The purpose of the present study is to take a general view of the documents of our country concerning the discharge planning of the past ten years. How is the concept concerning the discharge planning used. The findings are brought together and the problem examined. 15 documents were examined. The features of the subjects for whom leaving hospital was difficalt were forecast as a medical situation and a social situation. The effect on the patient and the nurse of support in leaving hospital section installation was clarified. There is a necessity for the maintenance of a system that works throughout the entire hospital, such as continuing execution of discharge planning, staff assignment, and the education of the floor nurse.

Background : Homecare nursing is an important service for older adults with dementia and their families to manage their living at home and to avoid institutionalization. However the contents and process of good homecare nursing for those with dementia and their family are not necessarily well understood. The purpose of this study is to describe the contents and process of homecare nursing for older adults with dementia.

Methods : A qualitative study design was utilized. Open-ended, in-depth interview was conducted to 12 homecare nurses on their experience of providing care for an older adult with dementia and their family. The constant comparative approach was used for data collection and analysis.

Results : Seven categories that belong to the process of dementia homecare nursing have emerged; 1) developing a situation in which the client allows the nurse to enter his/her house; 2) letting clients get used to nurse’s routine visits; 3) solving problems associated with client’s daily life; 4) providing enjoyment in client’s life; 5) introducing social services; 6) reducing the home care nurse’s involvement; 7) supporting the family caregiving. An additional category that underlines these seven categories was also found: basing one’s care on a long-term scenario.

Conclusions : The process of homecare nursing for older adults with dementia consisted of several categories that form stages. These categories allow the new nurses to understand the contents and process of homecare nursing for older adults with dementia.

The purpose of this study was to investigate the possible use of the measurement value of maximum expiratory pressure(MEP) as trunk superficial flexor muscle strength assessment. Respiratory muscle strength assessment, muscle strength assessment, walking ability assessment, subjective assessment of life views, exercise performance assessment and the number of sit-ups were conducted in 235(male46, female189) home-bound elderly persons. There was significant correlation between MEP and the number of sit-ups. The number of sit-ups, % grip strength, % maximal muscle strength of the quadriceps, toe grasp power, maximal walking speed, timed up and go test, walking time on 10-m hurdle, 6-minute walk distance, active ability were significantly superior in the High-value group of MEP than in the low-value group. Intensity of influencing factor was 1.13 odds ratio on the number of sit-ups. We considered that MEP could inflect as trunk superficial flexor muscle strength assessment.

The purpose of this research is to reveal the reality of the self-injection of insulin practiced by the diabetic elders at home.

11 elders who obtain home ser vices and their assisters have been sur veyed to collect data by participatory observation, and its course has been classified by reference to the nursing system of Orem from the viewpoint of how independent the self-injection was.

As a result, the following types were classified, and their characteristic care by the nurses, care manager and helper were observed as follows :

Independent type, in which they suffer physical difficulty, but with no sign of cognitive impairment.

Cognitive dysfunctional type, in which they suffer cognitive impairment and forget injection

Physically unstable type, un which self-injection becomes difficult as complications progress, which leads deconditioning.

Taken care of type, in which they rely on others for injection because of heavy mental and physical disability.

In order to maintain self-care, which is predicted to move from independent type to taken care of type, as much as possible, it is important that the care manager and the visiting nurses predict the change in selfcare and provide assistance at the right timing.

“HRM checklist” was used to verify related factors of work commitment (WC) in nursing and in working for a homevisit nursing care station, and the relationships to the attributes were verified. The subjects were 212 home visit nurses in 44 facilities in the Kanto region ,and 177 responses were used for the research (response rate 83.5%). As a result of the analysis, ① three items, age, employment title, and the form of employment were shown to be attributes related to WC. Moreover, a relationship to non-work life was seen for three of these attributes. ②“Remaining and desire” regarding organizational commitment of 50-year-old or more staff was higher in comparison with those less than 50 years old, and “Normative” was less among 50 years olds than 40 years olds. ③ Regarding employment title, managers and chiefs were compared with regular employees. There were many items that were high in both WC and work satisfaction regarding organizational commitment and this confirmed the dual commitment to organization “Affective” and “Continuous” and career. ④Commitment to duty was thus seen to be higher among permanent staff in comparison with part-time staff.

The purpose of this study was to identify grief care practices for bereaved caregivers in visiting nurse stations and to consider the nursing challenges. Data were generated from a mail survey using an original researcher-developed self-administered questionnaire. Respondents were administrators of the visiting nurse stations throughout Japan, which were established by the Long-term Care Insurance Law.

Valid responses were 332 (90.7%). Regarding the duty of grief care after death as being a part of their work, which included voluntarily living in the caregivers home to provide support: 149 (44.9%) nurses said, “it is a part of work”. Of those respondents 147 (98.7%) replied that they had done grief care by home visiting after the patient’s death. Eighty percent of respondents acknowledged the need for grief care as part of their work but noted there were multifaceted challenges, for example: not enough time or staff for some of the work, economic problems, uncertainty about care methods and not enough community support for systems of grief care.

Grief care for bereaved caregivers in the visiting nurse stations was mostly one-on-one care by home visiting. It is important to respect the individuality of family caregivers, but the challenges are to manage nurses’ large workload: too much time involved, and moving to family caregiver’s home after the patient’s death is difficult.

This study aimed to clarify the characteristic social activities of frail elderly women living alone. Subjects of the study were six elderly women. Data were collected through interviews and analyzed using an inductive and qualitative method. Fifteen categories were identified and integrated into the following three core categories: “They interact with people to the best of their ability;” “They lead an independent life within their homes, taking into consideration their physical condition;” and “They go out with a definite purpose.” The characteristic social activities of these women were outside activities (those with a clear purpose and need for going out) and activities in their own homes, where they displayed proactive actions such as physical and cognition functions and non-proactive actions such participating in community activities. To support these women, we suggest that a person close to them should interact with them at regular intervals; services for activities closely connected to their everyday life should be offered; and their social activities should be promoted through healthcare service providers.

The purpose of this study is to identify the correlation between 24-hour home visiting nursing stations, collaboration with health care professionals at health care facilities and home care service providers, and home care, as well as examine medical collaboration system of home visiting nursing stations for realizing home care. Anonymous self-administered questionnaires were mailed to administrators at 1,590 home visiting nursing stations.

Home visiting nursing stations in areas having high at-home mortality rates provided support through a 24-hour home care system, provided emergency home visit nursing outside ordinary working hours, and collaborated with home care support clinics. Moreover, they are also thought to have provided 24-hour accommodation of changes in patient symptoms and apprehension among family members as a result of controlling symptoms through the use of drugs, and at-home continuous subcutaneous injections.

It was suggested that in order to realize terminal care in the home, it is necessary for visiting nurses to collaborate with health care facilities and provide high-quality care that focuses on the progress of the patient as well as education for enabling family members to care for patients with peace of mind.

The purpose of this study was to clarify the kinds of things said by family caregivers to elderly people with dementia, and related factors, with a focus on the relationship of the family caregiver.

A self-completed questionnaire was given, using the storage method, to 593 family caregivers who used day services in 2 cities in the northern Kanto region. Valid responses from 251 people (response rate 42.3%) were analyzed.

The words of family caregivers consist of the first factor “encouragement of independence in daily activities”, the second factor “emotional interactions”. The reliability of the factors was indicated by Cronbach’s α coefficients of .796 and .705, respectively. The level of words spoken was high for wives, and the second factor was seen to be significant with husbands, sons, and sons’ wives (p＜0.01). It was also shown that factors related to speaking differed according to the family relationship.

The present findings suggest that, when suppor ting family caregivers, non-standard, ef fective intervention is possible by clarifying the family relationship.

The purpose of the present study was to compare murder and double suicide cases, and to compare socio-demographic characteristics and the situation of cases which were caregivers’ murder or double suicide cases between urban and rural areas. A total of 224 murder and double suicide cases which occurred in disabled elders aged 65 years old and over, and their families, were selected from the newspaper article databases of the Asahi Shimbun, and analyzed. Characteristics and situations of cases including age and gender in elders and caregivers, their family relationships, time of occurrence and area were investigated in each article. After comparing murder and double suicide cases, it was understood that none were significantly related, Acomparison of these characteristics between urban and rural areas, showed that 43.8% of cases occurred in urban areas, and 56.3% in rural areas. In urban area 60.6% of cases occurred between wives and husbands, and in rural area 52.5% of those occurred between disabled mothers or fathers and children caregivers. Family relationships were significantly related with community characteristics for both urban and rural areas (p=.0019). These results suggested that caregivers’ murder or double suicide cases were more likely to occur in urban areas, those between wives and husbands were more likely to develop in urban area and those between parents and their children were more likely to develop in rural area.