Objective: This study aimed to analyze requirements with regard to nursing consultation by mental health consultation liaison nurses (MHCLNs) and examine suggestions for MHCLN intervention.
Methods: Subjects included 4 MHCLNs from a university hospital with approximately 1400 hospital beds located in the Tokyo metropolitan area and 143 patients and family members who either volunteered or were requested to participate by nurses. The consultation request route common to all 4 activity record formats, age and sex of the individual requesting counseling, and diagnosis and consultation data were retrospectively studied.
Results: Of the 143 subjects, 58 were male (40.6%) and 85 were female (59.4%), with a mean age of 54.2 years. Of 124 diagnoses, cancer was the most common (n = 66, 53.2%). With regard to patients’ psychiatric status, acceptance of the disease was the most common difficulty (n = 39, 27.3%), followed by adjustment disorder (n = 29, 20.3%) and mood disorder (n = 10, 7.0%). Psychiatric symptoms included anxiety (n = 75, 45.1%), depression (n = 38, 22.9%), and anger (n = 29, 17.4%).
The consultation requests came most commonly from staff (n = 66, 46.2%), followed by attending physicians, psychiatrists, or the palliative care team (n = 26, 18.2%) and administrators (n = 26, 18.3%). Twenty-two (15.7%) requests were made directly by the patient or family member. MHCLNs collaborated with psychiatrists for 74 (51.7%) subjects, whereas they did not collaborate for 68 subjects (47.6%).
Details of direct care included interviews using supportive psychotherapy (n = 92, 64.3%) combined with relaxation (n = 18, 12.5%) and an approach to partial recognition (n = 11, 7.7%). Nursing consultations totaled 127 (88.8%).
Conclusions: Among the subjects consulted by an MHCLN, those that were counseled by a nurse alone (i.e., no liaison with the psychiatry department) often had difficulty in accepting the disease or were maladjusted with symptoms such as anxiety, depression, or anger. If these symptoms can be relieved during the early stages, medication may not be required and consultation or practice may prevent deterioration in the psychiatric condition and lead to an improvement in symptoms. In patients with somatic disorders requiring psychological care, nurses highly specialized in mental health care, such as MHCLNs, are required to serve as liaison personnel. This is especially required for patients with psychological problems caused by the stress of the disease and treatment, albeit within normal limits, or for patients in a condition requiring psychiatric treatment.
Aim: The purpose of this study was to determine whether the amount of nursing services estimated under the classification of Nursing Need Degree is adequately evaluated for each Diagnostic Procedure Combination (DPC) reimbursement.
Methods: A longitudinal cohort study design was employed to examine all 28,757 hospitalizations, except for those due to tuberculosis, in Hospital A in Japan between July 2008 and March 2010. We excluded the following patients from analysis: patients who were not applicable to the DPC system; patients who were hospitalized beyond the specified DPC period; and patients who were applicable to the specified hospital fee. We collected data from the administration system of medical business and Nursing Need Degree (NND). We calculated the mean of the hospital fee portion (i.e., fees for room and nursing services) per total number of nurses required and created a list of per-nurseday unit price for each DPC group, only if the number of patients included in the identical DPC group exceeded 20. We described about the number of assigned DPC codes, in such a way as to distribution of percent difference from the mean of hospital fee portion/total necessary number of nurses for each DPC group. In addition, we focused on the difference from the mean by 30%.
Results: A significant correlation was found between the hospital fee portion and total number of nurses required under the DPC system. However, the distribution of percent differences among the mean of the hospital fee portion per total number of nurses required revealed that 39 of 179 DPC code groups were either underestimated or overestimated. The underestimated group included a number of obstetrics- and gynecology-related diseases, whereas the overestimated group included many non-surgical, cancer-related diseases.
Conclusions: Our results significantly contribute to the identification of DPC codes that do not adequately reflect nursing services required under the present DPC payment system.
To shed a light on problems and areas of needs in health care services for foreign residents, this research focuses on identifying these problem areas that affect health care provision to foreign residents. This study was conducted in cooperation with an organization that provided everyday life support consultation to foreign resides in multiple languages at a Center for International Exchange. An analysis on contents of multi-lingual consultations provided by a foreign resident support organization in a major urban area identified these issues which are chosen from records of health related consultation cases which were selected from all everyday life support consultation records dating from April 2004 to March 2010. There were, in total, fifty-one health related consultation cases. Thirty one consultations were carried out in Japanese, issues that were caused by language barriers and cultural differences: communication problems, lack of information on health services and welfare services, difficulty in applying for benefits which resulted in the inability to pay medical costs and stress from unfamiliar work and life environment. Two elements of health service improvement would be “revised ways of information provision for the foreign residents” and “awareness of the multicultural society”.
Several studies have highlighted the fact that long-term care facilities and caring staff are not ready for quality endof- life care provision. The present study is aimed at shedding light on how caring staff provide care at the end of life and the emotions they experience in the provision of this care. Study participants were 4 long-term care leaders from different long-term care facilities. The subject for focus group discussion was end-of-life care at long-term care facilities. We used the KJ method (Kawakita Jiro’s initials) as a qualitative research tool, which is widely employed in Japan. The emotions and experiences were organized into 9 groups (including 2 loner labels): 1) Active family involvement is important to successful end-of-life care; 2 Caring staff want to provide end-of-life care with compassion as well as logic; 3 Caring staff would rather avoid facing death or dealing with dying residents; 4 Caring staff are at a loss as to how to behave around the time of a resident’s death; 5) There are language and psychological communication barriers among members of the end-of-life care team; 6) Caring staff get used to death through repetition; 7) End-of-life care for the elderly is challenging work. The loner labels were “A person who can remain calm and collected when facing the death of a resident” and “There are no complete manuals on providing end-of-life care due to the diversity in dying processes of elderly residents”.
The present study reveals that long-term care leaders require a person who is able to remain composed in a demanding and emotional end-of-life care environment. Also, they thought that such a cool-headed person is best suited to tend to the needs of caring staff and residents’ family and to promote communication among end-of-life care team.
Midori Kamizato, Sayuri Jahana, Naomi Tamai, Yuko Aihara, Kaori Saeki, Kaori Shimizu, Yukari Tukahara, Ryuta Yoshizawa, Kasumi Hamada, Kayo Nagano, Mieko Taira, Risa Takamiya, Kumiko Tamashiro and Mizuho Tajima
Purpose/Objective: To identify oncology nurses’ use of complementary and alternative medicine (CAM) for cancer patients in Japan.
Design: Descriptive, cross sectional.
Setting: Five central cancer hospitals, five general hospitals, and four Palliative Care Units in Japan.
Sample: A convenience sample consisting of 1134 oncology nurses with a Japanese Nursing license.
Methods: A researcher-developed self-reported questionnaire for CAM was delivered to nurses who were involved with cancer patients in hospitals and palliative care units (PCU).
Findings: The response rate was 71% (801/1134). The nurses’ knowledge of CAM was 42 % (40% in hospitals and 68.4% in PCU). The use of CAM for nursing practice was 29.4% (26% in hospitals and 71% in PCU). The types of CAM used were massage therapy (78%), lymph drainage (46%), aromatherapy (43%), touching (42%), music therapy (33%), acupressure and breathing (19%), hot pack therapy (16%), acupuncture (13%). Barriers of using CAM in nursing practice were because of insufficient skill (73%) and knowledge (68%), and having no time (70%) for CAM. However, 80% of the nurses wanted to use CAM such as aromatherapy (72%), massage therapy (61%), lymph drainage (53%), and music therapy (43%). The purposes of aroma and music therapy use for patients were relaxation, relieving anxiety, pain, insomnia, edema, and fatigue. Fifty-six percent of nurses had been asked by patients about healthy food or supplement. Only 8.7% of nurses knew about the Cancer CAM guideline (hospitals 8% vs. PCU 23%).
Conclusion: Nurses performing CAM do not yet have sufficient knowledge or utilization practices, and there are difficulties with both skills and time management. However, there is reason to be optimistic about providing safe and effective CAM treatment to cancer patients. Therefore, it is necessary to enhance the education afforded to nurses in order to realize effective CAM usage. Developing CAM educational programs for nurses will be the next step in research with simple and easy to use CAM therapies in nursing practices in Japan.
Purpose: The research purpose was to investigate the short-term effectiveness of exercise intervention to improve pharyngeal functions in the elderly using day- care services.
Methods: Subjects were totally 84 elderly people. The participants were analyzed at 2 points: baseline and 2 weeks after the starting date of the study. This exercise comprised pronunciation practice, a pushing exercise with crying out in a loud voice, and a falsetto exercise. A questionnaire of ingestion and deglutition functions was also answered at 2 points. The collected data were statistically analyzed using SPSS J16.0. The intervention duration of this study was from February 2 to March 4, 2008.
Results: The average participant age was 82.4 ± 8.6 years. Comparing the evaluative items of the swallowing functions at 2 points, significant differences were observed in the movement of the upper and lower sides of the tongue, optional cough, consecutive pronunciation [ta], hoarseness, and the RSST test. The total frequency of participation in this programmed exercise was significantly related to lip and tongue movement, pronunciation [ka], and utterance time. A positive change of feeling was observed in the score of the 2 items.
Conclusion: The results of this study showed very useful hypothetical information about intervention to arouse pharyngeal functions for the elderly using day care services.