1. The association between nurses’ coordination with physicians and clients’ ability to die at home
Takashi NARUSE, Natsuki YAMAMOTO, Takashi SUGIMOTO, Mahiro FUJISAKI-SAKAI, Satoko NAGATA
Department of Community Health Nursing, Graduate School of Medicine, The University of Tokyo Mail:

2. Palliative care in community in JAPAN
Over 60% of Japanese people hope to die at home
Assisting dying clients in achieving this outcome is an important responsibility of care providers and public health professions.
Home visiting nursing (HVN) is the most major home nursing service, about 10,000 agencies working at 2017
Usually, home dwelling people at terminally illness stage received medical treatment and symptom management by community clinic physicians and HVN nurses.
Community Clinics
HVN Agency
1-2 visits
/ month
1-2 visits
/ week
Takashi NARUSE

3. Focus of this study Focused on RC of Manager nurses in HVN agencies.
When managers collaborate with physicians providing care with high-quality communication, this can contribute to better supervisory support for their reporting nurses, then better care provision for their clients.
This study aimed to investigate the association between HVN manager nurses’ RC with physicians and clients’ place of death. RC ??
Takashi NARUSE

4. Method and Participants
Design
Second analysis of public health survey in K-city, 2015
Ns managers at 30 HVN agencies were asked to participate.
27 agencies participated (response rate: 90.0%)
1) Questionnaire about managers’ RC* and demographics
2) Chart survey about deceased clients who have died between 1 April to 31 July 2015**
Data of Agency　　　
Data from 17 HVN agencies were analyzed
Remaining 10 agencies had no inclusion criteria**
Data of clients
85 deceased clients of 17 HVN agencies
Died at home
Age at death
Male
Presence of cancer at death
N = 52 (61.2%)
76.4 (SD 16.4, )
N = 61 (71.8%)
*Managers were asked about their experience of RC with home clinic physicians in their community
Takashi NARUSE

5. Data of 17 participant agencies
FTE: Full time equivalent
Facility ID
Deceased clients' place of death
Agency characteristics n
Home
Institution RC
FTE of Nurses A 21 18
(85.7) 3
(14.3)
4.7
6.0 B 16 8
(50.0)
3.0
15.0 C 10
(30.0) 7
(70.0)
3.3 D 6 2
(33.3) 4
(66.7)
2.9
8.0 E 5
(40.0)
(60.0)
3.7
10.0 F
4.3
4.0 G
4.1 H
(100.0)
(0.0) I 1
2.4
7.0 J
3.9 K L M N
5.0 O
2.3 P Q
N/A
Takashi NARUSE

6. Multilevel logistic regression analysis (n = 84)
model 1
model 2 OR
95% CI
Agency variable
RC with physicians
2.488
(1.442-
4.293)
2.275
(1.079-
4.796)
FTE number of nurses
0.967
(0.831-
1.124)
Client variables
Age
1.016
(0.996-
1.037)
Gender (ref: male)
1.204
(0.385-
3.762)
Presence of cancer (ref: not present)
0.866
(0.307-
2.445)
AIC
371.43
384.31
BIC
373.79
Multilevel logistic models included random intercepts for agencies and individual- and agency-level independent variables
Takashi NARUSE

7. Discussion 1
When managers experienced better RC with physicians, their clients tended to die at home rather than in hospital.
Managers became information HUB between HVN nurses and physicians
Manager
Nurse
Physicians
Report
Nurses RC
Information about “Preferred place of death” of each clients
Anticipatory care, including communication about place of death is important for home death.
Information about “Symptom management” of each clients
Symptom management, including pain control is important for home death. Previous study showed that RC among inpatient care providers related to better pain control (Weinberg et al. 2007).
Takashi NARUSE

8. Additional Qualitative data from Participants
I showed the results for participants, and some participant managers respond as below; “We think that relationship with community residents is important factor of home death as well as RC with physicians. When we could communicate with community residents well, they can help us in information sharing. They provide so rich information about clients’ daily condition in timely, and culture of their living community.“
Takashi NARUSE

9. Searching feedback from you
I am now interested in RC between professions and non- professional community residents as promoting factor of home care performance. It looks natural in Japanese culture.
In addition, because Japan has many disasters, it is significant issue to foster mutual support relationship in community residents.
However I am afraid that definition of “community residents” is too unclear to evaluate RC with them.
How do you think about evaluation of RC with “community residents (or neighbors of clients) ?
Takashi NARUSE