Eiko Nakanishi

Introduction: The purpose of this study was to clarify the relationship between the available service information on small-scale multifunctional in-home nursing care (KANTAKI) and its operational status via text mining. Methods: We obtained nationwide textual information on KANTAKI from the Nursing Care Service Information Disclosure System and the Ministry of Health, Labour, and Welfare, and analyzed the characteristics of the word usage using KH Coder. The number of users and employees and the implementation of services were compared among the facilities that used terms relating to medical dependency and end-of-life care, which are KANTAKI characteristics, and with other facilities. Results: The facilities that used terms relating to medical dependency and end-of-life care showed significantly more users requiring nursing care level 5 and more full-time nursing staff than those not using such terms. Moreover, regarding service provision, the rate of procedures was significantly higher in 11 of 12 items, except for stoma. Conclusion: The facilities that use terms relating to medical dependency and end-of-life care in their information have more users and provide a greater variety of services. In the future, educational support is required to enable facility managers to understand the services and translate them into their work.

<jats:sec> <jats:title>Background</jats:title> <jats:p>Japan is a superaging society unparalleled in the world. Elderly people who need medical care do not receive adequate support in the community. As a new service to address this issue, a small-scale multifunctional in-home care nursing service called Kantaki was created in 2012. Kantaki, in collaboration with a primary physician, operates 24 hours a day and provides various nursing services (home visits, home care, day care, and overnight stays) to older people living in the community. The Japanese Nursing Association is working hard to promote this system; however, its low utilization rate is an issue.</jats:p> </jats:sec> <jats:sec> <jats:title>Objective</jats:title> <jats:p>This study aimed to determine factors influencing the utilization rate of Kantaki facilities.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>This was a cross-sectional study. A questionnaire on the operation of Kantaki was sent to all administrators of Kantaki facilities operating in Japan from October 1 to December 31, 2020. A multiple regression analysis was used to determine factors associated with a high utilization rate.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Responses from 154 of the 593 facilities were analyzed. The average utilization rate for all valid responding facilities was 79.4%. The average number of actual users and the break-even point were almost equal, resulting in little surplus profit from facility operations. A multiple regression analysis showed that factors that had a significant impact on the utilization rate included the break-even point, a surplus of users relative to the break-even point (ie, the margin of revenues), the number of months in office of the administrator, the type of corporation (ie, nonprofit), and Kantaki’s profit from operating home-visit nursing offices. The break-even point, a surplus of users relative to the break-even point, and the number of months in office of the administrator were robust. In addition, support for reducing the burden on family helpers, a service sought by the system, significantly and negatively affected the utilization rate. In the analysis that removed the most influential factors, the cooperation of the home-visit nursing office, Kantaki’s profit from operating the home-visit nursing office, and the number of full-time care workers were significantly related.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>To improve the utilization rate, managers need to stabilize their organization and increase profitability. However, a positive relationship was found between the break-even point and utilization rate, suggesting that simply increasing users did not contribute to cost reduction. Moreover, providing services that meet the needs of individual clients may result in lower utilization rates. These results, which are inconsistent with common sense, reflect the divergence between the assumptions underlying the system’s design and actual conditions. To solve these issues, institutional reforms, such as an increase in nursing care fee points, may be necessary.</jats:p> </jats:sec>

Purpose: To identify the behavioral characteristics of nurses working in nursing multifunctional in-home long-term care service (Kantaki). Methods: Semi-structured personal face-to-face interviews based on Behavioral Event Interview were conducted with 29 nurses who were rated as excellent job performers by the director of Kantaki, followed by qualitative descriptive analysis of the interview data. Results: Two categories were extracted as desired care outcomes: “improvement of the quality of life of patients and their families” and “improvement of the quality of care provided to patients and their families.” Additionally, eight subcategories were extracted. Organizing the content that was thought to lead to these outcomes, the following seven categories and 37 subcategories were extracted as the caregiving practices of the nurses: 1) remain close to the care receiver, 2) draw out the strengths of the care receiver and their family and encourage them to use those strengths to improve life, 3) provide flexible care tailored to the individual’s needs, 4) protect life, 5) support end-of-life care, 6) create a comfortable space for the care receiver, and 7) mobilize a team to support the care receiver. Conclusion: Nurses’ behavioral characteristics were expected to promote the role of Kantaki which enables the elderly to continue living in their own homes and communities until the end of their lives.

Objectives: In order to cope with a rapidly aging national population, the Japanese government promotes the use of a comprehensive community care system known as Kantaki, which was established in 2012. Aimed at older populations, Kantaki offers a variety of services, including home-visit nursing care, day care, and overnight care. This study clarified the factors that affect the estimated revenue of Kantaki services through a secondary analysis of detailed information released by the Ministry of Health, Labour and Welfare (MHLW). Our goal was to provide information that may facilitate the stable management of Kantaki operations across Japan. Methods: We conducted a secondary analysis of official statistics data and detailed information released by the MHLW in April 2020. As such, we calculated the estimated revenue for Kantaki services. We then conducted a logistic regression analysis with estimated revenue set as the dependent variable in order to assess the magnitude of each influencing factor. Results: A total of 594 multifunctional in-home long-term care services were established. Of these, 506 met the requirements for Kantaki set in this study’s analysis. The logistic regression analysis showed that items with large odds ratios included tube feeding (2.59), enhanced working conditions for care workers (I) (2.58), and colostomy/ileostomy care (1.76). Conclusion: To achieve stable management practices for Kantaki, it is important to handle at-home medical needs through the use of skilled care workers, who must be properly trained and ensured stable employment.

電子カルテシステムの導入率は上昇傾向にあると報告されている。看護師は最善のケアの提供を目的に、看護研究を継続教育の一環として取り組んでおり、電子カルテシステムに入力されている看護に関するデータ活用に向けて、看護師にもデータ収集や処理に関する知識が必要になっている。そこで本研究では、データ処理研修における教育効果および、データ処理研修に教育用電子カルテを用いた効果を明らかにすることを目的とした。調査対象者は、電子カルテシステムが導入された400床未満の2病院に勤務する看護研究の指導者となりうる看護師で、所属病院の看護師長等により人選された者である。データ処理研修では教育用電子カルテを用いた効果を明らかにするために、2つのうち1病院で、教育用電子カルテを用いた演習を実施した。研修受講者数は62名、教育用電子カルテを使用した演習を受講した群20名、教育用電子カルテを使用しない演習を受講した群42名であった。研修終了後、受講前後の理解度を比較した結果では受講後の平均点が有意に高く、教育用電子カルテを使用した演習の有無による受講前後の理解度を比較した結果では、教育用電子カルテを使用した演習を受講した群の平均点が有意に高かった。これらの結果から、データ処理研修の教育効果および、教育用電子カルテを用いた演習が研修内容の理解を促す効果が示唆された。(著者抄録)

This longitudinal study aimed to clarify the relationship of oral health in infancy with that in adulthood among participants who were the subjects of the oral health promotion project (OHPP) conducted in Miyako Island, Okinawa Prefecture, Japan, since 1984. Twenty-seven subjects, around 35 years of age, were examined for dental caries, periodontal diseases (community periodontal index), dental plaque, occlusion, and bite-force and compared with those at 4 and 13-15 years of age. The dental caries status and maximum bite force in adulthood was significantly reflected for those at 4 and 13-15 years of age (p < 0.05). CPI in adulthood was related to the dental caries status at 4 and 13-15 years of age but not to the gingival score at 4 years of age, and it was weakly related to the gingival score at 13-15 years (r = 0.264, p > 0.05). Most of the normal occlusion at 4 years of age became normal permanent occlusion in adulthood (88.9%). Most of the cases involving the discrepancy factor retained the same condition in both the deciduous and permanent dentitions (83.3%) (p < 0.001). Those who participated in the OHPP soon after birth showed significantly fewer DMFT (p < 0.05) compared with those who did not. This study revealed that oral health at 4 years of age was related to that in adulthood, suggesting that fostering good oral health soon after birth is of great importance.

【目的】健やかな地域生活を促進するためのプログラムへの参加高齢者に対する,COVID-19の感染拡大防止対策の影響と,それによって生じた身体状況及び生活状況の変化を明らかにすることである。【方法】プログラム開始前,プログラム実施6ヵ月後,再開時の3回分の評価が揃っている参加高齢者13名(全員女性,平均年齢80.5歳)を対象とし,身体状況の計測値と生活状況の変化について分析した。【結果】プログラム開始前,プログラム実施6ヵ月後,再開時の比較で,体重,骨密度,2ステップテスト値に有意な変化が確認された。体重は51.4kg,49.1kg,51.2kgと変化し(p=.013),介入前と再開時の比較に減少が認められた。また,骨密度は66.0g/cm2,76.0g/cm2,73.2g/cm2と変化し(p=.013),介入前と介入6ヵ月後の比較で上昇が認められ,2ステップテスト値も0.9,1.1,1.0と変化し(p=.018),介入前と介入6ヵ月後の比較で上昇が認められた。また,生活上の変化として「体調に問題ない」と「外出を控えた/頻度が減少した」の回答者数は同数だったが,その半数に「足腰の弱りを自覚する」状況があり,転倒や骨折による入院に至ったケースもあった。【結論】本研究の結果より,COVID-19の感染拡大による半年以上の健やかな地域生活を促進するためのプログラム休止は,参加高齢者の外出頻度を低下させ,運動機能に影響を与えたことが分かった。高齢者にとって低下した運動機能を引き上げることは容易ではなく,骨折など受傷に伴う入院は廃用性症候群を引き起こす可能性もある。今後は感染対策下であっても,高齢者の活動の場を確保できるような新たな交流方法を整備するとともに,地域で生活する高齢者に持続的にアプローチできる支援活動が必要である。(著者抄録)

[Background] To promote an integrated community care system, the Japanese government created a multifunctional long-term care service model called Kantaki in 2012, aiming to provide a combination of services such as short-stay, day-care, and home visit by aides and/or nurses to meet various client needs. However, it is unclear how well this model has been utilized and accessed throughout Japan.[Objective] This study aimed to understand the distribution status of Kantaki through a secondary analysis of information on its operations and population trends released by public institutions.[Methods] The study determined the number of Kantaki, Shotaki (a service that is similar to the Kantaki model except it does not provide home visit service by nurses), and visiting nurse stations from the Ministry of Health, Labour and Welfare website registry. Population trend information was collected from the national census. Statistical processing included a correlation analysis using descriptive analysis and Spearman's correlation coefficient.[Results] As of December 31, 2018, there were 479 Kantaki operations throughout Japan. The mean number of Kantaki operations by prefecture was 10.19 ± 10.51. Of the municipalities, 233 (13.5%) out of 1,724 had Kantaki operations available. The number of Shotaki (.765), number of visiting nurse stations (.747), population (.703), population density (.513), and the rate of aging (-.442) were found to have a significant correlation with the number of Kantaki operations present.[Discussion] The number of Kantaki operations showed a large variation across regions, with a higher prevalence in population-dense urban areas, and lower prevalence in regions with a high aging rate. This reveals the distribution model is unrelated to the elderly population, who can be potential clients, and must be affected by other reasons such as staffing issues and operating costs. To promote Kantaki throughout Japan, such operational issues should be analyzed further.

This study evaluated the effectiveness of a life-enhancement program designed to focus on dining conditions in welfare facilities for seniors living in Japan. Effectiveness was specifically evaluated based on whether improvements were achieved in (1) nutritional status, (2) oral health, (3) frequency of fever, and (4) vitality of appetite across three sites. As part of a comprehensive-care initiative that began with dining support, the program consisted of two main components: (1) a 3-month intensive program comprised of (a) collective experiential learning for residents and staff (including nutritionists, nurses, and physiotherapists) and (b) a tailor-made individual program for residents followed by (2) a 3-month continuation program. Participants included 168 individuals (31 males and 137 females) from a total of three facilities (average age was 85.9 [60-104] years). Results showed that the intensive program significantly improved nutritional status (e.g., BMI, caloric intake, and water intake; P < 0.000-0.005) and tongue movement (P < 0.000) while significantly reducing dental-plaque and tongue-coating indices (P < 0.000). Significant improvements were also achieved for degree of appetite and vitality indices (P < 0.000-0.001). However, incidences of fever were not reduced. These findings indicate that the program effectively improved nutritional status, oral health, vitality, and appetite. However, these effects did not sufficiently remain once the program was finished, thus suggesting the need for a continuous intervention.

[Objective] More than two decades have passed since the situation-specific theory (SST) was proposed. This literature review analyzes changes in the number of SST-related articles, their contents, methodologies, and sources for the construction. This study aimed to clarify the developing process and prospects in future SST constructions.[Methods] Using the CINAHL, PubMed, and ICHUSHI databases, we searched for papers in English with the key words of "situation-specific theory" and "situation-specific theories" and those words translated in Japanese. Eighty-eight articles were found and screened. At the end, fifty articles were to be reviewed, and they were sorted by year of publication and contents. Additionally, articles reporting SST construction were analyzed for the theory constructing methodologies and sources used for the constructions.[Results] All articles were classified into the following six categories: theory development, concept analysis, clarification of theory sub-concepts, theory testing, research based on theoretical framework, and review/commentary. The number of published articles is increased every year. The review of these articles revealed that constructions of SST were validated and utilized as research frameworks, and SST has been contributing to the construction of knowledge in the field of nursing science. SSTs were constructed in 23 articles, all of which focused on restricted phenomena in particular fields or subjects. The integrative approach was the most commonly employed for construction methods; however, other methods were found in some articles. The sources frequently used for the constructions were preexisting theories, research findings, and literature reviews, whereas practical experiences were rarely used as the sources.[Conclusion] Based on the increase in constructions of STT, utilization of SST as frameworks, and validation of the theory, the awareness of SST will grow in the field of nursing science. As construction methods other than the integrative approach are emerging, additional SSTs should be constructed with a broader range of approaches.