| Co-Investigator(Kenkyū-buntansha) |
MORITA Toshiko Kumamoto University, School of Medicine, professor, 医学部, 教授 (30242746)
NANKE Kimiyo Kumamoto University, School of Medicine, Research associate, 医学部, 助手 (80264315)
ARIMATSU Misao Kumamoto University, School of Medicine, Research associate, 医学部, 助手 (50289659)
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| Budget Amount *help |
¥2,000,000 (Direct Cost: ¥2,000,000)
Fiscal Year 2006: ¥900,000 (Direct Cost: ¥900,000)
Fiscal Year 2005: ¥1,100,000 (Direct Cost: ¥1,100,000)
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| Research Abstract |
This study aimed to elucidate the current situation regarding advocacy in terminal nursing care of the elderly. Interviews were conducted with 25 nursing professionals at domiciliary care services and 18 such professionals at special-care nursing homes in "A" prefecture, Japan. This was followed by a nationwide mail-in questionnaire survey of nursing professionals at 800 randomly selected domiciliary care facilities, with two individuals from each institution. Questionnaires were developed based on the results of the interview, and they included 23 items relevant to advocacy role in nursing; as revealed by the interview findings. Results of the interview sessions indicated eight situation categories in domiciliary terminal care of the elderly in which the patient's benefits and rights were likely to be threatened. They included: (1) further development of physical pain and symptoms that impede the maintenance of the present condition; (2) difficulties in understanding the patient's tru
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e will; (3) patient's intention influenced by the will of his or her family; (4) caregiver's unreliable nursing skills, (5) caregiver's unstable emotions, (6) patient and family's inability to communicate with the physician; (7) physician and nurse's questionable abilities and attitudes; and (8) inadequacies of the health care system. Strategies for resolving difficulties in understanding patients true will, and for facilitating patient advocacy included seven categories of acts, such as: forging mutual trust with the patient, consulting those who understand the patient, acquiring a complete picture of the patient, assessing the patient's true will, and increasing quality, duration, and frequency of patient contact. Interview results also revealed five categories relevant to advocacy role in terminal nursing care at special-care nursing homes: (1) experiencing dilemmas due to care-related decision making by people other than the patient; (2) understanding the patient's thoughts and feelings and providing support that reflects them; (3) informing the paient while closely observing him or her; (4) assisting the patient in living comfortably throughout his or her remaining life; and (5) respecting the patient's human dignity.
Results of the questionnaire survey, with 368 responses returned, showed that 80% of nursing professionals considered 22 of the 23 items, such as communicating the patient and family's feelings to the physician, to be acts of advocacy in nursing. Findings also revealed that it is difficult (59%) or very difficult (12%) for nursing professionals to serve as patient advocates due to factors such as their own abilities (19%) or the attitude of the physician (18%). Less
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