Usefulness Evaluation/Utilization of Clinical Pathway/Care Management Method for Elderly Clients Hnspice Carp at, Home

从2005年度到2007年度，每年在日本进行案例研究，并在国外案例中评估临床路径的有效性。受试者是家中的晚期老年客户，案例研究组分为两组，非癌症客户（癌症和癌症以外的疾病客户）。临床路径的项目经过精心选择，以供患者家属和专业人员使用。将居家照护时间分为四个照护阶段（导入期、稳定期、濒死期和死后期），揭示各照护阶段的共同照护需求和照护需求差异。此外，它还探讨了临终关怀应该是什么，以鼓励客户，客户的家庭成员和专业人员参与他们的家庭护理。本研究共分析了近800个个案，并根据分析结果制定了临终关怀方案。很难估计病人和病人家属的死亡过程，因此卫生专业人员往往在临终关怀中采取主动。客户、其家庭成员和专业人员应共同选择方法，以提供高质量的护理。制定这一护理方案是为了在早期阶段发现客户及其家庭成员的需求，以提高家庭临终护理的质量。护理方法和护理细节的有效性从客户的家庭成员的结果的实现来确定。患者家属和医护人员使用相同的临床路径项目，并对两组患者对应的项目进行验证。此外，适当的护理管理方法，在四个护理阶段确定。我们为护士、医生和社会工作者（参与者90和125）举办了两次使用护理方案的培训。我们将于2008年8月与Initia出版社共同出版这本关爱计划书。

From fiscal 2005 to fiscal 2007, case studies had been conducted annually in Japan and usefulness of the clinical pathway was evaluated in foreign cases, also. The subjects were terminally elderly clients at home and the case study groups were divided into two groups, non-cancer clients (with cancer and clients with diseases other than cancer). The items of clinical pathway were selected carefully in order to be utilized by family members of clients and professionals. The duration of care at home is classified into four care stages (Introductory stage, Stability stage, Near death stage and After death stage) and common care needs and difference of care needs in each care stages were revealed. In addition, it examined that what hospice care should be to encourage clients, clients' family members and professionals to participate them in home care. About 800 case studies had been analyzed and the End of Life Care Program was accomplished based on the results of analysis. It is difficult to estimate a process of dying for clients and clients' family members therefore health professionals tend to take the initiative in terminal care. Clients, their family members and professionals should choose methods together to provide good quality of care. This care program was developed to find clients and their family members' needs in early stages in order to improve quality of End of Life Care at home. The validity of care methods and details of care was identified from the attainment of outcome of clients' family members. Clients' family members and health care professionals used same items of clinical pathway and the items which corresponded with two groups are verified. In addition, appropriate care management methods in four care stages are identified. We have held twice training for nurses, doctors and social workers (Participants 90 and 125) using the care program. We are going to publish the care program book in August, 2008 with Initia publisher.