I work as a visiting nurse in Katsushika, Tokyo, a suburban area of Tokyo. The population of Katsushika is about 450,000, and the aging rate is 24.5%, which ranks it the third highest among Tokyo's 23 wards. There are many old households and elderly people living alone. Katsushika has a 23.7% home mortality rate (13.0% nationwide average). This is due to the shortening of hospital stays, fewer hospital beds, and increased availability of physicians and visiting nurse stations. These conditions have created a culture of aged people spending their time in their familiar communities until the end.
Heart, the visiting nurse station where I work, consists of nurses, therapists, nurse assistants, clerical workers, and drivers. We see about 160 patients at any given time, from infant to more than 100 years old, with a variety of illnesses. Heart puts its emphasis on palliative care and about 100 patients pass away at their home or home hospice every year.
We hold a staff meeting every morning. During these meetings, we consider cases that are especially severe from a medical point of view, and new cases are introduced. We also hold conferences with home doctors, small team meetings, and case-study presentations, depending on the day of the week. After the morning meeting, each of us visits four or five patients a day. We usually use electric bicycles for our visits, because Katsushika is a flat area. Today we travel by car because the patients are far away. Because our station is an education station, there are trainees and students every day and they visit our patients with us.
Today, I visited five patients by car, accompanied by a trainee. I explained the cases to her, while being taken to the visits by our driver. The first case was a woman in her 60s with multiple system atrophy who uses a wheelchair, and requires bowel and bladder management and personal care. The couple has no children; the primary caregiver is her husband, who takes tender care of her. My role is to help her to maintain her remaining physical abilities.
The second case was one of symptom management by continuous subcutaneous injection, and elimination management, for a man with brain cancer. He was told his life expectancy was a few days when he left the hospital, but he was having a good time with his family at home. We want to support him in own home until the last moment.
After lunch, we visited the third case, which was respiratory care for a man with amyotrophic lateral sclerosis (ALS) on a ventilator. He made up his mind to live in order to see a day when treatment for ALS is established. He joined an overnight trip to the beach that our company planned, and spoke at a public seminar to support our activities. He consults with people who are diagnosed with ALS, and often connects such people to us as new users of visiting nursing care.
The fourth case was for symptom and intravenous management of a woman with stomach cancer. She currently lives in home hospice because she had difficulty living alone, but she will eventually return home, wishing to die where she saw her husband's last living moments. The fifth was bathing assistance and tracheal cannula management for a 3-year-old girl. She enjoys origami and drawing after her bath. To our delight, her recent growth is impressive since she began attending kindergarten.
At the station, I reviewed today's cases with the trainee, and received reports and consultations from co-workers. As I already contacted some doctors while traveling, I just cleared up my records and ordered supplies. After that, I gave a report to the night staff, adjusted my visits for tomorrow, enrolled in a training program, and that was the end of my workday.