Objectives: The purpose of this this study was to clarify the structure of primary causes towards positive attitudes and daily life for the chronic heart failure （CHF） patients who manage their illness well. Methods: To join the study, each subject had to have a physician confirmed diagnosis of CHF during the past year. Subjects also had to be older than 20 years. This is a cross-sectional study that employed a self-administered questionnaire and interviews. Data-analysis consisted of formulating a structural equation model using SPSS & AMOS． Result: 116 CHF patients （72 male and 44 female） participated in this study. The variable “family support system”（“ ” means latent variable） functioned as fundamental variable and linked, indirectly, via “self-care behavior” to “positive attitude toward life”. Goodness of fit indicators in our model were CFI=0.958, RMSEA=0.059, whereas sex adjusted determination coefficients of the “positive attitude toward life” was 17% （20% for men and 25% for women）. This research adds “positive attitude toward life” among patients with CHF to previous research findings that clearly showed that “self-care behavior” prevents frequent hospitalization. Conclusion: A structure stipulating factors of self-care behavior in CHF patients was developed. Future research is needed to clarify the influences of gender and severity of disease research as well as the external validity of the model. Future research into developing interprofessional collaborative support system is needed too.

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This is a discussion of a better way of understandig the so-called 'hard to treat' cases in health care services. In this paper, it aims at showing the dialectical epistemology about the personalities and the characteristic needs of 'hard to treat' cases. The epistemology is different from a diagnosis in medicine and an assessment in nursing science and social work. Mitsuo Taketani（1911～2000） was a physicist and a philosopher of science. He showed the theory of recognition in the science by three phases. The first phase is a knowledge of phenomenon level. This means the only description of a phenomenon. The second is a knowledge of substance phase. We can get knowledge of the structure that a phenomenon happens. The third is an essence level. This level is recognition about the laws of the interaction of substance. Helping professions can use this theory to understand clients so-called 'hard to treat' cases. Hard to treat cases often have multi-problem. Using this theory helping professions will be able to understand the structure of their multi-problem. And this knowledge must be shared in a team of helping professions.

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Purpose: The purpose of this study was to survey the opinions of professionals in medical institutions and care managers （CM） providing home-based care towards older people with heart disease and examine differences in attitude towards multidisciplinary collaboration between professionals in medical institutions. . Methods:1. We administered questionnaires to elucidate opinions of professionals working in medical institutions.　2. Opinions of CMs involved in home-based care, with 6 or more years’ work experience, where elucidated using interviews. Results: Medical institution professionals wanted CMs in charge of older people with heart disease to provide management care that also considers medical aspects. In particular, while ADL, medication supervision, nutritional care, essential care, exercise, family, awareness, burden and risk were points that require attention, nutritional care, risk and awareness were overlooked. Conclusion: We propose planning workshops for CMs given by medical institutions about care for people with heart disease and creating a single unified list of information about patients from various professionals.

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