Background: This study explored visiting nurses' knowledge and beliefs regarding pain management in community-dwelling older adults with moderate-to-severe dementia. Methods: A cross-sectional study design was used to collect data in 2019. A questionnaire was mailed to nursing managers at 1037 home-visiting nursing stations in Japan. Findings: The final analysis included 230 responses. The mean score on the knowledge and belief statements was 14 out of a possible 18, and respondents with more pain management training obtained a higher total score on knowledge than those without such training (p<.001). More than 95% indicated that they needed training on pain management for older adults with dementia. Conclusion: Visiting nurses in Japan require training in pain management for older adults with moderate-to-severe dementia. Despite its usefulness, the current pain management training programme should be improved to enable visiting nurses to manage dementia patients' pain more confidently.

Amyotrophic lateral sclerosis (ALS) is a devastating neurodegenerative disease for which there is currently no cure. This study aimed to explore the situations with which nurses struggled, their implemented practical measures, and the challenges they experienced when caring for patients with ALS comorbid with cognitive impairment (hereinafter, targeted patients). In this qualitative study, we conducted a survey with nurses (n = 121) experienced in caring for ALS patients; the survey contained a free-writing section in which participants described their struggles regarding care delivery for these patients. To collect data on practical measures that nurses had already implemented or wanted to propose regarding care delivery for the targeted patients, we conducted four focus group interviews (n = 22). We used a qualitative inductive approach to extract the categories. Fifty-eight nurses (49.6%) completed the free-writing survey section. The situations in which nurses struggled in care for the targeted patients were organized into three categories: “Patients’ strong persistency on specific requirements for nursing assistance in their daily lives,” “Patients’ problematic behaviors toward nurses,” and “Struggles in communicating with and understanding patients’ wishes.” Nurses reported these situations as stressful, and they affected care quality. The practical measures implemented when caring for the targeted patients were organized into five categories: “Cognitive impairment assessment,” “Care delivery to deal with patients’ strong persistency on specific requirements for assistance in their daily lives,” “Communication,” “Supporting the decision-making process,” and “Collaboration between the hospital and the community.” Multidisciplinary collaboration in the hospital, and collaboration between the hospital and the community from an early stage is necessary to share the results of the assessment and diagnosis of cognitive impairment. Our evidence underlines that guideline and care manual establishment may lead to improved care delivery and to the unification of care deliveries to respond to patients’ strong persistency.

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Background & Aims: To clarify the background characteristics of patients with chronic obstructive pulmonary disease (COPD) and the introduction status of COPD action plans (AP) at visiting nursing stations (hereinafter stations) in Gunma Prefecture. Methods: We conducted an anonymous self-administered questionnaire survey by mail, targeting 187 stations. The managers at these stations answered the questionnaire regarding the status at the time of the survey. Results: Seventy-nine stations returned the questionnaires (return rate 42.2%); 45 stations (57.0%) had patients with COPD. All patients were over 65 years old； 80% of them required assistance. Twenty stations had patients with an AP. The contents of AP were different every stations. Patients with an AP had higher care practice scores compared to those without an AP on "providing inhalation instruction to patients receiving inhalants" and "teaching how to respond to exacerbations" (p＜0.05). The stations that had patients with COPD were associated with higher"number of full-time nursing stuff" (p＜0.01), higher"total number of users" (p＜0.01), and higher "charging additional medical fees for around-the-clock services" (p＜0.05). Conclusions: In order for patients with COPD to continue living in the community, it is necessary to prepare an AP that takes into consideration the patient' s characteristics individuality at the station.

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