[Objective] The objective of this study was to understand the patterns that arise in the support process of visiting nurses caring for patients during the terminal stage of chronic obstructive pulmonary disease (COPD), and to clarify the aspects of support that change depending on these patterns.

[Methods] The research design was the exploratory qualitative study using grounded theory approach of Strauss & Corbin (1990/1999). Data were collected from visiting nurses in Japan’s Kanto region.

[Results] The support process provided by home visit nurses for end-stage COPD patients was classified into four patterns, based on the nurse’s perception of the patient’s distinctive condition a peaceful death, a sudden and unexpected clinical outcome, divergence from the patient’s expected condition, and increased feelings of loneliness. Factors such as the challenge of predicting prognosis, the difficulty of controlling dyspnea, the recognition of impending death, and the skill to provide immediate care impacted these patterns.

[Conclusions] The support process provided by home visit nurses for end-stage COPD patients consisted of estimating the time the patient has left, respecting the patient’s wishes that are integral to their survival, and building up their strength to survive while helping them develop the resolve to face death.

[Purpose] This study aimed to understand the thoughts and desired support of long-term dialysis patients regarding their future treatment choices and discussions. Additionally, this is to obtain suggestions for support for future treatment modification and discussions.

[Methods] Semi-structured interviews were conducted with 10 hemodialysis patients who had been on dialysis for more than 10 years. Interviews were analyzed qualitatively and descriptively.

[Results] Seven categories of thoughts about future treatment choices emerged, two of which included: “If I lose consciousness and freedom of movement, I want you to respect my decision.” Also, seven categories of discussions emerged, one of which was, “I want to talk with people who know me well about my treatment and myself in preparation for the future.”

[Conclusions] Future treatment choices are influenced by the desire for informed decision-making based on current and potential circumstances. However, some patients are hesitant to consider or discuss end-of-life treatment options. Therefore, thoughtful dialogue and support tailored to individual needs are crucial.

[Objective] This study aimed to identify the knowledge acquired by healthcare professionals who participated in the “Program for ACP Supporters Involved in the Community.”

[Methods] Group interviews were conducted with 47 participants, and the interview data were analyzed qualitatively and descriptively.

[Results] The following six themes were identified: “By reflecting on my own end-of-life care, leading to reconsideration death and thoughts about a desirable death,” “Facing difficulties as a support person in supporting intention-expression,” “As a supporter, realizing that building a relationship with the individual and family is important for discussing thoughts and feelings,” “Recognizing the necessity of connecting and fulfilling the will of the person/family, including cooperation with multiple professions,” “It is crucial to sharpen the knowledge and skills necessary for supporting intention expression,” and “Reflecting on death while in good health and realizing the importance of being aware of and express one’s way of life.”

[Conclusions] Learning ACP among professionals provides an opportunity to discuss life and death with others and deepen introspection and reflection on their practice as supporters.

[Purpose] To examine conflicts experienced by nurses caring for patients with end-stage dementia at a dementia treatment ward.

[Methods] Semi-structured interviews were conducted with eight nurses with more than two years of experience working at a dementia treatment ward. Participants were interviewed about the conflicts they experienced while caring for patients with end-stage dementia. The data were analyzed qualitatively and inductively.

[Results] Seven categories were extracted as conflicts faced by nurses caring for end-stage dementia patients in dementia treatment wards: [conflicts arising from the continuation and limitations of dementia treatment in psychiatry ward], [conflicts over reduced activity due to treatment and care], [conflicts arising between patients/families and medical professionals], [conflicts over not being able to confirm the patient’s wishes], [conflicts over DNAR selection], [conflicts over nursing care arising from the distress of families towards dementia patients], and [conflicts over the relationship between patients and families].

[Conclusions] The entire nursing team must anticipate situations or scenarios where conflicts are likely to occur, arrange a place for discussion, and practice care based on common understanding.

[Purpose] To clarify the actual situation of Initial Advance Care Planning (ACP) used for elderly heart failure patients admitted to an acute care hospital and to obtain suggestions for future ACP methodology.

[Methods] A observational study on medical records of 17 elderly heart failure patients admitted to an acute care hospital. The patients were asked to discuss their ACP medical choices in case of future deterioration.

[Results] The mean age of the patients was 84 years, about 80% were first-time heart failure patients, and 70% were transported by ambulance. 16 patients defined their values, 11 patients described their preferred place of care, 13 patients decided on their future medical care, and 2 patients designated their advocate. Some of the stated values included, “I don’t want to live long,” and “I want to die in my sleep.” Among the 11 elderly first-time patients that discussed their future medical care, 7 indicated a preference for no invasive treatment.

[Conclusions] The results provided important suggestions for avoiding treatments and procedures that are not desired by elderly heart failure patients themselves. Even for elderly first-time heart failure patients having their initial ACP discussions, it is advisable to confirm the patient’s values and medical treatment preferences.

[Purpose] In November 2015, C Hospital critical care center introduced family-witnessed resuscitation (FWR) guidelines on a trial basis. This study aimed to determine the perceptions of doctors and nurses who experienced before and after FWR.

[Methods] From August 2015 to 2016, a survey of doctors and nurses who have before and after experience in FWR was conducted to determine changes in doctors’ and nurses’ awareness of FWR and conditions for doctors’ and nurses’ FWR.

[Results] Responses were received from 9 doctors and 23 nurses before and after FWR introduction. As regards changes in awareness, both doctors and nurses observed significant increases in three items after FWR: [⑤ Family members can understand the situation (doctors, p=0.01,; nurses, p<0.01)], [⑨ family members can see the actual treatment contents and state of the medical staff (doctors, p=0.02,; nurses, p<0.01)], and one other item. Regarding conditions after FWR, both doctors and nurses showed increases in [① family’s wishes], [⑩ there are staff members who can respond], and two other items.

[Purpose] This study aimed to clarify the nursing practice of homecare nurses with regard to end-of-life support for terminal cancer patients and their families.

[Methods] The research method consisted of semi-structured interviews with five homecare nurses with experience in end-of-life care regarding situations in which they were involved with terminally cancer patients and their families, and qualitative analysis of the data obtained.

[Results] The nursing care provided by homecare nurses who cared for cancer patients who lived longer than her life expectancy was summarized in four categories. ① Value the basic care of cleaning the body ② Committed to a listening attitude that leads to emotional stability for the patient and family ③ Anticipate risks while allowing the patient freedom in the home and providing nursing care ④ Understand the situation of the family members they are caring for and talk to them

[Conclusions] It is thought that the homecare nurses were respectful of the wishes of individual patients and their families, and supported their ability to live through basic cleanliness care.