Backgrounds & aims : The number of children with chronic conditions who receive care at home, particularly those who are dependent on medical technology are rapidly increasing. Systematic studies about nursing practice during the transition of technology-dependent children from hospital to home are very limited in Japan. This study explored the nursing practice supporting the transition of technology-dependent children from hospital to home. Methods : Qualitative descriptive design was used. Data were collected via semi-structured interviews from 15 nurses in three different settings : nurses of inpatient pediatric units ; nurse discharge coordinators ; and home care nurses. Results : Nursing practices unique to each of the three settings were identified ; hospital primary nurses advocated for the parents ; nurse discharge coordinators assumed the mediating role ; home care nurses respected and monitored parents' way of care. Promoting parents' self-efficacy was a key role common in hospital and home care nurses. The roles of the nurse discharge coordinators in dealing with this pediatric population were newly reported. Conclusions : Nursing practices of each setting were identified. The findings are expected to guide the nurses to recognize and appreciate their roles for each other which in turn would enable development of nurse-to-nurse collaboration for successful transition.
Pulmonary tumor thrombotic microangiopath (PTTM) presents with severe manifestations and rapid progression and is difficult to diagnose ante mortem. We report a case of gastric adenocarcinoma diagnosed with PTTM before death. Chest XR and CT showed ground-glass shadows in the bilateral lung fields, gastric adenocarcinoma was demonstrated by gastrointestinal fiber scopy and biopsy, and poorly differentiated carcinoma cells were detected in the pulmonary arterial blood by pulmonary wedge aspiration cytology on cardiac catheterization. After diagnosis of PTTM, prednisolone therapy of 30 mg/day was started. Dyspnea and hypoxemia were improved on the next day of administration of prednisolone. Although PTTM is rare, it should be considered the differential diagnosis of pulmonary hypertension and progressive respiratory failure with diffuse ground-glass shadow on chest radiographies. Furthermore, administration of prednisolone should be considered one of the treatment for the dyspnea by PTTM.