Transmission of the techniques of Care by nurses in Close Contact with the Patient’s Living Space: A Case Study of a Visiting Nurse Station in Japan
Authors: Otani Kagari , Ito Yasunobu 
Published: June 2023

We have been examining home care nursing from the perspective of service research/service design research. We have presented the process of 'co-creation' between visiting nurses and patients to restore/continue the patient's daily life (Otani and Ito 2021: 503-509) and have also examined the work of visiting nurses made with patients and their families in the patients' homes as sticky information that is difficult to detach from the context and difficult to transfer (von Hippel 1994, Otani and Ito 2021: 503-509). In light of these findings, this paper aims to identify the difficulties visiting nurses face in transferring the knowledge they co-create with patients and patients' families in patients' homes to their fellow nurses and health professionals in the workplace.In service research, the importance of the perspective that providers and recipients "co-create" value together (Vargo and Lusch 2004, 2008, 2014) has been pointed out. On the other hand, in previous anthropological research on the transmission of deeds (eg. Lemonnier 2002), there is little analysis from the perspective of the relationship between the provider of the deeds and the recipient of the value of the deeds, or from the perspective of co-creation by both parties. The analysis in this paper is significant and novel in that it incorporates the perspective of co-creation in service research into previous anthropological research on the transmission of deeds.The study period was from 2013 to November 2022. The study site was X visiting nurse station in Nagoya City. The research method consisted of observation and interviews at the home-visit nursing station and at the patients' homes.The provider (visiting nurse) listened to the requests of the recipients (patients) and their families and develops nursing care techniques(services) to support their preferred way of life. The nurses listed them and had the patient and family select them proactively to their satisfaction. In order for patients and their families to remain satisfied with nursing care, the co-created nursing skills had to be transferred to fellow nurses and health professionals so that other nurses, not just the nurse who created them, could also perform them. Nurses recorded their inventions in their electronic health records and explain them in meetings, but there were limitations to recording and explaining them verbally. Because (1) the techniques created by visiting nurses and others were stored in the nurse's body. Because of their dependence on the nurse's body, the only way to communicate them to others was to express them with gestures or to communicate them verbally in parts (using the 'craft language'). In addition, (2) the techniques produced by visiting nurses and others were closely linked to the context of the patient's home. This is because, unlike care in hospital nursing, visiting nurses form (co-create) the skills in the patient's home, together with the patient and their family. That was difficult to transfer the skills embedded in the context of the patient's home to other nurses and health professionals.