Japan's population is aging, and the ratio of elderly people aged 65 and above to the total population is about to reach 40%. In 2000, in anticipation of such a super-aging society, the Japanese government established a long-term care insurance system to reduce the number of days spent in hospitals and planned for a shift to home care. The long-term care insurance system is operated by municipalities as insurers as a mechanism to support the care of the elderly in Japan's super-aging society by the entire society. It is a system that is jointly supported by the Japanese government, the case, medical insurers, pension insurers, and others. In addition, the long-term care insurance system aims to enable elderly people who need nursing care to lead independent daily lives at home as much as possible by selecting services according to their physical and mental conditions and living environment. In order to use the services, the level of care required must be certified, and the maximum amount is set according to the level of care. The user pays 10% or 20% of the amount for services under the long-term care insurance system. Although Japan has a universal health care insurance system, the long-term care insurance system was established because it is not possible to cover the medical expenses of all citizens in a super-aging society.Under the long-term care insurance system, it is possible to have visiting nurses and care workers at home. In addition, in the case of severe patients such as those in the terminal stages of cancer or intractable diseases, medical insurance and long-term care insurance can be used together to care for the patient at home. Patients with severe conditions have a high level of nursing care, and the maximum amount of services they can use in one month is also high. In order to make efficient use of various services, there is an occupation called care manager, who prepares care plans for home care patients. In addition, a variety of social resources are available in the community to support home care patients, their families, and caregivers. While this shift to home care is being promoted, a shortage of home care nurses is also becoming an issue. Although the number of people receiving home care is increasing, it is also essential to develop human resources for home care nurses.The number of people requiring home care was 170,000 in 2011, and is expected to increase to 290,000 by 2025 (Ministry of Health, Labor and Welfare, 2019). 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 [1].The place of employment for nurses is shifting 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. Home nursing theory, which is an integrated subject of basic nursing education, has been taught and practical training has been promoted mainly for visiting nursing for home care patients, but nursing small-scale multifunctional home care and regular patrol/as-needed visiting nursing care have been established as community-based services. In addition, the activities of nurses are expanding to include consultation activities close to people's lives, such as "health centers for daily life" [2] For this reason, the guideline for the operation of training institutes for nurses proposed to revise the home nursing theory to "community and home nursing theory," in which students learn the basics of nursing by understanding local people and their families in diverse settings in the community. Although there are calls for the enhancement of "home health care nursing" in basic nursing education, there is no unified view on the core teaching content of home health care nursing [3]. This is also true for home health care nursing practice, and it will be necessary to devise new educational methods to understand the lives of people living in the community from home health care nursing practice [4].The home health care nursing practical training at the university is the first semester of the fourth year, and with the objective of "understanding how to provide nursing care for the health and life issues of home care patients and their families, and learning about the roles of home health care nurses and the cooperation of multiple professions in home care," the practical training focuses on visiting with home health care nurses at home health care nursing stations. In addition to the above, the students are also given the opportunity to learn about the role of home health care. The goal is to understand local people and their families in diverse settings in the community. In order to achieve this goal, it is necessary to analyze whether the nursing students were able to learn about a wide variety of care givers in comparison with the current situation of home care in Japan.

To examine whether nursing students were able to learn about a wide variety of medical care providers by comparing the characteristics of medical care providers visited by nursing students during home health care nursing practice with those of medical care providers in Japan.

Research Design

The research design is descriptive statistics

Research Methods

Research Subjects: Ninety-three fourth-year students who attended the home health care nursing practice at the university and gave consent to participate in the study. Prepared from the [5] Ministry of Health, Labor and Welfare Survey of Nursing Care Service Facilities and Offices.

Data Collected: The age, level of care, gender, primary caregiver, name of disease, and type of insurance for home nursing use of the recuperator who accompanied the visit were collected from the student's visit records 2016 Ministry of Health, Labor and Welfare. Data collected from the Survey of Long-Term Care Service Facilities and Offices on the age, level of care, gender, primary caregiver, name of disease, and type of insurance for home nursing use of home care patients in Japan.

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

Analysis Method

A comparative analysis was made of the data collected by disease, gender, level of care, primary caregiver, age, and insurance of home nursing use of the medical patients who accompanied each student's visit during the practical training period and those who were treated at home in Japan. Ethical considerations in research. This study was conducted with the approval of the Research and Ethics Committee of Nihon University of Medical Science.

Research Results

Characteristics of the patients who were accompanied by the therapists, Table 1 shows the aggregated results of the characteristics of the medical patients who were visited. By disease, the most common disease was circulatory system (22%). This was followed by diseases of the nervous system (17%), and both terminal and malignant tumors and mental and behavioral disorders (10%).In terms of gender, 45% of the patients were male and 54% female, with more female patients receiving care. In terms of the level of care required by the patients, the highest percentage (23%) was nursing care level 5, followed by nursing care level 2 (18%) and nursing care level 4 (14%). The most common primary caregiver was the spouse (37%), followed by children (26%) and those living alone (11%). By age, those in their 80s accounted for the highest percentage at 33%, followed by those in their 70s at 29% and those in their 90s at 11%. The average number of visits in two weeks was 19.3, and the average number of visits per day was 2.4. The average number of visits for two weeks was 19.3, and the average number of visits per day was 2.4. The number of visits without a description or unknown for each item was six or more per day, and the number of visits could not be counted because the students could not obtain information on the patient or the description was incomplete. However, the 14% of pending, uncertified, and unknown nursing care needs include those for which the nursing care level is not listed because the patient is using home nursing care under medical insurance.

Table 1: Characteristics of the medical patients visited by the students.

Table 2: 2016 Ministry of Health, Labour and Welfare Survey of long-term care service facilities and offices.

Considerations

A wide variety of medical patients, A look at the characteristics of home care patients in Japan shows that a wide variety of patients, including those with various diseases and ages, are treated at home.?From the results of the characteristics of the medical patients who were accompanied by the students, it became clear that the students visited medical patients ranging from infants (0-9 years old) to the elderly (over 100 years old). From the characteristics of the patients visited, it became clear that the students were able to interact with a wide variety of patients, including those with cardiovascular and neurological diseases, those requiring nursing care (5), those in their 80s, and those with nursing care insurance (54%) and medical insurance (44%). [6] stated that the construction of a comprehensive community care system that aims to enable all people, not just the elderly, to spend their final days in a familiar place is an essential learning content in home nursing. Since the characteristics of the patients the students visited were a wide range of ages, diseases, and levels of care, it can be said that the students learned something that is relevant to the construction of a comprehensive community care system. It can be said that the students learned a lot by visiting a wide variety of patients and their families, which they did not have the opportunity to do in their hospital training. Children, intractable diseases, and terminally ill patients who use visiting nurses under medical insurance have a high level of nursing care, and observation of their general condition is important because it leads directly to early detection of abnormalities. I believe that we could learn a lot from the visiting nurses who support such patients of all ages with various diseases. We also believe that they were able to learn about the role of visiting nurses by observing how nurses build specific trusting relationships with the recuperators and their families, how they interact with them, and how they provide nursing skills [7] as they repeatedly visited with various [8] states that collaboration among medical and welfare professionals in the community is important, and comprehensive  support that includes the family is essential, and visiting nurses play a central role in this. It became clear that the students visited with visiting nurses, interacted with patients ranging from  children to the elderly, intractable diseases, and terminal stage of cancer, and learned about the role of visiting nurses, who are the  core of community healthcare, based on the current status of home nursing in Japan.In addition, many lessons were learned from the scenes where visiting nurses were supporting not only the recuperators but also the caregivers and the families of the caregivers. From the characteristics of the recuperators who were accompanied by the nurses, 80% of them were family members living together, excluding those whose main caregivers were at the office, family members or relatives living separately, or living alone. In addition, there are few opportunities to work with patients with intractable diseases or those on ventilators in the ward practice. In an interview conducted by [9] about their learning in the "visiting nurse course" at Shiga University of Medical Science, it was also mentioned that they saw patients with severe conditions in the visiting nurse course, which they did not often receive in hospital practice. It can be inferred that the severity of home care patients will continue to increase in the future, and that a higher level of both knowledge and skills will be required of home health care nurses. It can be said that students can learn about a wide variety of diseases through home health care nursing practice. The patients that the students visited were a wide variety of cases, and the fact that the visiting nurses provided support not only to the patients but also to their families, and that the students were able to actually experience scenes of multidisciplinary cooperation, is considered to be a great learning experience for the students. It is also necessary for the students' learning that patients with higher and more severe medical care than the current situation of home care patients in Japan can be seen in the visits accompanied by the trainees. Comparison with the current situation of home care patients in Japan In terms of the diseases of the home-care patients, there was no significant difference in the ranking of diseases between the patients that the trainees visited together and the Japanese home-care patients. This suggests that the students visited patients with intractable diseases and stomas in order to learn from their practical training. While mental and behavioral disorders accounted for 13.7% of the diseases among Japanese home-care patients, they accounted for less than half (6%) of the patients visited by the students. We believe that this is the result of taking care to have conversations with the patients when the students visited them. In terms of age, the ratio of males to females who were accompanied by students was half, while 68% of Japanese home care patients were female and 31.8% were male, more than double the number of females. In order for nursing students to visit with the patient, permission from the patient must be obtained. From this, we can assume that most of the male recuperators may have consented to the nursing students' visit. In the comparison of the level of care required, the most common level of care for the patients who were accompanied by the students was 5, which is the most severe level of care required. On the other hand, the most common level of care among home care patients in Japan was nursing care level 2. Based on this result, it is thought that the students were able to visit patients with a high level of medical care and severe medical conditions so that they could learn the difficulties of home care during their practical training. In a comparison of primary caregivers, 54% of the medical patients the students visited with had a spouse as their primary caregiver, and 25% had children. In contrast, 25.2% of the primary caregivers of Japanese home care patients were spouses and 21.8% were children. We believe this is because it was effective for students to visit the home of the primary caregiver by the spouse who lives with the patient in order to obtain information about the patient, considering the learning process. Therefore, we believe that only 1% of the students' accompanying visits were to family members or relatives who lived separately. In the comparison by age group, it was found that there were more recuperators in their 70s and 80s in both cases. The results for the other age groups were almost the same. As for the type of insurance, more than 70% of home care patients in Japan use nursing care insurance for home nursing, but 59% of the patients the students visited with had nursing care insurance and 41% had medical insurance. This may reflect the fact that, as mentioned in the results for the level of care required, the students visited those recuperators with a lot of medical care and severe conditions so that they could learn [10-14].

The purpose of this study was to clarify the characteristics of the home-care patients accompanied by the trainees of this university and to compare them with the current situation of home-care patients in Japan, which is a limitation of the study because of the limited subject

It can be said that the characteristics of the patients that the students visited are almost the same as those of the current situation of home care patients in Japan. However, it became clear that the students were visiting more severe patients with more medical care than the current situation of home care patients in Japan. I believe that the students will learn a lot about the current situation of home care patients in Japan, such as the role of home care nurses, multidisciplinary cooperation, and the situation of home care patients and caregivers, through accompanying visits, and will be able to achieve the goals of their practical training.

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