Objective: To evaluate the effect of telemonitoring by healthcare providers on the health outcomes of at-home patients with chronic obstructive pulmonary disease through a systematic review and meta-analysis.

Methods: To conduct a systematic review, this study evaluated the literature by utilizing the following eligibility criteria:

Criteria: (1) randomized controlled trials; (2) at least 40% of subjects had chronic obstructive pulmonary disease; (3) healthcare providers conducted telemonitoring; and (4), control groups with no telemonitoring. A subgroup analysis was performed for the support period. The Committee for Guideline Compilation of the Japan Academy of Home Care conducted the review.

Results: Twenty-six studies were included. Despite random allocation, the study observed a risk of bias. Support activities included teleconsultation and patient education, conducted by nurses and other healthcare providers. The intervention group had significantly lower mortality (p < 0.001), emergency department visits (p = 0.02), hospital bed days due to exacerbation (p = 0.02), and rate of subjects due to acute exacerbation (p = 0.002).

Conclusion: The findings of this study indicate that telemonitoring of at-home patients with chronic obstructive pulmonary disease by healthcare providers affected the patients’ health outcomes. However, conclusive evidence was limited.

While the need for home care is increasing in Japan, for a growing number of nuclear families and caregivers, the burden of long-term care is also increasing. Stroke caregiving is complex and can change dramatically depending on the stroke trajectory. Stroke caregivers must adapt to the changes caused by the stroke patient’s illness. Especially, stroke caregivers face a high burden of short and long-term care. Caring for stroke patients, particularly those with declined ADL, requiring treatment, and needing long-term care, is complex. When the caregivers are elderly, the burden of care becomes greater. Long-term care carries a heavy burden, and it is difficult to maintain care over time.

This study sought to clarify the factors related to continuous care provided by caregivers aged 75 and over. Semi-structured interviews were conducted with seven family caregivers for each stroke patient. The results were analyzed by referring to the grounded theory approach.

The analysis results generated five categories: “positive attitude toward care,” “improvement of daily care techniques,” “stable marital relationship,” “caregiver’s mental stability,” and “acceptance and utilization of the medical welfare system.” “Nursing care built into daily life” was identified as the core category. The results suggest that “nursing care built into daily life” best reflects the lives of caregivers and caregiving, leading to an improvement in the quality of life and the continued care of patients.

The study conducted two focus group interview (FGI) sessions, and six professionals were analyzed qualitatively and descriptively in each situation with respect to its practice of intervention/support.

Categories were extracted based on the results of the FGI session analysis. Eight categories were utilized in the assessment and observation period, including “Visit regularly and patiently to meet the care subjects in person as the initial goal,” and “Implement routine observation to prevent isolation.” Ten categories were utilized for the initial period, including “Identify issues the care subjects have,” or “Precisely explain highly life-threatening risks that care subjects face with self-neglect.” Finally, nine categories were utilized for the medium to long-term, including “Identify the life-threatening risk and prioritize protecting life,” and “Involve the community to establish a human connection.”

The results demonstrate that professionals should patiently build mutual trust with their care subjects, always stay vigilant regarding life-threatening risks, and develop support relationships with them, starting by resolving their minor personal issues to help them rebuild their former lives. The results also suggest that the establishment of a community network is the key to successful intervention and support.

This study examined the effects of brief individual reminiscence therapy for older adults with dementia, and its applicability to home-visit nursing. The subjects were seven elderly people with Alzheimer’s dementia type. Individual reminiscence therapy sessions of approximately 10 minutes were held once a week for a total of eight sessions (2 months). The effectiveness of the intervention was evaluated using three items: the Dementia Quality of Life Instrument (DQOL) as a dementia-specific QOL scale, the Alzheimer’s disease Rating Scale (BEHAVE-AD) to measure BPSD, and observation recording sheets. The DQOL and BEHAVE-AD scores were analyzed using the Wilcoxon signed-rank test. The results revealed that sense of self-respect significantly improved one month after the intervention. None of the BEHAVE-AD subscales indicated significant differences. Scores from the observation recording sheets showed increases in the following categories: facial expressions, happiness/joyfulness, overall impression, number of statements, and spontaneity/responsiveness. The users activated positive emotional expressions by recalling past emotions. Based on this, the therapy may be applicable as care to help elderly people with dementia rediscover self-fulfillment and stabilize their conditions. These results suggest that reminiscence is a useful therapy in home-visit nursing care that promotes positive emotions in elderly people with dementia.

The objectives of this study were to identify the factors underlying difficulties experienced by the Community General Support Center staff in responding to user consultations after the commencement of the “preventing long-term care/livelihood support service projects,” and to investigate how staff members are coped with those difficulties. Semi-structured interviews were conducted with 14 staff members from seven Community General Support Centers in Japan, and the collected data were analyzed using qualitative and descriptive methods. The results revealed that, while the Community General Support Centers provided staff with consultation guidelines and policies, staff members reported the following difficulties: “Lack of information about user conditions and living situations,” “Difficulty in predicting progression of dementia,” “Gap between user’s or user family’s hopes and professional judgements,” and “Gap between the thoughts of users and those of their families.” The staff members addressed these issues through the following coping mechanisms: “Understanding user conditions and living situations,” “Visiting users with other professionals to discuss and manage each case,” “Addressing issues internally within a center,” “Holding discussions in an individual care meeting,” and “Applying for both project support and a Certification of Needed Long Term Care.” These findings suggest that Community General Support Center staff need to utilize the services of related organizations and professionals. They also indicate that support systems need to be constructed for Center staff members who respond to consultations, in order to improve their consultation procedures.

Objective: This study sought to clarify the relationship between the “2.5-person perspective” of visiting nurses and the rewarding nature of visiting nursing.

Methods: 341 visiting nurses filled out an anonymous, self-administered questionnaire survey that included items on participant attributes, the rewarding nature of visiting nursing, and Suda and Kawaguchi’s Visiting Nurses’ “2.5-Person Perspective.” The relationship between the visiting nurses’ “2.5-Person Perspective” scale scores and the rewarding nature of visiting nursing were analyzed using Spearman’s rank correlation coefficient.

Results: Responses were obtained from 255 participants (collection rate: 74.8%). At least 60% of participants responded that they found visiting nursing rewarding, and that it was an attractive job that they liked. The results revealed a relatively strong positive correlation between the rewarding nature of visiting nursing scores and the overall Visiting Nurses’ “2.5-Person Perspective” scale scores (ρ=0.488–0.366; p<0.001). Respondents with greater professional composure and objectivity found visiting nursing particularly rewarding (ρ=0.527–0.396; p<0.001).

Conclusion: The more that the respondents utilized their expertise to make calm situational assessments when providing care, the more rewarding they found visiting nursing. The present findings indicate that, for visiting nurses, a professional attitude towards embracing psychological closeness with, and feeling sincere empathy for users and their families, is linked to maintaining and increasing the rewarding nature of their jobs.