The number of home visits carried out by public health nurses (PHNs) has been decreasing. As a result, concern has focused on PHNs' declining ability to understand their clients. Therefore, the present study was conducted in order to clarify PHNs' recognition of home visits and factors to influence. Subjects were 7 backboned PHNs. Data collected during focus-group interviews were analyzed using inductive and descriptive methods. Using constructive conceptualization, data were classified into the following 6 themes : "Individual PHNs' recognition of home visits," "Significance of home visits," "Actual conditions during home visits," "Atmosphere of PHNs' colleague," "Atmosphere of their places of work," and "Continuing education after entry into practice." PHNs recognized the significance of home visits : However, their feelings became negative while conducting actual home visit activities. PHNs occasionally worried about the significance of home visits and their ability to provide adequate care during home visits. The following themes were identified as influencing PHNs' recognition of home visits : "Actual conditions during home visits," "Atmosphere of PHNs' colleagues," "Atmosphere of their places of work" and "Continuing education after entry into practice."

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The purpose of this study was to describe the experiences of public health nurses (PHNs) in outsourced infant health examination services, and to identify the implications of the role of PHNs in outsourced services and the factors necessary to promote effective outsourcing. Semi-structured interviews were conducted with 11 municipal PHNs who had participated in the activities of the infant health examination service before and after outsourcing. The data were then qualitatively analyzed. For the PHNs, their experience with outsourcing the infant health exam was "a process in which they realized changes in the wake of outsourcing and identified the meaning of outsourcing." PHN responses reflected three perspectives on their relationships with community members ; as member-to-be-protected, member-as-client, or member-as-partner. Three meanings of outsourcing were identified : 1) "it creates distance from community members ;" 2) "outsourcing is a way for survival ;" and 3) "it brings more resources to the community." The analysis suggested that three factors were most important to the PHNs : 1) the realization they needed to focus on relationships with community members and work more to understand their perspectives ; 2) the value of attempting to see the services with a broader perspective ; 3) that their responsibility was to check with community members to see whether the services were provided in a suitable manner. Outsourcing required their vision of practice to change.

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Purpose : The purpose of the present study was to develop a qualitative evaluation index on the empowerment process of residents' organizations, from the perspective of public health professionals. This study examined the credibility, transferability, and usability of the index. Method : The index was developed based on the results of preliminary research. Following this, the author conducted self-report questionnaires twice ; these questionnaires were mailed to public health professionals who supported community development in health promotion. The respondents were required to evaluate each residents' organization with the index, score the state of the community empowerment process, and evaluate the development of the organizations' activity in five stages. They were also asked to consider the usability of the index. The data were analyzed statistically with the help of descriptive statistics, correlation coefficient, and t-test. Results : The index was comprised 3 areas and 14 items. The first survey had 129 respondents (response rate: 33.3%), and 125 valid responses were analyzed. A total of 46 responses were studied (response rate : 12.0%). The credibility of the evaluation index was confirmed by significant differences in all 14 items at the beginning and end of the health professionals' support. Further, the applicability of the index was confirmed because 97.8% of the respondents in this survey answered that the index was useful for their practice, and 91.3% replied that the index was of practical use in their activities. Conclusion : The result of this study suggests that this index has high applicability for evaluating the empowerment process of residents' organizations.

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Purpose : This research examines the frequency of positive and negative care assessment which family caregivers give. Also, it analyzes which factors contribute to both positive and negative assessments. Methods : A questionnaire was administered to 176 family caregivers at home, who scored higher than 3 in a 5-rank nursing care insurance. A positive cognitive care-giving assessment was rated when the caregivers answered that they are motivated for continuing homecare(1-5 score). When the caregivers marked anxiety/insomnia(28 Japanese GHQ), which attest to low emotional health, it was judged to be a negative cognitive care-giving assessment. When the caregivers feel fulfillment, it was considered to be a positive answer, and when they feel burden, it was considered to be a negative answer. This feeling is thought to be a process toward cognitive assessment. Caregiver's attributions, Waki's Family Caregiver Coping Style, feeling fulfillment, and feeling burden, were analyzed using a multiple logistic analysis. Results : 1) High "motivation for continuing homecare" and low "anxiety/insomnia" occupied 29.2% in the total. 2) The group displaying high motivation for continuing homecare showed a correlation to a feeling of fulfillment, while they did not show correlation to feeling burdened. The group claiming an anxiety or insomnia presented a correlation only to feeling burdened. Also, when the results were looked at in light of Coping Style, the group having high motivation for continuing homecare showed a correlation with Point of Problem-Focused Form of Coping.

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Purpose : The purpose of this study was to investigate diffidence in proficient public health nurses who conduct self-evaluations of community-focused nursing. Methods : Subjects were seven public health nurses with 6-10 years of experience at prefectural health care centers and were also experienced in developing community-focused nursing for those suffering from mental disorders based on individual support. The data were collected using semi-structured interviews. Diffidence is defined as "a feeling mainly occurring due to self-consciousness and insecurity wherein one does not trust or respect their own judgment, competence, and skill, leading to low self-esteem." In addition, qualitative, inductive analyses were conducted. Results : Based on the data, even the proficient public health nurses working at health care centers and building networks and organizations for mental disorder patients were found to be diffident. Diffidence included "worry and anxiety about collaborating with health care, medical and welfare workers," "difficulty in building a network among health care, medical and welfare workers," "difficulty in maintaining organization for those concerned about patients with mental disorders," "strain and anxiety of developing mental health nursing in the community" and "pain and anxiety in smoothly supporting individual cases." Discussion : We consider that the diffidence of the proficient public health nurses was self-questioning about their judgments and actions from the perspective of ideal competence and proficiency. Moreover, the diffidence of these proficient public health nurses appeared to be a self-evaluation of their judgments and actions with reflection about how to provide better support. It was suggested that it is important that the proficient public health nurses evaluate their own competence adequately, and that the support organization of chief nurses and colleagues should provide guidance and advice to these proficient but diffident nurses.

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Purpose : This study examined the importance and value of the behaviors and meanings, perceptions of public health nurses (PHNs) in settings of mass health checkups for elderly. Methods : Semi-structured interviews were conducted with 4 PHNs with at least 5 years of professional experience regarding the behaviors and meanings, perceptions of PHNs during health checkups. Behaviors were analyzed based on the stage and progress of the health checkups and whom the meanings of the behaviors were directed, while perceptions contributing to the behaviors were classified and organized into broad categories. Results : Among the 136 behaviors, "contact, report, confirm"-were observed during all process of health checkup. The 222 meanings of the behaviors were showed to : facilitate efficient, safe, and relaxed health checkups ; encourage relationship building among people ; and promote healthy behavior among local residents, community leaders, and health professionals. It was possible to classify the 22 instances in which it was good or useful as a perception that contributed to behaviors into 7 categories, and to classify the 12 hopes for the future into 6 categories. Discussion : The PHNs were constantly aware of the flow of the examinees in the conduct of health checkups as a whole, and they made an effort to play the role of a coordinator. They also had multiple intentions at the same time, and they put into practice activities that combined assistance skills and techniques. Seven points were suggested in terms of the importance and value of the high engagement levels of PHNs, including: "smooth conduct of health checkups," "deepening of relationships with residents," "getting to know the community," "identification of needs and tasks," "results of activities," "development and expansion of activities," and "introduction of administrative services."

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Purpose : The purpose was to clarify the meaning of independence in the elderly living alone in a rural community and to obtain the suggestion of the ideal way of the independence support of the elderly living alone in the future. Subjects : The total subjects were 26 persons consisting of 16 elders living alone (primary informant) and 10 professions (key informant) in A rural area in Tohoku in Japan. Methods : The qualitative research methods by micro ethnography was used. Data was collected by the semi-structural interview with the research question "what is the meaning of independence in the elderly living alone in rural community?" and the data was analyzed by using the method of a qualitative induction analysis. Results : Two main meanings of independence in the elderly living alone in the rural community ; <maintaining of dignity for own will and life> and <living together the nature and people of community> were detected. Moreover the former includes "Self decision-making," "Advance-directives," "Self-help to the living alone life," "Own role and task in everyday life," "Vitality enough for living alone life," and "Acceptance of reality and having emotional independence." The latter includes "Dignity to the rural community culture," "Rural community organization," "Living arrangement in the small community," and "Adaptation to the rural nature." Conclusion : It is necessary for elders living alone in the rural community to develop the health promotion program based on their cultural meaning of independence.

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The purpose of this study was to clarify the characteristics of community-oriented nursing as practiced by expert public health nurses by exploring actual nursing practice with nurses' intentions. The study examined 7 nursing task related to public health programs. The data were collected to evaluate the nature of with nurses' intentions and conducts, in order to clarify the characteristic of the nurses' overall practice. In this study it was assumed that nurses' conducts are oriented to nurses' intentions. Expert public health nurses evaluated the practice of nurses that had practiced for at least 5 years. The study demonstrated the following characteristics that community-oriented nursing practice to illuminate nurses' intentions. 1) In health promotion and illness prevention, nurses take on the obligation to define the needs of the individuals, families, and populations. 2) Nurses feel that they are accountable to the public as a whole. They have to focus their attention not only on the populations that are served for the public health program but also on those that are not. 3) Nurses try to improve the health of individuals, families, and populations by delivering health care in partnership with community members and other organizations. 4) Nurses emphasize the need to develop an advocacy role in community-oriented nursing practice on the basis of national and/or prefectural polices. These findings suggest that nurses need to describe their intentions and conducts in order to clarify the characteristics of community-oriented nursing practice.

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Objective : The objective of the present study was to identify problems related to "meal preparation" among husband caregivers providing care for their wives in elderly couple households. Methods : Home visit interviews were conducted on 38 husband caregivers in elderly couple households in a ward of metropolitan Tokyo. Subjects were classified into the following two groups based on the independence of their wives with regard to "meal preparation" for Instrumental Activities of Daily Living (IADL) : Group I, "capable" of meal preparation ; Group II, "incapable" of meal preparation. Implementation of meal preparation and problems faced by subjects were then compared. Results : Regarding implementation of meal preparation by husband caregivers, no problems were reported in Group I. However, in Group II, problems related to meal preparation and contents were reported in cases in which husband caregivers were incapable of or unaccustomed to meal preparation. Wives in the cases were dependent with regard to IADL, but independent with regard to ADL such as eating and toileting. Discussion : These findings suggest that problems related to meal preparation by husband caregivers tend to arise at the point where their wives may still be independent with regard to basic ADL, but become incapable of meal preparation. It is thus necessary to provide early support for the maintenance of appropriate eating habits and performance of household and caregiving tasks among husband caregivers.

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Remote islands have original life customs, culture, dialect and thinking attitudes. It is necessary for Public Health Nurses (PHNs) to have a basic understanding of these, but it is difficult for PHNs who grew up in a different culture or another prefecture. So, using Cultural Nursing Research methods, in particular, by studying the local historical background through conversation with residents, we were able to make a Chronological Table for people in their 50's showing their changing social history and diet. From this table it is possible to understand how these changes affect their present lifestyles. Our main information, the life history of four Clerks, was gathered at the town office in the Island M of Okinawa Prefecture and investigated thoroughly. We could understand the reasons for residents' bad life style through this method. In complement to the Analysis of Health Statistics, this method made it possible to understand residents' Real Lives.

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The purpose of this study was to identify the family care giving for elderly households by their separately living children and to discuss the support for the elderly and their children in an under populated region. The study participants were 2 single elderly and 4 couples households during a one-year period. Their daily lives and the support they received from their children who lived in different households were investigated. What help they needed and how we could support them were discussed. The results of the study were as follows ; the frequency of visits by their children varied, some of the support areas from children were helping with shopping, financial support, housekeeping, farming, and decision-making. Helping accessing services, support for the children, support for the decision making about family care giving, support from the neighbors, home health care service, financial support were some of the areas that these families needed assistance. The children visited their parents through out the week. "Commuting Care" is a suitable expression for this situation. Furthermore the term "Commuting Family" is also a suitable expression for the family. Support for commuting care and the commuting family were as follows : helping accessing services, support for the child's health, support for the elderly and their separately living family members by a care-manager, public health nurses and nurses, home care service for the elderly in order to keep their health and daily life, financial support, support networks with neighbors in the community.

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Purpose : Health promotion volunteers (HPVs) who are members of community health organizations have been fostered and supported by municipal administrative officer including public health nurses in Japan. The purpose of this study was to clarify the association between the recognition for the relationship between HPVs organization and administrative officer on the activities, and the condition of the activities, the consciousness of the activities and the recognition for the involvement from administrative officer to the activities. Methods : The subjects were 600 HPVs in two cities in a prefecture. A mail-in self-check questionnaire survey was conducted in November 2004. The questionnaire consisted of items on "the condition of the activities," "the consciousness of the activities," "the initiative on the activities," and "the involvement from administrative officer to the activities." Results : A total of 449 questionnaires were analyzed (valid response rate: 74.8%). HPVs who recognized that "HPVs organization held the initiative on the activities (initiative of HPVs organization)" and "HPVs organization and administrative officer held the initiative equally on the activities (equal initiative)" felt more pleasant and challenging, and lower difficulty and burden on the activities, and evaluated higher to the activities than HPVs who recognized that "administrative officer held the initiative on the activities (initiative of administrative officer)." Besides, HPVs who recognized as "initiative of HPVs organization" and "equal initiative" were concerned more with the problem of the community than HPVs who recognized as "initiative of administrative officer." Moreover, HPVs who recognized as "initiative of HPVs organization" and "equal initiative" felt the involvement from administrative officer to the activities more affirmatively than HPVs who recognized as "initiative of administrative officer." Conclusion : The result suggested that it might be the desirable relationship on the activities that HPVs could recognize not as "initiative of administrative officer," but as "initiative of HPVs organization" or "equal initiative."

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