In Japan, complementary and alternative medicine (CAM) of knowledge and skills of the visiting nurses is required with the spread of palliative care due to an increase in cancer sufferers and complication of the disease structure in aging.
In the report of the group "Research on Complementary and Alternative therapy of cancer in our country" in the Ministry of Health, Labour and Welfare grant-in-aid for cancer research, for the use in the medical field, that 44.6% of cancer patients are using one or more types of CAM has been reported 1). This study is a thing of health care facilities, it would likewise be utilized from the hospital is considered to be people who were using the CAM in the medical facility needs of CAM in cancer patients to medical treatment at home is to be higher is presumed.
For CAM use of home care's, it has been reported per 1,000 medical users, 49 people and are using CAM 2). Also, in the survey of the general public, utilization of CAM has been reported 65% in 1999, 68% in 2005 3).
From these facts, it is considered that the need for CAM implementation of the visiting nurse is high, but the fact-finding of the CAM practice of the home visit nurse has not been carried out until now. Therefore we randomly selected approximately 30% of stations in Japan (1,700 facilities) and performed the mail investigation into questionnaire. As a result, it was revealed that only approximately 30% of temporary nursing at home stations practiced CAM 4).
Therefore, using our findings, it was intended to get a suggestion for the CAM spread in Japan in this study and analyzed it using technique of the text mining about the reason that did not carry out CAM.
1. The subject and data collection method
We randomly selected approximately 30% of stations in Japan (1,700 facilities) and performed the mail investigation into questionnaire. Among 1,687 facilities which excluded the place where there was the communication such as the facilities closedown, it was collected from 381 facilities (22.6% of recoveries). About 247 facilities that answered them, that it has not been performed CAM, it was the object of analyzing the reason for not implementing the CAM portion of the free described.
We carried out semi-structured interviews for the veteran nurse practitioners about thoughts for CAM. She has 30 years nurse career and nine years experience of visiting nurse.
About a free mention about reason which did not practice CAM, we analyzed it using technique of the text mining. We assumed the lower limit of the appearance frequency ten times. The software which we used is SPSS Analytics for Surveys 4.0.
“How did you incorporate CAM in nursing care" "How can we do to go spread the CAM" and "CAM needs of the patient and family", we carried out semi-structured interviews. The transcript verbatim record by recording, for talking of nurses, they were analyzed using the technique of text mining interview. We assumed the lower limit of the appearance frequency twenty times. The software which we used is SPSS Analytics for Surveys 4.0.
3) Ethical considerations
This research got the approval of the Ethical Review Board of the university where a researcher belonged to. For the interview, we explain in writing and verbally that research aims, methods, research cooperation are arbitrary, that there is no disadvantage of participation refusal, that the withdrawal of study participants is also possible, to protect the privacy. It was performed on with the consent.
The extracted category were [Knowledge], [Time], [Skill], [Staff], [CAM], [Understanding], [Patients-, [Practice],[Need].
The <lack of knowledge> and the <there is no way to learn> were included in the [Knowledge]. The < do not have time to study> and the <there is no time to perform the CAM to visit nursing time> were included in the [Time]. The < skill shortages> was includes in the [Skill]. The <lack of staff> and the <knowledge and skill shortage of staff> were included in the [Staff]. The < I do not know the CAM> and the <I first heard the term CAM> were included in the CAM]. The <difficult to obtain an understanding of the staff>, the <difficult to obtain an understanding of the attending physician> and the <it is difficult to obtain an understanding of the family> were included in the [Understanding]. The <it is difficult to obtain an understanding of the patient > and the < It is necessary to have a patient purchase aroma oil > were included in the [Patients-. The <It is difficult to do > was included in the [Practice]. The <requiring high-skill > and the < need for permission from a boss> were included in the [Need].
The extracted category were [I-Myself], [Doctors], [Patients],[Nursing Care].
The < I also healed> and the <I think that it boost the immune system> were included in the [I-Myself]. The <doctors believe that they can not do anything to the patient> and the <patient rejoice doctor just to home visit > were included in the [Doctors]. The <patient's happiness> and the <be taught from patients> were included in the [Patients]. The < care to make use of natural healing power in to the maximum> and the <our care> were included in the [Nursing Care].
In this research, reasons of the home visit nursing station which did not practice CAM included lack of [Knowledge] , [Time], [SKill], were able to extract the points such as the difficulty of getting understanding of the staff of the station and the understanding of the governing body of the station. In addition, from the narrative of visiting nurse veteran, it has been found and that it has implemented care while being healed, that the joy of the patient is in the motivation of practice.
In Japan, we cannot get the knowledge about CAM in the school education. Because knowledge and the technical acquisition are left to nurse oneself, it is thought that the difference of a person with knowledge and a technique and the person who do not have is very large. What is adopted in a curriculum of the school education is desirable to diffuse CAM in a visit nurse, but it is difficult under the present conditions. We thought that it is important to make an opportunity of the learning to the managers of the home visit nursing station at first. But, there is a big issue that who performs it and how to make a opportunity to learning. We think that it is necessary to cooperate with the College of Nursing which can teach CAM and professional organizations such as the Japanese Nursing Association.
1) Hyodo I, et al.FNationwide Survey on Complementary and Alternative Medicine in Cancer Patients in Japan. J Clin Oncol, 2005,23(12),2645-2654
2) Fikui T, et al.FThe Ecology of Medical Care in Japan. JMAJ, 2005,48(4),163-167
3) Imanishi J et al.FComplementary and alternative medicine for health care workers current situation and problems at home and abroad of complementary and alternative therapies, Jiro Imanishi eds, KimuKaoru- do, Kyoto,2009,9-22
4) Tokushige A and Tanaka S:The current situation of practice of Complementary and Alternative Medicine (CAM) in home-visit nursing. JJIM, 2013,6(1),83-92
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