[in Japanese]

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The purpose of this study was to clarify the process through which patients displayed independence during the postoperative acute phase of esophageal cancer surgery, and to obtain suggestions for nursing practice. Data was collected from fifteen subjects using participant observation (participant-as-observer) and semi-structured interviews, and analyzed using the Modified Grounded Theory Approach.
Two core process categories were identified: 1) Patients taking steps on their own to regain their lives, and 2) Patients creating their own foothold. Even before surgery, patients could be divided between those who began to prepare for the postoperative phase and those who left all preparation and decision making in the hands of the medical staff. No matter the pre-surgery attitude; post-surgery, all patients had no choice but to consciously breathe and begin to move on their own using their somatic senses. Even patients who totally relied upon the support of the medical staff for everything came to the realization that the extent of their recovery depended on themselves. All of the subjects took some steps on their own towards independence.
The results suggest that the most important recommendation for nursing practice is to start preparing patients pre-surgery for the fact that their post-surgery independence is possible through their own efforts, even in the event of a severely invasive operation.

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This study examined the effectiveness of deep breathing practice to prevent postoperative atelectasis by clarifying its effects on ventilation and the respiratory muscle strength/resistance. Twenty-eight healthy females aged 18 to 22 were divided into 2 groups with (experimental: 15) and without (control: 13) deep breathing practice. The former performed 4 sets of deep breathing daily, each of which consisted of 10 repetitions, for 10 days. In both groups, ventilation, the respiratory muscle strength, and respiratory resistance were measured before and 10 days after the initiation of the experiment.
The vital (VC) and forced vital (FVC) capacities significantly increased in the experimental group, revealing similar effects of deep breathing practice to those of breathing training using devices. Furthermore, in this group, the maximal expiratory pressure (MEP) markedly increased with the rises in the VC and FVC, suggesting that such practice also improves the ability to expectorate. As for respiratory resistance, there were no significant changes in the all measurement items. Based on this, deep breathing practice may have increased the VC and FVC by expanding the lung tissues (alveoli) .

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[Aim] This study aims to clarify the effect of removal of contaminants produced by oral care for intubated patients and the degree of oral health condition and inflow in each care method.
[Methods] We conducted oral care using one of three methods for 75 ICU inpatients. The first method is wiping, the second is washing, and the third is an aspiration brushing wipe. The effect of removal was evaluated by bacterial count and ATP level at time of oral care. The oral health condition was observed by objective oral evaluation, moisture of the oral mucosa, and prevalence of oral bacteria. The degree of inflow was measured by the degree of cuff pollution after extubation.
[Results] The bacterial count was decreased after oral care in all methods, but the ATP level showed no significant decreases with the wipe. There was no significant difference in objective oral evaluation by each method. However, with the washing method, the moisture content in the mouth was significantly lower than with other methods, and the possession rate of resident bacteria was high. There was no significant difference in the degree of cuff pollution, but it was high with the washing method.
[Conclusion] Focusing on the effect of removal of contaminants, the washing method was effective. Washing had a high percentage of prevalence of oral bacteria, but some moisture of the oral mucosa was insufficient. The wipe and the aspiration brushing wipe maintained the moisture content. However, the aspiration brushing wipe was more effective than the wipe in suppressing growth of pathogens. It was suggested that the degree of inflow was easy in washing.

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It is essential to clarify a delirious patient when claiming for appropriate medical service fee. We made a survey of the current situation for delirium assessment/delirium care after 2016 revision of medical service fee with all the members of the critical care nursing specialist organization (Critical care nursing specialist, certified nurse in intensive care, and certified nurse in emergency nursing) often providing medical care to patients with "the requirement of a highly-intensive medical treatment". We conducted a Web-based anonymous questionnaire survey, simple totaling, and then qualitative/descriptive analysis. The number of the study subjects was 1,798 respondents with the response rate 9.6% and the valid response rate 100%. Delirium assessment with validity/reliability was not continuously conducted throughout the entire perioperative period. Thus, it is important to maintain a tool assessment accuracy in addition to introduction of delirium assessment tool to improve claiming for appropriate medical service fee and also necessary to provide an educational support through academic conference. Furthermore, a support for establishing a medically-economical/political delirium assessment with a nursing need degree possibly promotes a patient care while encouraging to set a common language of delirium care during the progress of interdisciplinary collaboration/team collaboration.

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This study examines the significance of bedside photographs for families of ICU patients in order to understand using such photographs more effectively in nursing intervention. Families of critically ill patients who have photographs at their bedsides were interviewed with semi-structured interviews. The revised grounded theory approach was used as a reference for analyzing their responses.
From the results, five aspects of significance that such photographs have for families were selected. The aspects were important proof of patient connections with the world outside the hospital and family ties, anxieties attached to bringing photographs, sorrows triggered by photographs, joys triggered by photographs, and a wish and anxiety to recovery and recovery support.
For families of ICU patients, bedside photographs may satisfy their needs, cause their anticipatory grief, and aggravate crises when families are in the shock. Bedside photographs can be double-edged swords, presenting both benefits and disadvantages. The results suggest that being aware that photograph significance differs depending on family crisis levels and family systems and that using photographs carefully is important.

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[in Japanese]

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[in Japanese]

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This study aimed to clarify the views on work practices held by nurses working in the critical care field immediately after graduation and early in their second year. Data was collected in May and June in both 2017 and 2018. Interviews were conducted with the nurses, who were asked what they had become able to do and in what areas they lacked confidence. Their objective evaluations of their own practice as well as common issues were transcribed for analysis. Twelve nurses participated in the study. The interviews lasted 41.7 minutes on average. The analysis found that, when providing care, the nurses felt unsure and apprehensive as to whether their clinical decisions or nursing interventions were right for the patient. They appeared, therefore, to be gauging the appropriateness of their actions based on their colleagues’ reactions. They further built on their experience and acquired necessary skills by collating their own views with those of the senior staff. Because learning from the senior staff’s superior clinical decisions can turn knowledge acquired in the early days after starting work into explicit knowledge, our results suggest that a space is needed for the nurses to speak about and discuss their typical findings as second-year nurses with their work colleagues.

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[in Japanese]

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[in Japanese]

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