Objective : This study aimed to develop guidelines in public health nursing practice for the promotion of preventive long-term care systems, and to investigate the validity and reliability of the guidelines. Method : In this study, we surveyed 1612 public health nurses at municipal and Community General Support Centers nationwide, and from that group we resurveyed 141 public health nurses after obtaining consent for the resurvey. The contents of the survey included items on basic attributes, the "proposed guidelines for public health nursing practice in the promotion of preventive long-term care systems" , and an evaluation scale for collaborative activities. Results : Valid responses came from 509 public health nurses and responses to the resurvey from 91 public health nurses. They were analyzed based on the factor analysis results of the original 42 guideline items. We developed 29 guideline items for public health nursing practice for the promotion of preventive long-term care systems, into 4 factors: (1) "laying the foundations for proactive involvement of citizens" ; (2) "strengthening preventive care activities through the evaluation and provision of information" ; (3) "understanding the needs for preventive care using various methods", and (4) "sharing the challenges and objectives of preventive long-term care." The cumulative proportion was 51.9 %, confirming the content validity. The Cronbach's alpha of all items in the guidelines developed was 0.95, and the Cronbach's alpha for each factor ranged from 0.80 to 0.90, indicating internal consistency. The interclass correlation coefficient was 0.83, indicating reliability. Conclusion : We confirmed the validity and reliability of the developed guidelines, consisting of 4 factors, and 29 items for public health nursing practice in the promotion of preventive long-term care systems. These guidelines examine the activities of public health nurses from the standpoint of system promotion and are expected to become indices for the development of targeted activities. The guidelines function as indices comprising specific features to promote preventive long-term care systems.

View full abstract

Purpose : The processes of unplanned readmissions among older patients were studied to gain information to be used for prevention of readmission. Method : Among all patients who were admitted to the internal medicine wards for circulatory or respiratory problems in an acute care hospital in a metropolitan area, 29 patients became study participants. These patients were 65 years or over, had an unplanned readmission within 6 months after a previous admission, and consented to participate in this study. In addition to a structured interview of the patient/family, information was gathered from medical records, physicians and nurses. Results : The reasons for readmission were classified as "unpreventable aggravation and adequate management after condition worsened", "perceived symptoms but no aggravation in underlying medical condition", "aggravation despite adequate care or management", and "unpreventable aggravation but inadequate management after the condition worsened". Conclusions : From these results, it can be considered important for prevention of readmission among elderly to provide adequate discharge guidance according to patients' condition, to coordinate a followup system with a community health care provider, and to encourage information exchange among health care providers.

View full abstract

Purpose: We investigated the occupational experiences of male public health nurses (PHNs) with respect to gender. Methods: Semi-structured interviews were conducted with 12 male PHNs working for local governments. We qualitatively analyzed 10 out of 12 transcripts in which PHNs narrated their experiences with respect to gender while working, in reference to the modified grounded theory approach. Results: The analysis suggested that while performing occupational activities, male PHNs went through various experiences such as having problems interacting with co-workers or clients, using strategies for these problems, being role models for male clients, and establishing their own methods for occupational activities. They particularly experienced difficulties providing care to female clients and mothers during the perinatal period. Furthermore, they faced difficulties providing care during home visits or telephone counseling. When they started their career, they were nervous about working as nurses. However, after gathering experience, they changed the perceptions of their own gender. Support from peers or co-workers was useful in continuing their career. Conclusion: The results suggested that male PHNs felt less recognized by co-workers and clients, and their being male made their occupational tasks difficult. However, support from female co-workers was instrumental in dealing with such difficulties and continuing their careers. Thus, it is expected that male and female PHNs should cooperate with each other.

View full abstract

Purpose: To investigate post-discharge problems recognized by parents of medically fragile children who received discharge planning during hospitalization and the reasons why the problems occurred. Methods: Three discharge planning nurses and 10 parents who were recipients of discharge planning by these nurses were interviewed. Interview data were analyzed using a qualitative descriptive method. Results: Post-discharge problems with medically fragile children and their families are "Problems concerning the physical condition and care of the child" and "Problems in living with the child". The problems were caused by "characteristics of medically fragile children," "parents situation related to caring for their child," "care provided by the hospital" or "lack of resources." Discussion: It was suggested that pre-discharge preparation in recognizing the post-discharge situation, a mechanism flexibly responsive to changing demands, continuing home care support by discharge planning nurse and out-patient nurse, increases in respite care, and support for siblings were necessary.

View full abstract

Purpose: To clarify the viewpoints of visiting nurses to support mothers caring for children with special health-care needs. Method: Participants were 6 expert visiting nurses working at a visiting nursing station for children with special health-care needs. A semi-structured focused group interview was conducted in September 2007. The interview data were analyzed using a qualitative descriptive analysis. The transcripts of the viewpoints were coded. Categories and subcategories were determined by comparing the coded summary. Results: The viewpoints of visiting nurses were divided into information assessed by nurses and the stances of nurses. The visiting nurses considered the following 10 categories to be important information: ability of the mother to provide care, acceptance of the child by the mother, maternal personality, maternal mental status, maternal physical condition, child's physical condition, child' s ability to understand and respond, family support of home care, family's intention to home-care nursing, relationship between the mother and nurse. The stances of visiting nurses were the following 3 categories: getting involved with mother and child in stages keeping pace with mother, sharing childrearing in the family's life, linking mother and society looking the long-term home care. Conclusion: It is important for visiting nurses to provide the following assistance: (1) understanding mothers' mental or living condition, (2) enhancing ability of the mother to provide care and family support of home care, (3) building relationship between mother and nurse keeping pace with mother and (4) linking mother and other organizations looking to long-term home care.

View full abstract

Purpose : To develop and evaluate a group-work program consisting of self care and community cohesion of elderly men living alone in the city, toward independent active life as long as possible. Method : The research participants were 12 citizens charged with the role of health promotion in a community and 22 elderly men living alone in the city. The interventional research method was conducted with the original group work session program, and consisted of mental health, physical health, and community cohesion based on the Deci's self-decision theory. Result : The effect of the intervention program on the self-efficacy for health promotion in communitydwelling had a positive tendency in 'Information collecting to preserve one's health' and 'acquaint oneself with people in the neighborhood, so as not to be isolated' from the baseline to the followup. Moreover, a significant rise was confirmed in the perception of importance and interest in the neighborhood and community from the baseline to the follow-up. Conclusion : It was suggested that the program made an effective contribution to the support network of the elderly men living alone and their community in the future.

View full abstract

Objective : This paper examines the effectiveness and significance of a program to encourage interaction among women in their 50s and 60s living in a new residential area. Methodology : The program was designed to raise awareness of proactive health promotion in community life, focusing on "daily mutual caring interaction," the core concept identified in a previous study as a typical factor for improving QOL among younger elderly women, and "daily mutual interest" and "empathic mutual understanding," two constructs of the interaction. Questionnaire surveys directly before and after, and 1, 6 and 12 months into the program were complemented by interviews directly after, and six months into the program, on attitudes toward interaction with community peers. Results and Discussion : Nineteen of the 24 participants, aged 59.47 on average (SD 4.98), responded to all questionnaire surveys. QOL perception showed a significant change after 6 to 12 months of the program in its psychosocial aspects, i.e. sense of happiness and social relationships, which may be attributed to the change of attitude toward daily life and interaction with community peers in the early months of the program. Participation in the program and voluntary group activities led to a proactive attitude looking 10 years ahead, as attested by friendship, attachment to neighbors and action based on a sense of mission as community members. Conclusion : The program proved to be effective at the individual, group and community levels, providing useful public health activities supporting the improvement and maintenance of QOL for middle-aged and elderly women.

View full abstract

Purpose: This study was conducted to examine the efficacy of an education program of smoking prevention according to the risk of future smoking. Methods: We provided an education program of smoking prevention for 548 first-year students (234 males and 314 females) attending three high schools of three prefectures in the Kinki region, and conducted questionnaire surveys three times: prior to, immediately after, and six months after the implementation of the program. Question items include gender, their smoking behavior, their expectation to smoke in adulthood, the confidence to refuse to smoke, the will to encourage others to stop smoking, and smokers' interest in smoking cessation. In the education program the authors grouped participants into three divisions (low-, medium-, and high-risks of future smoking) and assigned 50-minute lectures about smoking, group work sessions, and homework assignment to each group for assessing the effects of the program on their intention to smoke in the future. Results: In the low- and medium-risk groups there was little change in students' attitudes on smoking, except for boys' expectation to smoke in adulthood in the medium-risk group. In the high-risk group there were statistically significant improvements in the expectation to smoke in adulthood and smokers' interest in smoking cessation. Conclusions This education program had positive effects on the high-risk groups though it was not effective in improving participants'attitudes on smoking in the medium-risk group. These findings show that it is necessary to change the contents of education program for making high-school students have confidence to refuse to smoke

View full abstract

Purpose: This study aims to describe food preparation styles of son caregivers according to their employment status and to compare the intake of salt, dietary fiber and alcohol in the different food preparation styles. Method: A structured interview was conducted with 42 son caregivers from 26 community health care agencies. The "brief-type self-administered diet history questionnaire" was used to assess the participants' intake of salt, dietary fiber, and alcohol. Reterring the criteria, 40 participants' data were analysed. Result Among the 40 participants, 38 (95.0%) prepared their food by themselves, and 22 out of these 38 had previously been served in food preparation by their parents before they had started to care for them. More than half of jobholders mainly prepared ready-to-serve dishes, but most of the unemployed participants mainly cooked at home. Even though they cooked at home, the decreased intake of the excess ingestion and the dietary fiber of the salt and alcohol was at the same proportions as ready-to-serve dishes. Conclusion: While providing dietary instructions to son caregivers, it is important not only to encourage the ready-to-serve dishes, but also to give information on nutrition regarding salt, dietary fiber, and alcohol, with due consideration for the conditions of their working and caregiving.

View full abstract

Purpose: The number of students with possible mental problems visiting health room service personnel and seeking advice has been increasing. At the same time, more health room service personnel are experiencing difficulties in health counseling. This study aims to clarify the problems encountered and the current lack of methodology for producing favorable outcomes. Method: A semi-structured interview process was conducted with five health room service personnel at their small private university or junior college. Results: A total of 197 useful codes pertaining to health room service personnel's difficulties in health consulting were obtained from the interviews. Six core categories were extracted from the total codes. To clarify the core factors of the identified difficulties, these factors were categorized into three parts: 1) seriousness of students' mental health problems, 2) difficulties in obtaining understanding and cooperation of teachers and other school staff, and 3) difficulties in dealing with student mental health issues. Three approaches derived from the interviews to overcome the health counseling difficulties were: 1) support for student mental development, 2) buildup of cooperative relationship among teaching and other school staff, and 3) an organizational approach to student counseling. Conclusion: Health room service personnel clearly have difficulties in providing mental health counseling as such problems increase and the need for assistance grows. This suggests the necessity of more cooperation among everyone involved and an organized approach to student counseling.

View full abstract

Purpose : The purpose of this study was to clarify associated associate with stress and needs and social support for families with mentally retarded children, families with special needs education school of mentally retarded children. Method : We distributed anonymous personal response questionnaires to 594 members of families with mentally retarded children in special needs education schools, to be answered at home. A total of 453 (76.3%) questionnaires were collected, of which 436 (73.4%) provided valid responses. The questionnaire survey focused on affection and action support, sources of support, stress, and family needs. Items on sources of support and on family needs were analyzed by factor analysis. The data were analyzed by using t-test, one-way analysis of variance and Pearson correlation. Result : Higher scores of stress were associated with nuclear families and with the mentally retarded children going to hospital and having to take medicine. Their families had greater need for treatment information/consultation, and for people's understanding, and for a better treatment environment for autistic children and for those from 6 to 14 years old. Significant relations with mentally retarded children were found among 6-11 years old, and with going to the hospital and having to take medicine, and with families, were found to be the nuclear family, and mothers' occupation. For mentally retarded children's families, a positive correlation was seen in affection dynamic, active support, family, friends, the vicinity, the nature of education, the medical institution, and each related organization support. Discussion : The importance of people's information exchanges and a related organizations for mentally retarded children's families, was suggested.

View full abstract

Purpose : The purpose of this study was to characterize the experiences of bereaved family members with respect to how they perceived and attached significance to nursing visits in order to identify roles played by nurses when visiting bereaved families. Methods : Semi-structured interviews were conducted with 17 members of bereaved families who received visits from visiting nurses, and the results were analyzed qualitatively and inductively. Results : The results revealed that bereaved families perceived the visits in seven overall aspects and found significance in them as follows: "as a reaffirmation of their ties with other people in the form of the visiting nurse," "emotional stability," "closure of the time period during which their family member received care," and "for attaining the proper mindset to face their life ahead." Discussion : This suggests that nurses who visit bereaved families help the latter sort out their feelings following bereavement by providing care so that negative feelings associated with the care period are perceived in a positive light; by providing emotional and social support in coming to terms with issues related to care, in listening with sincerity to words of appreciation, and serving as a bridge for families as they resume their lives.

View full abstract

The purpose of this research is to elucidate the kinds of assistance techniques used in nursing within support groups for the mentally handicapped. Participation was observed and semi-structured interviews were conducted with five nurses that had participated as staff members in groups for mentally handicapped persons. Interview contents were analyzed both qualitatively and by examining various factors. Fourteen categories were elucidated regarding the "Group Assistance Techniques" given by the nurses to the mentally handicapped and to groups. Categories included the following:<Assist persons that draw one's attention>,<Protect the members>,<Assist self-expression>,<Assist the person's capability to self-examine and view things objectively>,<Promote growth>,<Acceptance as a member>,<Equal involvement>,<Assist participation in the group>,<Assist each person to be accepted as a member by the group>,<Promote mutual interactions>,<Protect the group structure>,<Manage group activities>,<Assistance for thinking within the group>, and <Tying group activities to other assistance activities>, These were divided into the following: {Techniques to support the handicapped person themselves} , {Techniques to link handicapped persons to the group}, {Techniques to link individuals}, and {Techniques related to the group of mentally handicapped persons}. The assistance techniques of <Promote growth> and <Equal involvement> were easily provided due to the group method and place. Nurses and other professions use the same techniques. But even in groups, the perception of the nurses centered on individual illnesses, handicaps and health, and assistance was given accordingly. The nurses give assistance to mentally handicapped persons as a continuous internal and external group, and throughout their assistance they are conscious of illnesses, handicaps and health. These techniques of assistance are unique to the nursing profession.

View full abstract

[in Japanese]

View full abstract

[in Japanese]

View full abstract