1. Nami Imai, Ph.D, RN Mie University, JAPAN The Construction of the Nursing Care System for Chemical Sensitivity Syndrome Patients at the Local Area

2. Introduction Multiple Chemical Sensitivity (MCS) MCS patients have symptoms associated with low-level exposure to a variety of substances. ◆ Significant medical problem caused by environment ◆ 10% of the general population in North America ◆ Many cases switch from SHS to CS or MCS in Japan ◆ Not generally well known disorder in Japan ◆ Some physicians lack recognition of MCS in Japan

3. What’s happen in Japan? 2001 ～ 2003 Investigation into the actual conditions

4. Background 1 Psychosocial aggravating factors of MCS in Japan Specialized Hospital for SHS, CS General Hospital MCS SHS CS A lack of knowledge illness Role in the society and family Be late for diagnosis Can not treat Can not go Poor stamina Restricted movement Economic crisis Imai N, et al. J. Jpn Int. Illness Nurs. Soc. 2004

5. Why dose the condition aggravate? 2004 ～ 2006 The Qualitative Method

6. Prolongation of exposure to toxic chemicals Lack of knowledge about disorder Difficulties establishing a diagnosis Difficulties taking radical measures to improve the environment Time axis Moving into the housediagnosisTaking measures Imai N, et al. Nurs.& Health Sciences, 2008. Background 2 Time course of the appearance of psychosocial aggravating factors of sick house syndrome in Japan

7. What can a nurse do? 2006 ～ 2008 The Intervened Method The Action Research

8. Consultation at N ursing C ounseling R oom email telephone counseling Fax Method 1 What are nurses’ roles for CS patients and people of related to CS patients? Research I To clarify users’ expectations of NCR Are there any effects by nursing intervention? Research II To verify the effect of nursing intervention for MCS

9. First counseling session Check the health condition with QEESI Interview with the user If the users need more counseling, repeat counseling by nurses Final counseling Check of health condition with QEESI Interview with the user Evaluate the effect of the nursing interventions Consultation at Nursing Counseling Room Method 2

10. QEESI Quick Environment Exposure Sensitivity Inventory developed by Ashford and Miller (1998) Symptom severity scale The 10 items include, Each item 0-10 rating 1 Head-related 2 Cognitive 3 Affective 4 Neuromuscular 5 Musculoskeletal The Check of Health Status for Patients 6 Skin 7 Genitourinary 8 Gastro internal 9 heart /chest-related 10 Airway or mucous membrane-related Tool

11. Contents of Demand to Nursing in NCR Information on the condition and treatment Information that could improve the safety of daily living Mental support Action to promote social understanding of their situation Users:70 ， code:179 Users’ Demands to Nurse 46 ％ 22 ％ 21 ％ 11 ％ Result 1 Nami Imai, QHR, Banff, 2008.

12. AF29beauticianpeer counseling, sauna BF36office workerpeer counseling, special doctor safe water Case A: SHSCase B: CS Outcome of QEESI and main intervention Result 2 Nami Imai et al. Jpn J Clin Ecol Vol 17(1) 2008.

13. International Program of Psycho-Social Health Research, Podcast #52 Living in a Chemical World: Psycho-Social Factors Aggravating the Symptoms of Sick House Syndrome Appendix

14. What can nurses do in society? 2009 ～ 2013 The Intervened Method The Action Research (Expansion Sphere of Activity to Regional Society)

15. Patients Support System Medical Doctors DentistMidwifeArchitectIndustrialistBeautician Public health nurse Supporters(Sup porting group) NCR TAKAOKA CLINIC at Tsu, Mie, JAPAN