Purpose: The purpose of this study was to identify the relationship among job retention, work empowerment, job difficulties and work engagement in administrators of visiting nursing stations. Method: An anonymous self-completed questionnaire survey was conducted among 2,882 administrators of every other visiting nursing station registered in each prefecture randomly selected. The following items were surveyed: demographic characteristics of visiting nursing stations and administrators; work empowerment; job difficulties; work engagement; and intention to remain in their present position. It was hypothesized that work empowerment has an indirect effect, through job difficulties and work engagement, on intention of administrators to remain in their current jobs. Structural equation modeling was used to investigate causal relationships among relevant variables. Results: The administrators' perceived work empowerment had an indirect effect, through job difficulties and work engagement independently, on their intention to continue in their jobs. Job difficulties had a stronger influence on intention to continue than work engagement. Conclusion: Findings of this study suggest that in order for administrators to continue their duties, it is essential to reduce job difficulties by improving their work empowerment.

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The aim of this research was to clarify how Japanese women cope with physical and mental affliction and distress when they experience stress, their social relations and assistance seeking behaviors leading to resolution, to consider the cultural attributes affecting the health of Japanese women, and make suggestions for nursing intervention. Semi-structured interviews were carried out and an analytic ethnography was conducted among 12 Japanese women. As a result, four core themes of social relations were extracted: unbalanced family life, distorted parent-child relationships that have longstanding effects, beneficial social interaction, and continuation of social relations wherein true intentions are not revealed. These are thought to be influenced by the Japanese culture of honne and tatemae (the contrast between a person's genuine feelings and the opinions they display in public ) as well as traditional roles of the sexes and marital companionship. As for assistance seeking behavior, three core themes were extracted: rational inhibitions about disclosing one's troubles, decision-making to resolve problems and active self-resolving of problems, suggesting that Japanese social values represented by the culture of shame have an influence.

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Objectives: This study aimed at clarifying the factors associated with people's belief in the possibility of remaining at home at the end of life in semi-urban (City A) and rural (Town B) areas in Japan. Method: A questionnaire survey was conducted by mail to residents using age classification random sampling in City A (N = 1,800) and Town B (N = 1,800) in Japan. We performed multivariate logistic regression analysis on semi-urban and rural groups while using all potentially significant predictors that were identified by the univariate analysis (p < 0.05). Results: A total 620 subjects in City A group (34.8%) and 493 subjects in the Town B group (29.0%) completed the questionnaire. 117 (18.9%) in City A and 68 (13.8%) in Town B believed in the possibility of remaining at home at the end of life. City A residents who had knowledge of the end of life medical care resources in the community (OR = 3.28, 95%CI : 1.94-5.53), were confident about the cost-saving aspect of home care (OR = 0.33, 95%CI : 0.18-0.61), thought that their community members would help them in care giving (OR = 2.09, 95%CI : 1.11-3.90), and had experienced bereavement during the last five years (OR = 0.55, 95%CI : 0.34-0.89) were more likely to believe in the possibility of remaining at home at the end of life. Among Town B resident, the ones who perceived end of life home care positively (OR = 2.88, 95%CI : 1.58-5.23) thought that their community members would help them in care giving (OR = 2.67, 95%CI : 1.40-5.08), and had experienced bereavement during the last five years (OR = 0.52, 95%CI : 0.29-0.93). Conclusion: The factors related to belief in the possibility of remaining at home at the end of life differed in semi-urban and rural areas. In order to foster residents' belief in the possibility of remaining at home at the end of life, specific intervention might be effective in each community.

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Purpose: Patients with neurological diseases who receive care at home may require a variety of services provided by community resource organizations. This study aimed to describe the coordination efforts of public health nurses (PHNs) who help these patients receive good care from the relevant organizations. Method: Six PHNs who had experience in supporting home care patients with neurological diseases participated in a semi-structured interview. Interview data were analyzed qualitatively and quantitatively. Results: Coordination activities by PHNs were extracted from the interview data and divided into 4 categories and 28 subcategories. The categories identified skills used by PHNs: 1) to facilitate mutual understanding between patients, their families, and resource organizations, to make base of support-network; 2) to introduce patients to appropriate organizations when they need support; 3) to support the coordinators from outside the framework of the system; and 4) to support relevant organizations in continued care by keeping their strong ties. Discussion: PHNs worked with patients and their families to determine the necessity of care by community organizations, and worked with community organizations to better understand patients. PHNs recognized the importance of key persons who lead to the necessary support. Other important roles of PHNs were to support organizations in the continued care of patients and to support the independent work of the coordinators. If PHNs are given the resources to develop these activities, they can network and liaison to improve the environment and accessibility to services for patients with neurological diseases who receive care at home.

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Objective: To examine the effectiveness of Group Triple P (GTP) administered to parents of children with developmental disorders by public health nurses Procedure: Twelve parents of children with developmental disorders were assigned randomly to Group A, which underwent GTP intervention, and to Group B, which underwent no intervention. Group A just after intervention was compared with Group B as the control group by evaluation index. Group A just after intervention was also compared with one month after the intervention and three months after. In addition, the combined Group A and Group B was compared before and after intervention. Results: The control group showed no change, but Group A, which had undergone intervention, showed a tendency toward improvement of the parent's loquaciousness and the child's emotional symptoms. Group A was more significantly improved in depression one month after intervention and in depression, lax child-rearing and excessive response three months after than just before intervention. The combined group was significantly improved in the total scores and excessive response of Parenting Scale (PS), and in the total scores and stress of Strength and Difficulties Questionnaire (SDQ), compared to that just before intervention. Discussion: GTP produced significantly effective improvement in PS, SDQ, stress and depression. Though this study had the limitation of a low number of subjects for examination, GTP was suggested to be an effective support method for the parents of children with developmental disorders.

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Purpose : The purpose of this research was to identify public health nurses' thought processes used in support for setting client's lifestyle improvement goals in specific health guidance. Method : In Survey 1, interviews were held with 19 public health nurses. They described their thoughts on support for client's life style improvement goal at the first time of the specific health guidance. The interview data were transcribed verbatim and analyzed by Modified-Grounded Theory Analysis. In Survey 2, 11 public health nurses were divided into 2 groups and each group was interviewed concerning the validity of the analysis results of Survey 1. Based on it, the results of Survey 1 were modified. Results and Discussion : The thinking process of public health nurses was comprised of self-empowerment process consisting of "imagining a client holistically", "sharing health problems with a client", "extracting the desire for lifestyle improvement" and "supporting for setting lifestyle improvement goals" ; and a core process consisting of "having insight into a client's mind" and "considering how to proceed with the interview". It was found that public health nurses regarded the core process as important, especially at the first interview.

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Objective : This study aimed to analyze information-sharing difficulties and factors during discharge planning for stroke patients being transferred from acute phase hospitals to rehabilitation hospitals. Method : A questionnaire was conducted with 590 acute phase hospitals. Respondents were categorized as "Having difficulty", "No difficulty" and "Neither" with sharing information. The associations between difficulty of information-sharing and the contextual factors - "general information about the hospital", "coordination", "acute phase hospital factors from management's perspective", "acute phase hospital factors from the staff's perspective", "cooperative partner" and "patient and family" were analyzed using a rank order logistic regression analysis. Results : 139 (23.6%) of the hospitals were analyzed. Compared to "No Difficulty" hospitals, "Having difficulty" hospitals were more likely to have ability difference concerning discharge planning among staffs (β= -1.872, p = 0.001) and lack of understanding by staff about the function of rehabilitation hospitals (β= -1.474, p = 0.009). Conclusion : Efforts are needed to better inform and educate the medical community including acute hospital staffs about the functions and roles of different facilities and institutions.

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[in Japanese]

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