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 OJN  Vol.9 No.8 , August 2019
Contents of Care and Perception of Home Hospice Nurses Who Work at Visiting Medical Treatment Hospitals
Abstract: Goal: The aim of this study was to examine the perception of nurses who worked at the clinic which proposed home hospice and contents of care to better understand home hospice and enhance home care. Methods: Six nurses who worked at the clinic where proposed visiting medical treatment participated voluntarily. They received one interview for approximately one hour, in which they narrated their perception of home hospice and content of nursing care. The narrative was recorded by an IC recorder and analyzed as contents analysis. This study was approved by the Ethical Board at St. Mary’s College. Results: About the content of nursing care, some categories were selected such as “Understanding a patient as a living person,” “Examining if a patient and caregiver live at ease,” or “Caring for a caregiver accepting a loved one’s death and care given at death.” Nurses perceived the theme as “Time and space for listening carefully,” the theme as “Feeling of responsibility and attractiveness of work,” the theme as the “Economics and manpower to continue home hospice,” the as a “Required connection between hospitals and home hospice clinics.” Conclusion: Visiting medical treatment nurses understand a patient and a family as living people based on intimate relationships, support them as the disease progresses, and connect to a visiting nurse station. They perceived that “patients can enjoy freedom; the nurses had responsibility and strong relationships. They felt the economic or man-power needs to continue and the requirement of a connection between hospitals and home hospice clinics.

1. Introduction

Recently the elderly population is increasing and the number of aging people is expected to continue to increase. Many people hope to die in their own home [1] , however, not many are able to do so [2] [3] .

Family caregivers experience some difficulties. Family caregivers of advanced cancer patients feel distressed along with sadness, sorrow and exhaustion, or anxiety and depression [4] . Family caregivers at home hospice had moderate-to-severe anxiety or similar symptoms [5] , and they experienced crisis, such as patient signs and symptoms, emotional distress, and burdens [6] . Also, Reblin, et al. [7] showed that caregivers had moderate levels of depression. These researches suggest the need for support for a patient and a family caregiver in home hospice. Visiting nurse is a very important role. However, there are few studies about the care or perception of home visiting nurses. Thus the present study examined the content of nursing and perception for home hospice patients with nurses who worked at a clinic which propose visiting medical care.

2. Methods

2.1. Participants

The participants were six nurses. The inclusion criteria were followings; they worked at clinics which proposed visiting medical treatment, they accompanied a physician and visiting medical treatments, apart from the daily visiting nurse station, their nursing experience was over five years. The exclusion criteria was that the nurse who might feel burden to talk in the interview was excluded.

2.2. Procedure

The researchers recruited nurses who worked at one of four home hospice clinics where visiting medical treatments were proposed and the nurses agreed with participation.

The research interviewers visited clinics, explained about the research again, and received informed consent after agreement for participation. There were three interviewers and all had counseling certification.

The interview lasted approximately 60 minutes and was only completed once. The questions were; “How do you care for a patient and a family member when you visit their home as a nurse with a physician?” and “How do you perceive home hospice? Each nurses’ narrative was recorded by an IC recorder after getting their permission. This study was approved by the ethical boards of St. Mary’s College (June, 2017).

2.3. Analysis

For the narrative data, we employed “qualitative analysis” by Funashima [8] based on the work of Berelson [9] . In narratives, we separated sentences into each shortest sentence without losing meanings, which is called as code. The similar codes were integrated into subcategories. Then similar subcategories were integrated into one category. Categories are separated into some themes. To maintain reliability, the categorization and coding were validated independently by researchers. Inconsistencies were discussed and negotiated until agreement was reached.

3. Results

3.1. Contents of Care in Home Hospice

We selected categories from narratives about importance, changes, and hopes. We show the subcategory as < > and category as “ ”. A “clinic” means a “clinic which proposed visiting medical treatment”.

About the contents of care by a nurse, we chose six categories (Table 1). The category “1) Understanding a patient as a living person” included subcategories such as . “2) Making an atmosphere where a patient and family talk to staff easily” included subcategories like . The category “3) Examining if a patient and caregiver live at ease” included subcategories like . “4) Support for caregivers to continue care at home” included subcategories like or . The category “5) Sharing information and cooperation with other professions” included subcategories like . The category “6) Caring for a caregiver to accept a loved one’s death and care at death” included subcategories like .

3.2. Perception for Home Hospice

The nurse’s narratives were categorized into 11 groups of about four themes (Table 2).

About the theme [Environment of home hospice], there are three categories. The category “7) Time and space for listening carefully” included subcategories like . The Category “8) Enjoyment of freedom in home” included subcategories like . The category “9) Appearance of hope to live” included subcategories like .

About the theme [Care of nurses], there are four categories. The category “10) Feeling of responsibility and attractiveness of work” included subcategories like . The category “11) Thinking of a patient and a family completely and intimate relationships” included subcategories like . The category “12) Focus on mental care in home hospice” included subcategories like . The category “13) Adjustment of relationships between a visiting nurse station and a clinic” included subcategories like .

About the theme [Introduction to home hospice and continuation], there are two categories. The category “14) Hopes for home hospice by a patient and caregiver for introduction” included . The category “15) Economics and man-power to continue home care” included subcategories like .

About the theme [Relationships between a hospital and a clinic], there are two categories. The category “16) The different opinions of observation among a family, a hospital and a clinic” included subcategories like . The category “17) Requirement of connection between hospitals and home hospice clinic” included subcategories like

Table 1. Contents of care by a nurse.

Table 2. Perception for home hospice by a visiting medical treatment nurse.

4. Discussion

4.1. Contents of Care of Nurses in Visiting Medical Care

Nurses could understand patients including their lives as a person. They can make intimate relationships between a patient or a family and staff. Relationships at home hospice may be stronger than at general hospitals. It is a beneficial point for home hospice. The category “3) Examining it a patient and caregiver live at ease” showed that people were made to feel safe to contact nurses for help at any time. Shalev, et al. [10] showed that caregivers in home hospice needed more information, and the nurses in this study tried to communicate with each other. Also, nurses use communication skills well. Oliver, et al. [11] showed that hospice nurses appear to use basic validation techniques naturally, and they use higher-level of techniques on complex occasions. Nurses in home hospice may be required to use higher-level communication technique sometimes because the number of visiting nurse is limited.

In the observation categories, nurses tried to make intimate relationships by understanding a patient and caregiver, they supported choices to continue care at home, and supported the acceptance of a loved one’s death during the diseases progress. These nursing processes may offer support for family resilience. A patient and family are confronted with the stressful or traumatic event of death, however, they have power to go through recovery; that is resilience. Nurses supported a patient and caregiver in regaining resilience. Previous studies showed that resilience is related to the quality of life (QOL). McDonald et al. [12] investigated the quality of life of caregivers and showed the importance of “maintaining resilience”. Moreover Yuli, et al. [13] showed that the resilience of caregivers of cancer patients contributed QOL to the caregiver’s burden.

4.2. Perception of Nurses for Home Hospice by Visiting Medical Treatment

Recently, the places where a patient spends time are various. About the theme [Environment of home hospice], nurses perceived that a patient at home can enjoy their time freely and sometimes hope appears. The number of patients in home hospice is not high, the place may be important to realize a good death [1] .

About the theme [Care of nurses], nurses with visiting medical treatments worry about the mental health of a patient and caregiver, a visiting nurse proposes mental care. Kozlov, et al. [5] showed that home hospice patients experience moderate-to-severe symptoms of anxiety and depression in the last week of life. Since family caregivers worry about the physical and emotional symptoms at the very end of care, support for this point may be important. Reblin, et al. [7] described that communication demonstrating emotional expression between cancer spouse caregivers and nurses during home hospice may have implications for caregiver depression up to a year after a patient’s death. That is, expressing emotion promotes a caregiver’s mental health. In the future, various kinds of intervention will be needed for mental health, and measurement of its effects will be also needed for evidence-based practice about home hospice.

Related to the theme [Relation between a hospital and a clinic], the category “16) The different opinions of observation among a family, a hospital and a clinic” showed the differences in opinions about places of care or observation. Recently, a patient’s intention is important, therefore, advanced care planning also seems to be important [14] . Nurses have an important role of talking to patients. Moreover, moving from a hospital where a patient gets medical treatment to a clinic in home hospice sometimes does not go well. Smoother transitions may be required. Also, teamwork between a visiting medical treatment clinic and a visiting nurse station is required. Limardi, et al. [15] showed the importance of healthcare team communication.

There are some economical or man-power problems of care giving that will need to be addressed in the future.

5. Conclusions

Nurses who work as visiting medical treatment providence understand a patient and a family as living people based on intimate relationships. They work apart from visiting nurses. They also felt the economic or man-power problems. We need to make a system which a national level system supports. Moreover, we need to measure the effects of nursing care such as quality of life or satisfaction of a patient or a family caregiver.

This study is supported by KAKENHI (17K12559).

Conflicts of Interest

The authors declare no conflicts of interest regarding the publication of this paper.

References

Cite this paper: Ando, M. , Kukihara, H. , Yamamoto, M. and Ninosaka, Y. (2019) Contents of Care and Perception of Home Hospice Nurses Who Work at Visiting Medical Treatment Hospitals. Open Journal of Nursing, 9, 801-808. doi: 10.4236/ojn.2019.98061.
References

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