Abstract
Background: Home care in Japan has increased rapidly among older adults and individuals with cancer, neurodegenerative diseases, and chronic conditions (Ministry of Health, Labour and Welfare, 2021). Within this expanding community-based care system, Advance Care Planning (ACP) is essential for supporting patients’ values and end-of-life preferences (Rietjens et al., 2017). Home health nurses, who observe patients’ daily lives closely, play a central role in ACP (Chan et al., 2020). However, their roles and emotional burdens remain underexplored.
Objective: To clarify the roles, barriers, and emotional experiences of home health nurses in ACP support in Japan and identify implications for educational and institutional reinforcement.
Methods: A web-based survey was conducted with 191 home health nursing stations nationwide (Nov–Dec 2022). Free-text responses from 112 nurses were analyzed using the User Local Text Mining Tool with word cloud, co-occurrence network, and sentiment analyses.
Results: Twenty-seven nurses described ACP-related roles, 31 identified barriers, and 37 expressed hopes. Nurses reported engaging in information provision, decision-making support, communication bridging with physicians, and multidisciplinary coordination—findings aligned with prior studies (Bryant et al., 2019; Lund et al., 2020). Barriers included difficulties in information sharing, limited collaboration, and uncertainty regarding ACP timing. Sentiment analysis showed high joy (80.6%) about their ACP involvement and strong fear (77.9%) toward barriers, indicating substantial emotional labor in navigating life-and-death discussions at home.
Discussion: These emotional tensions align with Hochschild’s (1983) emotional labor theory, suggesting ACP requires advanced emotional regulation, empathy, and relational competence. Prior studies show that home health nurses manage sadness, anger, and uncertainty in end-of-life care (Fukita & Kobayashi, 2008). This study indicates that ACP similarly demands emotional navigation to uphold patient dignity while managing personal strain.
Conclusion: Home health nurses are essential to ACP through communication, preference elicitation, and team coordination. Yet communication gaps, weak collaboration, and emotional strain hinder ACP quality. As home care expands, these burdens may intensify. Enhancing ACP requires emotional labor training, shared ACP tools, and institutional systems supporting nurses’ psychological and collaborative needs.
Notes
References:
1．Bryant, J., et al. (2019). Nurses’ roles in advance care planning: A systematic review. Palliative Medicine.
2．Chan, H. Y., et al. (2020). Nursing perspectives on advance care planning: An integrative review. Journal of Advanced Nursing.
3．Fukita, A., & Kobayashi, M. (2008). Emotional experiences of home health nurses in end-of-life care. Journal of Japan Academy of Nursing Science.
4．Hochschild, A. R. (1983). The Managed Heart: Commercialization of Human Feeling. University of California Press.
5．Lund, S., et al. (2020). Community nurses’ experiences with advance care planning: A qualitative study. BMC Palliative Care.
6．Ministry of Health, Labour and Welfare. (2021). Home Care Statistics in Japan. Tokyo: MHLW.
7．Rietjens, J., et al. (2017). Definition and recommendations for advance care planning: An international Delphi consensus. The Lancet Oncology, 18(9), e543–e551.
Sigma Membership
Tau Nu
Type
Poster
Format Type
Text-based Document
Study Design/Type
Other
Research Approach
Other
Keywords:
Advance Care Planning, Home Health Nursing, Palliative Care, Terminal Care, End-of-Life Care, Nurses--Psychosocial Factors, Japan
Recommended Citation
Hashimoto, Yoko and Kotake, Kumiko, "ACP Roles, Barriers, and Emotional Labor of Home Health Nurses in Japan: A Text-Mining Analysis" (2026). International Nursing Research Congress (INRC). 53.
https://www.sigmarepository.org/inrc/2026/posters_2026/53
Conference Name
37th International Nursing Research Congress
Conference Host
Sigma Theta Tau International
Conference Location
Toronto, Ontario, Canada
Conference Year
2026
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.
Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Date of Issue
2026-08-03
ACP Roles, Barriers, and Emotional Labor of Home Health Nurses in Japan: A Text-Mining Analysis
Toronto, Ontario, Canada
Background: Home care in Japan has increased rapidly among older adults and individuals with cancer, neurodegenerative diseases, and chronic conditions (Ministry of Health, Labour and Welfare, 2021). Within this expanding community-based care system, Advance Care Planning (ACP) is essential for supporting patients’ values and end-of-life preferences (Rietjens et al., 2017). Home health nurses, who observe patients’ daily lives closely, play a central role in ACP (Chan et al., 2020). However, their roles and emotional burdens remain underexplored.
Objective: To clarify the roles, barriers, and emotional experiences of home health nurses in ACP support in Japan and identify implications for educational and institutional reinforcement.
Methods: A web-based survey was conducted with 191 home health nursing stations nationwide (Nov–Dec 2022). Free-text responses from 112 nurses were analyzed using the User Local Text Mining Tool with word cloud, co-occurrence network, and sentiment analyses.
Results: Twenty-seven nurses described ACP-related roles, 31 identified barriers, and 37 expressed hopes. Nurses reported engaging in information provision, decision-making support, communication bridging with physicians, and multidisciplinary coordination—findings aligned with prior studies (Bryant et al., 2019; Lund et al., 2020). Barriers included difficulties in information sharing, limited collaboration, and uncertainty regarding ACP timing. Sentiment analysis showed high joy (80.6%) about their ACP involvement and strong fear (77.9%) toward barriers, indicating substantial emotional labor in navigating life-and-death discussions at home.
Discussion: These emotional tensions align with Hochschild’s (1983) emotional labor theory, suggesting ACP requires advanced emotional regulation, empathy, and relational competence. Prior studies show that home health nurses manage sadness, anger, and uncertainty in end-of-life care (Fukita & Kobayashi, 2008). This study indicates that ACP similarly demands emotional navigation to uphold patient dignity while managing personal strain.
Conclusion: Home health nurses are essential to ACP through communication, preference elicitation, and team coordination. Yet communication gaps, weak collaboration, and emotional strain hinder ACP quality. As home care expands, these burdens may intensify. Enhancing ACP requires emotional labor training, shared ACP tools, and institutional systems supporting nurses’ psychological and collaborative needs.
Description
This study explored the roles, barriers, and emotions of home health nurses in Advance Care Planning (ACP) in Japan. A survey of 112 nurses showed key roles in information sharing, decision-making support, and communication bridging. Barriers included limited collaboration and timing challenges. Sentiment analysis revealed both joy and fear, indicating significant emotional labor. Strengthening ACP requires better teamwork and emotional support.
This study was supported by JSPS KAKENHI Grant-in Aid for Scientific Research(C) , Grant Number 20K10802.