The purpose of this study is to investigate the factor of extension to time in bed (TIB) of home care clients and influence of their daily life in recuperation. Of those getting health care services in H prefecture,fifty-one subjects (65-95 years of age, mean age 77.3 ± 7.9) were studied. Each respondent lived in an independent house with their family or spouse.The respondents were rated either A (semi-independent) or B (semi-bedridden). Using a structured questionnaire, the researcher interviewed all clients between September 1997 and October 1998.The findings are as follows:

1) Home care clients’ bedtime was early and getting up time was late, their TIB became extended and twenty-one clients’ TIB was over 9 hours.

2) Low degree of self-care level and household of couple were factors of sleeping for a long time, and it brought the state of bedridden.

3) The clients with low self-care level excreted in the bedroom at nighttime, and took a bath with day service has increased.

4) The place of the excretion and cleanness changed by self-care level, and the satisfaction to the living environment had lowered.

The results suggest the need that the care-givers should advise the family as well as the client at an early stage of their home care life, not to sleep for a long time, to improve the living environment, to expand the range of their action to increase the amount of the activity in daytime and to increase the chance of going out.

The purpose of this study was to identify factors related to satisfaction and expectation of residents’ hospital choice. We conducted a self-report questionnaire survey in 394 residents who received regular outpatient treatment in rural “A” city. The factor analysis extracted six factors for satisfaction ; doctor’s service (Fl), nurse’s service (F2), staff attitude (F3), facilities (F4), convenience (F5), and optional service(F6) . For expectation, four factors were extracted ; nurse and staff attitude (Fl),convenience and facilities(F2),doctor’s service (F3), and others(F4). The internal consistency was high. (The Cronbach’s alpha coefficient was 0.92 in 22 satisfaction items, and 0.84 in 22 expectation items, respectively.)

As a result of multiple regression analysis with hospital and resident characteristics, there was a positive correlation with satisfaction on “convenience,” while there were negative correlations with other satisfaction variables in those who visited “A” hospital in neighborhood. There were negative correlations with satisfaction on “staff attitude;’ “facilities,” and “convenience” in office workers, and also men and persons who could drive tended to show their negative correlation. As a result of simple regression analysis, age showed positive correlations with several factors of satisfaction and expectation. These results suggest that hospital name, occupation, gender, address, driver’s license, and age were determinant factors of hospital satisfaction, and age was a contributing factor of expectation.

Patients of “A” hospital in neighborhood were old women who could not drive a car due to old age, while young office workers who could drive tended to visit hospitals outside of the city. These residents’ characteristics can be determinant factors of residents’ hospital choice.

Purpose：The purposes of this study were to investigate the subjective burden on caregivers of caring for amyotrophic lateral sclerosis(ALS)patients at home, and to identify the characteristics and factors in patients and caregivers that were related to burden.

Methods：A questionnaire was distributed in August 2000 to all patient members of the Japan ALS Association and their families. Returned questionnaires were used to analyze 328 caregivers of ALS patients at home. The questionnaire included questions on demographic characteristics of patients and caregivers, subjective care burden and related factors regarding patients, caregivers and social support resources.

Result：Female caregivers for ALS patients comprised 76.3% of the sample population. In the majority of cases the relationship to the patient was that of a spouse (81.0%). Mean age was 56.7 years old (SD:10.9). The score of burden was rather high. Three factors characteristic of caregivers for ALS patients were identified through factor analysis, using a principal factor method with varimax rotation. These factors were “mental exhaustion” “anticipatory anxiety” and “positive caregiving attitude”.

Subjective care burden scores were significantly higher in the subgroups of elderly caregivers, male caregivers, primary caregivers with alternative caregivers, those reporting longer periods of daily care, and those feeling that their household budgets were insufficient to bear the necessary costs (p<0.05).Independent variables of age, gender, use of alternative caregivers, daily care duration and feelings regarding household budgets were analyzed using quantitative I-type analysis. As a result, subjective care burden was observed to be most significantly increased when caregivers were spending a long time every day involved in care activities, followed by the those with alternative care arrangements, and feeling under budgetary pressure, respectively.

Conclusion：These findings suggest that nurses are in a position to recognize a number of risk factors presented by caregivers.Older caregivers taking care of patients for extended periods every day and feeling financial stress due to caregiving are particularly likely to experience elevated levels of subjective care burden.Nursing staff should therefore be aware of potential opportunities to avert a crisis.

To improve the cooperation between nurses and care personnel, we analyzed the recognition of client information in 109 nurses and 77 care personnel.For each of 47 physical, psychological, social, and living environmental items, the degree of importance attached by the nurses and care personnel was investigated,and cluster analysis of data was performed. Both nurses and care personnel classified client information into two types:one related to the clients’ physical condition and the other to recognize the clients’ mental state. When the clients’ physical condition was evaluated, nurses focused on health problems while care personnel focused on problems in daily living. Differences were also observed in the recognition of the clients’ mental state.

These results suggested differences in the pattern of the recognition of client information between nurses and care personnel. Therefore, sharing of information between occupations may lead to improvements in elderly care.

Objectives：To study antitonic effects of music on the severely handicapped persons, we carried out basic experiments in music selection and determination of timing of music stimulation.

Methods：Music numbers fitting the above purpose were selected and delivered as stimuli to 30 healthy girl students aged 19.77years(mean) during 15 min, while their physiological responses were continuously measured on the pulse rate, respiration rate and skin temperatures of the back of the right hand and the right side of the neck. Furthermore, the subjects’, individual emotions during the experiment were asked through semi-structured interviews. The obtained data on the physiological responses and emotions were analyzed and compared between the stimulation phase when the girls listened to music and the non-stimulation phase when they listened to no sound.

Results and Discussion : The mean temperature of the back of the right hand in the stimulation phase was significantly lower(p<0.001)than in the non-stimulation phase. The pulse rate in the non-stimulation phase was significantly higher (p<0.001) than in the stimulation phase. The subjects’ emotions were stable in the stimulation phase,and unstable in the non-stimulation phase. As these facts indicate, properly selected music stimuli delivered for an appropriate time could produce antitonic effects on the severely handicapped,both mentally and motorically.

The purpose of this study was to develop functional training standards by activity level to assure the quality of rehabilitation services provided by nurses for clients at home. We studied the problems of functional training in home care, and standardized the process of functional training from assessment to evaluation from September 199 to December 2000.We evaluated clients’ outcomes before and after the development of functional training standards, and also implemented and evaluated the standards of 23 clients from December 2000 to March 2001.

The following results were obtained :

1.The developed standards responded well to elderly clients’ needs with various complications including mental disorders and dementia.

2.The standards were implemented for the 23 clients for almost all of the functional training items, and our results clients showed some improvements in expression and vigor. Thus, it suggests that the standards can be used in practice, and improvement can be expected.

3.Computerized assessment and integration with a care plan program by ･coding all items will improve its efficiency.

The purpose of this study is to look into the possible factors which thought to influence the female care-givers when they try to be engaged in nursing while keeping their work, ln survey 1, by conducting the interviews with 5 female care-givers who have work, the items which are considered to influence female care-givers’ continuation of their work were collected. In survey 2, interviews with questionnaire sheets were carried out for 146 care providers from home-care agencies, who are 40 years old and above. And based on the frequency distribution and mean value, the items which have been collected in the above survey were carefully selected. After conducting survey 1,120 items were collected, and they were categorized into following groups according to the content. 1.People who receive care, 2. main care-giver, 3. nursing, 4. family, 5. service, 6. work. As a result of survey 2. the factors which are considered to highly influence female care-givers’ continuation of their work were sampled out from each of these categories,and then the specific 46 items were selected. From this study, therefore, it can be concluded that these categories would serve assessment by care providers from home-care agencies when they try to support the female care-givers so that they are able to keep their work while being engaged in nursing activities.

The purpose of this study is to identify the kinds of skin disorders of the buttocks suffered by people requiring in-home care and the methods used to address the needs of these people after defecation. It is also intended that the results of this study be used as basic data for considering improvements in preventative care.The following study results were gathered through a paper survey mailed to 110 subjects.

1) Thirty to forty percent of in-home care recipients have experienced skin disorders in the buttocks.These disorders include chapping, redness, eczema, and decubitus ulcers (bedsores). It was also noted that the development of one of these disorders increases the likelihood of developing others.

2) People who, over long periods of time, require care after defecating, and those whose stool is soft or watery, showed an increased propensity for developing skin disorders in the buttocks.

3) This study classified methods for providing care after defecation as cleaning (e.g. with tepid water), wiping with a tissue manufactured for cleaning the buttocks,, and skin treatment(the application of oils, creams, etc. as a final step in care after defecation). It was determined that over 300% of caregivers use some combination of these care methods and that many in-home care recipients who were addressed by this study received care in the form of cleaning or skin treatment for the first time, after they had developed eczema or bedsores.

The results of this study indicate the importance of awareness of preventing the onset of even minor skin disorders when addressing the needs of those requiring care after defecating.