This study examines the changes in care needs level and home care services utilization among 100 elderly persons requiring long-term care for living alone by investigating long-term care insurance documents from the past five years. The reasons for terminating home care were analyzed; the rates of elderly people who were hospitalized, institutionalized, whose care needs level was improved, and who died at home were 45％, 31％, 15％, and 9％, respectively. When home care was terminated, elderly people who were institutionalized were more likely to have used various types of home care services (p = .047), and those who died at home were more likely to have used various types of home health care services (p = .036). The care needs levels of elderly people who improved their care needs remained lower (p ＜ .001) during the home care period and declined from a mean of 1.5 (standard deviation 0.7) to 2.4 (standard deviation 1.1) (p = .020) among those who were institutionalized. The results suggested that elderly people who improved their care needs level could maintain it during the home care period. At the end of home care, those who were institutionalized were more likely to have a lower care needs level and use various types of home care, and those who died at home were more likely to use various types of home health care.

  The purpose of this study was to develop and evaluate the reliability and validity of a Nursing Competence Scale for use at intensive care homes for the elderly. Scale items which were selected based on the data obtained through concept analysis and semi-structural interviews underwent a review on their face validity and content validity, and 50 of them were included in the draft of evaluation of capability of nurses at special elderly nursing homes. A total of 603 nurses at 194 special elderly nursing homes nationwide answered an anonymous written questionnaire and their answers were put through item analysis, I-T correlation analysis and exploratory factor analysis. The analyzed results were studied in terms of criterion-related validity, known-groups validity, internal consistency and stability. The exploratory factor analysis extracted 34 items of four factors, which were named: “capability to support elderly in living his/her own life”; “capability to collaborate with people of different types of jobs”; “ability to detect a change and cope with it”; and “capability to offer elderly their desired end-of-life care”. Cronbach’s α coefficient for the entire scale was 0.958. Regarding criterion-related validity, nursing competence self-evaluation scale and other scales showed significant positive correlation. In terms of known-groups validity, the scores were significantly high with nurses at administrative positions and nurses who have received training. In the test-retest reliability measurement the correlation coefficient ρ between the first and second round total scores was 0.791 (ρ = 0.510-0.801 for subordinate factors), showing a significant correlation between them. The validity and reliability of the Nursing Competence Scale for use at intensive care homes for the elderly were confirmed.

  The aim of this study was to clarify support provided by Certified Nurse in Dementia Nursing (DCN) to families of elderly individuals with dementia undergoing outpatient treatment and to identify related factors. A self-administered questionnaire survey was conducted among 499 DCN working at medical institutions across Japan. Responses from 199 DCN (valid response rate, 39.9％) were analyzed using descriptive statistics, χ² test, and binomial logistic regression test. The largest number of 133DCN (66.8％) belonged to a hospital ward, and 84 DCN (42.2％) were providing support to families of elderly individuals with dementia undergoing outpatient treatment. Factors related to provision of support by DCN to such families included : being assured of working hours as DCN ; availability of dementia consultation services ; affiliation with an outpatient department ; and years of experience. The DCN who did not belong to outpatient departments yet and provided support to families of elderly individuals with dementia undergoing outpatient treatment appeared to be highly aware of support to families of elderly individuals with dementia and played a role in supporting families. Administrators of medical institutions and DCN themselves should be aware of the importance of providing support to families of elderly individuals with dementia undergoing outpatient treatment and make coordinated efforts.

  After sending a questionnaire to visiting nurses inquiring about the current status of “respiratory arrest confirmation” at an aid scene for elderly persons facing “expected death,” we obtained responses from 122 nurses.

  Of those 122 nurses, 69 had confirmed respiratory arrest in the absence of a doctor; 53 had not. Among them different responses were received: 40 (32.8％) reported that they “advocate respiratory arrest confirmation” by a nurse; 3 (2.5％) responded that “think that they should confirm it,” even if they had never experienced “respiratory arrest confirmation”; 33 (27.0％) answered that they “think that they might do it if conditions are right.” Total percentages of respondents suggest that about six of ten positively accept “respiratory arrest confirmation” by a nurse. Additionally, certified nurses and nurse specialists significantly regarded “respiratory arrest confirmation” positively. Results revealed that the nurses had conducted “respiratory arrest confirmation” to provide better care for elderly persons facing death and for their families in spite of circumstances under which a doctor is likely to be late arriving.

  In recent years, as medical practice by nurses has increased rapidly, integration between care and cure must be implemented.

  Semi-structured interviews were conducted for 10 nurses who worked in an acute-phase hospital and had participated in a dementia-care training workshop. Data were analyzed using qualitative inductive analyses to elucidate the aspects of dementia nursing practice in nurses.

  Nurses’ “personal grounded sense of learning through participating in the training workshop” enabled them to perform “nursing that promotes emotional security of elderly with dementia in the best interests of the patient,” and “nursing that ensures patient safety without using body restraint methods” as well as to actively participate in “cooperation that allows the person to continue living like him/herself.” The nurses also obtained “responses by practicing dementia nursing.” This supported “subjective expression toward improving the quality of dementia nursing” in addition to reinforcing the nursing and cooperation required for the care of elderly patients with dementia. Furthermore, “the atmosphere and system conducive to practicing dementia nursing” was found to be necessary in dementia nursing practice and was further strengthened with practice. The results suggested that the promotion of dementia-care nursing practice is influenced by the standpoint or organization of the participants in the training workshop; thus, there is need to determine the objectives for organization building aimed toward improving the quality of dementia nursing.