Objective：This study aimed to explore the practice of cooperating with psychiatrists by home-visiting nurses who belong to organizations without psychiatrists and have non-psychiatric nursing experience.

Methods：Semi-structured interviews were held with nine nurses. Data were analyzed using a modified grounded theory approach.

Results：The results showed that when these nurses conveyed information to psychiatrists, they worked on: (1) ascertaining the psychiatrists’ personality and degree of interest in home medical care and (2) devising a certain strategy for conveying the information so that the psychiatrist could better visualize the conditions of patients with mental illness and actual situations that arise in these patients’ daily lives. The nurses expressed that when they do not receive instructions they anticipate from a psychiatrist, they may have a more emotionally motivated response. They consult with a psychiatrist because they have a sense of mission or desire to properly care for mentally ill patients, despite a personal lack of confidence. After these consultations, the nurses understood the actual meaning of the instructions and, after having providing care in accordance with the psychiatrist’s advice and instructions, noticed an improvement in their patients’ psychological conditions. The nurses also felt a sense of solidarity with the psychiatrist during the process.

Conclusion：The study findings suggest home-visiting nurses who belong to organizations without psychiatrists and have non-psychiatric nursing experience exhibit characteristic practices for cooperating with psychiatrists. These nurses communicate comprehensive details about mentally ill patients to the psychiatrists and secure time to consult with the psychiatrists without the patients present. This lets the nurses more clearly convey the appearance of mental conditions that patients themselves do not recognize.

Purpose：It is necessary to identify discharge difficulty factors to implement appropriate discharge planning interventions at early stages of hospitalization. However, the factors affecting discharge in Japan are still unclear. This study aimed to identify factors associated with discharge difficulty for pediatric patients.

Design and Method：Semi-structured interviews were conducted using a qualitative approach of 18 nurses with experience in pediatric patients’ care. Their average duration of work experience was 16.2 years. This study was approved by the ethics committee of our institution.

Results：The following 7 categories of patient factors were found to cause difficulties in seeking early discharge: unstable condition, poor nutrition, additional treatment, poor management, induction of medical care after discharge, requirement of in-home nursing after discharge, and requirement of rehabilitation after discharge. Additionally, the following 9 categories of family factors were identified: difficulty in confronting the child’s illness, disability of child’s care, hesitation about treatment decisions, difficulty in caring for the child, lack of support from family members for child care, unstable family relationships, financial concerns, need for house repair or relocation, and tendency to ignore the child’s needs. Thus, we clarified that patient and family factors influenced the discharge difficulty for pediatric patients.

Conclusion：A total of 16 categories of patient and family factors associated with discharge difficulty for pediatric patients were extracted.

Purpose：To elucidate the facts concerning home-visit nursing support for terminal cancer patients with respiratory distress and their family members

Method：We conducted a questionnaire survey on nursing staff members of home-visit stations in large cities with high rates of mortality at home. The survey sought to obtain information about the support services that the nurses provide to patients and their family members. We divided the respondents into those who had provided care services to terminal cancer patients with respiratory distress (TC/R) and those who had not and then performed a comparative analysis of the two groups.

Results：With regard to support for the patient, the TC/R respondents practiced the following actions more frequently than their non-TC/R colleagues: consulted with doctors beforehand about emergency responses, provided instructions for palliative care on the phone, promptly visited and treated patients at their homes, carefully listened to their patients’ complaints, adjusted their patients’ posture, and touched or massaged their patients. With regard to caring for the patient’s family members, the TC/R respondents practiced the following actions more frequently than their non-TC/R colleagues: explained the changes in the conditions of diseases using pamphlets and other materials, explained the emergency contact procedures in case a patient stops breathing, dealt compassionately with the family members’ anxieties about the patients’ worsening condition, clarified the uncertainties regarding changes in dietary requirements, asked each family member about their feelings, and encouraged other family members to participate in nursing care.

Conclusion：The survey revealed that home-visit nurses respond swiftly when a patient’s symptoms deteriorate, provide non-pharmacological palliative care, and show compassion in helping families understand and accept the worsening condition of the patient.