Chapter 2: Role and Professional Ethics of Care workers

1. Professional Ethics of Care workers:

 Care worker Job

 Ethics as a Care worker
 Code of Ethic
 Duty of Care worker
 Privacy Protection
 Users Rights and Nursing Care

1. Care worker Job - Caregiver jobs are specialized work that helps people who need care for them
to live. In order to provide assistance for meals, bathing, excretion, etc., it is important to learn
the basics of nursing care and understand why it is necessary.
2. Ethics as a Care worker - Care workers have a code of conduct that must be followed as a
professional. Care workers are professional that respects elderly who need care, so that they can
live independently. Care worker’s job is related to life, so it is greatly affecting users and their
families. As a care worker, you need to understand the importance of life, language, attitude, and
responsible behavior in order to provide better care.
(but providing care sa mga tigulang we also have ethics,respect,good attitude toward the user.)
3. Code of Ethics - is a code of conduct that must be followed by professional care workers. The
code of conduct is established by the Japan Care Welfare Society Code of Ethics)

Under of Code of Ethics

 User-oriented/Independence Support - Care workers protect the basic human rights of all
people, as much as possible respect each person’s self- determination so that they can live an
abundant life and retirement and continue to provide nursing care and welfare services for
independence.
(user - oriented /independence support the very important is to respect the user by determine their
self determination)
 Providing Professional Services- Care workers always strives to study specialized knowledge
and techniques, cultivates rich sensitivity and accurate judgment, and strives to provide
professional services with deep insight. In addition, the care worker will strive to improve the
quality of welfare care service and will always be responsible as a professional for the care
welfare service provided.

(so ang caregiver sa japan naa pud sila mga training pra mg grow ila profession.)( Sa japan as caregiver
didto if dghn k training naagian taas ila panan aw sa imu kay kng mkataraininh ka didto naay pat n work
sa nurse n pwede nimu ikaw mgbuhat)

 Privacy Protection - Care worker will protect the personal information they have learned in their
work to protect privacy.
  Providing Comprehensive - services and active collaboration /Cooperation-Care workers are
comprehensively providing optimal services to users in cooperation with those engaged in
welfare, medical care, health care, and other related work.

(guys as caregiver sa jpan dli ta pwede mgprescribed sa medicine only the doctor and nurse but some of
the facility the caregiver assist giving medicines to the user i think mostly diay sa fcility gamay lng man
gud nurse,ang mgprepre ang nurse ang nghatg ang crgiver)

 Speak in behalf of User’s needs - Care workers consider and act an important role of
recognizing the real needs of users from the perspective of supporting their lives.

(so as we caregiver kita mn gud direct sa tigulang so if evr naa cla conceror somthing naa cla gibati kita
ang moreport sa nurse or sa lider)

 Promotion of Community - based welfare-In order to solve nursing care problems that occur in
the community, as a professional care worker are constantly working with the residents in a
positive attitude and will endeavor to gain a deeper understanding of nursing care issues and
cooperate to strengthen their nursing care capabilities.

(not only in the facility but also ang caregiver ngalibot pud sa community..house to house..the do services
like cooking washing clothes)

 Training Successors - Care workers are committed on improving the level of education related
to care and developing successors so that everyone can enjoy the right to quality care in the
future.

(if sa jpan 3yrs nka experience cargiver naay exam to get a licence so as much ad possible we have to take
it motaas imu sweldo and for gaijin or parha nto pinoy n dli japnese if ever mkpasa ta ato n exam we can
live forever in japan wid ur family)

4. Duty of Care Worker

Under the "Social Welfare and long- term Care Welfare Act", care workers have five obligations to
fulfill as professionals.

 Responsibility of a Care Professional

1. Integrity -For the person in charge to maintain the dignity of the individual and to live an
independent daily life, the person in charge must always work from the standpoint of that
person.
2. Prohibit loss of trust behavior-Do not act to hurt the credibility of the care worker.
3. Confidentiality- Don't divulge the secrets of people you know about your work without a
good reason. The same shall apply even after the employee is no longer a care worker.
4. Cooperation-In order to provide comprehensive and appropriate welfare services
according to the mental and physical conditions of the person in charge, such as
dementia, we must maintain cooperation with people related to welfare services.
 5. Responsibility to quality improvement -We must strive to improve our knowledge and
skills in order to adapt to changes in the contents of work due to changes in the
environment surrounding nursing care.
5. Privacy Protection
1. Respect for Privacy - Privacy is the right to demand that others do not interfere about your
private information. In the field of care, we handle private information such as the user's
medical history, family relationships, and home environment. For example, avoid talking
about the user's illnesses and worries when there are other persons. When users take off their
clothes or go to the bathroom, it is necessary to consider privacy such as closing of curtains.
Being a caregiver, it’s not normal to be near, and looking at it is natural to see is not good.
The notion of privacy is not common and varies depending on gender, age, and culture.
It is very important to protect and respect the privacy of users.
2. Protection of Privacy - As stated in the Code of Ethics, caregivers are required to protect
user’s privacy and protect personal information.
Regarding the protection of personal information, the “Act on the Protection of Personal
Information” (Personal Information Protection Law) enacted in 2003 (Heisei 15) stipulates the
proper handling of personal information.

“Personal information should be handled carefully under the philosophy of respecting individual
personality”
Personal information is defined as "identifying specific individuals".
 Name
 Gender
 Date of birth
 Photo
 Address
 Mobile phone number
 E-mail address
 Body information
 Personal titles information
・Information obtained from work must not be divulged outside, even after leaving work.
・Do not seek profit or convenience with information obtained from work.
Example:
・When a patient ask, “Is it true that patient A’s liver is not in a good condition?” the care worker
should not answer the question.
・Records pertaining to work are being shredded and thrown away inside the premise only.

6. User's Rights and Nursing Care

1. Prohibition of physical restraint
One thing that must not be forgotten when caring for users is to consider human rights.
Do not use physical restrain because of “for caring”. Restricting actions with some device,
such as "tying the user’s body so they can’t move or can’t touch anything " is called Physical
Restraint. Physical restraint not only harms the dignity of the user, but also causes a decline
 in quality of life (QOL). Even if doing it for their own sake, care workers must not opt for
physical restraint.

Physical restraint has been prohibited since Heisei 12 (2000) in nursing care facilities.

Acts that are considered a form of Physical Restraint

1. Tying the body or extremities of the user in the wheelchair or in the bed to prevent wandering or
roaming around.

2. Tying the body or extremities of the user in the wheelchair or in the bed using a string, cord, etc. to
prevent fall.

3. To prevent user falling from the bed, surround the bed with side rails.

4. Tying the extremities with a string, cord, etc. to prevent user from removing the attached tubes or
feeding tubes.

(so mao n mga example na dli pwede buhaton sa user kng sapoton ginhawa lng jud tamam inhale ug
Exhale ta class if masapot na)

In addition, using of mitten- type gloves to prevent user from removing the attached tubes or feeding
tubes and scratching the skin.

(using mitten ok xa pero u nid first ask the doctor nurses the lider if applicable b n pwede xa gmiton
mahulog man gud xa physical abuse dpende sa case sa user)

Attaching of Y-shaped restraining waist band, waist belt, wheelchair table to prevent user from standing
and falling from the wheelchair.

6. Use a chair that prevents people from standing up.

8. Wear nursing clothes (coverall cloth) to limit undressing and diaper removal.

9. Tying the body or limbs with a string, cord, etc. to prevent user from bothering others.

10. Excessive use of anti-depressant medicine to calm the user.

11. Place the user in an isolated room where the they cannot open.

Emergency unavoidable case for Physical Restraint includes:

1. Urgency or must respond immediately

2. No other option

3. Temporary

【Three requirements that are exceptions to Physical Restraint】

Urgency Danger to life and physical health of the user or other users

No other option There is no other alternative way of caring other than physical restraint and other
behavioral restrictions

Temporary Physical Restraint and other behavioral restrictions are temporary

In the case where physical restraint was done, you are obliged to preserve the records for two years.
Establish a rule procedure that can be judged through the body, not the staff in charge.

・Explain the procedure to the users and family prior to physical restraint, gain understanding and again
explain individually when performing the procedure.

・In unavoidable emergency cases, you must always observe or re-evaluate whether or not the use of
physical restraint is necessary.

Immediately release body restraints when they no longer applicable

(preserve the records in 2yrs we nid to explain to the family y we nid to physical restrain pro mas maau n
kaubn nimu ng lider ug nurse pro usually ang lider mn mkpg storya sa family)

(you have also to assess the if nktabang ba ang physicl reatrain o dli)

・In cases of unavoidable emergency situations of physical restraint, be sure to record the contents, time,
reason, and physical condition of the user.

(as caregiver we have to maintain ang care nto ginhatg sa user so as much as possible record tanan)
Possible risk due to Physical Restraint

 body functions decline

 joint contracture
 heart and lungs functions decline
 anxiety and anger
 humiliation
 giving up
 dementia progresses
 decline in body functions
 decline in body functions
 decrease ADL as a result of decrease motivation
 risk for serious accidents by getting over the side rails due by unreasonable rising or climbing

Under sa users right and nursing care

Actual situation of the abuse Elderly and Disabled Person

Elderly Abuse - Elderly caretakers, nursing care facility workers, etc.

Disability Abuse- Elderly caretakers, Disabled welfare facility workers, etc.

Types of Abuse

There are five types of abuse for both the Elderly and the Disabled person.

 Physical Abuse - any assault that may cause trauma to the body
 Psychological Abuse Emotional Abuse - Doing behaviors that cause psychological trauma such
as verbal abuse and rejection
 Sexual Abuse- Doing obscene acts for the disabled person and elderly
 Neglect -Decreasing or depriving foods, leaving for a long period of time, and neglecting care
 Financial Abuse -Use of property or money without the consent of the person, or limit the use of
money desired by the person for no apparent reason.

Support for the Elderly’s Caretaker

Cause of occurrence of abuse is often related to the personality and relationship of the person, but often
the care worker himself needs help, such as fatigue from long- term care. It is important to understand the
problems you are having and to provide social support for the elderly and caretakers.

(as we crgiver guys we can fil aslo fatigue stress)

awareness of abuse

Even if there is no awareness of abuse, from an objective point of view, if you can confirm that your
rights have been infringed, suspicion of abuse must be considered and shall be dealt with accordingly.
2. Multi Professional Collaboration

(From the word multi daghn no so sa medical not only the doctor ang nagalihok but also wid da help of
nurses,cregivers in line wid medical profesional they are called team approach)

Under of Multi Professional Approach is the “Team Approach”

1. Team Approach

For those who need nursing care, welfare, medical care, and other related professionals, families,
and communities form a team to determine goals and policies. Supporting people is multi-professional
collaboration (team approach) in which everyone cooperates with each other while making use and taking
advantage of their specialized abilities. The center of the team approach is the User. It is important for
each to fully demonstrate their professional perspective, knowledge, and skills.

(they also sharing the information of the patient so in terms sa sharing only sa medical lng sa kaubn lng
nimu not sa silingan dli pud pwede sa mga ka barkada nimu)

 Volunteers and user’s families may become members also in terms of helping the user if naa cla
natabang for progress sa tigulang then they one of the team approach.

2. Team Approach and Role of the Care Worker

In the team approach, staff of various occupations gather and hold a care conference to
understand the user's daily life issues and to determine the direction of support. Since the care
workers are the ones who is closest to the user, it is required for them in such meetings to speak
in behalf of the users (user’s thoughts and feelings). It is important to be able to understand
through observation and communication what kind of changes can be seen in the mental and
physical state of the user and what emotions the family has.

(so ang pinakauan gud mg ases sa user or ang frotliner is ang mga caregiver kita man ang direct ngcare sa
adlaw sa tigulang so mkita nato ang chnges if naa xa gibati.)

Roles and Functions of other Occupations

Multi-professional staff cooperates and work together with the same goal is called Collaboration. For
them to work together, knowing what each other does is important.

People Working in the Facility

Person User - family Main constituent in life, center of the team. Put together the facility

Facility manager Manager who organizes the entire facility

Supports medical care Nurse Perform medical practice under doctor’s order

Life/Supports care Life counselor Provide consulting assistance from moving in to living

Care support specialist (care manager）Make contract, care plan and performing communication and
coordination
Care worker Caring for the mental and physical condition of the user

Supports rehabilitation

Physical Therapist（PT) - Person who performs rehabilitation for the purpose of gait training, muscle
strength maintenance, increase basic movement (walking, training of daily life movement)

Occupational Therapist（OT）- Perform rehabilitation through Applied Movement (meal movement,

posture movements, etc.

Speech Therapist（ST）- Performs language and swallowing exercise, hearing aid adjustment

Support eating habits Cook Cooks food for the user

Management Dietitian - Nutritionist Understand and manage the nutritional status of users and
provide nutritional guidance.

(so there are different type of people or person with their job)

3. The Significance and Purpose of Multi-professional Coordination

“Multi-professional collaboration” means that professionals with specialized knowledge work

together toward common goals in order to provide high-quality care.

The significance and purpose of multi-professional collaboration is to comprehensively provide the most
effective support to users by taking advantage of each specialized ability. Unification of mutual
awareness as care workers is important.

“For what purposes?”,“Direction of care”, What you are going to do?” is important in
nursing care thus, Care workers must have common understanding about this matter.

For example, during mealtime the user eats slowly by herself, one care worker observes her
closely, but another care worker is helping her out instead of promoting self-independence, so in that case
it is not helpful to the user.
 Too much help from the care worker during excretion, walking assistance, room arrangement,
etc. opens a possibility of depriving the user from using his remaining function.

(Communication is very important in colaboration guys without comunicating sa atong co-worker can
put the user in danger.)

Chapter 3: Care Services

Overview of Care Services

1. long term care insurance system-background of establishment

 Increase in elderly population (population over 65 years old) due to the declining birthrate and
aging population
 Longer and more serious nursing care due to longer life expectancy
 Deterioration of family care ability (for example, advancement of women into society, aging of
family)

Because of these factors, not only the efforts of each family member, but also a new system for
“Socialization of Nursing Care” that supports the elderly who need nursing care throughout the society
has come to be demanded.

1. Current State of Aging

o Total population 126.93 million (as of October 2016) (From the Cabinet Office website)
o Elderly people aged 65 and over are 34.59 million, or 27.3% of the total population
(aging rate).

Japan is a population decreasing society and a low birthrate society.

Progress of “Aging” in Japan

Name Aging Rate Year

Population Ageing 7% Showa period 45 (1970) ～
Aged society 14% Heisei period 6 (1994）～
Super Aging society 21% Heisei period 19(2007）～
* The percentage of elderly people over 65 years old is called the Aging Rate.

(so ang pinkadako n population nila aguys ang super aging society which is 21%)

Japan's population composition

Classification Age Population Percentage

Younger population 0~14 years old 1,578 12％
Working age population 15～64 years old 7,656 60％
Elderly population 65 years old and above 3,459 27％
Changes in households due to declining birthrate and aging population

1980 2016
Total number of households 8496 household 24165 household
Household with 65 years old or 24％ 48％
older
Living alone 10％ 27％
Household only for couples 16％ 31％

Current status of eligible caregivers

Main care worker 1. Spouse living together

2. Children living together
Main care worker age and gender 60% over 60 years old, women twice as men
Daily care time 56% almost all day (care level 5)
Main Care Worker Age And Gender: mas dghan ang babae kysa sa lalaki 60% over 60yrs old.

Daily care time 56% almost all day care level 5 mao n cla ang mga user n mdyo lala n ila situation or
condition.

Current status of the person need of nursing care

Main person requiring long- term care 66% of women, of which 50% are over 85 years
old
Reason for person requiring long- term care 1.Dementia
2. Cerebrovascular disorder
3. Debilitating age
*Mostly elderly women live longer
Under Of Life /Supports Care

Life Counselor, Care support specialist (care manager), While the nurses belong to support medical
care.

Under the support rehabilitation

 PT( physicl therapist)

 OT(occupational therapist)
 ST(speech therapist)

Current status of eligible caregivers and current status of the person need of nursing care.

3. Basic philosophy and creation of Long- term Care Insurance

In Japan, social hospitalization and bedridden elderly became problems in the 1980s.

The elderly was cared for by their families, but the number of older people who needed nursing
care increased due to the declining birthrate, aging, and the increasing number of nuclear families,
making it difficult to support them alone. Therefore, in April 2000, a long-term care insurance system
was established based on the basic philosophy of supporting nursing care throughout society.

Long-term care insurance system is “Nursing care that is supported not only by family members but by
society as a whole”.

It is a system that allows people who need nursing care a freedom of service selection.

Purpose is to improve public health care and welfare by using necessary medical insurance and welfare
services, to maintain the dignity of those who need care, functional training, nursing and medical
management, etc., and to be able to live independently in accordance with their existing abilities.

In order to use the long-term care insurance service, you will be certified by the municipality by
your degree of care (Support required 1-2［1-2］and Need of long- term care 1-5［1-5］). Subject of
certification, condition, and classification of certification are set for each of the two categories (Support
required) and Need of long- term care).

1. Support required. A condition that seems to be a hindrance to daily life because of physical
or mental disability.

Need of long- term care - (A condition that always need of nursing care) A condition of a person who
has physical or mental disabilities and requires constant care for daily activities such as bathing,
excretion, and meals. Example: Caregiving Homes

Self- support (Not Certified) - Can perform basic daily activities such as walking and getting up and can
perform routine daily life activities such as taking medicine and telephone use.
Support required

Level 1: Can almost do the basic actions in daily life but daily life movement needs some support.

Level 2: From support required level 1, it needs some help because the ability to perform instrumental
activities of daily living (IADL) declines.

Care Level 1: From support required level 2, a state where the ability to perform routine daily living
activities declines and partial care is required.

Care Level 2: From care level 1, a state that requires partial care for daily activities.

Care Level 3: From care level 2, situation in which activities of daily living (ADL) and instrumental
activities in daily living (IADL) have declined and almost full assistance is required.

Care Level 4: From care level 3, the movement is reduced, making it difficult to live daily without
nursing care.

Care Level 5: From care level 4, the movement is reduced, and it is almost impossible to live every day
without care.

Flow of Certification for support required and need of long- term care

Need of long- term care and support required certification starts from applying to the
municipality, followed by the certification survey ⇒ primary judgment ⇒ secondary judgment, and
the certification result will be notified to the insured person.

Certification of Needed Support/Long-term care need

Certification Survey Doctor’s opinion Remarks

Primary Judgement (Computer)

Application for secondary judgement (Care certification examination committee)

  Examination Judgement of degree need of nursing care
 Specific Disease of the second insured person

Certified by Municipalities

Care level 1-5 Support required level 1-2 Self- Supporting (Not
Certified)
Long – term care benefits Preventive long term care Community Support Project
benefits
 If not satisfied with the certification, can file a complaint to Certification Committee of Needed
Long-term Care.

4. Long- term Care insurance Insured person and Insurer

The Long-term Care Insurance Law consists of “Insurers” and “Insured Persons”.

An “Insurer” is a person who operates insurance and is an administrative district and municipality
familiar to the residents.

Person who can use care insurance service is what we called “Insured person”. Has two categories

“Primary Insured person [１]”. above 65 years old.

“Secondary Insured person [2]”. Medical insurance participants 40 to 64 years old. For those long-
term care need is caused by one of the 16 specific age- related diseases.

In addition, foreign nationals residing in Japan for a long period of time (special permanent residents) and
foreigners (mid- to long-term residents) living in Japan for more than 3 months are also insured.

16 Specific Disease

o Terminal Cancer
o Amyotrophic Lateral Sclerosis (ALS)
o Osteoporosis involving bone fractures
o Cerebrovascular Disease
o Dementia in the elderly (Alzheimer type dementia, Cerebrovascular dementia)
o Spinocerebellar degeneration
o Adult Progeria (Werner Syndrome)
o Diabetic neuropathy, Diabetic nephropathy, Diabetic retinopathy
o Progressive supra nuclear paralysis basal ganglia degeneration and Parkinson's disease
 o Chronic obstructive pulmonary disease
o Rheumatoid arthritis
o Ossification of the Posterior Longitudinal Ligament (OPLL)
o Spinal canal stenosis
o Multiple system atrophy
o Obstructive arteriosclerosis
o Osteoarthritis

5. Overview of long- term care insurance service

Long-term care insurance services this are the 3 kinds of service plan “Home- based services
［サービス］,” “Facility- based services［サービス］,” and “Community- based services［サービ
ス］” depending on where the service is provided. The names of the services and services that can be
used for these services differ depending on the person who needs long- term care (persons who are
certified as care level 1 to 5) and support required (persons who are certified as support required level 1 or
2).

HOME- VISIT SERVICES

 Home- visit Bathing

 Home visit Nursing

Day Services

 Outpatient Day Long- term care

Short-stay services

 Short-stay admission for daily life

 Short-stay admission for medical

Others

 Specific facility resident life care

 Rental Service of Welfare equipment

COMMUNITY-BASED SERVICES

 Nursing on visitation basis of regular rounds and on- demand response

 Small-scale multifunctional long- term care at home
 Night-time long-term care on visitation basis
 Dementia-based outpatient care
 Daily Life care in Communal Living for the Elderly with Dementia (Group Home)

Facility Services
  Special nursing homes for the elderly (welfare facilities for the elderly requiring long- term care)
 Health services facility for the aged (health facilities for the elderly in need of long- term care)
 Long- term care medical treatment facility (medical treatment beds for long- term care inpatients)

Specific Contents of Long- term Care Insurance Services

Home service

1. Home- visit care

Caring for daily life such as bathing, excretion, and meals at the home of a person need of long- term care

2. Home- visit bathing

Home visit for person need of long- term care, providing them bathtub and bathing

3. Home- visit Nursing

Nurses take care of medical care or assist in necessary medical care at the person need of long- term care

4. Home- visit Rehabilitation

Physical therapy, occupational therapy, and other necessary rehabilitation at the home of person need of
long- term care

5. Home care management guidance

Medical care management and guidance by doctors, dentists, pharmacists, etc. at the home of person need
of long- term care

6. Outpatient Day Long- term care

Caring for bathing, excretion, meals and function training at the day service center

7. Outpatient Rehabilitation

Visit a health care facility for the elderly or hospital, and perform physical therapy, occupational therapy,
and other rehabilitation based on medical management.

8. Short-stay admission for daily life

For person need of long- term care who need to enter a welfare facility for the elderly for a short period of
time, Caring for daily life such as bathing, excretion, and meals

9. Short-stay admission for medical care

Person need of long- term care is admitted to a nursing home for the elderly or a hospital for a short
period of time, and nurse, care under medical management, function training, and other necessary medical
care and daily life care are performed.

10. Specific facility resident life care

For person need of long- term care in specific facilities, caring for activities of daily living such as
bathing, excretion, and meals, functional training, and medical treatment based on a plan that defines the
contents of the service.

11. Rental Service of Welfare equipment

Renting of welfare equipment

12 Special Welfare tool Retail

Selling special welfare equipment

Community-Based Services

1. Nursing on visitation basis of regular rounds and on- demand response

 Provide services in cooperation between nurses and care workers throughout the day and night

2. Small-scale multifunctional long- term care at home

 Provide services in cooperation between nurses and care workers throughout the day and night.

3. Night-time long-term care on visitation basis

 Regular night visits, caring for daily life with reports from users

4. Day care for the Elderly with Dementia

 Caring for elderly people with dementia who attend day service centers, etc.

5. Daily Life care in Communal Living for the Elderly with Dementia

 (Group Home) Daily life caring and providing functional training in places where elderly people
with dementia live together

6. Daily life long- term care for a person admitted to a community- based specified facility

 Daily life caring based on a plan that defines the content of services at specific facilities (capacity
of 29 or less)

7. Daily life long- term care for a person admitted to a community-based welfare facility

 Caring for daily life at a nursing care facility for up to 29 people

8. Nursing small scale multifunctional home care

 Services provided by a combination of home-visit nursing and small-scale multi-functional home

care
9. Community-based day care

 Small day service with a capacity of 18 or less

Facility- Based Services

1. Special nursing homes for the elderly - Place of live for people who need constant care

2. Health services facility for the aged - Nursing, care and rehabilitation based on medical management

3. Long- term care medical treatment facility - Provide medical management and function training for
those who need long-term treatment

２．Care Process and Care Plan

Significance and Purpose of the Care Process

1. Significance of the care process

The “care process” is a process based on an objective and scientific basis to realize the life desired by
users. In order to support user independence and self-fulfillment, it is necessary to provide individual care
appropriate to that person.

By gathering information about users and conducting assessments to understand needs and lifestyle issues
(things that must be solved to realize and continue the life desired by users) we will be able to materialize
what kind of care is being sought. The care process is to repeat evaluation and practice of nursing care
based on objective and scientific grounds.

Assessment: To clarify user's life issues comprehensively by collecting, interpreting and analyzing user
information.

2. Purpose of Care Process

By performing care process, it will lead to unified team care and improvement of users' QOL and
maintenance of dignity.

The purpose of the care process is to achieve for user’s self-fulfillment through the practice of individual
care, and to provide appropriate support through cooperation of various occupations.

Nursing care process has 4 repetitive processes:

"Assessment" ⇒ "Planning" ⇒ "Implementation" ⇒ "Evaluation".

4 Processes of Care Process

1. Assessment
  Information gathering
 Information analysis
 Clarification of issues

2. Planning

 Goal setting
 Creation of support contents and method

3. Implementation

 Implementation based on the plan

4. Evaluation

 Achieving goals
 Appropriateness of support contents and methods
 Future tasks

2. Development of Care Process

1. How to Proceed with the Care Process Steps Content

Assessment

1.Information collection and analysis

 Use assessment sheets to understand the overall perspective of each user's life
 For information gathering, “What kind of thoughts and wants do users have?”

Think about the overall perspective of users from a wide field of view, such as "Awareness and
observation of care workers" and "Information obtained from other occupations such as medical
professionals"

 Analyzing the user's experiences and values, the user's thoughts, such as information about the
user, by associating life with the situation.

2 Clarification of issues

 Issues must be solved in order to implement the life desired by users

 Prioritize when there are multiple issues, prioritize

Nursing Care Plan

Goal Short-term goal (weeks to months)

Long-term goal (6 months to 1 year)

Set a final goal to solve life problems

  Write down the user’s state and set a deadline and make it feasible
 Indicate specific criteria so that you can see how much you have achieved your goals by
observing or measuring
 Detailed plan (individual assistance plan) to design and each profession cooperate in order to
implement the care plan.

2. Support

 Describe 5W 1H (when, where, who, what, why and how)

 Unify goals and methods that easy to understand

Implementation

 Based on the plan, implement in a unified way by the team

 Implement while paying attention on the user’s state that changes daily
 Record implementation status and user’s response

Evaluation

 Evaluate achievement of short-term goals、

 If achieved, support for long-term goals
 Evaluation is carried out scientifically and objectively
 If the goal is not achieved, consider the reason, revise the plan, and clarify future issues

2 Types of information and collection methods

Subjective Information

 User's own way of thinking, feelings, demands, etc.

 Information collection method: Utilizing not only verbal communication but also non- verbal
communication to draw out user needs.

Objective Information

 Health data and records, information obtained from multiple occupations and families.
Observations performed by care workers
 Information collection method: understanding the user's situation by daily observation, nursing
record, measurement of vital signs, and sharing with multiple occupations.

Visiting Care Plan

3) Care Plan (Nursing Care Service Plan)

 A care plan (home service plan / facility service plan) is a care service created by a person who
has received certification for long-term care in the long-term care insurance system based on the limit and
number of times the person wishes and needs. The “Home Service Plan” is for people who use the service
at home, and the “Facility Service Plan” is for people who use the service at the facility.

It is a plan to grasp the current situation and live a life that the user wants.

1. Management Flow

In long- term care insurance system, it is necessary to coordinate the user that they can use appropriate
service. This process of coordination and actual service is called “care management” and is mainly
performed by care support specialists (care managers).

2. Relevance of care management and care process

❶（Intake）

Intake is the first interview (application interview) with the user's family.

Check the current status of users and family members and ask what kind of service they want. This is a
process for explaining available services and making a contract.

❷ (Assessment)

Pre-assessment to understand the daily needs of the user. Through interviews with users and families, will
conduct a more detailed survey on the health status, living environment, and interpersonal relationships of
each other.

❸Goal setting and Care planning

Goals are set according to the assessment. Create a care plan (also called home service plan, preventive
care service plan, and facility service plan depending on the service) to achieve the goal.

❹Creation and implementation of care plans.

After preparing a draft of the care plan, it is necessary to explain the contents to the professionals
involved in service provision, users and family members, it’s important to seek their opinion and obtain
their consent. It is called "service representative meeting" or "care conference". After obtaining the
consent of the concerned parties, coordinate with the service provider and implement the care plan.

❺Monitoring

Understand the situation and check whether the services provided by the care plan is well implemented,
or are there any changes in the user’s needs.

The one who made the care plan needs to visit users and their families once a month to conduct
interviews about the contents of the care plan and record the results.

❻Evaluation and re-assessment

Based on the results of monitoring, evaluation of the care management will be done.

If there are any new living issues or changes in needs, reassessment to review the care plan is done.

❼Termination

At the last stage, reflection of the flow will be done in order to apply to the future care management.

CHAPTER 4: Securing Safety and Risk Management in Caregiving

１．Securing Safety in Caregiving

1. The Importance of Observation

① Meaning of Observation

Observation means “looking, listening, smelling, touching” etc., and using tools such as thermometer
and understand the daily life situation of the user without having preconception and prejudice. It is
important to observe even the very little changes in the daily life of the user.

Checkpoint Example

Facial Feature Face Color Skin Color Skin Glow Movement

expression
Field of vision Sense of sight Sense of Sense of taste Posture Walking
hearing
Comprehension Judgement Emotion Will Mental Way of talking
condition
Breathing Sleep Appetite Swallowing Excrement Pain
condition
Weight Pulse rate Temperature Oxygen Appearance
saturation
② Observations Based on Health Abnormalities

 Lack of energy, fatigue, redness of the face, lack of appetite...fever

 swelling of the face, swelling of the back of the feet...swelling (edema)
 fever, dryness of the skin, decrease of appetite, dryness of the tongue, low urine
content...dehydration
 choking, aspiration, nausea...difficulty in swallowing
 When you get closer you can smell urine, often goes to the toilet, restless...urinary incontinence

③ Observations based on words (checking of physical condition)

You can get important information when you have conversations with the user.
Greetings like 「good morning」「hello」 becomes an important health condition checkpoint. The
loudness or smallness of the voice becomes one of the basic of observation.

Greetings

「Good morning, did you sleep well last night？」

「Did you enjoy the food deliciously？」

「How’s your body condition?」

「How are you feeling today？」

「Is the any changes? (with the body condition)」

【Responding to an unusual feeling】

「Are there any changes today？」

「What the matter? 」

→As a result of observation, if there is something to be worried about, confirm it.

「How are you today?」

「How’s your body condition today？」 「Do you have any pain?」etc.

→ As a result, for example, if your back hurts, you can identify the site.

「Which part of your back is painful? Would it be alright if you show it to

me?」

Gently touch the area「Is this the painful area？」

→ Understanding the symptoms

「When did the pain started？What kind of pain is it? Is it painful when you move?」

→ contact the medical personnel, perform appropriate measures

④Checking of Health Condition through Vital Signs
Vital signs
 body temperature
 pulse rate
 respiratory rate
 blood pressure (consciousness is also included).
Basic information when checking vital signs.
Vital signs and its Standard Values
Respiration - 12～18 times per minute
Blood pressure
Systolic blood pressure not more than 120㎜Hg
Diastolic blood pressure 80㎜Hg and below
（optimal blood pressure）
Pulse 60～80 beats per minute
 For japan blood pressure normal pressure is 140/90. Above 140/90 is considers as high blood
pressure.
 For Philippines 120/80 normal blood pressure. Pulse 60-80 beats per minute.
Method Of Measurement And Its Condition
 The function of taking in oxygen and
discharging carbon dioxide happens in the
lungs (gas exchange), which is called
external breathing
 If the person knows that you are taking the
respiration rate, the result might change.
Keep in mind it is better not to inform the
person that you are measuring the
respiration rate
 exercise bathing meal excretion
nervousness, etc., respiration rate increases
 if you have chills lips and nails becomes
bluish in color (cyanosis)
 When the body pumps blood into the body,
the pressure presses the arterial wall
 When using the blood pressure apparatus,
wrap the cuff around the upper arm, loose
enough to insert at least 2-3 fingers, and
measure.
 Hypertension is having a systolic pressure
of 140mmHg and above, and a diastolic
pressure of 90mmHg and above
 Low blood pressure can be a cause of large
amount of bleeding that leads to shock
condition, in that case, check the blood
pressure cuff if it is too tight or loosed.
 When the heart contracts it pushes blood
into the blood vessel. The number of times
the blood passes through the blood vessel
depends on the elasticity of the arterial
wall.

Pulse 60～80 beats per minute
Body temperature 36℃～37℃
⑤Check Respiration status with pulse oximeter
 When taking pulse rate, you can use the
four fingers except the thumb and touch the
surface near the location of the pulse.
 Radial pulse and brachial pulse are often
used.
 increases when doing exercise bathing,
meal excretion nervous
 100 beats per minute and above is
tachycardia
 below 60 beats per minute is bradycardia
 Increased pulse rate・disturbed rhythm is
called “Arrhythmia”
 When the value is high, the environment
might be hot and humid. Suspect infection
from viruses, bacteria etc.
 If the value is low, does the thermometer
might not touch the skin well or it is
measured on the affected side of the body.
Suspect hypothermia or infectious disease.

 It is a small medical device used to measure oxygen saturation in the blood and to know the
respiratory state.
 It measures how much oxygen is bound to hemoglobin in the red blood cells and displays the
value in %. (96-100% for healthy people)

Procedure and Cautions

1. Choose a site which has no nail polish and avoid paralysis and painful fingers.

2. From the base of the nail, attach the pulse oximeter firmly

3. In case of a person who moves and with hand tremors, hold the side of the finger steadily it during the
measurement.

Pulse Oximeter – it measure the oxygen of the

blood to our body. normal is 95-99%
Health Management for Caregiver (Back pain prevention, Infection Prevention)

①Mental Health Management

Caregiving is a job that interacts with user and their families. Every day in various aspects Care givers
feel stress too. To provide good care, caregiving staff must give importance to their own health. Mental
health management is a very important matter.

BURN OUT SYNDROME

People who have enthusiasm towards work are easy to be burned out. It is a sudden state of
tiredness and fatigue, lack of energy and lack of interest towards everything.

And because there is a loss of willingness to work, it is thought to interfere with work performance.

Stress Management and Coping in the Workplace

Stress management is about find your own way of refreshing so that stress will not pile up. In
addition, stress countermeasure are taken as mental healthcare, it is important to keep the entire
organization (workplace) well-organized.

② Physical health management

Since caregiving is a job involving the use your body, health management is important.

Measures to prevent lower back pain

These are the measures to prevent low back pain related to body movement especially in moving and
transferring of users (in bed, wheelchairs, etc.)

 Always keep in mind to maintain correct body posture and avoid bending for a long time
 In relation to moving users, keep the shoulder and waist parallel without twisting the body.
 Use body mechanics
 To prevent back pain, do physical exercises. Keep the muscles at a stretched state. Static
stretching is effective.

③ Infection Prevention Measures

Infection is when pathogens enter the body, bacteria multiplies, and symptoms such as fever and cough
appear. Older people are more susceptible to viruses that do not develop in healthy people due to
decreased immune function. Measures for infection prevention should be regulated.

COUNTER MEASURES IMPORTANT POINTS

Handwashing  Wash your hands before and after each
nursing procedure
 For hand-washing, wash with running
water and soap; for the soap, you should
choose a liquid soap that does not easily
 increase bacteria.
 Wipe your hands with a dry towel or paper
towel (Do not share towels, etc.)
Disinfection  Use quick-drying rubbing alcohol for
disinfection of fingers
Health Management  Gargle regularly
 If there is a user who is suspected of
having an infection, use a mask, apron, or
disposable gloves.
 The caregiver must take a day off in the
event that he/she is suspected to be
infected (e.g. high fever)

What Is Standard Precaution Is Hand Washing

BODY MECHANICS

①Basic Principles of Body Mechanics

The important thing when moving and transferring is the safety of users, is there is no burden on the
caregivers. It is important to understand the concept of “body mechanics” because it allows individuals to
carry out activities without excessive use of energy, and helps prevent injuries for patients and health care
providers “Body Mechanics” is a technique that analyzes the movements and postures with less burden,
considering how skeletal and muscle movements affect each other.

The important thing about moving and transferring is the safety of the user.

Nursing care workers are not burdened, and it is important to understand the concept of "body mechanics"
in order to take care of them safely.

Body mechanics is a technique for analyzing less burdensome behavior and posture by considering how
skeletal and muscle movements affect each other.

PRINCIPLES OF BODY MECHANICS

Body Mechanics involves the coordinated effort of muscles, bones and the nervous system to maintain
balance, posture, and alignment during moving, transferring and positioning.
Lower your body balance and widen the support
base area.

When giving care to the user, put the user’s

extremities together.

You can use a large muscle group by lowering the

waist.

Lift using this principle of lever. When you wake

up a person of full assistance, make the buttocks a
fulcrum.

When transferring, move the foot and the body of

the care worker in the direction you are going
・Bring the center of gravity closer, bring one’s body together

・Get close to the user.

２．Accident Prevention・Safety Measure

１）Fall・Fall Prevention, Fracture Prevention

In order to protect the safety of users, it is important to take specific measures against possible accidents.
These measures are called safety management.

For example, Due to the decrease in their strength, elderly people are more likely to fall with a slight step
or bump in road. For users who are anxious about walking, we will consider environmental maintenance,
such as installing “handrails” and using “slip-resistant flooring” for home improvement.

Nursing Care Accident

Accidents at the site of nursing care such as “facility services” and “home services” are called nursing
care accidents, and there are some accidents that can be prevented if care workers are careful, and also
there are accidents that cannot be prevented.

2. Falling down・Fall・Bone fracture Prevention Measures

PROBLEM MEASURE
Bone Weakness  Nutrition and exercise, taking in calcium
and vitamins, exposure to sunlight
strengthen the bones.
Risk of outdoor falls  To ensure the safety of the user, care
worker must accompany when going
outdoors
Impact of the fall  Wear a hip protector, use bones and
muscles on a daily basis whenever
possible.
 An environment that is easy to cause a fall.
  Adjust the obstacles or steps that can cause
falling, consider the brightness, darkness,
glare and other aspects of vision.

3. Medication Assistance and Response to User Incidents

The doctor prescribes the medicine. The caregiver confirms that the user follows the instructions
of the doctor and follows the correct dosage. Caregiver must not change the description based on his/her
own judgement. If you feel that there is a sudden and unusual change, immediately contact the doctor or
nurse.

Time to Take Medication

Medication before meal Drink 30 minutes to 1 hour before meals

In between-meal Medication Drink 2-3 hours after meals (ex. In between
breakfast and lunch)
Post-meal Medication Drink within 30 minutes after eating
(PRN) Medicine as per needed Drink only when symptoms occur

Conditions which care workers can take care of medicines

1. The user’s condition is stable, and there is no need for admission and treatment.

2. There is no need for continuous follow-up observation by doctors and nurses, no needed adjustment of
dosage and side effects.

3. There is no need for professional consideration on how to use the medicine (Cannot be done if there is
a high risk of aspiration or anal bleeding).

4. When you meet the requirements of 1-3, a family member or person who is not a professional but
knows care giving will be assisted and will receive guidance from a medical profession.

２）Disaster Prevention Measure

Facilities that provide nursing care services are obligated to:

 Create a concrete plan for emergency disasters

 Development of cooperation system to related organizations at the time of fire emergency
 Conduct a regular evacuation and rescue training

Specifically consider the following:

 Curtains and wallpapers must be flameproof

 Install a fire extinguisher, sprinkler, smoke detector, heat detector, etc.
Due to the weakness in the lower limbs, older people may not be able to move as expected when an
accident occurs. Care workers interact with local residents and establish a system of cooperation in the
event of a disaster.

３）Inspection Management of Welfare Equipment

Products that have been quality guaranteed by a third party certified organization registered in the country
with "JIS Mark (Japanese Industrial Standards)" is attached. Certification system such as “welfare
equipment JIS mark” is introduced for accident prevention and safety measures. The welfare tools of
long-term care insurance are tools for functional training of daily life for Need for Care level user. They
are covered by insurance benefits to make users live independently.

Welfare Equipment Rental Target Item

 Wheelchair (including accessories)

 Special bed for bedridden (including accessories)
 Anti-rust device
 Position converter device
 Handrail
 Slope and Walker
 Walking support cane
 Lift for movement
 Dementia elderly wandering device
 Automatic excretion processing equipment

<exception>

 Stool seat
 Bathing Aid
 (bathing chair, bathtub railing, bathtub chair, bath table, bathroom, bath tub, bath belt)
 Simple bathtub
 Transfer lift hanger

CHECK POINT OF INSPECTION

1. There is little air in the tires
2. Check if the tire is too old
3. Missing knob for brake lever
WHEELCHAIR The brake does not hit the tire
Using the same urethane cushion
for a long time
The brake does not hit the tire
wheelchair moves when
transferring
may lead to a fall accident
1. It becomes difficult to get
close to the bed and the toilet, it
can cause a fall.
2. When the foot support is loose,
it falls naturally and may stumble
on the ground or steps
Pressure ulcers collapse
 The cushion’s back and front side
is in a different direction
Damage of cater wheel’s resin
part
BED The cord is entangled
The bed is leaning on the wall
1. Remove the safety belt and
mat, loosen the safety belt and
check if the Velcro is working or
not
2. Poor adhesion or loose sewing
may lead to accidents such as
falling
3. Do not expose the mat and
safety belt to sunlight (prevent
STRETCHER deformation and discoloration)
4. Do not pour hot water on the
mat (prevent deformation)
Cane
 Is the rubber tip of the cane not old
 Adjust the length of the cane properly
 The length of the adjustable cane must be fixed to the adjustment section
Hard tip/ferrule
The cushion leans back and forth
The brake is not working and the
bed is moving. Committing
mistakes while transferring may
lead to falling
The user may fall over the cord
or the cord may be cut if the
lifting function is used while the
cord is tangled in the bed
When using the lift function, the
power plug and bed collides and
may destroy the outlet
Do not pour water in the remote
control, electric actuator and
control pack lifting device
Loose brake leads to falling when
the stretcher moves while
assisting the user in washing the
bod
Remote control hook is broken
When the hook comes off, the
remote control cannot be
attached in the remote holder and
so caregivers put the remote on
the sheets,
May accidentally press the
remote when changing position
in bed
 Cane length

Machine bath- The caster wheel is scraped off making it difficult to apply the break

４）Response to Accident, Risk Management

The accident not only impairs the physical and mental health and safety of the user, It will also cause
serious problems for the care worker. An accident in which the care staff encounters damage is referred to
as a "work accident", and an accident in which the user encounters damage is referred to as a "care
accident".

The purpose of risk management and crisis management is to prevent accidents.

[Even if an accident occurs, it minimize the damage]. Always observe the user, make risk predictions ad
plan, provide care with an accurate technology.

①Risk management・Crisis management · Risk assessment

Risk Management

 Creating measures before and after the occurrence of an accident based from preventive activities
that respond in advance to predictable accidents and disasters.
 Risk is the probability of occurrence of damage (harm)

Crisis Management

 Based on post-accident measures (post-measures), this helps in minimizing damage, injury after
effects.

Risk Assessment Hazard, analyze and evaluate the cause of damage

②Points of risk management in Nursing care

*System・Environmental Maintenance

 Establish a risk management committee

 Installation of handrails and elimination of steps for accident prevention, etc. Prepare a barrier-
free environment

*Do not limit life too much

 Stress due to the living environment is also thought to lead to an accident

  Do not restrict the user's life for the convenience of the care worker

*Create Incident Report

 Analyze cases such as near miss accident (event that could lead to an accident) Near miss
accidental reports and analyzation of previous accidents should be shared within the facility and
used for accident preventive measures.

③“Unsafe state” and “unsafe behavior” that are likely to occur in Nursing care accidents

Example：

A After wiping the hallway with a wet mop, it was left not dried up completely. (Unsafe state: slippery)

B The hallway is wet but without noticing it a person rushed and ran (Unsafe behavior: should not run
in the hallway)

When A and B happens at the same time, it leads to fall accident and as a result disability and injury will
likely to occur.

If situation A(wet hallway) was noticed, and in situation B, if a person avoided running in the hallways,
accident can be prevented. In addition, even if a person run in the hallway, but the hallway was dried up
completely there will be lesser possibility of accident to happen.

④Causes of Nursing care accidents that are common among elderly

Early detection is very important is very important to understand various factors regarding “unsafe state”
and “unsafe behavior” for the elderly.

DECLINE IN VISION

Aside from aging, there are other causes for poor vision which include diseases such as, diabetes,
atopic dermatitis, and ultra violet rays.
Perspective adjustment ability (force to adjust the focus according to the distance.
Peripheral vision (ability to distinguish left and right areas from the center of the field of view).
Deep vision( force to grasp distance by vision) the adaptability with brightness and darkness.

DECLINE IN HEARING

Aside from aging, it is a damage to auditory function due to noise.

It is also a problem that the attention is likely to be distracted by noise and reverberation.
Decline in physical ability
Long-term use of muscle, age-related factors, may reduce physical ability and may cause
osteoarthritis and diabetes
Physical strength for 20-60yrs old decreases for about 15%-20%
DECLINE IN COGNITIVE FUNCTION

Along with aging, memory function declines. It becomes difficult to retain long term memory.

⑤Measures to be taken when nursing care accident occurs

Within nursing care office, information regarding nursing care accidents are communicated entirely thru
written or verbal. It is important to share systematically the information about the accident and what to do
next.

RESPONSE TO ACCIDENTS

The first priority is the safety of the user.

Check the user’s (vital signs, presence of bleeding, bruise, trauma, pain). Depending on the
condition of the user, medical consultation, request for medical ambulance should be responded and
coordinated by the nurses and doctors. At the same time, care worker should not deal with the situation
alone. Ask the surrounding staff for help and report the accident to the leader/supervisor. Act quickly and
accurately, make decisions that will minimize damage from accident. Immediately inform municipalities
and user’s family about the accident occurred.

ACCIDENT REPORT ・RECORD

Delays in reporting to the family and inaccuracies can lead to distrust.

You are responsible to honestly report any serious accidents. About the cause and progress and
how to deal with the staff involved, compile the report and submit it to the municipality office.

ACCIDENT REPORT

Make an appropriate record visible to every one

５）Response in-case of emergency・Response when the accident is discovered

1. State of emergency and accidents

It is important to understand the sudden changes in the physical condition of the user, grasp the
situation correctly and respond appropriately to emergency situations involving the user’s body. Failure to
do so can leave users with disabilities or even death.

2. Emergency response

flow whenin terms of contacting or renraku

Communication during emergency

As needed, contact the Police station, Fire department, Public health center and Long-term care insurance
department. Explain the user’s condition (skin complexion, state of consciousness, Vital signs etc.)to
nurses if hospital or Ambulance crew if ambulance.
Call 119

Make a call

Tell them「I need an ambulance」

Relay the important information that you know such as, gender, age, condition (situation, consciousness,
bleeding site, etc.) address, phone number.

Until the arrival of the ambulance (while waiting)

Do not leave the user, prepare the user’s personal file, medical information *medicines prescribed by the
doctor, insurance card, etc.

Procedure for emergency resuscitation

First-aid for Accident Emergency Response

ACCIDENT METHOD OF RESPONSE

Injury  Apply clean gauze to the wound to prevent infection
 When there is bleeding: direct compression
Bone fracture  Open fractures (fractures where the wound reaches the skin surface),
apply direct compression to stop bleeding
 Non-open fracture (scratches fractures that have not reached the skin
surface) Use splints long enough to cover the upper and lower joints of
the affected area, and fix the affected area

Mis-swallowing When you cough...in order to remove the foreign objects, cough heavily

When unable to cough...remove foreign material (finger sweep method, back tapping method)

※Finger sweeping method...If you can see the foreign object in the mouth, wrap your finger with a
handkerchief, and take it out from the throat

※Back tapping method...One hand supports the entire chest, while the other hand strongly taps the area
in between the shoulder blades

※Heimlich Maneuver（Upper Abdominal Compression Method/abdominal thrusts)... The care worker

stands at the back of the care recipient, reach your arm around the armpit, make a fist with one hand, the
other hand holds the fist,Give inward outward abdominal pressure just above the navel

Picture
Burn - Avoid immersing in the water, instead cool the area with ample amount of cold water until the pain
is gone. When the burn is big, seek immediate medical care while cooling

1st degree redness in the skin, redness subsides in 3-4 days

2nd degree damage extend beyond the top layer of the skin, results blisters

3rd degree deep burn, damage causes skin to harden and become yellowish, when healed keloid
scars remain

3. Three Necessary points for Emergency Response

 Do not panic….the care worker must remain calm, observing the situation of the accident and any
sudden illness of the user.
 Calmness...because of the wound, sudden illness, the person becomes worried, having a sense of
relief is very important.
 Cooperation system ... Rather than responding by yourself, get help from others.

Immediate respond to emergencies has a big impact on users' lives and it’s further treatment method. For
proper response and clarification of responsibilities, user’s family consent, nurse judgment, and doctor’s
instructions are required.

4. Japan Coma Scale (JCS)

「20R」expression used as a classification method of the level of consciousness that is used most often
in Japan. Patient status is classified into digit 1 (eyes open), digit 2 (eyes open when stimulus given),
digit 3 (eyes don’t open,

Moreover, it is also called as the 3 stage evaluation or 「３・３・9 degree method 」.

The higher the value, indicates a serious failure of the level of consciousness.

「Somehow things are different than usual」「today, he/she isn’t well」etc., it is the family member or
the caregiver who can observe these things first. When the level of consciousness declines, the response
to pain also decreases, even if the person looks fine, the ability to comprehend becomes worse.

Along with the changes observed in the user’s condition, the results of the measurement (vital signs) are
reported to the medical institution. There are times that the user will not complain, it is important to
carefully observe the user’s body, and try to discover abnormalities at an early stage. When drinking
water or assisting with meals, make sure that the user is conscious that he/she is drinking.
Ⅰ Awake even without stimulation（Expressed with digit I）

1 Mostly conscious but vague (ill-defined)

2 Having difficulty in determining person, place and time

3 Unable to remember their own name or date of birth

Ⅱ Awakens when stimulated- Sleeps when stimulation is stopped

(Expressed in digits II)

10 Open eyes immediately with a normal call (for example, holding the right hand and let go), can
utter words but there are many mistakes)

20 Eyes open when shaking the body and speaking in a loud voice (responds to a simple command.
For example, release handshake)

30 When repeatedly stimulated or given pain, the eyes finally open

Ⅲ Does not awake even when stimulated

(Expressed in digits III)

100 Shows irritation/dislike behavior when given pain or stimulation

200 Shows movement of the hands/feet when given pain or stimulation

300 Does not respond to pain or stimulation

R: Restless, I: Incontinence A: Spontaneity Loss

3. Infection Control

1. Basic knowledge of infection prevention

Infection is a disease that occurs when infected with pathogens such as viruses, bacteria, fungi, and
parasites. It may not manifest an outbreak even if you are already infected (non-manifestation infection).
The elderly are more susceptible to infection because of the decline in their immune system.

Opportunistic infection is an infection caused by pathogens that take advantage of a normal host which
weakened immune system. Because it may become severe, the infection control should be firmly prepared
in the facility.

2. Principles of infection prevention and infection pathways

1 Three principles for infection control

The source of the infection...containing microorganisms (bacteria, viruses, etc.) that cause infections

o Eliminate the source of infection

 o Cut off the route of infection

*It is important not to bring in the source of infection, not to take it out, and not to spread it.

o Eliminate the source of infection by increasing the resistance of the host (people infested with
causing microorganisms)

2. Infection pathways and major infections

INFECTION PATHWAYS FLOW OF INFECTION MAJOR INFECTIOUS

DISEASE
DROPLET INFECTION  Particles caused by  Influenza
coughing or sneezing of  Rubella
the infected person
infected by inhaling flu.
AIR BONE INFECTION  Particle in the air by  Tuberculosis, Measles,
coughing or sneezing of Chickenpox
an infected person
infected by inhaling
DIRECT CONTACT  Transmitted by touching  MRSA, SCABIES
skin, goods, and
instruments with
pathogens
ORAL INFECTION  Infected by in taking  Norovirus, intestinal
contaminated food or hemorrghagic E. coli
water
BLOOD INFECTION  Infection enters the body  HIV, HEPATITIS B
through blood
contamination, blood
transfusions,wounds,etc

3. Various infection and its characteristics

NAME OF INFECTION CHARACTERISTICS PREVENTION METHOD

 Infection from oyster and
other food poisoning
 Causes gastroenteritis
infection
NOROVIRUS  It is easy to have group
infection
 Main symptoms:
vomiting, diarrhea,
abdominal pain, etc.
 It is easy to be infected
INFLUENZA as a group during winter.
 Main symptoms: high
fever, cough, sore throat
 More likely to develop
elderly people and
 Excrement and vomit of
the infected person
should be disinfected
with sodium
hypochlorite solution.
 When cooking,
Ingredients should be
heated for more than
85celcius and more than
1 minute.
 Influenza vaccine hand
washing, gargle.
 Through hand washing
and hand disinfection,
 MRSA (METHICILLIN- children with reduced
RESISTANT YELLOW immune system.
BUDOCOCCUS)  Main symptoms:
Depending on the site of
infection, fever, cough,
phlegm, diarrhea, etc.
 Caused by the parasitic
itch mite attached in
clothes and bleeding.
 Main symptoms: severe
itching of the skin.
SCABIES  Norway’s scabies are
particularly contagious
and prone to serious
illness.
wearing gowns and
gloves.
 Wear disposable
preventive clothing for
bathing assistance.
 The infected person
should practice private
room management,
clothes and bedding
should be washed
everyday separate from
other users. After
washing, use dryer.
 The infected person
should take a bath lastly,
after everyone has
bathed.

The stratum corneum is a type In the case of feet, dry the feet
of mold in the skin, develops after bathing and exercising to
RINGWORM infection with fungi. prevent the growth of bacteria.
Main symptoms: Itchy head/ Avoid sharing towels and mats.
hand/foot.
A typical one is 0-157 Thoroughly heat the ingredients
In addition to infected food, in cooking. Always use
ENTEROHEMORRHAGIC bacteria that adheres in fingers disposable gloves when changing
BACTERIA (ESCHERICHIA from the excrement of infected diapers. Treat dirty diapers as a
COLI) E.COLI people can be a cause of source of infection.
infection by touching the mouth.
Main symptoms: Abdominal
pain, diarrhea, bloody stool,etc.
*VIRAL HEPATITIS C IS PRONE TO LIVER CANCER, AND HEPATITIS B IS OFTEN INFECTED
BY MATERNAL AND CHILD INFECTION.

4. Precautions for infection prevention

CLASSIFICATION POINTS TO CONSIDER

 Wash your hands before and after each
nursing action.
 Wash your hands with running water and
HAND WASHING soup.
 Use liquid soap instead of bar soup
 After hand washing, wipe with a dry towel
or paper towel.
DISINFECTION  Use quick-drying rubbing alcohol for hand
disinfection.
 Making gargle a habit
When there is a user who is suspected of having an
infectious disease, use a mask, apron, disposable
HEALTH CARE gloves in provide care.
Seek for treatment and take a rest if the caregiver
himself is suspected of having an infection with
symptoms such as fever, vomiting,diarrhea,etc.
⑤ Infection control

When an infectious disease develops in an elderly care facility, problems such as the spread of infection
and the severity of infected people occur due to the characteristics of the facility. Damage can be
minimized by thorough infection control (measures). It is necessary to create an infection control
committee, create an infection prevention manual, and make sure all the staff is fully aware of the
measures to take.

[Main activities of the Infection Control Committee]

 Understanding the health status of users and employees

 Check if the new resident has infectious disease or previous infectious disease
 Staff training on infection control
 Creation of infection manual
 Report to related organizations the moment there is an outbreak of infection
 Confirmation and evaluation of the implementated of infectious disease countermeasures

3) Hygiene Management

 Infectious diseases can also be caused by inadequate hygiene. Although it is not possible to
eliminate all infections, it is possible to eliminate the occurrence of infections through thorough
daily hygiene.

[Hygiene management from the environmental aspect]

 Appropriate temperature・humidity・ventilation adjustments are considered as infection

prevention measures.
 It is important to adjust the humidity as a countermeasure against influenza during the dryness of
the winter season.
 A humidifier is installed to prevent drying, and the air is regularly ventilated to create a good
environment.

[Conditions for facilities required for hygiene management]

 Install many hand washing areas (places where you can easily wash and gargle)
 Put disinfectant in the hand washing area
 Separate the area that handles dirt from the clean area
[Standard Precautions]

This is a preventive measure that applies to all users.

● Hand hygiene

Hand hygiene (hand washing, hand food poisoning) is the most important measure in preventing
infection.

●Wearing protective equipment

To prevent direct contact with blood, body fluids, secretions and excretion, wear gloves, aprons, gowns,
and surgical masks, combine multiple measures suitable to care and treatment.

● Example of using gloves

1. When handling blood, body fluids, vomit, etc. If there is a possibility of contaminating the eyes, nose
or mouth of a care worker, wear mask, goggles or face mask

Use or Wear disposable aprons and gowns when there is a risk of contaminating the clothing

2. When cleaning wounds

3. When changing diapers and processing excrement

4. When performing oral care

5. When you have a wound in your own hand

* After treatment, be sure to wash your hands with running water and soap, and do not use shared towels.

● Precautions when using gloves

1. Contamination spreads when you touch various places with dirty gloves

2. If you touch another body part of the same person, replace the gloves

3. Throw away gloves that has been used once as they may be torn and may cause cross-infection.

4. If it is torn, your hands may be contaminated during use. Wash your hands thoroughly and disinfect
them after removing the gloves.

[Basics of hand washing] As an infection control measure, it is necessary to acquire the correct hand-
washing method with “1 care 1 hand wash”.

 Remove ring and watch washing your hands

 Keep the nails short so that you can wash the tip of the nail completely
 Carefully wash areas that are difficult to wash
 Use disposable paper towels after hand washing
 Dry your hands completely
HOW TO WASH HANDS

1. Remove watch and ring and wet the hands

2. Remove the soap and make foam

3. Wash the palm

4. Wash the back of the hand

5. Fold your fingers and wash between your fingers

6. Wash your fingertips and nails

7. Twist the thumb in washing hands

8.Twist the wrist in washing hands

9. Rinse with running water

10. Wipe off moisture well

11. When the lever is not automatic, Stop water

with paper

12. Wipe the surrounding with a paper towel

(Alcohol disinfection) After washing your hands, wipe your hands. Disinfect.

1. Take about 1㎖ of disinfectant solution

2. Squeeze the disinfectant into the fingertips of

both hands

3. Rub the palm well

4. Rub the back of the hand

5. Rubbing between the thumb

6. Rub on your thumb

7. Rub the wrist until it dries

PART OF THE HAND WITH COMMON WASHING RESIDUE

How To Remove The Disposable Gloves

1. Grab the outside of the edge near your wrist

2. Remove the gloves so that the inside part will be visible

3. Hold the removed glove with the hand wearing gloves

4. Put your finger inside the wrist area of the glove

5. Remove the glove, the inside part of the glove should be facing up

6. Gloves, Wash Your Hands And Disinfect

HOW TO PUT ON A MASK

1. Place the wire on the nose with the folds down

2. Extend the folds to cover the chin

3. Hold the wire and adjust it to the height of the

nose

4. Make sure that the mouth and nose are covered

and there are no gaps in the cheeks
ASSIGNMENT 1

CHAPTER 1: FUNDAMENTALS OF CARE

TEST 1 HUMAN DIGNITY AND INDEPENDENCE IN CARE

IDENTIFICATION

1. MULTIFACETED UNDERSTANDING OF HUMAN BEINGS – is to understand the person from

various perspectives.

2. In japan, human dignity is regulated and based on “Japanese Constitution”, Artcle 13 Respect for
Individuals and Article 25 RESPECT TO LIVE

3. Independence is to support user to be able to live a fulfilling life.

4. People who use care giving service is called USER.

5. RECREATION a term for activities that create comfort and enjoyment necessary for daily life.

TRUE OR FALSE

6. The purpose of nursing care is to protect the dignity of the care worker especially the foreign care
workers. FALSE

7. Ethics are imposed by the caregivers. FALSE

8. For user with dementia, care worker should decide for them to make their everyday life simple.
FALSE

9. Physical therapist aims to restore applied motion ability and social adaptability. FALSE

10. Normalization is creating a society where normal people and people with disabilities live together
harmoniously. TRUE

SHORT TEST CHAPTER 2 ROLE AND PROFESSIONAL ETHICS OF CARE WORKERS

TEST 1

IDENTIFICATION

1. In case physical restraint was done you are obliged to preserve the care records for 2 YEARS.

2. URGENCY DANGER – it is an exception to physical restraint which means danger to lifeof the user
and other users.

3. TRAINING SUCCESSORS – is a code of ethics where care workers are committed to on improving
the level of education.

4. Personal information is defined as IDENTIFYING SPECIFIC INDIVIDUALS

5. Restricting actions with some device called PHYSICAL RESTRAINT

TRUE OR FALSE

6. Leaving the elderly with no food and proper care is considered as Financial Abuse.FALSE

7. Caregiving Law protects the elderly from any type of abuse. FALSE

8. Sexual abuse is susceptible for younger people especially the girls. Older personsare not subject to
sexual abuse. FALSE

9. It is okay to disclose information after the user’s death. FALSE

10. To prevent user from falling from the bed, surround the bed with side rails. FALSE

ASSIGNMENT 2

TEST 2: Multi-professional Collaboration Answer key

Identification

1. LIFE COUNSELOR provides consulting assistance from moving in to living.

2. OCCUPATIONAL THERAPIST perform rehabilitation through applied movement

3. CARE MANAGER Make contract, care plan

4. PHYSICAL THERAPIST person who performs rehabilitation for the purpose of gait training

5. CARE WORKER Caring for the mental and physical condition of the user.

Short test Chapter 3 Care service

Test 1

Answer Key

1. Support required and need of long-term care certification will be given by the MUNICIPALITY.

2. SECONDARY INSURED PERSON are those who suffers one of the 16 specific age-related diseases.

3. GROUP HOME It is a type of community-based service which provides functional training for elderly
people with dementia.

4. HEALTH SERVICES FACILITY FOR THE AGED It is a type of facility-based service that
provides nursing care and rehabilitation.

5. HOME-VISIT BATHING It is a type of home service which provides bathtub and bathing.

True or False
1. Deterioration of the ability of the family to provide care is one of the reason why the Long-term care
insurance has been established. TRUE

2. Japan was considered as super aging society starting on the 1994. FALSE (2007)

3. Mostly elderly men live longer than the elderly women. FALSE (WOMEN)

4. As of 2016, the rate of elderly people aged 65 years and above now covers 26.3% of the total
population of Japan. FALSE (27.3%)

5. Long-term care insurance system was established in April 2000. TRUE

Chapter 3 Care Process and Care plan

Answer Key

1. ASSESSMENT to clarify user’s life issues comprehensively by collecting, interpreting, and analyzing
user information.

2. Nursing care process: Assessment, Planning, IMPLEMENTATION, Evaluation.

3. This goal usually lasts from weeks to months SHORT-TERM GOAL.

4. SUBJECTIVE INFORMATION user’s own way of thinking, feelings, demands.

5. CARE PROCESS is a process based on an objective and scientific basis to realize the life desired by
the users.

True or false

1. Observations performed by care workers such as records and health data is called subjective
information. FALSE (OBJECTIVE INFORMATION)

2. As long as the user agrees, there is no need to obtain the family’s consent after drafting the care plan.
FALSE (OBTAIN USER AND FAMILIES CONSENT)

3. In order to carefully follow the care process, termination of the care plan should be done whether the
desired goal is achieved or not. FALSE (MAY REVISE THE CARE PLAN CONTENT ACCORDING
TO THE USER’S CONDITION)

4. The one who made the care plan needs to visit the users and their families once a month for monitoring.
TRUE

5. Care plan should be standard and most likely applicable to all users. FALSE (INDIVIDUAL PLAN
ACCORDING TO EACH USER’S NEED AND CONDITION)
ASSIGNMENT NO.3

Chapter 4 Securing Safety and Risk Management

Test 1 Securing safety in caregiving Manual page 42-49

Identification

1. BURN OUT SYNDROME a state in which the care giver feels lack of energy and interests
towards everything

2. ARRHYTHMIA condition of increased pulse rate or disturbed rhythm

3. BODY MECHANICS a technique that analyzes movements and postures with less
burden.

4. VITAL SIGNS body temperature, pulse rate, respiratory rate, blood pressure

5. INFECTIONS it is a state when pathogens enter the body bacteria multiplies

and symptoms appear.

True or false

6. It is a must to inform the user and make sure he/ she is aware that you
are measuring her respiration rate. FALSE

7. The care giver can still work in the event he/she is suspected to be infected as long as proper hand
washing and wearing of mask must be done. FALSE

8. When transferring, move the foot and the body of the care worker in the direction you are going. TRUE

9. To prevent back pain, static stretching is effective. TRUE

10. Wash your hands with running water and bar soap for effective infection prevention. FALSE

Identification

1. OPEN FRACTURE a type of fracture where the wound reaches the skin surface.

2. HEIMLICH MANEUVER a method of response for people who experiences choking, giving inward
and outward abdominal pressure.

3. NURSING CARE ACCIDENT accidents that occur in facility services or home services

4. WORK ACCIDENT an accident in which the care staff encounters damage.

5. Three points for emergency response do not panic, CALMNESS and cooperation system.
True or false

1. Once the user is burned, immediately remove his/her clothes to prevent further burning of other body
parts. FALSE

2. There is no need to call the family of the user if the accident is not life threatening. FALSE

3. The first priority is the safety of the user. TRUE

4. Care workers can take care or administer medicines. TRUE

5. Elderly people are more likely to fall with a visible bump in the road than a slight step or bump.
FALSE

ASSIGNMENT NO 4

Chapter 4 Infection Control

Manual page 64-71

Identification

1. _______________Infection caused by a parasitic itch mite.

2. _______________ occurs during winter season, infection from oysters and other food poisoning.

3. ____________________ this type of Hepatitis is prone to liver cancer.

4. ____________________ usually occurs in the feet, caused by molds that develops infection.

5. ____________________ infection pathway that transmitted by touching skin, goods with

pathogens.

True or false

1. Norovirus is has the symptoms of high fever, cough, and sore throat.

2. Hepatitis B is caused by blood infection.

3. User that is infected by scabies should stay in a private room to prevent group infection.

4. It is acceptable not to wash hands before and after care procedure because you are using gloves.

5. We may offend the user, but it is important to check if the new resident has infectious disease or
previous infectious disease.
CLASS QUIZ

ANSWER:

1. X 6. O

2. O 7. X

3. O 8. O

4. X 9. O

5. O 10. O

1. Because the user's old friend contacted the facility by phone, the caregiver told the old friend about the
user's condition.

2. Caregivers work with welfare service personnel.

3. In order for care management to function effectively, it is necessary that various related organizations,
facilities, organizations, etc. in the region are and a network in the region is established.

4. In the event of a disaster, as a caregiver's response to the elderly at evacuation centers, it is

recommended to spend time during daytime to prevent fatigue.

5. At the time of a disaster, as a caregiver's response to elderly people at the evacuation center, consider
“group care” rather than “individual care” so as not to disturb the harmony within the evacuation center

6. The day care service is obliged to carry out emergency disaster training for two days.

7. Users of designated dementia-compatible outpatient care services (Day service)are limited to those 65
years of age or older who have dementia.

8. As a general rule, users of designated dementia-compatible outpatient care services are residents of the
municipality where the office is located.

9. The pleasant service provided by combining home-visit nursing and small-scale multifunctional home
care is a combined service (nursing small-scale multifunctional home care)
10. Payment for home medical care management guidance is paid from long-term care insurance.

CLASS QUIZ 5/26/20

1. BASIC OF CAREGIVING

CLASS QUIZ 5/27/20

Care Process 1

ANSWER:

1. X 6. O

2. X 7. X

3. O 8. X

4. X 9. O

5. O 10. X

1. The care process is to realize to realize a better life that the caregiver wants.

2. The purpose of the care process is that each type of job has a different end goal.

3. It is necessary to observe recent changes in the behavior of users whose food intake has suddenly
decreased.

4. Caregivers does not need to know about the health status of users.

5. When there are many life issues, prioritizing is important.

6. What the user wants to do and what the user can do, should be included during the assessment.

7. Intake is the term used to clarify issues, needs and strength of the users through analysis and integration
of related information.

8. The purpose of assessment in the care process is to improve the skills of care workers.

9. The purpose of assessment in the care process is to clarify life issues.

10. The purpose of the care process is to classify information from the viewpoint of ICF (International
Classification of Functioning, Disability and Health)
CLASS QUIZ 6/2/2020

Short test 4: Care Process 3

ANSWER:

1. X 6. X

2. O 7. O

3. X 8. O

4. O 9. X

5. O 10. X

1. Assessments in the care process do not consider user's dislike.

2. In consideration of information collection by care workers, information is collected in a multiple

aspects and continuous manner.

3. Points to keep in mind when collecting information by care workers, privacy information is collected
through group interviews.

4. Obtain the consent of the user during creating a nursing care plan

5. In documenting an objective information, it was recorded that there was a food stained jacket inside the
cabinet.

6. The doctor's opinion about the disease is subjective information in nursing care.

7. The life history of users obtained from family members is an objective information in the care process.

8. User remarks or verbal complains are subjective information in the care process.

9. When planning a long-term care, incorporate the past success experiences of care workers

10. When creating a care plan, plan with goals even if it is not reachable.