This study aims to clarify family difficulties and nursing encountered when a patient with cerebral stroke induced consciousness disorder leaves the ICU for a general ward. Respondents to the survey were selected from people who visited hospitals because their family members had undergone emergency surgery. Seven individuals gave written consent to cooperate in the research. We joined and observed the families when they visited the patients in the ICU and when they were being informed by doctors, and conducted a semi-constitutive interview with them three times after the patients left the ICU. We also acquired some data from medical records. We then made a qualitative analysis using a phenomenological approach referring to A. Giorgi's method. The result indicated that the transition period when patients were moved from the ICU to a general ward was classified into four periods:preparatory period for the transition, starting period of the transition, duration period of the transition, completion period of the transition. We also found that the families tended to have the following thoughts in the transition period: " Thoughts about the life and treatment environment of patients," "thoughts about the consciousness disorder, " " thoughts about family life and hospital life," "thoughts about image of patients" and "thoughts about the economic burden." The tendency of the thoughts that the families had in the transition period was clarified by constructing a "structural diagram of the thoughts that the families of consciousness disorder patients had in the transition period," which schematically presented the essential meaning of each of the four periods.

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This study was intended to investigate and identify, from the viewpoint of resilience, factors assumed to affect QOL of those early-stage breast cancer patients in their adult life stage who were within 30 months after having received breast surgery. For this purpose, a questionnaire survey composed of such items as QOL-ACD, GSES, SRS-18, Resilience Scale and personal attributes was conducted by means of mailing the questionnaire form to 150 patients. The answers were collected from 110 people, out of which valid responses were 93(response rate:84.5%).
First, by applying a hierarchical multiple regression analysis method the author observed and studied the changes of the decision coefficient R2 in order to check each factor for the explicability. As a result, it was proved that Positive Future Orientation provided a positive influence on the QOL-ACD total score as well as on the Physical condition, Psychological condition, Social attitude, and Face scale QOLs. It implied that paying attention to the patients' resilience is a significant contribution to considering the assistance of the improvement of the patients' QOL.
Logistic regression analysis revealed that in terms of QOL enhancement the following factors are implied as affecting to the QOL:daughter's support(OR=4.24)had significant relationships with the activity QOL;less Anxiety Concerning Failure(OR=3.30)and daughter's support(OR=2.56)with the physical condition QOL;less Anxiety Concerning Failure(OR=6.12)with the Psychological condition QOL;more Positive Future Orientation(OR=4.88)with the Social attitude QOL. No significant relationships were observed with the personal factor or disease factor.

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The study of 206 critical care nurses who are working more than 3 years was conducted to asses how critical care nurses's perceptions of critical care family needs and to investigate the association of relation factors. Data were collected using Critical Care Family Needs Inventory-Japanease edition(CCFNI-J)translated by the authors, the Emotional Empathy Scale(EES), the Social Rericence Scale, and the Twelve-Item General Health Questionnaire(GHQ-12).
The results showed that critical care nurse's perceptions of critical care family needs were classified 3 group; "perceptions of crisis group" (15.8%), "perceptions of middle group" (49.1%), and "perceptions of present satisfaction group" (35.1%). In perceptions of crisis group, about half(51.8%)were nurses of below the age of thirty. And in perceptions of present satisfaction group, nurses of forty and over accounted for 26.7%. Perceptions of crisis group were higher sensitivity for emotion scores(p<0.05), perceptions of middle group were higher Social Rericence scores(p<0.05), and perceptions of present satisfaction group were higher coldness scores(p<0.01)than other groups. Nurses's perceptions of critical care family needs have a relation to nurse's personal factors.

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[in Japanese]

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[in Japanese]

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The objective of this study was to specifically clarify the nursing practice of nurses with expertise in intensive care units(ICU), as well as to respond to recurring doubts about the "lack of nursing roles in ICU."
This study followed a qualitative approach using participant observation and semi-structured interviews.
In the present manuscript(Part 1), we elucidated nursing practice and its characteristics in response to the process of changes following heart surgery.
The results indicated that the nursing practice of nurses with expertise in ICU is comprised of "prevention of life-threatening situations," "adjustments for the promotion of functional independence," and "guidance toward the resumption of activities of daily living." In addition, characteristics were identified with regard to interpretation of physiological data. Specifically, nurses with expertise in ICU 1)applied these data to the detection of pain in patients and 2)were simultaneously prepared for measures against both the critical situation at hand and the possible critical situations that may follow, to thus prevent life-threatening situations. The above interpretation of physiological data among nurses with expertise in ICU indicates integration of care based on a perspective of caring, and involves functions unique to these nurses.
These results indicate a model of ICU nursing practice that establishes a smooth process for postoperative changes. In addition, issues in ICU nursing from the perspective of applying data from advanced medical equipment were also considered, and will be discussed in the next manuscript.

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In the present manuscript(Part 2), we elucidated the uniqueness of ICU nursing practice in hospitals specializing in heart surgery from the perspective of its relationship to advanced medical equipment, with a focus on responses to the process of weaning off mechanical ventilation.
As with the previous study, this study followed a qualitative approach using participant observation and interviews.
The results indicated that ICU nursing practice involved an orderly approach for promoting independent respiratory function. Specifically, nurses with expertise in ICU focused on emotional changes during endotracheal intubation, and attempted to encourage patients to breathe independently while recognizing and responding to pain, which tended to increase. This was part of the "adjustments for the promotion of functional independence" described in the previous manuscript. Nurses with expertise in ICU prepared in advance for measures against possible situations that may follow, in order to realize nursing practice for promoting independent respiratory function as described above. Nurses developed this stance by predicting possible situations that may follow in relation to events at hand based on data from advanced medical equipment.
Approaches for applying data from advanced medical equipment in nursing practice are difficult to share in ICU.
The present findings, which specifically demonstrated "when and where" events occur in ICU nursing practice, were thought to lead to sharing of the focus and intentions of ICU nurses and to enable nurses to recognize aspects of nursing in their actions.

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Traditionally, nursing practice in critical care settings has been focused on recognizing and addressing the needs of the patient with an acute and critical illness. However, family also needs crisis intervention and we should focuses on recognizing the needs of individual family members.
The purpose of this study is to review the literature from 1996 to 2006 that has examined needs of relatives in foreign countries and compare the review of foreign countries with Japanese. The ultimate goal of the review is to determine our usefulness for nursing practice in critical care and make the future theme clarify.
Studies about family needs in circumference stage of surgery were six cases out of 60. In our country, also there was a little study that treated scheduled operation with total 30%. As for the assessment tool, there was the most study using the original and a translated sentence of CCFNI. In our country, there was the most study that used CCFNI which removed the item which did not adjust to Japanese culture. Both domestic and foreign, the place of sampling was confined by ICU and CCU. In addition, study aimed for grasp of need held half abroad and agreed with a trend of our country.
In both domestic and foreign, there was a little study to relate to the patient and was aimed for an operation and nursing practice of concreteness to family needs. Therefore investigational need to be depended in future, and to enable presentation of nursing practice was suggested.

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