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 Objective：Chronic kidney disease significantly impacts patient mortality and quality of life. Advance care planning allows patients to receive their preferred treatment when entering the end stage of the disease and reduces anxiety in family members and healthcare professionals. However, it remains less practiced among this patient group, and effective intervention is needed. Thus, this literature review aims to identify advance care planning interventions for chronic kidney disease patients.
　Methods：A literature search was conducted using keywords that included chronic kidney disease, advance care planning intervention, advance care directive, and living will in ProQuest, PubMed, Scopus, Cochrane, and Google Scholar. Inclusion criteria: research articles published in peer-reviewed journals or research papers within the last ten years, only articles written in English, original research, and full-text. Articles that were excluded were studies not related to advance care planning intervention, focused on only the health professionals’ training program, and studied only pediatric participants. Data was illustrated using a descriptive and narrative approach.
　Results：Of 7,117 citations, 24 articles were included. The successful implementations comprise establishing trust between patient and healthcare staff, adjusting individualized advance care planning, discussing based on the individual’s situation, responses, and perspective, developing culturally appropriate intervention, training healthcare staff regarding advance care planning intervention, inviting family members to discuss, adapting documentation simply to use, initiating discussion by the proper time, place, and introduction, training patients as expert patients, and conducting communication simulation. In contrast, difficulties include inappropriate intervention methods and disagreements between patients and their proxies. There is a diverse evaluation among previous studies, and few studies have evaluated the concordance of patients’ wishes and their received end-of-life care.
　Conclusion：Further studies should apply successful strategies, be aware of difficulties, and evaluate whether patients receive end-of-life care following their preference, which is determined by the advance care planning intervention process.

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　This study aims to identify the experiences of male partners supporting adolescents and young adults （AYA） with breast cancer during the initial treatment following diagnosis. Semistructured interviews were conducted with three partners of patients with breast cancer in the AYA generation who had been diagnosed approximately 5 years ago and had undergone surgery and chemotherapy during their initial treatment. The interviews were analyzed qualitatively and inductively.

　The analysis identified six main categories of experiences in supporting patients. The partners “faced the fear of losing their wives” while “striving to minimize their burden and ensure the completion of the initial treatment.” Simultaneously, they “supported the family, which had changed due to their wives’ breast cancer.” While shouldering multiple roles and being in a situation where “they could not handle everything alone,” they overcame the situation by “drawing strength from people around them,” and they “constructed a new form of family and lived with a readiness for potential recurrence.” Three key characteristics emerged from their experiences: the challenge of managing multiple roles while protecting the patient, the importance of acknowledging the patient’s own feelings as an AYA generation woman, and the recognition that they could not support the patient without support from others. These findings suggest that, in nursing practice, it is important to anticipate the processes involved in the experiences identified in this study, provide information as resources to alleviate the partners’ burden of performing multiple roles, share the experiences of partners in the same generation, and offer support to help them express their vulnerabilities.

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　Purpose：This study aimed to clarify the process by which visiting nurses approach older adults with dementia and delirium-like symptoms.

　Methods：Semi-structured interviews were conducted with visiting nurses regarding the process of approaching homebound older adults with dementia and delirium-like symptoms. Interviews addressed information used, information-gathering methods, responses to symptoms, and results. A narrative analysis of 10 cases was conducted.

　Results：Three patterns were identified：（1） a pattern in which delirium was inferred and addressed before the home visit （four cases）, （2） a pattern in which the possibility of delirium and other illnesses was considered based on the symptoms （three cases）, and （3） a pattern in which cognitive decline was broadly considered （three cases）.

　Discussion：If information on delirium-like symptoms and factors associated with the onset of delirium is available from family caregivers and medical facilities before a home visit, identifying relevant factors at an early stage and appropriately approaching older adults with dementia may be possible. If the pre-visit information and symptoms indicate the possibility of delirium and other illnesses, investigating the factors for these conditions is necessary. If information prior to the visit is scarce or if behavioral or psychological symptoms of dementia are suspected, considering the symptoms as cognitive decline and exploring the factors related to these symptoms individually are necessary.

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　Objective：To evaluate a trial educational support program for home-health care nurses to become from competent to proficient and identify areas of program refinement.

　Methods：Competencies were derived from six growth categories toward proficient that home-health care nurses are expected to achieve after reaching a competent, as identified in a previous study. Achievement evaluation criteria were developed based on a four-level rubric.

A trial educational support program was created based on these criteria and administered to competent home-health care nurses and station managers.

　Results：Competent nurses confirmed their achievement levels and identified future developmental challenges. The rubric-based achievement evaluation criteria also guided the competent nurses and their managers.

　Conclusion：The trial of the program reaffirmed the diverse backgrounds of home-health care nurses and highlighted the significance of the standardized and on-the-job training programs, where nurses address their individual challenges in daily practice. Future considerations include refining the achievement evaluation criteria, verifying the program’s implementation period, and modifying the program to enhance its practicality and usability for practitioners.

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[in Japanese]

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[in Japanese]

View full abstract