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Methods: We asked nursing departments of 409 designated regional cancer centers and hospitals to participate in our research. We asked each institution about the number of nurses who had had nursing experiences of caring for patients who lost the most of oral cavity function after the surgeries of larynx cancer and hypopharynx cancer, and then sent a sufficient number of questionnaires to representatives in each institution for distributing them to nurses. Participation of this survey was voluntary and anonymous. Participants in this research were asked to put questionnaires in enclosed reply envelopes and send them back to us. This study was conducted with the approval of Research Ethics Committees in University J and University S.
Subjects in this research were 100 nurses who completed and returned questionnaires.
Relevant patients need enough discharge support and adjustment during a period of hospitalization after surgery because they are put under difficult conditions on several functions such as speaking, eating, and breathing. In other words, we consider that the “perspective of home nursing” hospital ward nurses have for developing discharge support and adjustments is deeply related to the quality of life among patients who lost the oral cavity function after discharge from hospital. The “perspective of home nursing” in this research refers to the estimation of the matters and problems that can happen on patients and their families after discharge from hospital, the instruction for them, and the assessment of necessary service (Yamagishi, et al., 2014).
We used the “discharge planning process scale for hospital ward nurses” (Yamagishi, 2012) in order to measure their “perspective of home nursing.” This scale is composed of five subscales on a scale of 1 (do not at all) to 6 (always do): the confirmation of a patient and his/her family's thinking about their plan of medical treatment (5 items), the continued enhancement of medical care (5 items), collaboration with medical experts in the community (5 items), the instruction of a patient and his/her family according to medical care environment after discharge from hospital (5 items), and an assessment of daily living after discharge from hospital (5 items). Its reliability and validity have been verified. It was interpreted that its score was positively associated with the level of the perspective of home nursing. We calculated the scores of each subscale and the total score (a maximum of 100).
We also asked subjects about their basic attributes such as the years of nursing experience, the years of visiting nursing experience, current affiliation, age, and sex. Current affiliation is classified into Group 1 (ear, nose, and throat, head and neck surgery, and oral surgery wards) and Group 2 (other wards). Outpatients were excluded from the analysis.
We got the descriptive statistics first, and conducted a t-test to evaluate the mean difference between them and the results of Yamagishi's study (2012). Then, we conducted a multiple regression analysis on 5 subscales of “discharge planning process scale for hospital ward nurses.” There was multicollinearity between age and the years of nursing experience, so that we conducted a multiple regression analysis focusing on the years of nursing experience and current affiliation.
Results: The average age was 34.2 years (ranging 22 to 60 years). There were 95 females and 5 males. The average years of nursing experience was 11.7 years (ranging 0 to 39 years). Only one subject had visiting nursing experience (5 years).
The average total scores of the confirmation of a patient and his/her family's thinking about their plan of medical treatment, the continued enhancement of medical care, collaboration with medical experts in the community, the instruction of a patient and his/her family according to medical care environment after discharge from hospital, and an assessment of daily living after discharge from hospital were 22.7, 23.6, 19.8, 25.0 and 23.6, respectively. Comparison between this results and the analysis of 1,164 hospital ward nurses in 5 hospitals in 4 regions before the introduction of Yamagishi's discharge support and adjustment programs revealed that nurses in this research gained high scores in every subscales at a statistically significant level (p < .0001).
Multiple regression analysis revealed that there was no significant difference between the years of nursing experience and current affiliation on the confirmation of a patient and his/her family's thinking about their plan to medical treatment, the continued enforcement of medical care, the instruction of a patient and his/her family according to medical care environment after discharge from hospital, an assessment of daily living after discharge from hospital, and collaboration with medical experts in the community.
Conclusion: The scores of 5 subscales were significantly higher than those of Yamagishi's study (2012) because the revision of the medical payment system after 2012 induced the establishment of a full-time branch of discharge support and adjustment in acute hospitals and made its education involving the role development of nurses active.
The finding that there was no association between the years of nursing experience and current affiliation in all 5 subscales of “discharge planning process scale for hospital ward nurses” suggests that there is a possibility that all nurses including novice nurses would be able to have a perspective of home nursing.
Yet, patients and their family members still feel difficulty in daily life even one year after discharge from hospital (Kotake, et al., 2014), suggesting the necessity to continue to nurse patients who lost the oral cavity function after their discharge from hospital. The scores were higher than previous studies but the score of collaboration with medical experts in the community was below 20, showing the necessity to collaborate consciously with medical experts in the community.