Introduction: We aimed to clarify the characteristics of the activities of nurses who provide end-of-life care to users of small-sized multifunctional in-home care services (SMICS) and consider effective end-of-life care for elderly persons who use SMICS.Methods: Semi-structured interviews were conducted with 16 nurses who belonged to SMICSs, and the results were analyzed qualitatively and inductively.Results: The nurses provided four core categories of support: "support so that the elderly person and their family can spend a better end-of-life period together while maintaining their everyday lifestyle," "support so that the family and care staff can deal with the elderly person's dying process," "support so that the elderly person or their family can clarify where and how they want to spend their end-of-life and fulfillment of their wishes," and "provision of medical care suitable for the wishes of the elderly person or their family and disease conditions." Conclusion: The results indicated that nurses supported the elderly and their families by clarifying the care they desire and to support the elderly person, their family, and those who assist them in daily living. In addition, nurses should help not only toward maintenance of daily living but also adapt the medical system so that the elderly person can spend their end-of-life period in a familiar place.

Introduction: The purpose of this study was to identify the thinking and practice of skilled home health care nurses to determine the necessity of multidisciplinary collaboration for users with complex issues.Methods: Semi-structured interviews were conducted with 7 home health care nurses who met the following criteria: years of home health care nursing experience, affiliation, etc. Data on the thoughts and practices of the home-visit nurses were extracted from the interview records and analyzed qualitatively.Results: Seven categories were extracted as thoughts of skilled home health care nurses when judging the need for multidisciplinary collaboration to support users with complex issues, such as: "intending to foster a common understanding among related organizations and professions". Eight categories were extracted for practices of related organizations and professions, such as: "Establish a system appropriate for the conditions of the user and his/her family", and 4 categories were extracted regarding practices for users and their families, such as: "Involvement to reduce the burden of caregiving on the family".Conclusion: The study revealed that skilled home health care nurses promote multidisciplinary collaboration by utilizing various means while emphasizing a common understanding with related organizations and professionals. In collaboration with other professions, it was necessary to utilize the expertise of nursing professionals for assessment and management.

Introduction: The aims of this study were to clarify the characteristics and examine measures for improving the nursing practice competencies of home health nurses.Methods: A narrative review was conducted to analyze the definitions of key elements that constitute the competencies in nursing practice of home health nurses in Japan.Results: The competencies of home healthcare nurses were based on professional attitudes, knowledge, and skills. The characteristics of these competencies were demonstrated in daily life in the practice of home health care. The following common elements were extracted from more than half of the seven articles reviewed: "support for users and their families with independence and individuality," "utilization of the health care system, social resources, and inter-professional collaboration," "basic professional attitude and demeanor as a home health nurse," and "risk management for disaster and infection." Conclusion: The development of these four elements of nursing practice in the training of home healthcare nurses should be prioritized. To improve the competencies of home healthcare nurses, on-the-job training that focuses on the individuality of users and opportunities for team management should be provided. In the training of newcomers, competencies should be achieved based on their attitude as professionals and risk management skills.

Purpose: To clarify the strengths and problems of nursing in multifunctional long-term care in a small group home and home-visit nursing (MLSH).Methods: Selected case reports using Ichushi, the Current Index to Japanese Nursing Literature, and DiaL were extracted and categorized based on the descriptions of the strengths and issues of service in MLSH.Results: Strengths included "flexible and continual? users / family support", "care of users with high medical needs, including end-of-life care", "support for a smooth transition from hospital to home with consecutive stay", "reduction of economic burden of users using a fixed monthly system", and "cooperation between nurses and care workers, and growth by learning from each other". Problems included "difficulty in dealing with diverse needs", "economic burden of low-income users and welfare equipment", and "insufficient cooperation with other occupations inside and outside the office".Conclusion: The strengths of service in MLSH were demonstrated via the support of users with high medical needs and support during the transition period at home. The economic burden of users and cooperation with other occupations are both strengths and problems to be addressed. Support according to user characteristics and public awareness of the existence and strengths of MLSH are required.

Introduction: In Japan, multifunctional long-term care in small group homes and home-visit nursing (MLSH) was created for elderly people who continue to live in the community as one of the long-term care insurance services. The aim of this study was to clarify the benefits and challenges of, and ideas for nursing in MLSH.Methods: A semi-structured interview survey was administered to 11 nurses carrying out MLSH in the Kansai region, and the responses were analyzed qualitatively and descriptively.Results: The benefits of nursing were divided into five categories, including "nurses' expertise and ingenuity can be utilized" and "nursing can continue to support home life even in difficult cases." There were seven categories of challenges, including "difficult to judge, educate, and collaborate; this burdens nurses" and "difficult to educate and collaborate with care workers." There were six categories of nursing ideas, including "utilize knowledge and connections from study sessions, and external training at facilities" and "ensure that nurses and care workers can provide unified care." Conclusion: Although nurses considered it an advantage to support patients' home-based life in cooperation with patients' family members using professional originality, it was difficult for them to judge, learn, and collaborate with others. Moreover, nurses faced burdens. Strategies must be developed to provide nurses with training inside and outside of the facility, and also to strengthen connections with external resources. It is necessary to further review the system and disseminate knowledge about MLSH.