Junko Fujita

Late referrals to home palliative care service affecting death at home in advanced cancer patients in Japan: a nationwide survey

BACKGROUND To identify factors influencing place of death among home palliative care patients with advanced cancer, focusing on the timing of referrals from hospital to home care settings. METHODS A cross-sectional nationwide questionnaire survey was conducted on home palliative care patients at 1000 randomly selected home care agencies in Japan. A total of 568 responses were analyzed (effective response rate, 69%). RESULTS Multivariate logistic regression analysis revealed that (i) predischarge health care supports in hospital (e.g. early referral 8 days or more before discharge; clear explanation by hospital staffs to patients and families regarding discharge to live and die at home) and (ii) postdischarge health care supports after transferring home care (e.g. signing a 24-h support insurance contract of network between primary physician and nurse as a home palliative care team; primary nurse consultation with primary physician >3 times during the first week after discharge) have an effect on place of death among home palliative care patients. CONCLUSION An early and carefully coordinated referral support system for smooth discharge by hospital staffs as well as intensive and highly qualified support just after discharge by the home care team would help to increase the number of patients who could die at home.

Determinants of financial performance of home-visit nursing agencies in Japan.

BackgroundJapan has the highest aging population in the world and promotion of home health services is an urgent policy issue. As home-visit nursing plays a major role in home health services, the Japanese government began promotion of this activity in 1994. However, the scale of home-visit nursing agencies has remained small (the average numbers of nursing staff and other staff were 4.2 and 1.7, respectively, in 2011) and financial performance (profitability) is a concern in such small agencies. Additionally, the factors related to profitability in home-visit nursing agencies in Japan have not been examined multilaterally and in detail. Therefore, the purpose of the study was to examine the determinants of financial performance of home-visit nursing agencies.MethodsWe performed a nationwide survey of 2,912 randomly selected home-visit nursing agencies in Japan. Multinomial logistic regression was used to clarify the determinants of profitability of the agency (profitable, stable or unprofitable) based on variables related to management of the agency (operating structure, management by a nurse manager, employment, patient utilization, quality control, regional cooperation, and financial condition).ResultsAmong the selected home-visit nursing agencies, responses suitable for analysis were obtained from 1,340 (effective response rate, 46.0%). Multinomial logistic regression analysis showed that both profitability and unprofitability were related to multiple variables in management of the agency when compared to agencies with stable financial performance. These variables included the number of nursing staff/rehabilitation staff/patients, being owned by a hospital, the number of cooperative hospitals, home-death rate among terminal patients, controlling staff objectives by nurse managers, and income going to compensation.ConclusionsThe results suggest that many variables in management of a home-visit nursing agency, including the operating structure of the agency, regional cooperation, staff employment, patient utilization, and quality control of care, have an influence in both profitable and unprofitable agencies. These findings indicate the importance of consideration of management issues in achieving stable financial performance in home-visit nursing agencies in Japan. The findings may also be useful in other countries with growing aging populations.

Cultural characteristics of nursing practice in Japan.

The population of Japan has become multi-cultural, and there is more demand for culturally competent nursing care. The purpose of this study was to explore cultural characteristics of nursing practice in Japan focusing on behaviour. We interviewed 25 professionals with experience in or knowledge of nursing practice both in Japan and either the United States, the United Kingdom, Sweden, Thailand or South Korea. Qualitative content analysis has yielded three themes for cultural characteristics of nursing practice in Japan: practice expectations, communication and relationships with patients. Practice expectations for nurses in Japan involved various aspects; nurses conducted a wide range of basic nursing tasks, including bed baths and toileting. They often relied on non-verbal communication to deliver thoughtfulness and perceptiveness. They typically show deference to doctors and colleagues, emphasizing building and maintaining harmony with them. This emphasis on a multifaceted, non-verbal, and harmonious approach seemed characteristic of practice among Japanese nurses.

Analysis of team types based on collaborative relationships among doctors, home-visiting nurses and care managers for effective support of patients in end-of-life home care

To define the team types consisting of doctors, home‐visiting nurses and care managers for end‐of‐life care by measuring the collaboration relationship, and to identify the factors related to the team types.

Survey on the use of health consultation services provided in a Japanese urban public housing area with a high elderly population.

The aim of the present study was to determine how the elderly in an urban public housing area intends to utilize health consultation services.