It is difficult for patients and their families who need medical treatment due to illness or sequelae, management of symptoms, recovery of physical function, and maintenance of physical function to incorporate treatment into their daily lives, and it tends to be insufficient to lead the desired life. The condition is called “ineffective health care”.
<Differences in how to use “ineffective health maintenance” and “ineffective health management”>
“Ineffective health maintenance” is used for individuals who want to change their unhealthy lifestyle such as overeating, lack of exercise, and smoking, and is used for primary prevention to prevent the onset of illness.
“Ineffective health care” is used for patients who need education on self-management of illness or health condition.
<What is home oxygen therapy?>
Home oxygen therapy is oxygen inhalation at home when oxygen therapy is required due to chronic respiratory failure.
Oxygen supply devices include oxygen concentrators and liquefied oxygen devices.
Precautions for installation
1. Avoid sunny areas.
2. Keep at least 2m away from the place where you use fire.
3. Keep the oxygen concentrator 15 cm away from the wall.
4. In the case of a liquefied oxygen device, it is important to enforce ventilation. It is also necessary to prepare a digestive system nearby.
<Nursing care plan>
Acquire the knowledge and skills necessary for self-management
Be aware of management problems in your life and use your knowledge and skills to deal with them
Get the support you need and live a quality life
1. Vital signs
2. Age, cognition, comprehension
3. Medical condition, treatment content, side effects, presence / absence and degree of complications
5. Presence or absence of oxygen therapy, necessity of breathing training
6. Presence or absence of internal use
7. Understanding the need for infection prevention
8. Breathing status (resting, operating)
-Respiratory rate, breathing pattern, SpO2
-Presence of wheezing, lung accessory noise and cyanosis
-Presence or absence of dyspnea
-Presence of cough and sputum
-Pulmonary function test data
9. How patients and their families perceive disease treatment
10. Patients and their families are worried
11. Family relationships, support between families
12. Reaction and understanding of the instruction content
-Understanding the flow rate confirmation, remaining amount confirmation, and operation confirmation of oxygen cylinders
-Is the oxygen cannula length and fixing method appropriate?
-Oxygen concentrator management
-Is it possible to deal with abnormalities?
13. Contents of self-management
-What is the current situation of the patient and what should be done?
-How do you perceive what the patient should do?
-Is what the patient is doing right?
-Is the patient able to continue to act?
14. Living conditions before hospitalization
-How to spend one day
-Habits (dietary habits, smoking, drinking, etc.)
-Residential environment, local environment and means of transportation
-Role (home, society)
-Values, beliefs, religions
15. How is the illness and management described?
-Understanding the workplace and school
-Resting place, means of transportation, support system
-Adjustment of working hours and learning content
16. Utilization of social support
17. Economic situation, whether or not to use the public subsidy system for medical expenses
1. Treat patients and their families with respect for their feelings
2. Listen to patients and their families about their problems and anxieties
3. Self-management after discharge Use illustrations, DVDs, etc. to help patients understand what they are doing now and what they will do in the future.
4. Help reduce anxiety and fear of dyspnea
-Adjust to interact with patients undergoing home oxygen therapy
-Introduce the patient association
5. Report the respiratory condition associated with the expansion of activity to the doctor and receive instructions such as oxygen.
6. Care for exhaustion when sputum is difficult
-Use inhaled medicine as directed by your doctor
-Postural drainage, squeezing
7. Adjust so that explanations such as respiratory status, treatment progress, and precautions for living at home can be explained to the whole family.
8. Hold a pre-discharge conference in collaboration with multiple occupations
-Tell the home service supporter about the discharge guidance
-Help patients and their families express what they want and feel uneasy about
9. Stay out of the exam before discharge to clarify the problem
10. Try to solve the problems that can be confirmed when staying out
11. Cooperate with medical counselors to prepare for consultation and reception with medical institutions (family doctors)
1. Check if the patient’s family is ready to accept guidance based on their physical condition and psychological condition.
2. Do it in the way and environment that the patient’s family wants
3. In collaboration with multiple occupations, plan, implement, and evaluate guidance tailored to the needs of patients and their families.
-Explain the pathophysiology of the disease
-Explain how to take it
-Explain inhalation therapy
-Explain how to use and use the inhaler
-Explain diaphragmatic breathing and pursed palate breathing
-Explain home oxygen therapy, equipment handling and precautions regarding fire
-Use an oxygen concentrator during hospitalization so that you can learn how to use the device
-Explain how to deal with sputum difficulty (to humidify by inhalation)
-Explain precautions in daily life
-Explain the need for respiratory infection prevention (hand washing and gargling)
-Explain the triggers for seizures and how to eliminate them
-Explain breathing training and sputum removal methods
-Meals: Explain the need for pre-meal sputum, the importance of dietary balance, refraining from salt and encouraging hydration, reducing the amount of meals and eating more often.
-Bathing: Guidance on how to take a bath that does not cause shortness of breath, and explain how to assist and devise routes.
-Explain to get a bowel habit
-Explain that you need to quit smoking
3. Clarify and guide patient and family self-management issues
-Confirm management methods and understanding based on life after discharge
-Check what kind of management you want to manage based on your life after discharge
-Make sure management is done the right way
4. Explain the social support that can be utilized