The purpose of this study was to examine the Visual Analogue Scale(VAS) as a method of self-assessment of health in order to facilitate the investigation even for elderly patients. Subjects were N=108 (45 men, women 63,average age of 74.3 years). The reliability of VAS was very high and positively related to general SUBI scores, as well as delete the most of the sub-scales of SUBI. Multiple regression analyses indicated that the factors of SUBI, “perceived health”, “confidence in coping” and “transcendence” were significant predictors to VAS. These results suggested that VAS is useful for validating subjective mental and physical health for individual cross-sectional follow-ups, also an accurate method of assessment for the health condition of both chronic patients and other elderly people.

The students of the Community Health Nursing Course have little experience, even by the end of the course, in encountering the disabled-child, and there is a considerable difference in students’ awareness of the issues involved.

Practical use of concept mapping was tried in problem based learning and offers special content for disabled-chlid support. Concept mapping was utilized and problem solution type education was tried. The student raised the question before a lesson at his lecture, and mostly was able to solve it.

Moreover, the future subject of educational support or disabled-child support was specially extracted by drawing the conclusion of a lesson after the lesson had ended. The concept indicated by lesson evaluation and concept mapping by the student and the number of key words were considered to be somewhat effective as an index of education.

Furthermore, concept mapping which can clarify a subject from a future view while supporting a student’s strategic thinking by stratification of a concept or key words was considered effective in practical use in the present condition.

ln order to further heighten the study effect, development of learning plans to include an Educational evaluation index so that a student who is weak in a particular subject can project it into a future plan.

In order to reduce expenditure by a health insurance society associated with unnecessary medical consultations among the elderly, we have been conducting a home-visit nursing program since 1996. The present study confirmed that home-visit activities by public health nurses had a considerable impact in reducing medical expenditure. Comparing the 6-month period before the service was introduced with that after implementation, medical expenditure associated with outpatient and dentistry consultations, hospitalization, and prescriptions was reduced by 13% in the group receiving home visits by the public health nurse service. On the other hand, comparing the first and latter half of 2002, medical expenditure increased by 129% in the group not receiving the home-visit service. Before implementation of the program, overall medical expenditure in the group receiving the program was significantly higher than in the group not receiving the program. In contrast, overall medical expenditure measured after introduction of the service showed no significant inter-group difference. Comparing the 6-month period before and after implementation of the program, average medical expenditure related to outpatient services decreased by 20% while that in the group not receiving home visits increased by 126%. A tendency was seen for medical expenditure to be reduced as a result of public health nurse home visits(p=0.08). Average number of outpatient consultations was reduced by 22% from before to after implementation of the program, compared to an increase of 129% in the group not receiving home visits. Hence home-visit nursing had a significant impact on reducing number of outpatient consultations with doctors(p＜0.05).

In summary, home-visit activities by public health nurses had a clear impact in reducing the number of outpatient consultations. However、no clear effect of home-visit activities on outpatient medical expenditure was apparent. The findings may be explained by the fact that although elderly people wish to live healthily, their health may be compromised due to lack of support from family or social contacts. In the future, public health nurses and the community must work together in supporting the elderly.

In this study, I researched into the nature of the difficulties with which family care workers usually are confront in the process of acquiring care work, in order to clarify the working situation of family care workers. The objects are family care workers engaging in medical treatments for serious patients after leaving hospital, and I conducted the study by a quality study method.

Delete in the result of this study, I found that the family care workers usually experience three stages within 3 or 4 months from the start to do home care: “being surprised and puzzled”, “trying the best treatment”, and “getting used to the smooth treatment”. Delete and I also found that there is some relationship between the difficulties and the guidance which family care workers receive from hospital staffs, on their patient’s leaving hospital.

Through this study, I suggest it is necessary for family care workers to strengthen the support at the time of the patient’s leaving the hospital and just after starting delete the family care.

For the sake of their respectability, families tending a mentally impaired patient are apt to hesitate to use social resources. The aim of this study was to clarify the disturbing factors in introducing social resources to families living with a mentally impaired dementia patient and nurses’ perception of the introduction of these resources. Visiting nurses at 126 nurse stations in O Prefecture were preliminarily surveyed to choose qualified nurses for further study. Then 92 fu11 time nurses at 31stations were selected based on their experiences of associating with families tending a mentally impaired patient and their knowledge and skills in handling these families. They were examined using our originally devised questionnaires. Among 52 nurses giving valid answers (56.5% of the 92 surveyed), 42 nurses (76.9%) were consulted by families about utilizing social resources for their patients, while 23 nurses (44．2％) had disturbing experiences in trying to adopt social resources for families. According to the perception of the visiting nurses examined, families’ refusal to utilize social resources has come from their concern about social reputation, economic burden, sense and belief of values, etc. Moreover, nurses have perceived the lack in national resources; i.e., lack of day care facilities, social service systems, caregivers’ interchange of information and special doctors in the local community all needed for mentally impaired patients. These results have revealed that it is important for us to establish a good teamwork system in cooperation with all staff members as well as patients and families including all people concerned on the basis of the local community system.

The Long Term Care Insurance System (LTCIS) was introduced to enrich home care and to save the cost of health care in April 2000. There has been no study comparing details of home care before and after LTCIS. This study reviews the details given by care helpers to clarify user’s needs in order to provide better home care. We analyzed the reports obtained from the helpers at a visiting home help service station in the western part of Shizuoka Prefecture for thirty days before and after LTCIS. The users and their families agreed to our study plan with a written consent. The home helpers checked a survey form consisting of 55 items concerning the details of home care. The data were analyzed by SPSS Ⅱ. There were 96 users during the 30 days before LTCIS (group A) and 208 after LTCIS (group B). The average age of group B was 77.1 years, seven years older than group A. Users in convalescence and stable health accounted for 90％; there were only several users in terminal stage in both groups. In group B, 201 users (97%) used LTCIS. Most frequent services of both times included cooking food, setting meals, house cleaning, assisting with clothes, assisting with transferring and intercommunication between the user and other social health services. In group B, the number of times of giving instruction on the dosage of medicine and applying ointment were increased. The needs of users who lived alone concerned a large amount of house cleaning and cooking food, even in those with high self-reliance. Users with low self-reliance depended more on services especially in the field of intercommunication. We considered that convalescence of the elderly should provide care for physical fitness so they can take care of personal matters by themselves.