Five years have passed since creating the 'My Life Notebook' as a community dissemination activity for ACP in M City. We conducted an online anonymous questionnaire survey to clarify the level of awareness of ACP among care managers and the state of practice in five years, and to identify challenging issues for the dissemination of ACP. We received 162 responses (response rate: 35%). 58.6% were aware of the ACP and 75.3% were aware of "My Life Notebook". The five categories were generated as challenges to improving the ability of care managers to implement ACP: [Improving the knowledge and skills of care managers to disseminate ACP], [Building trusting relationships with users and their families], [Work environment improvement and multidisciplinary collaboration for ACP initiatives that respect the wishes of users and their families], [Supporting users and their families to start ACP at an early stage], and [Building a system for proactive ACP initiatives from care managers towards users' families]. It is necessary to consider ACP dissemination activities and to create references and practical manuals to facilitate care managers' efforts in ACP and to create an environment that facilitates their use.

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OBJECTIVE: To conduct a conceptual analysis of patient self-disclosure in the nursing literature to identify attributes, antecedent requirements, consequences, and definitions of self-disclosure. METHODS: Databases such as Ichushi web were searched using "self-disclosure," "patient," and "nursing" as keywords. Finally, references were extracted and analyzed by Rodgers' method. Results: Four attributes were extracted, including "thoughts about illness" and "thoughts about living with illness," five antecedents, including "having support for disclosure" and "having motivation to disclose," and five consequences, including "obtaining support" and "leading to self understanding and behavior change. Discussion:One of the most important findings of this study is that self-disclosure results in gaining support from those around them. Research on self disclosure in psychology has revealed only the effects on the discloser him⁄herself. However, the fact that the present study revealed the relationship with the people around the patient as a result of self-disclosure is a characteristic of nursing that differs from that of psychology. In the nursing literature, patient self-disclosure is defined as " a person with an illness has his or her own factors such as motivation and skills to self-disclose, as well as support from others, to be able to convey the thoughts of living with illness and to request support from those around them, which lead to personal factors such as self-understanding and behavior change, as well as support and improvement of the quality of nursing."

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【Introduction】The purpose of this study was to clarify the situation of hospital deaths of long-term care insurance users living in the community, the reasons of users repeatedly hospitalized by emergency transport and post-discharge care from care managers to examine how elderly people can live until the end of their lives in their familiar communities. 【Methods】164 care managers in City B responded to the anonymous online survey in FY2022. Of these, 133 respondents who reported a death among users were included in the analysis. 【Results】About 80% of the respondents answered that they had a patient who died in the hospital, and 23 responded that those wished to receive end-of-life care at home. Approximately 40% of respondents reported having users who were repeatedly admitted to the hospital by ambulance, of whom 50% reported having no visiting medical consultation services and 30% reported having visiting nursing services. Reasons for emergency care included worsening heart failure, aspiration pneumonia, fractures due to falls, and anxiety. Intentions for emergency transport were confirmed and ACP was performed. 【Conclusions】 There were many hospital deaths. To reduce the number of patients who died in hospital against their wishes, it is necessary to strengthen the cooperation between medical and nursing care in dealing with deteriorating conditions and to reduce the anxiety of people living alone and their families in emergency situations.

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The purpose of this study was to clarify the implementation of ACP in patients admitted to the university hospital after emergency transport from elderly care facilities. The subjects were 29 patients aged 65 years or older with medical symptoms of non-cancer diseases. Medical chart review was performed regarding the subjects’ demographic information and the implementation status of ACP before and during hospitalization. Data were analyzed using descriptive statistics. Results showed that the mean age was 85 years, 15 males and 14 females, and 12 patients suffered from dementia. The reason for emergency transport was loss of consciousness in nine patients and deterioration of respiratory status in eight patients. The emergency call was made by the facility staff. Of the eight patients with ACP prior to admission, five did not wish to receive life-prolonging treatment. Medical staff discussed ACP with four patients while hospitalized and facilitated two patients ACP discussions after discharge. Elderly patients residing in the facility had a wide range of symptoms in the event of a sudden change, and the facility staff, who were not medically qualified, called for emergency care. It was necessary to have specific discussions with family members and the facility about the desired medical care while the elderly was still able to express their wishes.

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Abstract Objective: To identify nursing support for self-care among older adults with diabetes based on previous research. Methods: Eighteen articles were selected from Ichushi Web using the following keywords that aligned with our research objectives: "elderly," "diabetes," "self-care" (including self-management or chronic disease self-management), "support," "nurse," and "original article." These articles were then qualitatively analyzed qualitatively inductively. Results: The following six categories were established: 1) Establishing a foundation for a supportive relationship by paying attention to older adults and listening to their life history to encourage adherence to the medical regimen. 2) Assessing "potentiality" from various perspectives and consider providing support anticipating a functional decline. 3) Respecting older adults' self-esteem, acknowledging their life experiences, and supporting their self-determination in setting reasonable goals. 4) Considering management methods that can be sustained at home and educating older adults with tools that match their communication and abilities. 5) Recognizing their capabilities and enhancing their self-efficacy to maintain motivation for self-care. 6) Viewing family members as care recipients and coordinating support systems through interprofessional collaboration. Conclusion: In promoting self-care among older adults with diabetes, nurses should actively listen to their life history and a thorough assessment of their potential from various perspectives. Further, nurses should respect their self-esteem and support them in making self-determined choices for their self-care that suit their unique life circumstances. Subsequently, nurses educate older adults on home-based management suited to their abilities. Simultaneously, they utilize appropriate tools, and they focus on boosting their self-efficacy to sustain motivation. Additionally, caregivers should recognize family members as care recipients, and the establishment of a support system through interprofessional collaboration is essential. These are the care　supports for the older adults with diabetes to practice self-care. As a future issue, since it is not sufficient only to instruct older adults with diabetes to practice self-care for the subject, we would like to make it clear that it is necessary to provide support tailored to the older adult's life after listening to his/her life history, so that this support can be utilized in education for nurses.

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Abstract: Purpose: The purpose of this study is to clarify the needs of nursing students for mutual support in their academic activities, and to examine the feasibility of mutual support by implementing and evaluating the "Consultation on practical training by senior students". Method: An anonymous online survey was conducted with first- to fourth-year students majoring in nursing at University A. The survey asked students whether they were experiencing difficulties in five categories of learning activity, namely, preparing for the National Nurse Licensure Examination, job-seeking, on-site training, preparing for examinations, and course registration. Students were also surveyed regarding their need for mutual supports in relation to these learning activities and whether they wanted to become a learning advisor to provide such support. In addition, we analyzed the evaluations and impressions of students who participated in the "Consultation on practical training by senior students". Results: Responses from 115 students were analyzed (valid response rate: 36.0%). A high percentage of students (89.6%) responded that they needed support from other students in relation to preparing for the national examination and job seeking. In contrast, low percentages of students expressed a desire to become a learning advisor to support with either of these categories of activity (48.7% and 47.8%, respectively). Discussion: The results suggest that it is important to provide support among students involved in career development from the first grade. In addition to support from seniors, it was also indicated that it is necessary to utilize mutual support among classmates.

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In this case, a male patient had some grievances against the care medical workers took of him, and it was difficult to had the sufferer take good care by himself in his daily life. In response to this, a Certified Nurse Specialist (CNS) in chronic care nursing, who was well acquainted with Professional Learning Climate (PLC), gave support to the patient so as to improve his self-efficiency ,and as a result, this led to the behavioral changes of the patient. Patients with chronic diseases need to change their habitual lifestyles and incorporate treatment behaviors to prevent exacerbations and incorporate treatment behaviors for health maintenance. Self-efficacy is a psychosocial factor related to individual patients' physical functions, living environment, social background, and support status, etc. Improving self-efficacy create positive and effective behaviors and maintains emotional stability. One of the sources of increasing self-efficacy is verbal persuasion, and we provided support to patient B based on the belief that support using PLC would be effective. Patient B (in his 50s) had been visiting the hospital for 10 years, and this was his seventh hospitalization; he had been hospitalized for heart failure a month earlier, and his hospital stay was shortening. The CNS, was aware of the PLC, believed in and respected patient B, and worked to build a trusting relationship with him. Specifically, the CNS worked with patient B to establish goals that respected his enjoyment and proposed feasible ways to achieve them. As a result, patient B experienced many successes, and his sense of self-efficacy increased, leading to behavioral change.

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Mr. B, an old man in his 90s who lives in assisted living facility A, suffered repeatedly from aspiration pneumonia. Mr. B’s wishes were to spend his remaining life in this residence , to defecate in the toilet until his death, and to eat whatever he wanted through his own mouth. In order to respect his wishes, Mr. B was provided house calls and home-visit nursing with care services such as toilet assistance and meal planning, and angel care was provided at the end of his life. As a result, Mr. B could spend his remaining life at A, and the bereaved family seemed satisfied with the care provided in accordance with his wishes.

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