Purpose : The purpose of this study was to describe the strength, weakness, and community characteristics related to social isolation in older men living alone in an urban area. Method : The subjects were 20 older men living alone (primary Informant : PI) in an urban O high-rise apartment's district and Y suburban farm district in a metropolitan city, and 14 public health nurses, social care workers (Key Informant : KI). The study design was a qualitative induction research. The data was collected by semi-structured interview and analyzed from the viewpoint of the strength, weaknesses in older men and community. Result : The mean age of PI was 79.5 years, the mean period of livng alone was 8.4 years, and the mean period of professional experience of KI was 10.8 years. The theme of strength was "autonomy", the theme of weakness was "loneliness" in both districts. However, "socializing among neighbors and community" differed between two area: that of Y district showed <strong membership and kinship in community>, and that of O district was <weak membership and kinship in community>. Conclusion : In order to facilitate the establishment of the interrelationship among the older men living alone and their neighborhood in urban area, it is necessary to consider the interpersonal relationships between the elderly and their neighborhood in their community.

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Purpose : This paper examines the sufferings derived from social relations and the process toward symbiotic society experienced by persons with cervical spinal cord injury. Method : Semi-structured home interviews were conducted from April to August in 2009 with 29 participants dwelling in three prefectures. Transcripts were analyzed based on grounded theory approach. Results : Participants experienced dilemmas over internalized social norms that center on able-bodied persons and suffering from social interactions. They also experienced the process toward symbiosis that consists of restoration of able-ness based on social norms, objectification of internalized social norms and appeal of the worth of disability to society. Participants had possessed a sense of values as ablebodied persons and their perceived failure of observing social norms and others' discriminative responses to persons with physical disabilities brought them suffering. Participants tried to realize social inclusion by proving their ability to meet social expectations. However, some participants acknowledged their inclination to obey able-bodied-persons' viewpoints and they appealed to society to rethink negativelyshaped images of disabilities. Conclusion : This study implies that it is essential not only to support individuals who had strong orientation to able-bodied-persons' culture to reconstruct their identity but also to organize the community to develop inclusive social norms that put a value on disability is also essential.

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Aim : The purpose of this study was to describe the process in which lonely primiparae developed community-based interpersonal relationships with neighbors. Methods : The subjects were eight primiparae who were raising children of less than three years of old. They were asked by semi-structured interview about the child-rearing situation, the situation, ideas and feelings about interpersonal relationship from the time of childbirth to the present. The results were analyzed by using the inductive approach. Results : The process in which lonely primiparae developed interpersonal relationships with neighbors was divided into four stages. The first stage was, "Loss of raison d'etre by painful parenting and social isolation". Three to four months after childbirth, primiparae entered the second stage, "Impulse to get social relationships and growing interest in fellow mothers". After primiparae made friends with fellow mothers, they entered the third stage, "Extension of the world to participate and longing for true friends". Then they entered the fourth stage, "Stability of mind by true friends and expansion of consciousness of human relations surrounding parenting". Discussions : It was shown that the process in which lonely primiparae developed interpersonal relationships with neighbors is accompanied by a large conversion of sense of values. That is, they came to attach greater importance to the interpersonal relationships in the neighborhood than to family and conventional friends, as a place of the life in which to bring up a child.

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Purpose : To identify elements that constitute the dilemmas of public health nurses assigned to a municipal welfare sector and to clarify the relationships among these elements, focusing on the support of individual psychiatric patients. Method : The participants were public health nurses with more than 1 year of experience supporting individual psychiatric patients. All the participants were assigned to the municipal welfare department of "A" prefecture. The participants were questioned regarding 3 topics: 1) experience of dilemmas, 2) specific examples of dilemmas, and 3) contents of actual dilemmas and final decisions. A semi-structured interview was conducted, and the interview data were qualitatively analyzed using the KJ method. Result : Three elements of dilemmas were clarified: "My life will become intermingled with the life of the patient", "I must act without knowing the correct answer", and "I must perform tasks that fall outside my field of expertise." The interrelation of these 3 elements causes dilemmas. In other words, public health nurses recognize the significance of their effects on the lives of psychiatric patients, which conflicts with their lack of confidence or lack of occupational identity. Discussion : Dilemmas arise from the contradictory relationship between the actual situation of work in the welfare sector and the attitudes affecting psychiatric patients. To overcome these dilemmas, support and education to increase the recognition of the significance of public health nurse activities is important, so as to establish an occupational identity in the welfare sector.

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Aim : To identify changes in the parenting style among parents who participated in the individualized parent training program for parents of pre-kindergarten children with developmental disabilities and to evaluate the impact of the program on parents. Method : Twelve pre-kindergarten children with developmental disabilities and their parents participated in an eight-weekly program. After the program, we interviewed 12 parents using a semi-structured format. Results : The average age of the children was 37.9 ± 7.2 months. The changes observed in the parenting style after the program were classified as: changes in parenting behaviors and changes in parenting emotions. Changes in parenting behaviors consisted of 14 sub-categories such as "completely engaged with the child," "praised the child's positive actions," and "imitated the child's actions and sounds," respectively. Changes in parenting emotions consisted of 4 sub-categories such as "increased confidence while parenting," "enjoyed parenting," "decreased parenting stress," and "felt tenderness towards the child," respectively. Discussion : Based on the changes in the parenting behaviors, we considered the program to be effective due to the acquisition of parenting methods such as those involving positive parenting, those matching the child's learning and growth, and those increasing the interactions with the child. With respect to changes in parenting emotions, the program was considered to be effective due to the increase in parental self-efficacy, decrease in parenting stress, and increase in affection towards the child.

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Purpose : The purpose of this study was to verify the effectiveness of a learning outcome creation program by implementing a training course to improve the explanation skills of PHN. Methods : Eleven medium-level PHNs participated in a training course from the local government controlled by Healthcare Center A. We verified the outcomes by making measurements before and after the learning programs using three evaluation tables. The evaluation process included checking whether the essential stages of the changing process had been cleared, based on learning worksheets and transcripts from the training sessions. Results : The "skill review sheet to demonstrate the necessity and outcomes of activities" indicated improvement in at least 5 of the 39 items for all participants, with a mean value of 12.6 items per person. A significant improvement in the overall score was found in the "scale of capability to develop professionalism as PHN", as well as in "transfer and development of professionalism," "compliance with rules in activities" and "self-development of skills." As regards "self-assessment of skills to perform professional activities as PHN," a significant improvement was observed in the overall score and "community support and management skills." Furthermore, three participants aiming to improve "skills to demonstrate the necessity and outcomes of activities," as well as eight participants aiming for "establishment of professionalism," cleared the essential stages: "recognition of one's current status and challenges" and "preparation and execution of a learning plan." All participants recognized that explanation skills are indispensable for their activities. Observation : We found that the learning program effectively improved the explanation skills of PHNs of the local government. The program is therefore suitable for municipal in-service training.

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[in Japanese]

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[in Japanese]

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