|Budget Amount *help
¥2,900,000 (Direct Cost : ¥2,900,000)
Fiscal Year 2005 : ¥600,000 (Direct Cost : ¥600,000)
Fiscal Year 2004 : ¥1,000,000 (Direct Cost : ¥1,000,000)
Fiscal Year 2003 : ¥1,300,000 (Direct Cost : ¥1,300,000)
Care management for meeting the temporal needs of terminal-stage elderly individuals requiring nursing care
1.Analysis of temporal changes was performed for terminal-stage elderly individuals requiring nursing care for conditions other than cancer (e.g.chronic respiratory failure, stroke, severe dementia).
1)Among the elderly individuals requiring nursing care, a common symptom that decreased gradually was oral intake.
2)Opinions regarding the appropriateness of intravenous treatment varied among doctors, nurses, and families.
3)Although senility was sometimes suspected, some individuals were found to be dehydrated or have mild pneumonia instead, and recovered with treatment.
4)Symptoms such as edema, dehydration, pain, breathing difficulty, fever, and bedsores were common, and require palliative knowledge and skills.
2.Four conditions for high-quality care management
Results of a survey conducted on nurses at home-visit nursing care facilities revealed the following 4 conditions for high-qua
lity terminal care : 1)indication of the individual's and his/her family's intent, 2)ability of nurses to maintain care and support from people around the individual, 3)medical care that supports terminal care, and 4)care management that connects the resources available for realizing the desires of the individual and his/her family, In addition, a format that applies these 4 conditions, "Terminal care clinical path", was created, and refined for applications in case investigations.
3.Terminal care in France
Data collected from interviews conducted for the home hospitalization federation (HAD, Hospitalization a domicile) and nurse practitioners in Paris, France, are summarized below :
1)At-home death rate was 15%, and has leveled off in recent years.
2)85% of subject patients at HAD were cancer patients, and a month of intensive care is provided immediately after discharge. Mean stay at facilities is 18.3 days. Care provided includes administration of anticancer drugs, pain management, central intravenous nutrition, nutritional management, infusion, and psychological and social care.
3)Conditions necessary for terminal care during home hospitalization comprise smooth cooperation between hospitals and clinics, availability of a full-time coordinator (under a doctor's charge), a multidisciplinary team approach, and high-quality palliative care skills and nursing methods.
4)The role of nurse practitioners in terminal care is not to provide advanced medical technology, but to provide nursing care close to nursing. Less