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

本研究的第一个目的是调查来访护士和社区卫生护士在家访期间的风险管理和安全问题。根据结果，我们的最终目标是为来访护士制定风险管理和安全问题的指导方针1。访问护士和社区卫生护士感知的风险：向全国各地的访问护士邮寄了自填式问卷，包括G县的社区卫生护士。对1887名护士的调查结果如下：1)15%的受访者在探视病人时经历过交通事故；2)他们感觉到的危险与建筑、房屋结构、宠物和天气状况有关；3)他们中的许多人在受到病人或其家人的辱骂、激动和精神错乱的威胁或骚扰时都有危险。13%的人承认他们在病人家里经历过性骚扰。4)15.4%的人在就诊期间经历过性行为不端。它们是病人摔倒或护士伤到病人的皮肤。美国家庭护理护士感知风险管理访谈：访问了美国俄勒冈州波特兰的9名护士。结果显示，所有受访者在访问期间都通过内部定向或正式的护理教育为风险管理做好了准备，他们也得到了公司交通事故保险的保护。他们认为，感觉到危险是自我保护的最重要因素。与G县居家护理机构管理人员的访谈：G地区6名家庭护理代理机构的管理人员透露，他们没有风险管理指南。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制定了一份风险管理清单。

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.