We Watch Over and Care for Your Life and Living

Home-visit Nursing ServiceReference : Japan Visiting Nursing Foundation

The goal of the Home-visit Nursing Service is to provide support for individuals wishingto spend their autumn years in the comfort of their own home and community. The
Home-visit Nursing Service, specified by law as the provision of in-home medical careor assistance in required medical treatment, is designed to improve individual quality oflife (QOL)
Nursing services are based on preventive care. We observe the condition of patient,work on the early detection and prevention of disease and impairment as well as therestoration of health.
Support is provided for patients discharged from the hospital to reduce patient anxiety inthe transition to homecare.
Support is provided for home care. Even patients without the need for hospital treatment
can become suddenly ill. For such needs we also provide 24-hour, 365-day emergency
service.
Care of patients who wish to live out their life at home. In the future, we are going tohave more people who need both medical and nursing care. The role of the home-visit
nurse is very important.
Now, let us provide an overview of the home-visit nurse through the four following
cases:

1Case 1: Mr. A, a patient who lives independently at home despite paralysis of theextremities


The name of disease and other information:
Cervical cord injury, CystostomyBackground of home care
Mr. A was injured in a traffic accident while at work. After undergoing hospitaltreatment and rehabilitation, he began recuperation at home. Although he spends
the majority of his day in bed, various services available in his community areenabling him to live on his own.

Family structure
Living aloneService used•

Home-visit nursing service

3 times/week•

Visiting care service

Every day (assist in daily life, physical care,assist in going out)

•Home-visit rehabilitation

Once/week•

Home visit by a doctor

Twice/month•

Assistive equipment rental service:

Bed, wheel chair, shower chair, liftPoints of the home-visit nursing service

1.

Physical assessment
For patients with cervical cord injury it is difficult for the body to control temperatureand blood pressure. More precise observation is required for fever, low bodytemperature and low blood pressure even when the patient does not notice anysymptoms.
As the patient is at high risk for bedsores, which he developed in the past,observation of places vulnerable to bedsores is also essential.
22.

Bowel control
The home-visit nurse checks for intestinal gas, observes fecal properties and gives
advice on meals. Stool extraction is performed three times per week.

3.

Bathing assistanceBathing is not only a good opportunity for physical assessment but also has thebenefit of preventing bedsores and improving blood circulation. At the same time, it
has a healing effect on the patient, both physically and mentally. The home-visit
nurse assesses the condition of the patient to determine whether a shower bath ora tub bath would be more appropriate. Of course, it is necessary to provide careaccording to patient preference.
A lift is installed to provide support for moving. Bathing service is provided incooperation with a visiting care worker; however, assessment of health condition isa crucial nursing role.

4.

Care of cystostomy
The patient has a cystostomy due to neurogenic bladder. The home-visit nurse
observes the amount and properties of urine as well as the insertion site, andprovides indwelling bladder catheter care. In the case of indwelling catheter inparticular, the home-visit nurse gives assistance in bathing and treatment afterbathing.

5.

General consultation and support for daily life
Besides physical care, the home-visit nurse provides consultation on the homecare
environment, such as room temperature and humidity, as well as how to spend theday.

3Case 2: Miss. B, who is growing up in a community network
The name of disease and other information:
Cerebral paralysis, epilepsy, tracheomalacia



Background of home care
As a delay in development was seen after birth, she was diagnosed with cerebralparalysis. She had been repeatedly hospitalized and released until six years ago
when she and her parents moved. Since then, she has continued recuperation athome using visiting care and other services. She is enrolled in a special needs highschool course and provided with home-visit teaching.

Family structure
Living with parentsService used•

Home-visit nursing service

4 times/week (including visit by two nurses)•

Home-visit rehabilitation

Physical therapy: once/week
Occupational therapy: once/two weeks•

Home visit by a doctor

Twice/month•

Assistive equipment rental service:

Bed, wheel chair•

Rental medical equipment

Artificial respirator

•

Other

Home-visit teaching: 3 times/weekPoints of the home-visit nursing service

1.

Physical assessment
For Miss. B, who has difficulty expressing complaints, detailed physical assessmentby the home-visit nurse is essential. It is particularly important to prevent problems
with the artificial respirator, ensure stable breathing and prevent infection.
42.

Coordination with doctor
Coordination with other professionals is imperative in all cases. Close coordination
with the doctor is especially important for medical treatment as well as safety whena patient is highly dependent on care.

3.

Support for growth and development
For a pediatric patient, support for growth and development is important. In thecommunity network, we keep an eye on the child’s own growth and development incooperation with the family and home-visit teacher.

4.

Support for familyParents, particularly mothers raising children with disabilities often have anxiety orproblems. It is crucial to provide not only care for the patient but also support tohis/her family by listening to them.

Case 3: Mr. C, who is an aged patient receiving care by an aged caregiverThe name of disease and other information:
Diabetes, diabetic retinopathy, right pontine infraction, foot ulceration

Background of home care
Onset of diabetes occurred in the patient’s forties, and he had a stroke three years
ago. Now he continues his recuperation at home under the care of his wife. She
decided to use the home-visit nursing service for her husband because she foundthe service to be very good for her mother in the past.

Degree of necessity of care
Degree 4Family structure
Living with wifeService used5

•Home-visit nursing service

Twice/week•

Assistive equipment rental service:

Bed, portable toilet•

Home-visit bathing service

Once/week•

Home-visit rehabilitation

Twice/week•

Home visit by a doctor

Twice/month

Points of the home-visit nursing service
Support for hygiene care
Foot bath and shampooing can be provided by visiting care service. However, Mr.
C has lesions on his toes and nails caused by diabetes that require observation. Inaddition, he has eczema on his head that requires treatment. For this reason, thehome-visit nurse also gives him a foot bath and shampoo.

Coordination with doctor
When an abnormal finding is observed, the home-visit nurse immediately informs
the doctor and responds appropriately. Unlike medical institutions, in which thedoctor is always available, it is often difficult for homecare patients to be seen by
the doctor immediately. Therefore, the utilization of IT is essential. IT is also used
for reporting the condition of foot ulceration.
Support for family
There are increasing cases of so-called elder-to elder nursing care, in which anaged care giver provides nursing care for an aged care receiver. Mr. C’s wife, whoseems healthy, actually suffers from a chronic disease and makes regular clinicvisits. Considering that some of the care givers have their own health problems, thehome-visit nurse must pay attention to the condition of care givers.

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Case 4: Mrs. D, who recovered to an independent life from a bedridden
state.
The name of disease and other information:
Old myocardial infarction, chronic respiratory failure

Background of home care
She was largely bedridden and receiving home oxygen therapy, which had been
introduced following an acute exacerbation of chronic respiratory failure brought onby tuberculosis.
Then, she started to use the home-visit nursing service on the recommendation of ahome-care worker who was concerned about her.
The home-visit nurse encouraged her to visit a respiratory specialist, where she
received appropriate treatment and respiratory rehabilitation. As a result, she wasfreed from home-oxygen therapy.
Furthermore, thanks to respiratory rehabilitation and daily life guidance provided by
the home-visit nurse ,she recovered to the extent that she could go out.
Now, she can control her own health so well that she lives independently without
difficulty breathing.

Degree of necessity of care
Degree 1

Family structure
Living aloneService used•

Home-visit nursing service

Once/2 weeks•

Visiting care service

Once/week•

Outpatient day long-term care (four hours)

Once/week•

Paid volunteer

Once/month7

•

Visit to specialist

Once/six weeks•

Visit to personal doctor

Once/month

Points of the home-visit nursing service
Physical assessment (respiratory condition in particular)
As elderly people tend to be unaware of their condition, such as fever, dehydrationor oxygen desaturation, their condition is sometimes already advanced when they
notice it. Even if visits are made infrequently, it is crucial for the home-visit nurse tolook for changes in patient conditions and be involved in prevention to detect
abnormality earlier and prevent aggravation.
* Please note that the nurse is using a high-performance stethoscope for
auscultation over patient’s clothes. Usually, the stethoscope is applied to the skinsurface.
Support for everyday life
In the case of chronic respiratory failure, it is important to provide not only
therapeutic respiratory rehabilitation but also training in how to move in everyday
life. We provide support to help patients breathe as easily as possible even during
casual movements such as eating, elimination, changing clothes, bathing, walking
and going up and down stairs so that they will not become bedridden.
Moral support
We would like to provide support so that the patient can exercise her potential andfind her life worth living, and convey the message that “we are watching over andcaring about you” in a casual way.
Emergency care
As patients tend to feel a threat to life when they have breathing difficulty, it isnecessary to plan responses to worsening or an abrupt change in conditions,especially for patients living alone. Our 24-hour, 365-day system will be prepared todeal with emergencies.

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