[A case of trial change in home parenteral nutrition--role of visiting nurses in the care insurance system].Gan To Kagaku Ryoho. 2000 Dec; 27 Suppl 3:724-8.GT
Enteral nutrition is generally selected as a means of administering nutrients during hospital treatment. In the home, however, it is necessary to investigate this from the advantages of care ability and economics. The present patient had long term difficulties in ingesting food. After a gastrostomy in December 1999, the patient returned home with the aim of improving his quality of life, as strongly desired by both the patient and his carer. Since the patient experienced symptoms of diarrhea with enteral alimentation after the gastrostomy, combination oral nutrients (terumiru mini) were diluted and injected after discharge from the hospital. However, this alimentation was not covered by medical insurance, making its cost performance high. At the start of the nursing care insurance system, the patient was certified as having a care level of 5, and the caregiver, who is the patient's eldest son (myelogenic leukemia), had great expectations. However, his burden in the form of purchasing the current alimentation and using the service was extremely difficult financially, so that he was nearly forced to give up hope. Managing the speed of the injection was also a source of great anxiety. Thus, with a view to the lifestyle of the family, an evaluation of their care ability, and analysis of methods able to meet the needs and overcome problems in care crises, as well as adopting the condition that the method be covered by medical insurance, we attempted a change in alimentation and the purchase of an enteral pump. The process of making these changes involved a nutritionist working in cooperation with the doctor, a nurse from a care facility, and a visiting nurse who took the role of coordinator with a medical supply company. The above was possible due to continuous support while confirming a satisfactory care status was being maintained. As a result, we were able to alleviate the economic and psychological burden of care. In the present process, we learned that a care crisis should always be expected, and that we must have the ability to judge the overall needs of the patient while evaluating care ability. Moreover, we discovered that the nursing ability to provide timely, continuing care, including the psychological aspect, is demanded.