and large number of benefits obtained from the checkup. The result indicate the need to give sufficient consideration to the feeling of parents in order to provide satisfactory health checkups for infants.

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The purpose of this study was to examine factors related to caregiver satisfaction after the death of an elderly person at home. The research was conducted at a public nursing office that serves the Bunkyo ward in the center of metropolitan Tokyo. Information collected from all available nursing records of elderly persons, who between April 1993 and June 1997, died at home or died within 1 week of hospital admission was reviewed, and the nurses in charge of all such person were interviewed. To our nurses, the final care given to any patient just before their decease is of the utmost significance, and caregivers allow themselves to be fully engaged with and mindful of their dying patients. The records kept by these nurses at this time are very detailed. The information we extracted from the nursing records and interviews was as follows: demographic characteristics of the patients and their caregivers, utilization of medical services, notations about where the patient preferred to die or where their caregiver desired for them to die, and details of the person's death including the caregiver's impression at the time. Three nurses read each caregiver's notes and judged whether or not the caregiver was personally satisfied Satisfaction was ascribed by a consensus among the judges that the caregiver expressed appropriate satisfaction. We identified factors that contributed to caregiver satisfaction, and we statistically examined the relationship between this satisfaction and each factor using Student's t-test and the chi-square test. After that, we used logistic regression analysis to find the model that explained caregiver satisfaction appropriately. Among the 97 elderly persons in this study group, 62 died at home and 35 died within 1 week after hospital admission. Thirty-seven out of 97 caregivers were judged to be satisfied. As a result of the statistical analysis, we found two important factors associated with caregiver satisfaction. They were as follows : 1. The caregiver was a child of the dying person. 2. The person died without pain but with loss of appetite. We conclude that these factors should be paid attention to by home visiting nurses in their assessment of patients in the terminal period.

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Purpose : We conducted time study to identify the required time for direct and indirect care such as coordination time and administration works, frequency of visit and characteristics of care services by client groups. Method : The subjects were 391 clients of aged 40 or older at 30 visiting nursing stations and 8 hospitals in Kanto region. We asked visiting nurses to record the workload time of direct care, coordination time, administration works and frequency of visit in a week for four groups : (1) terminal care group, (2) medical treatment group, (3) dementia group and (4) life-assisted group. Results : 1) There were 60 clients (15.3%) in terminal care group, 147 (37.7%) in medical treatment group, 92 (23.5%) in dementia group and 92 (23.5%) in life-assisted group. 2) The longest direct care time per week in visiting nursing jobs was "skin and cleanliness care" (54.2min) followed by "ingestion and excretion care" (38.0min) and "physical function/ ADL care" (36.8min). The total amount of care time was longer in terminal care group than in other groups and a substantial amount of time was spent on mental care and family support, The treatment time was three to four times longer in medical treatment group than in dementia and life assisted groups. More time was spent on communication and recognition care in dementia group than other groups. In life-assisted group, the total amount of care time was shorter than other groups. 3) Average frequency of visit per week was 2.4 ± 2.3 times in all four groups, 4.3 in terminal care group, 2.2 in medical treatment group, 2.0 in dementia group and 2.1 in life-assisted group. Frequency of visit was significantly higher in terminal care group than in other groups (p < 0.01). 4) Average time of nursing administration per week was 48.5 ± 68.2 min in all four groups, 79.9 min in terminal care group, 49.4 in medical treatment group, 35.0 in dementia group and 39.9 in life-assisted group. It was significantly higher in terminal care group than in other groups (p < 0.05). 5) Average time required for coordination with other agencies per week was 28.5 ± 51.1 min in all four groups, 46.3 min in terminal care group, 28.1 in medical treatment group, 27.6 in dementia group and 18.8 in life assisted group. There was a significant difference between terminal care and life-assisted groups (p < 0.01). Conclusion : These results can be useful for determining capacity of visiting nursing agency and allocation of nursing time per client for improving the effectiveness of visiting nursing system and administration.

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The purpose of this study was to evaluate the effectiveness of an intervention care program to prevent decline of physiological function, ADL (activities of daily living), communication and non-lying time in bed among the bed-ridden elderly at home. Subjects were 82 community-living bed-ridden elderly 65 years and older in a rural district in Japan (41 intervention group, 41 control group). The intervention was conducted by care program of sitting tolerance training and the program was performed by a home care nursing during three months. On the other hand, to control group, We didn't enforce care program and observed progress. Results were as follows : In stratified analyses, There seemed to be a difference between the intervention group and the control group about reach test. The intervention group didn't decline of its score, but the control group was apt to decline. And there were significant differences between the intervention group and the control group about ADL and non-lying time imbed, After three months from baseline, ADL scores were significantly higher for intervention group than for controls ; intervention group maintained their functional status, while control group experienced during the follow up month (grooming = p < 0.001, dressing-upper body = p < 0.001, dressing-lower body = p < 0.001 and the total self-care score = p < 0.001). And non-lying time in bed per one day increased significantly among intervention group, but not among control group(p < 0.01). Furthermore, a change of the total self-care score of ADL had positive correlations with a change of non-lying time in bed per one day (r = .47, p = 0.009), But in communication, there was not significance between the intervention group and the control group. The intervention care program suggests effective to prevent decline of ADL mainly on self care activity of the bed-ridden elderly. For the bed-ridden elderly, even if it is assumed that their locomotion is inability, it is very important to expand sitting tolerance and non-lying time in bed from a standpoint of prevention for a decline of ADL.

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The purpose of this study is to clarify the competencies used by public health nurses in organizing health care systems in community health services. The subjects were 37 PHNs who had been working in the regional government for over 15 years and organizing the health care systems in the community. Individual interviews were tape-recorded and the grounded theory approach was used for analyzing. As a result, 3 categories were derived from data analyzing. The first category consisted in 9 items that were essential competencies to be needed in community health nursing. The second category consisted in 15 items that were the competencies for community health nursing skills and practices to provide care to individuals, families and groups in the community. The third category consisted in 8 items that were the competences to organize health care systems in the community.

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The purpose of this study is to identify the cognitive tasks that are estimated important by public health nurses (PHNs) in today's Japan who function as public administration service and their roles and significance. Data was collected from 147 leaders of PHNs practicing community health nursing who were employed by 106 city governments, 7 public health centers of ordinance-designated city governments and 34 prefectural public health centers with a self-report questionnarie. The questionnarie was consisted of items of the reason and the way PHNs wrestle with and the contents of health care needs about the activities that PHNs oneself judged the most important as the, today's nursing practice provided as public administration service of health and welfare. PHNs' cognition in the description of the questionnaire was analysed in terms of what they aimed for and what they thought important . Seven hundred and sixty-nine separate accounts of their cognition were identified and they were coded to 79 items. They were further broken down into 10 categories : 1. To improve consciousness about health of the people ; 2. To support the activity of the daily life as a family ; 3. To care improving the quality of social life ; 4. Promotion of the ability of a community through collaborating with people and concerned organizations to construct social support systems in their communities ; 5. To take comprehensive/consistent care that correlated care ; 6. To care for the health care needs that should be conducted over a large area ; 7. Promotion of preventive care from a long term view point ; 8. Promotion of health care activities by clarification of the health care needs ; 9. Construction of health care systems to support needs that are cared insufficient ; and 10. To care for the health care needs that are difficult to cope by the people or private service.

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Purpose : The Purpose of this study is to develop a guideline for community inspection as a way to gather first-hand information about the community as a client for public health nursing activities. In addition, the validity of this guideline is examined. Method : The developed "Guideline for Community Inspection" was based on the elements of the windshield survey by Anderson and MacFarlane and modified to be more suitable for the Japanese community. the guideline consists of 15 elements and their examples and explanations. Using this guideline, 7 research assistants conducted a community inspection in a rural area of Japan and asked the public health nurses in that area to assess the validity of the recorded information. Furthermore, the public health nurses were asked to evaluate whether the elements were sufficient or not and to give their evaluation of the overall assessment and any comments for the improvement of the guideline. Results : The total number of the information items observed with the guideline and recorded was 298, and more than 90% of them were evaluated to be valid by the area public health nurses. In cases when the recorded information was not valid or insufficient, it was mainly because of misunderstanding of the assessed area or shortness of the survey period. The evaluation of the overall assessment was relatively high, and public health nurses commented,that using the guideline seemed to help understand the atmosphere of the assessed area. Conclusion : Although there are still some aspects remained to be improved, this guideline is considered to be useful for community inspection.

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To convey the characteristics of public health nursing activities to students and to help them learn the role and responsibility of public health nurses, role playing by instructors simulating the scene of the first visit of a home was incorporated in the class room sessions. Opinions and comments by the students after the sessions suggested that they understood the significance of home visits and the role of a public health nurse in home visits in more concrete terms through role playing and that role playing is effective for nursing education.

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