訪問看護—病院から訪問看護ステーションへ

Visiting Nurse Service in Japan: Focused on the Trend from Hospital-based to Community-based

訪問看護の芽生えと病院を基盤にした地域看護活動

　看護の歴史を紐解くと，かなり早くから在宅における看護，すなわち訪問看護が展開されていたことがわかる。例えば，William Rathborneは1859年にLiverpoolで看護婦を雇用して貧困者の家庭を訪問させ，これが英国における組織的な訪問看護活動に発展していった。また米国では，1883年にLillian Waldが貧民街に泊まり込んで訪問看護を提供していった。これら欧米の活動は，その後も発展し，district nurseやvisiting nurseserviceとして現在に至っている。

　日本では，萌芽的活動として明治時代の派出看護婦，京都看病婦学校の巡回看護があった。病院からの訪問看護活動は，1923年に関東大震災が起こった時に，済生会病院が被災地区に巡回看護を提供したことが有名である。聖路加病院は，1927年に母子の訪問看護活動を開始している。このようななかからの訪問看護は，しかし，定着したところは少なかった。わずかに聖路加病院では，終戦直後の混乱期を通して，訪問看護を継続してきた。これは，病院が進駐軍に接収されてしまったため，非常に狭いスペースで病院を運営せざるを得ず，手術後すぐに帰宅させなければならなかったためである。術後の処置に看護婦が自宅を訪問してまわったのが，その後，訪問看護を継続して実施していく原動力となっていった。

　The short history of Visiting Nurse Service (VNS) in Japan after the World War Ⅱ can be described as follows:

　In many places of Japan. pioneer hospitals started to provide VNS in 1970's, even though the cost was not covered by health insurance at that time. With the enormous efforts of these hospitals as well as progressive municipalities of local governments, health insurance started to be provided to cover the cost for VNS in 1983 when the Health and Medical Service Law for the Aged was enacted. Since then the number of the hospitals which provides this kind of service has rapidly increased up to 3,863 (41.6%) out of all 9,286 hospitals in Japan in 1999.

　In 1992, the system of Visiting Nurse Service Stations　(VNSSs)　was newly established. It brought a drastic change to the whole system of Japanese nursing care. enabling nurses to be the heads of VNSSs and encouraging them to manage the finance independently. The quality of home nursing care has been much improved and the range of clients has been even widened. The number of stations has been increased up to about 5,000 during these 10 years.

　Now in Japan two major systems of home nursing care covered by medical insurance are co-existing. One is provided by hospitals and the other by VNSSs. Hospitals take care of seriously and terminally ill patients who need more professional medical and nursing care, while VNSSs take care of clients who need more personal and private care. Work sharing by hospitals and VNSSs is definitely needed for the efficiency and effectiveness of nursing care system in the community.

　Even if its history is short, the system of Japanese VNS was acquired through extraordinary efforts of nurses and their associates, who have been working so hard to meet the demand of patients at home in Japan.