The number of people requiring home care in Japan was 170,000 in 2011 and is expected to increase to 290,000 by 2025 [1]. In addition, the number of visiting nurse stations, which was 5,731 in 2011, has increased to 10,418 as of 2019, nearly doubling in eight years. With the shortening of hospital stays, there is a shift in emphasis from medical facilities to home care. Against this backdrop, nurses are expected to build community-based comprehensive care systems that meet regional characteristics and demonstrate their nursing expertise as members of the home care team [2].The place of employment for nurses will shift from hospitals to the community and home, and they are expected to provide appropriate comprehensive health, medical, and welfare services in collaboration with multiple professions in a variety of settings, not limited to medical institutions, and curriculum revision for basic nursing education in 2022 is being discussed Basic Nursing Education Study Group, 2019. Home nursing theory, which is an integrated subject of basic nursing education, has been taught and practical training has been promoted focusing on home nursing for home care patients, but nursing small-scale multifunctional in-home care and regular patrol/as-needed home nursing care have been established as community-based services. In addition, the activities of nurses have expanded to include consultation activities close to people's lives, such as "health centers for daily life. For this reason, the guideline for the operation of training institutes for nurses proposed that home nursing theory be revised to "community and home nursing theory," in which students learn the basics of nursing by understanding local people and their families in a variety of settings in the community (Basic Nursing Education Study Group, 2019). Home nursing theory is not a facility-centered practical training, but rather a way to understand people living in the community and people living with disabilities and their families, and to acquire nursing care for people receiving treatment at home [3]. The practical training in home health care nursing at our university is a first semester course for fourth-year students, and is conducted mainly through accompanying visits to home health care nursing stations, based on the practical training objective of "understanding how to provide nursing care for the health and life issues of home care patients and their families, and learning the roles of multidisciplinary cooperation and home health care nurses in home care. Students who visit with nurses from the home care nursing station measure vital signs, assist with cleanliness, and assist with elimination. Although assistance in daily living is mandatory in the ward practice, it was unclear what nursing skills the students were performing in the home health care nursing practice. We thought that it was necessary to clarify and analyze which nursing skills the students experienced when they interacted with a wide variety of medical patients in home health care nursing practice. By analyzing the nursing skills experienced by students in practical training, we would like to indicate the direction of future teaching methods.

To analyze the nursing skills experienced by students in home health care nursing practice and to discuss the nursing skills necessary for home health care nursing.

Research Design

This is a statistical study of the nursing skills that the students observed or experienced during the home health care nursing practice by accompanying the visiting nurses to the homes of the patients Research Method.

Research Subjects: Nursing skill experience records of 93 students who described the nursing skills they experienced during the home health care nursing practice where they visited with home health care nurses and submitted the records after the practice.

Data Collected: Students' nursing skill experiences described in the "Nursing Skill Experience Record" submitted as a record of their practical training.

Data Collection Period: May 16, 2019 - November 30, 2019

Analysis Method

Students' "Nursing Skill Experience Record" was divided into columns to be filled in for A, B, and C: A: Performed under the supervision of a visiting nurse, B: Performed with guidance, and C: Observed only. The contents of the nursing skill experience items were not categorized into A, B, or C. If the respondents had any of A, B, or C, they were counted as having experience, and the results were expressed as percentages.

Tabulation of the nursing skill experiences

(Table 1) shows the results of tabulating the items experienced.

Table 1: Summary of nursing skills experience.

during the two-week training period from the 90 nursing skill content items. The items that 100% of the students experienced (including observation) were "able to measure vital signs," "able to listen to breath sounds," and "able to perform hand washing based on standard precautions. The second most common item experienced by 80% to 99% of the students (including observation) was the ability to listen to intestinal peristalsis. Next, 60% to 79% of students experienced (including observation) the following items: 74% were able to maintain pubic hygiene (e.g., wash and wipe pubic area), 73% were able to assist with grooming, 69% were able to listen to heart sounds, 69% were able to provide care to prevent pressure ulcers, 67% were able to change bed clothes, 66% were able to care for nails, and 66% were able to change nails. The items that 50% to 59% of the students experienced (including observation) were "able to perform a full-body cleaning" (57%), "able to assist with walking and moving (assistive devices)" (57%) The items that 40% to 49% of the students experienced (including observation) were "shower bathing" (49%), "fall, fall, and trauma prevention" (48%), and "management of indwelling bladder catheters (fixation, confirmation, and management). (including observation)," 49%, "Able to take a shower," 47%, "Able to manage indwelling catheters (fix, check, prevent infection, etc.)," 46%, "Able to perform oral and nasal suction," 45%, "Able to perform joint range of motion exercises," 45%, "Able to provide assistance to promote natural urination and defecation," 45%, "Able to wash hair," 45%, "Able to provide assistance to regulate body temperature while paying attention to subjective symptoms," 44%, and "Able to provide a comfortable environment for the subject. The items that 30% to 39% of the students experienced (including observation) were "able to perform oxygen inhalation (mask, cannula, etc.)" 39%, "able to perform nebulizer inhalation" 39%, "able to assist with bathing" 39%, "able to assist with creating a comfortable medical environment for the patient" 42%, "able to provide guidance" 42%, and "able to transfer from bed to wheelchair" 41%. The items in which 20% to 29% of the students had experience (including observation) were "able to measure the body" (29%), "able to make the bed" (28%), "able to make the bed" (28%), "able to give oral medication" (35%), "able to give oral medication" (35%), "able to handle medical waste" (34%), and "able to transport by wheelchair" (31%). Between 20% and 29% of the students had experience (including observation) in the following areas: 29% were able to perform body measurements, 28% were able to make beds, 28% were able to perform endotracheal suctioning, 27% were able to provide aerial care to unconscious patients, 27% were able to administer transdermal and topical medications, 27% were able to perform automatic and ambulatory movements, 26% were able to inject liquid food through a gastrostomy catheter, 23% were able to perform positional drainage, 23% were able to perform hot compresses and warm compresses, and 23% were able to perform warm and cold compresses. The items that 10% to 19% of the students had experience with (including observation) were "wound care," "wound care," "wound care," "wound care," "wound care," "wound care," "wound care," "wound care," and "wound care. The items that 10% to 19% of the students experienced (including observation) were: "Able to perform aseptic manipulation for wound treatment" (19%), "Able to dispose of equipment used" (19%), "Able to teach diet according to the subject's disease" (19%), "Able to perform bandaging" (16%), "Able to select a toilet bowl and urinal according to the subject and provide toileting assistance" (16%), "Able to insert and manage nasal catheters" (14%), and "Able to perform urinary drainage assistance" (16%). 16%, "Can insert and manage nasal catheters" 14%, "Can manage intravenous fluids for intravenous infusion" 14%, "Can assist subjects at risk of aspiration to eat" 13%, "Can perform urinary diversion" 13%, "Can observe subjects receiving intravenous nutrition" 13%, "Can change bed clothes of subjects with IV lines" 11%, "Can change bed clothes of subjects with IV lines" 11 For those who had less than 10% of experience (including observation), the following items were selected: "Can assist with immobilization and restraint," 9%; "Can assist with eating (except for those with swallowing problems)," 10%; and "Can assist with improving respiratory function (e.g., abdominal breathing, mouth swallowing)," 10%.  assistance" (5%), "stretcher transfer" (4%), "subcutaneous injection" (2%), "intravenous injection assistance" (2%), "blood transfusion management" (1%), "disconnection during insertion of continuous epidural tube" (1%), "venous blood collection" (1%), and "specimen collection and handling (urine collection and urinalysis)" (1%). collection and handling of specimens (urine collection, urinalysis)" (1%). The 0% items that none of the students experienced (including observation) were "can perform intramuscular injection," "can perform intradermal injection," "can perform airway clearance," "can perform artificial respiration," "can perform closed-heart massage," "can perform defibrillation using AED," "can observe ECG," and "can perform drug (chemotherapy)," and "prevent radiation exposure.

Items Experienced By More than Half of the Students

Of the 90 nursing skills, the following 21 items were experienced by more than 50% of the 93 students: 12. listening to intestinal peristalsis, 13. glycerin enema, 14. Stool extraction, 16. diaper changing, 17. stoma care, 18. ambulation/mobility assistance, 24. 24. position change, 27. assistance with comfortable positions, 28. assistance with grooming, 29. changing bed clothes, 31. partial bathing, 32. full body wiping, 37. maintaining pubic hygiene, 38. nail care, 41. massage, 49. care for bedsore prevention. Vital signs can be measured, 73. heart sounds can be heard, 74. respiratory sounds can be heard, 79. hand washing based on standard precautions can be performed, 81. protective equipment can be worn. These items can be said to be basic nursing skills essential for home nursing. The nursing skills that more than half of the students experience in home health care nursing practice will be the same skills they will use when caring for patients at home as home health care nurses. Therefore, it is necessary to make adjustments so that students can review their knowledge and practice before the practical training. In addition, the following three items were experienced by 100% of the students in the home health care nursing practice: 72. measurement of vital signs, 74. Listening to breathing sounds, and 79. hand washing based on standard precautions. These three items are the basic nursing skills that students learn first after entering the school, and considering that they are the nursing skills that 100% of the students experience, it is necessary to confirm the skills of the students before the practical training. The care provided to home-treated patients should not be a burden to them. In addition, since they have to visit and provide care in a limited time, the burden on visiting nurses who accompany them must be considered. In particular, vital sign measurement is an important indicator to observe the condition of the patient during the visit. In addition, the measurement of vital signs provides the best opportunity to obtain information from the patient about his/her life during home care. This is an important technical experience because it provides students with an opportunity to learn how visiting nurses obtain information from the patient during vital sign measurement.The following items are required as basic nursing skills in the first year of college: 16. Changing diapers, 24. Changing positions, 28. assisting with personal grooming, 29. Changing bed clothes, 31. partial bathing, 32. full body cleansing, 37. Maintaining pubic hygiene, and 38. nail care. The items of basic nursing skills are to be learned in the first year of university. The items of basic nursing skills are the items that the students will experience in the hospital practice in their third year of university, and it can be predicted that the students were able to perform these skills with confidence. In this way, by clarifying what nursing skills were implemented in the home health care nursing practice, we can identify the skill items that need to be kept in mind in the home health care nursing class. It will also give students an opportunity to practice the nursing skills necessary for practical training prior to home health care nursing practice.

Nursing Skills for Severely Convalescent Patients Who Need Medical Care

About 70% of the total numbers of convalescents use home nursing services under the long-term care insurance system, and about 30% use home nursing services under the medical insurance system [1]. Most of the patients who use home nursing care under medical insurance are patients with severe diseases that require medical care, such as terminal cancer patients and patients with intractable diseases. In terms of experience in nursing techniques for patients with severe medical care needs (including observation), 26% were able to inject liquid food through a gastrostomy catheter, 42% were able to inhale oxygen, 39% were able to inhale oxygen, 45% were able to suction in the oral and nasal cavities, 46% were able to suction in the trachea, 28% were able to suction in the trachea, 47% were able to perform positional drainage, 23% were able to perform positional drainage, 51% were able to perform aseptic drainage for wound care, and 23% were able to perform aseptic drainage for wound care. 19% were able to perform aseptic manipulation for wound care, 57% were able to administer intravenous fluids, 14% were able to administer intravenous fluids, 8% were able to operate an infusion pump, 13% were able to observe a patient receiving intravenous nutrition, 1% was able to administer blood transfusions, and 1% was able to administer a continuous epidural tube. The results were as follows. Medical care of severe patients was recorded by the students as an observation, but it ranged from 1% to 46%, which means that less than half of the students experienced it. This clearly indicates that accompanying visits to patients with severe conditions is also a practical training [4]. interviewed students about their learning in the "visiting nurse course" at Shiga University of Medical Science, and they also mentioned that they saw patients with severe conditions in the visiting nurse course, which they did not often receive in their hospital practice. It can be inferred that the severity of home care patients will continue to increase in the future, and a higher level of knowledge and skills will be required of visiting nurses.It is thought that the students learned a great deal from the fact that they were able to actually experience situations in which visiting nurses provided not only support for the patient but also for the family and multidisciplinary cooperation.

Nursing Skill Items Not Experienced In Home Health Care Nursing Practice

Among the 90 nursing skill experiences described by the students, there were 8 items that none of the students experienced in the home health care nursing practice. These were: 62. Muscle injection, 67. Airway clearance, 68. Ventilator, 69. Closed-heart massage, 70. Defibrillation with AED, 75. Observation of ECG, 87. Prevention of drug exposure (chemotherapy), and 88. Prevention of radiation exposure. The nursing skills that no one performs are the nursing skills that none of the trainees performed were technical items related to injection, cardiac arrest, chemotherapy, and radiation therapy. These were not only items that the trainees did not experience, but also items that home care nurses did not implement at home as part of their skill set for home care patients. After all, the environment and facilities are very different between hospitals and homes, so there are limits to what visiting nurses can do in terms of nursing techniques for home care patients. Intramuscular injection is one of the nursing techniques that home health care nurses can perform on homebound patients, but it was an item that none of the students experienced in this survey. Other items that involved the use of medical equipment were those used when a patient had a sudden change or when a sudden change occurred in the patient's body. We believe that it is unlikely that students will be able to experience these items because they are emergency responses that were not planned for. However, in the future, if students were present when a patient's condition suddenly changed during home nursing practice, they may experience them. It is safe to say that the nursing skills to be implemented in the event of a sudden change in the patient's condition are unlikely to be experienced in the hospital practice. Nursing skills that students cannot experience in practical training need to be experienced in on-campus exercises using model dolls and DVDs [5-7].

Limitations of This Study and Future Issues

Since the subjects of this study were 93 fourth-year students at our university, and the scale of each student's training facility and the characteristics of the medical patients involved in the accompanying visits varied, there are limits to generalization. In order to avoid differences in learning, it is necessary for teachers to be involved in drawing out the students' learning and guiding them in the direction of their learning.

We analyzed the nursing skills experienced by the students in the home health care nursing practice and discussed the nursing skills necessary for home health care nursing. We found that many of the nursing skills were different from those practiced in medical institutions. Daily life support such as vital sign measurement, hygiene, and elimination are skills that are implemented both in hospitals and in home health care nursing practice. It was found that basic nursing skills are necessary for nurses everywhere. It is important that we continue to teach basic nursing skills to nursing students so that they can acquire them well.

1. Ministry of Health, Labour and Welfare Overview of the 2016 Survey of Nursing Care Service Facilities and Offices. 2017.
2. Masako A. The Importance of home-visit nursing for linking medical care and nursing care: from the approach of kurashi-no-health office. Social movements. 2016; 423: 155-167.
3. Hiroko N, Shizuko T. A study on the current status and issues concerning the educational curriculum of home health care nursing in the integrated field, Report of the Research Grant Project funded by the President of Okayama University. 2009
4. Akito Y, Yona K, Fumiaki K. What i learned and gained in the visiting nurse course at shiga university of medical science. Home-Visit Nursing and Care. 2017; 22: 908-913.
5. Izumi M, Mariko T. An analysis of nursing students' practice experience and evaluation in home health care nursing practice: Learning effects of home health care nursing station practice as seen from practice records. Jrnl of Nurs. Hirosaki Gakuin University. 2013; 8: 25-33.
6. Nakane Y, Araki A, Ito T. A survey of practical training experience in home health care nursing stations (1st report) - differences in students' practical training experience in home health care nursing by facility size. Jrnl of Med and Heal Sci. 2018; 9: 23-32.
7. Kinuyo T, Yuko T, Yuka K. Characteristics and issues of care for children with severe mental and physical disabilities in home-visit nursing: results of interviews at 15 home-visit nursing stations. Jrnl of the Jap Soc for the Study of Sev Men and Phy Disorders. 2017; 42: 144.