Risk managements and safety issues in home-care agents in Japan

本研究的目的为探讨访视护士与社区卫生服务人员在居家访视时的风险管理与安全问题。根据研究结果，我们的最终目标是为访问护士创建风险管理和安全问题的指南。访问护士和社区卫生护士感知的风险：自填式问卷邮寄给全国各地的访问护士，包括G县的社区卫生护士。调查结果显示：（1）15%的受访者在探视病人时曾遭遇交通意外;（2）受访者所感知的危险与建筑、房屋结构、宠物及天气状况有关;（3）受访者中有许多人在受到病人或其家属的辱骂、激动及精神混乱的威胁或骚扰时会感到危险。13%的人承认在病人家中发生过性骚扰，4）15.4%的人在就诊期间发生过性骚扰。他们是病人摔倒或护士伤害病人的皮肤。美国家庭护理护士感知风险管理的访谈：对美国俄勒冈州波特兰的9名护士进行了访谈。结果显示，所有受访者都准备在他们的访问期间，通过内部的方向或正式的护理教育的风险管理，他们也受到他们的公司保险的交通事故。他们认为“本能”，感觉危险，作为最重要的因素，他们的自我保护。G县居家照护机构管理人员访谈：G县居家照护机构管理人员中有6人表示没有风险管理指引。问题通常在代理商的会议上讨论.建议：基于上述结果，我们为日本家庭护理护士创建了一个风险管理清单。

The first aim of this study was to investigate into risk managements and safety issues of visiting nurses and community health nurses during their home visit. Based on the results, our final goal was to create a guideline for risk managements and safety issues for visiting nurses.1. Risks perceived by visiting nurses and community health nurses : Self-administered questionnaires were mailed to visiting nurses throughout the nation including community health nurses in G prefecture. The results of 1,887 nurses' responses are as follows :1) 15% of the respondents experienced a traffic accident when visiting a patient.2) Risks perceived by them were related to constructions, house structures, pets and weather conditions.3) Many of them experienced risks when being threatened or harassed by either a patient or his/her family member's abusive statements, agitations and mental confusions. 13% of them confessed that they experienced sexual hafassment at a patient's home.4) 15.4% of them experienced malpractices during their visit. They were a patient's falling down or nurses' injuring a patient's skin.2. Interviews on perceived risk managements of American home-care nurses : Nine nurses in Portland, Oregon in the USA were interviewed. The results showed that all the interviewees were prepared for risk managements during their visit through an in-house orientation or formal nursing education and they were also protected by their company insurance for a traffic accident. They perceived 'an instinct', feeling dangers, as the most important factor for their self-protection.3. Interviews with administrators of home-care agents in G prefecture : Six administrators of the agents in G prefecture revealed that they had no guidelines of risk managements. Problems are usually discussed at conferences in the agents.4. Proposal : Based on the results above, we created a checklist of risk managements for Japanese home-care nurses.