The purpose of the study was to provide insight to the decision making process that Japanese patients and their families undergo when considering heart transplants in the US(via travel for transplantation)and to illustrate the interactions and decision making patterns between the patient and his or her family. The study used a grounded theory approach. Participants were interviewed in an unstructured environment, using semi-structural interview and monitoring techniques to collect data.
The participants observed consisted of six families:five patients and ten family members. Our study revealed that there were two patterns revealed in the four steps decision-making process during the interactions between the patient and his or her family, and six influencing factors. The first pattern showed where only the family made the decision. The second pattern was where the patient and family arrive at a decision together;these decisions were not always reached in the same fashion. The interactions between the family and patient revealed the following:a. Both the patient and family agree to move forward with the transplant;b. The family reaches a decision to move forward with the transplant before the patient decides to do the same;c. The patient reaches a decision to move forward with the transplant, and persuades the family to support him or her in that decision. Understanding how patients and families reach these decisions at each step will help organize a supporting structure.

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The purpose of this research is to clarify the patients' experiences of patient-controlled analgesia for post-operative pain. I performed semi-structured interviews with 30 patients whose post-operative pain management has been effected via PCA, and who have pushed PCA buttons on their own, and then I conducted content analysis.
According to the analysis, the main merits of PCA for the patients are that there were analgesic effects, patients did not have to be concerned with medical staff, and they got faster response to their pain than they did via other analgesic methods. As for primary negative outcomes, patients had anxiety about analgesics and refrained from pushing the PCA buttons, recognizing that they had to self-manage their pain, analgesics and side-effects. As one of the patients' experiences of PCA orientation, there are numerous explanation before having operations and the patients could not receive pre-operation explanations because of their fear of operations.
In Japan, since effective PCA orientation has yet to emerge, further consideration regarding what is to be explained, and when and how to give explanations will be necessary in the future.

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The purpose of this study is to clarify the present conditions and problems with the kind of support is provided for a families waiting during operations. We conducted an unsigned questionnaire of 975 hospitals which have more than 300 beds as well as their anesthesia department. The survey was carried out from January through February in 2006. Together with the questionnaire, we attached documents describing the objectives of our research, adding that answering the questionnaire was voluntary and we would not publicly disclose the names of the institutions for ethical reasons. In advance, approval was obtained from the Ehime Prefectural University of Health Sciences Ethical Review Board. We received responses from 556 hospitals out of the 975 surveyed, a response rate of 57.1%. Of these, only 42 hospitals(7.6%)offered the some kind of support for families waiting during operations, while remaining 508(91.4%)have none at all. After all, less than 10% of the hospitals which answered our questionnaires offered some kind of support. By supporting families waiting during operations, nurses can meet the need of those families and improve their nursing quality as well as enhance the nurses' sense of effectiveness. The problem is whether medical staff including doctor could be more aware of this and cooperate in supporting these families.

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[in Japanese]

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[in Japanese]

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[in Japanese]

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