[Purpose] The objective of the present study was to examine the status of newly established visiting nurse agencies and factors related their efforts toward community.

[Method] This was a cross-sectional study of administrators of visiting nurse agencies that were established after April 2012 (N = 1,458). Data primarily included agency characteristics and efforts toward the community: participating in the cooperation network of community care providers, finding out community residents’ needs, sharing agency equipment with the residents, and using their expertise to run workshops for residents or other agencies. These variables were analyzed using bivariate analysis in which efforts made toward the community were considered dependent variables.

[Results] The respondents were 211 administrators. Of these, 88.9%, 58.2%, 42.0%, and 38.5% of the agencies implemented the above efforts, respectively. Finding out community residents’ needs was associated with agencies where the administrator was relatively younger and the nursing staff was less experienced in home visit nursing when the agency started. Non-profit agencies were associated with sharing agency equipment with the residents. Running workshops were associated when other visiting nurse agencies were operated by the same company and employed many nursing staff.

[Conclusion] Nearly half the number of agencies did not find out community residents’ needs; nor did they organize activities to improve local welfare. The present findings suggest that the limiting factors toward community efforts in the operation of these agencies was their reliance on the experience of the staff, a profit-driven policy, and lack of equipment and staff for running projects that contribute to improve local welfare.

PURPOSE: This case study focused on elucidating nursing practice for an older woman with chronic respiratory failure, while the client’s family and family physician have been making decisions about the location of the client’s end-of-life phase.

METHODS: This study was a case study focusing on nursing practice. Information concerning the care process was obtained from the nursing record, client’s diary provided by the family, and an interview with the family. All authors and colleagues of the nurse discussed this case using the process table and the work sheet for a case study, and developed nursing practice categories.

RESULTS: The client was a female (in her 80s) with end-of-life stage chronic respiratory failure. A nurse 1) identified the client’s words implying the future. However, such words implying the future disappeared gradually. The nurse 2) asked about the client’s hopes, including “I want to be admitted to a hospital and undergo an examination,” and became the voice of the client for the family and family physician. In all phases, nurses 3) supported the client and family members to make them feel satisfied and provide usual care at the usual pace for patients to fully enjoy their time with family members.

CONCLUSION: Although the client died in her own home, which was different from her preference, the hospital, shared decision-making might be possible because nursing practice facilitated sharing the client’s preference.

Objective: Community general support center is a public institution to provide care prevention support to the frail elderly and their family members and at the same time to make an adjustment to necessary care services. Professionals who work at a center are comprised by public health nurses, social workers, and senior care managers. Public health nurses who work at a center have responsibilities and functions different from public health nurses who work in administrative health. The objective is to clarify the concept of “competency for public health nurses in a community general support center” based on the papers published on practical activities of public health nurses who work at community general support centers.

Method: Rodgers’ concept analysis was used as an analysis method for the concept. 42 papers published between 2006 and 2015 were considered by using the Igaku Chuo Zasshi.

Results: Five categories were identified as attributes including “to draw out motivation and strength of the elderly themselves,” “to link supporters who provide support to the elderly,” “to involve community through individual support,” “to create an atmosphere to facilitate opinion exchange among three professionals in a community general support center,” and “to enhance the capability to contribute as a public health nurse.” Preceding requirements were comprised of four categories including “experience and knowledge,” “support structure,” etc. Consequences were comprised of six categories including “high-quality practice,” etc.

Conclusion: It is necessary to clarify specific competency items based on this study and to define insufficient competency that has not been fully acquired as well as educational issues in the future.