Mayuko Tsujimura

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.

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.

Efficient Active Sensing with Categorized Further Explorations for a Home Behavior-Monitoring Robot

Mobile robotics is a potential solution to home behavior monitoring for the elderly. For a mobile robot in the real world, there are several types of uncertainties for its perceptions, such as the ambiguity between a target object and the surrounding objects and occlusions by furniture. The problem could be more serious for a home behavior-monitoring system, which aims to accurately recognize the activity of a target person, in spite of these uncertainties. It detects irregularities and categorizes situations requiring further explorations, which strategically maximize the information needed for activity recognition while minimizing the costs. Two schemes of active sensing, based on two irregularity detections, namely, heuristic-based and template-matching-based irregularity detections, were implemented and examined for body contour-based activity recognition. Their time cost and accuracy in activity recognition were evaluated through experiments in both a controlled scenario and a home living scenario. Experiment results showed that the categorized further explorations guided the robot system to sense the target person actively. As a result, with the proposed approach, the robot system has achieved higher accuracy of activity recognition.

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.

Sensing kuuki among visiting nurses.

This study aimed to explore how visiting nurses in Japan sense Kuuki (mood or atmosphere) in the homes of patients and families. Participants were 15 Japanese visiting nurses with experience sensing kuuki in homes of patients and families. Data were collected through two 90 min focus group interviews with experienced visiting nurses, and a qualitative content analysis was performed. The qualitative analysis showed that experienced visiting nurses sensed kuuki in eight ways. Kuuki differs based on type of illness, state of health and number of visits. Sensitivity to kuuki is thought to be linked to understanding of patient and family feelings, changes in the physical condition of patients and evaluation of nursing care delivery. Perception of kuuki also contributes to care planning especially on the very first home visit and when visiting terminally ill patients.