The purpose of this study was to clarify the contents, quantity and structure of around the clock care services in Japan, and to assess the services currently provided. We surveyed the 1,398 visiting nurse stations throughout the country, of which 734 stations （or 52.4%）responded to our questionnaire. The administrators of these stations answered the questionnaire regarding 1,658 clients who were considered to be around the clock care clients.

Data was analyzed with a focus on certain periods of time, specifically during nights, early mornings and holiday periods. The services, those in particular that were expected to be provided, during these time periods, included medical treatment （599 clients or 36.1%）, changing diapers（475 or 28.6%）, taking the pulse（469 or 28.3%）and checking general health conditions （445 or 26.8%）, The rate of provision of these services in actual practice was 53.9%.

The services were classified into four groups, resulting from cluster analysis; type A: observation of client’s physical and mental condition, type B: medical are, type C: help with housekeeping and support for self-help, and type D: care for basic living. Types A and B were provided more than types C and D in the same period of time, according to priority. There were mainly three different ways to deliver these services; planned visit （463 clients or 27.9%）, temporary visit（380 or 22.9%）, and consultation through telephone （143 or 8.6%）. It varied depending on the service to be provided, the most requested（or 70%）were weekday evenings and holidays. Most services（or 93.7%）were the kinds that would be provided by visiting nurses as well as by occupational helpers.

The purpose of this study is to clarify the components of the quality of public health nurses practice care management in home care. The methods were interview and mailed questionnaire to expert P.H.Ns for coding and factor-searching. The results are as follows : from the coding, it was found that the items. consisted of 6 processes and 4 aspects. And from the factor analyses, it was found that the items consisted of 5 factors as follows that included specific processes and aspects in each factor : 1）Comprehensive monitoring and Quality improvement ; 2）Cooperative discussion by team ; 3）Care manager’s judgement ; 4）Appropriate linkage ; 5）Finding needs’ and Supporting the User, and construct validity was supported. In addition, it was confirmed that the factors which P.H.Ns considered high priority were 5）, 1）, 3） in that order.

The purpose of this study was to identify the specific problems of stoke survivors as recognized by themselves in their rehabilitation process and discuss about care for them. In this study, 25 stroke survivors in a municipal rehabilitation senter in Metropolitan area were interviewed. The Stress-Coping theory by Lazarus was used as the framework for this qualitative analysis. This study indicated 9 problems: ［Difficulty of ADL］, ［Limitation of Action］, ［Need Amount of Support］, ［Approval of Changing］, ［Imposed Dependence］, ［Evalution by Others］, ［Unclear Information］, ［Risky Disease］ and ［Emotional Instability］. The study identified ［Imposed Dependernce］ as a new concept which could be translated into the expression of independence of stroke survivors. The new concept indicated the importance of care for stroke survivor which activate independence of them in the relationship without hesitation.

We examined the requirements for terminal care at home according, to analysis of our patients who died at their home with our medical home care.

In patients given our medical home care, from April 1994 to August 1996, 36 died. 10 died at home and 26 died in our hospital. Most patients who died at home spoke their mind of death at home and had plural persons helped their care in family. In comparison with this, most patients who died in hospital did not have chance to speak their mind and had only one person to be able to help their care in family. Home-helper was not useful to their terminal care at home. Unfortunately,about half of patients with terminal care at home did not have chance to speak their mind and were given care at home for wish of their family. In cancer patients only, all patients who received our terminal care at home had plural persons in family. In 6 patients with cancer who was not able to die at home, 2 lived alone and 2 lived with only one family and 2 died in hospital caused by complications.

We concluded that in the requirements for terminal care at home, to confer with the patients on his terminal stage in early time of home care and to secure many persons for their care were important.

The survey was conducted on visiting nurses of 10 home health care agencies to find out what components were influencing quantity of nursing care（length of visiting hours at clients’ home and frequency of home visits） delivered to 210 clients. These home care agencies are three prefecture-authorized home care agencies, three hospital based home care services, and four municipal home care services. The relationships between the quantity of nursing care and each following factor were analyzed : client and family caregiver’s nursing needs, nurse characteristics, home care agency criteria.

The following results were found. The frequency of home visits was influenced by clients’ health condition and life support devices that clients used. The length of visiting hours at clients’ home was influenced by treatment and medication required to each client, positive attitudes by family caregivers toward caring number of home visits for a nurse per day, and the demand to increase number of home visits by agency managers. It was also found that the length of visiting hour by the nurses under those demanding managers was 30 minutes shorter than the average length of visiting hours by nurses from other agencies.

It is expected that we would be able to choose the best optimal services for ourselves in the near future. Here, we present an approach on constructing a system for supporting novice people to design better packages that would match well with their requirements for home care services.

The system is remarkable by four significant units for supporting care management:（1）it can estimate the potential needs of users and propose the best care strategy, according to the answers to 30 queries about the condition of target people and the relatives;（2）it can suggest the most appropriate health care menu to the users who accepted the proposal care strategy;（3）It has supporting functions that enable the users to select their desired care plan set and to make weekly plans;（4）It can give information about the best service providers who can carry the service most fitful to the users ÉÜ selected care plan set.

We applied the decision tree techniques of artificial intelligence to the needs assessment, and used the genetic algorithms to make a set of service providers. For the users who are very busy, not used to talking about privacy problems, or searching for information on health care, this system could be an easy and useful consultant.