1. Aim: To identify the thoughts of patients with pressure ulcer in the terminal stage. 2. Subjects: Twelve patients with terminal cancer complicated by pressure ulcer. 3. Method: The investigation was performed by qualitative assessment. We interviewed patients about their concerns regarding pressure ulcer when skin damage occurred and when it was healed. Narrative data was categorized by Berelson’s method. 4. Results: There were five males and seven females. The average patient age was 66.0（SD11.3, 45～95）years old. When their pressure ulcer occurred, they were conscious of impending death. When their pressure ulcer healed, wound healing was connected with “The will to live”. When they received wound management care, patients longed for alleviation of pain. Patients experienced a dilemma between wound healing and palliation of symptoms.
In the present study, we used the action research（AR）methodology to elucidate the process of improving perioperative ostomy care through a multi professional team approach. The study was conducted at A University Hospital between August 2009 and March 2010, and AR members（hereafter “the team”）were comprised of seven staff representing different professions working in clinical settings and two researchers. The team held regular monthly meetings to discuss problems in perioperative ostomy care and measure to improve care. The team clarified problems by soliciting opinions from outside the team, and discussed factors such as the collaborators necessary for implementing each measure as well as the care environment and schedule. The team established a detailed plan, which was explained by the team to others within the same profession prior to implementation, and the feasibility of the plan was judged based on the conditions in each setting. During each meeting, the team evaluated and revised proposed improvement measures and shared their thoughts. The results showed that the process of care improvement developed in three repeated phases; clarification of the problem, planning and implementation, and evaluation and reflection, and then changes were implemented in three cycles: 1）identification of current problems and feasible improvement measures; 2）establishment of care environment and staff cooperation; and 3）coordination between preoperative education in outpatient settings and relevant departments. In the process of implementing improvement measures, the team's approaches spread throughout the entire organization. The present findings suggested that processes using the AR method enhanced the team’s awareness of problem resolution, deepened understanding among the team, and promoted a team approach to medicine.