Objective: This study aimed to reveal the relationship between the terminal care attitudes, personal attributes, and views on life and death of care workers in nursing and group homes. Method: An anonymous self-administered questionnaire survey was mailed to 772 staff members at nursing and group homes. We used the Frommelt Attitudes Toward Care of the Dying Scale Form B (Japanese version) and the Death Attitude Inventory, which is a scale of views on life and death, to form the questionnaire. Results: After excluding missing data, 338 staff responses were analyzed (valid response rate: 43.8%). The total terminal care attitude scores were significantly higher among managers compared to other staff members (β=0.182, p=0.001), and among those having provided end-of-life cared to 10 or more people (β=0.155, p=0.003). Additionally, the total terminal care attitude scores were significantly higher among those with lower scores in the “death avoidance” subscale (β=−0.183, p=0.001) and higher scores in the “afterlife beliefs” subscale (β=0.168, p=0.001) of the Death Attitude Inventory. Conclusion: Terminal care attitudes were influenced by job position, the number of persons provided with end-of-life care to, and views on life and death. We need to investigate factors that affect terminal care attitudes to ensure provision of high quality care in nursing homes.

Objective: The purposes of this study are to explore current status and tasks of a pamphlet for families of terminally ill patients at home. Methods: We sent out the questionnaire to 419 home-visit nursing administrators, and obtained an answer from 118. Results: About 42% administrators used the pamphlet. Most pamphlet users were considering as follow: degree of worry and anxiety of the family, the family’s and the patient’s hope of being home death (each more than 82.6%). Usefulness of the pamphlet; the families could prepare for their patient’s death, understand the present condition of the patient, etc. However, 67% users were feeling difficulty to decide the timing to hand the pamphlet to the families. As a reason without the pamphlet, there are not any pamphlets available (64.1%). Conclusion: Nursing administrators who used the pamphlet have recognized the usefulness, but have felt difficulty of the use.

We describe a novel method for repeat median sternotomy. We have successfully used ‘finger’ lifting resternotomy technique and achieved zero major cardiovascular injury/catastrophic hemorrhage events at reoperation. After general anesthesia, all patients were placed in the supine position and two external defibrillator pads were placed on the chest wall. We perform a median skin and subcutaneous incision along the previous sternotomy incision extending 3 cm distal to the sternum. The sternal wires that had been used for the previous closure were left in place but untied. Using a long electric cautery, right thoracotomy was performed under the right costal arch approach. Then, the operator could approximate the sternal wires in the retro-sternal space. At the same time, the operator could confirm the retro-sternal adhesion status which by touching with a finger. Resternotomy was performed using an oscillating saw pointed toward the operator's finger, which allowed safe re-median sternotomy from the lower to the upper part of the sternum. This technique of finger-lifting resternotomy has been employed in 50 cardiovascular reoperations and resulted in 0 incident of major cardiac injury or catastrophic hemorrhage. The finger-lifting resternotomy technique is safe and simple in reoperation procedures and yield excellent early outcomes.

Objective: The purposes of this study were to explore the actual usage of a pamphlet for families of terminally ill patients both with and without cancer at home. Methods: We sent a questionnaire to 2,000 home-visit nursing administrators and obtained answers from 430. This study included 224 pamphlet users. Results: The pamphlet was used with 95.1% of families of cancer patients and with 76.8% of families of non-cancer patients. Most pamphlet users were concerned with the following: degree of worry and anxiety of the family, and the family’s and the patient’s hope for an at home death (families of both cancer patients and non-cancer patients more than 84%). The pamphlet was given to about 60% of families of both cancer patients and non-cancer patients between last last week and last month of life. Administrators found it difficult to decide the appropriate timing to hand out the pamphlet to 59.6% of families of cancer patients and 69.7% of families of non-cancer patients. Conclusion: Pamphlet use may be improved by clarifying the appropriate timing to give out the pamphlet.

Objective: This study aimed to evaluate posttraumatic growth (PTG) from bereavement and other related factors among family members of deceased cancer patients who had been admitted to a general ward. Methods: A self-administered questionnaire was mailed to 42 bereaved family members who agreed to participate in the present study. The time from the death of their loved ones was between one and four years. Results: Of 42, 37 returned their responses. The average PTGI total score was 2.63, which was consistent with previous studies examined the scores at a general hospital and palliative care units. The PTGI was positively correlated with the emotion focus type coping, the recognition estimating support, and the emotional support. The PTGI of the bereaved whose loved ones underwent medical treatment at home was significantly higher than the score of the bereaved whose loved ones passed away at general ward. Conclusion: It is crucial to evaluate whether or not the bereaved experienced a healthy grieving process, and if they received social support. Moreover, it is important to provide the information regarding where the support is offered to the bereaved. Additionally, clinicians need to improve the support system so that the cancer patients can undergo medical treatment at home.