Practice of University Hospital Nurses Related to Assisting Discharged Patients to Access Community-based Integrated Care

Purpose: Faced with serving the needs of a super-aging society, the Japanese government is actively seeking to establish a community-based integrated care system. The goal is to shift hospital-based medical and nursing care to home or community-based settings. Medical and nursing personnel need to be educated to meet this social change. The purpose of this study was to clarify the current nursing practice of hospital nurses regarding the process for patients who are discharged to home. Method: A questionnaire survey was distributed to 720 nurses who worked in a university hospital; 533 responded (response rate 74.0%). Results: The results showed that half of the respondents thought they were fairly capable at helping patients who were discharged. In order to assist these patients, nurses required knowledge of the patients' living conditions at home and ability to perform discharge coordination and guidance through the discharge process. Conclusion: Collaboration with the discharge support center and seminars about utilization of social resources are especially needed to enhance the nurses' ability to smoothly assist patients as they are discharged from the hospital into community-based settings.