Japanese Adult Day Service Nurses' Bathing Decisions for Persons Requiring Long-Term Care: A Focused Ethnography.

INTRODUCTION: Adult day services in Japan operate under the Long-Term Care Insurance Law, and care is provided mainly by caregivers. However, because doctors are often not on site, nurses manage the health of the person requiring long-term care. Adult day services provide bathing and functional training; however, although Japanese-style bathing relieves fatigue and brings a sense of well-being, it also entails the risk of bathing accidents for those in need of care. To continue living at home, those in need of care who have difficulty bathing at home must be provided with safe bathing during adult day services and supported in returning home safely. Nurses are responsible for accurately assessing the health status of users and implementing safe bathing. This study aimed to identify how nurses working in adult day services make bathing decisions for home-dwelling persons requiring long-term care. METHOD: Qualitative manifest and latent content analyses were performed using a focused ethnography. FINDINGS: Six themes were identified: 'gather information to compare with baseline', 'make observations based on information from others to understand the big picture', 'give persons time to get in shape', 'consideration of life at home', 'determining the need for medical institutions' and 'devise ways to communicate to promote collaboration'. CONCLUSIONS: Adult day service nurses' decisions about whether to bathe persons requiring care are characterised by their emphasis on information from others, consideration of the home living conditions of persons requiring care and their wishes regarding bathing. In addition, based on their observations, they determine the need for cooperation with medical institutions and communicate this information to family members and multiple professions.