The purposes of this study are to develop an index to assess professional support for family groups with the mentally ill, and to compare support until initiated time with support at the present. We grasped the details of support by interview to professionals who supported family groups actually. Questionnaire items based on interview contents were devised. We conducted a nationwide survey using the items. Subjects of this study are one professional who supported the family group until initiated time and one professional who support the group at the present each eligible group. Eligible groups were 150 community-based groups all over the country that were initiated after 1990 with professional support. We selected 23 items having the same factor structure to compare support until initiated time with support at the present. The assessment index consisted of 6 factors and 23 items was developed. These factors were considered kinds of support. The kinds of support were as follows support for mutual aid, support for social action, support for running by members, co-running and co-leading, coordinate of the group and community agencies, personal support. We examined validity and reliability of the index. Support until initiated time was compared to support at the present using the index. The result indicated that support until initiated time was carried out more intensive, especially 'support for mutual aid' and 'co-running and co-leading'.

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Purpose : We conducted this research to classify the contents of visiting nursing care and to clarify the difficulty ranking regarding the kinds of visiting nursing care from the knowledge, judgment and skill, furthermore to study the methods to utilize the above results. Methods : The subjects were 118 visiting nurses and public health nurses with five years and more experience who were selected as expert nurses by the research team members. The survey was conducted by mailing questionnaires regarding the difficulty level of visiting nursing care. The classification of visiting nursing care made in this research includes large classification (14 items), medium classification (45 items), and small classification (130 items). In the each small classification, a) observation and judgement, b) care implementation, c) patient and family teaching, and d) selection, procurement and preparation of materials were established as method of nursing care. Total numbers of the items were 491. The degree of difficulty was established in three levels from high to basic. It was established that the higher the item marks, the higher difficulty was. Results : 1) The number of effective answerer was 104 (88.1%). Average age of the subject nurses was 46.6 years old. 2) The order of the difficulty in 14 items in the large was classified four groups. The most difficult care were terminal situation and problems in cognition. The second care were medical treatment, communication, and problems of the family and caregiver. The third care were psychological and social problems, vital signs, problematic signs, living environment, sleep, ingest and excretion, use of social resources, physical functions and ADL. The fourth care were medication and examination care, skin problems and cleanliness. 3) The order of total average marks of the degree of difficulty by nursing methods was (1) patient and family teaching, (2) selection, procurement and preparation of materials, (3) observation, judgment, and (4) care implementation. This shows the characteristics of visiting nursing that were different from the nursing in facilities. The results mentioned above are applicable to the following two points. The first is the possibility to apply to the field. They are utilizable for clarifying the capacity to accept patients from the difficulty of the patients and staff conditions, assigning patients to nurses according to their proficiencies, and staff mix system in working schedule. Contents and their order in educational program can be decided based on the difficulty of kinds and methods of nursing care. It can be clearly said that education should be done step by step from basic contents to ones that require higher specialty and that what should be emphasized and reinforced for methods of nursing care.

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The purpose of this investigation was to comprehend the health behavior in young people who lived in the rural communities and their mental health state. The investigation was executed in February, 1999. One thousand one hundred and fifty-three young men and women who lived in four towns in the northwest of Shizuoka Pref. were extracted at random, and the questionnaires were distributed. The age of the young people were from 18 to 29 years old. They answered it in unsigned. Six hundred and thirty-one people answered the questionnaire, and 602 complete answers were targeted in the analysis. The results were as follows. There were the questions concerning sleeping, taking breakfast, smoking, drinking alcohol, exercise, eating between meals, the body figure, and taking the health examination regularly. And the General Health Questionnaire (GHQ) 12 items in Japanese was used to measure the psychological condition. The ratio to which four in eight health behaviors were executed was only 59.8%. Few men and women took the exercise customarily ; men's ratio was 33.3%, and women's one was 21.3%. Moreover, the custom of eating between meals was abundant with the men and women ; men's ratio was 53.5%, and women's one was 81.0%. The ratio of the person who smoked the cigarette of the man was 55.9%. There were differences in the health behaviors between men and women, and the women had selected healthier behaviors than the men. Only 27.1% of the housewife and the part-time workers took regularly the health examination. In those who smoked, the person from whom smoking became a custom in the age of the junior high school and the high school was 30.9%. The 39.7% of the people were poor in their mental health state. The result of logistic regression analysis indicated to take breakfast every day, to sleep for seven-nine hours and feel their body figure to be fit as items to forecast on the psychological condition. From the above-mentioned results, the mental health state in the young people was not good healthy, and it was admitted to relate in their health behavior and the mental health state. When the health care professional talks with young people about their lifestyles, the young people's mental health state should be considered carefully. The health promotion program concerning exercise, eating between meals for the young people, and concerning smoking for the young men might be necessary. It is necessary to execute the education against smoking from an early stage in the elementary school.

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The purpose of this study is to reveal the activities in Safety Management of Occupational Health Nurses (OHNrs) who should contribute to worker's health and safety and to consider the roles of OHNrs in Safety Management. The OHNrs' activities in Safety Management were shown by reviewing the reports of Journal of Occupational Health and of Japanese Nursing Association, and the roles of OHNrs in Safety Management were discussed by reviewing the papers of American Association of OHNrs Journal and of The Japanese Journal for Public Health Nurse. The followings were found : 1. OHNrs were not usually involved in Safety Management. 2. It is necessary for OHNrs to work upon various unsafe behavior factors, i.e. psychological factors, physiological factors, evironmental factors, working factors, management factors and education factors. 3. "Behavior Based Safety" is an important approach in Safety Management for the future activities of OHNrs.

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The purpose of this study was to focus on advocacy as the main method of promoting health, to analyze the process of advocacy conducted by Community Health Nurses (CHNs), and to consider the CHNs' role in the transformation of health behaviors. The subjects were 25 CHNs involved in 25 cases : 21 public health activity cases in local governments (reported as interchange promoting projects of pioneer public health activities by the Japanese Nursing Association), 3 cases promoting model project of resident-joint community health activities, and one as healthy community planning project. Questionnaires were sent to the subjects to investigate the responses to and the changes in each of the 5 health promotion means created by the CHNs advocacy, the transformation of health behaviors, and the makeup of local mnnicipalities. Though there were 14 valid answers (56,0%), we analyzed 13 cases from which the process of the CHNs' advocacy could be identified. The results were : (1)The processes of the CHNs' advocacy were categorized into 5 groups, in which the way to develop the activity seemed to reflect regional characteristics and needs. (2)Many of these activities were often developed by the critical minds created through the CHN activities. The CHNs influenced people concerned with policy making such as the heads of local governments. They also supported the residents' own activities. Situations having an impact on the persons concerned and model projects also promoted additional activities. (3)In the advocacy process of the most successful health promoting activity the CHNs continued talking with residents from the very beginning of the activity and developed the activity with them as partners in policy making. (4)The transformations of the residents' health behaviors were often identified in the activities which succeeded in promoting health. It was suggested that the CHNs' advocacy toward promoting health had something to do with the transformations of the residents' health behaviors.

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The purpose of this study was to describe nurses' judgement in elderly home care. We regarded this judgement in terms of the reasons why nurses decided to provide the nursing care for elderly persons. The subjects were 11 public health nurses and 9 visiting nurses who cared for the same elderly persons and had more than 4 years of experience. Semi-structured interviews were tape-recorded and data obtained were categorized according to the reasons for nursing care. The results were as follows. Eight categories were derived from 600 cases : 1. To maintain the health of all members of a family ; 2. To maintain family caregiving on a continuous basis ; 3. To improve QOL, 4. To respect the person cared for and their families' feeling ; 5. To smooth human relations in a family ; 6. To help clients use social resources well ; 7. To support clients as home care teams ; and 8. To find more effective means for supporting. These findings suggested that nursing care judgement concerning the elderly at home was based on reasons directly linked with care goals, reasons as to means to achieve care goals, and reasons involving the care effectiveness or efficiency.

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Purpose : Elements essential for providing home care and the abilities required of visiting nurses in order to provide home care were analyzed, focusing on the concept of promoting the personal growth of the people involved, which is a major function of care. Methods : The subjects of this study were 6 visiting nurses who provided care at home to 6 nonvoluntary clients and who were included among the subjects of the case review meeting for fiscal 1998. The nurses' oral presentations to the meeting were written down as faithfully as possible, without added interpretation. The printed records were then confirmed and corrected by the presenting nurses. The data thus obtained were analyzed by the content analysis, with an emphasis on studying changes in the patients and the nurses. The result of analysis were compared with the 8 elements proposed by M. Meyalov, to identify the kinds of abilities required of visiting nurses Results : (1) In addition to the 8 concepts which M. Meyalov described as essential elements (knowledge, changing rhythms, endurance, honest, reliance, humility, desire and courage), the following 10 elements were also extracted : listening to what others say, acceptance, adjustment, acting as a spokesperson for others, empowering, intentional participation, unintentional participation, remaining involved quitting and approving. (2)Of the 8 elements pointed out by M. Meyalov, "knowledge" and "changing rhythms" were found to be particularly important in this study. Four nurses whose knowledge was in sufficient or not well defined, the quality of the nursing care they provided was determined by whether or not they made active efforts to get adequate or clear knowledge. Changing rhythms was found to have two aspects (attempting other method and stopping certain actions). (3)Of the 10 additional elements revealed by this study, four (intentional participation, unintentional participation, remaining involved and quitting) were particularly characteristic. (4)Although the relationships between the visiting nurses and the care receiver varied greatly from case to case, and no universal features could be deduced from them, it was found that the nature of the relationship did affect the quality of care.

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Purpose : The purpose of this study was to identify the determinant factors of "the subjective well-being of the caregiver (mainly the mother) with a child receiving in-home high-technology medical care" ("family subjective well-being") such as home oxygen therapy and automated ventilator etc. and also to elaborate strategies for the maintenance and improvement of the subjective well-being of the family membera. Methds : This study was a secondary analysis of "the questionnaire survey for the evaluation of quality of life of family members" performed in 1997 by the committee for the evaluation of home care system for children organized in Osaka prefectural medical association. The questionnaire consisted of 4 groups of questions : (1)demographic characteristics of the family, (2)life status of the family, (3)changes in the child after the initiation of the in-home care, (4)changes in the family members, and each answer was scored or categorized for further analysis. We selected "satisfaction with the in-home care" ("satisfaction") and "good estimation of the effect of the in-home care on the family members" ("good estimation") as the representative items of "family subjective well-being". Results : We performed multiple regression analysis using these items as dependent factors and as independent factors, such items as yielded significant simple correlation coefficients. As a result, "satisfaction" was defined by "good family relationship", "expansion of social activity", "approval of the spouse", and "good estimation" was defined also by "good family relation", "expansion of social activity", and "the presence of siblings". Further multiple regression analysis setting "good family relation" as dependent factor showed that "degree of utilization of social resources", "reduction of physical strain", "increase in time for conversation between the father and the family" and "the presence of siblings" were the significant determinant factors. Conclusion : Thus the present study suggested that "the family subjective well-being" was shown to be better influenced not only by "the reduction of physical strain of the mother as the main caregiver" through "the utilization of social resources", but also by "good family relationship" which was derived from "the presence of siblings" and "positive participation of the father" to the in-home high technology child care.

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[in Japanese]

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[in Japanese]

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The social and economic backgrounds require patients to remove from a hospital to their homes. Under this situation, a nurse works as an assistant who helps public institutions or home health agencies perform their duties provide appropriate care for patients at their home, which are required by laws. So, if a patient suffers from negligence of a nurse, an employer of the nurse is liable for damages under Civil Code Article 415 or 715. Through medical (nursing) malpractice cases, this author foresees what kinds of nursing malpractices a nurse does in providing care for patients at their homes. In conclusion, a nurse needs more professional knowledge and technique to protect patients' interests than a nurse in the hospital does.

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The purpose of this study to clarify the relationship between acceptance of illness and aging and a sense of well-being through the daily life activities in the frail elderly at home. We examined 27 cases of the frail elderly who received care from visiting nurses based at two visiting nurse stations in H city. Individual interviews consisted of semi-structured questions were tape-recorded and the grounded theory approach was used for analyzing. The results of this study Were as follow : 1. Three structures of life activity were found to be associated with a sense of well-being ; basic life activity, social life activity and creative life activity. 2, The frail elderly were found to be divided into two groups with respect to their awareness of their illness and aging ; those who accepted their illness and aging and those who did not. 3. There were four patterns of lifestyle found ; who have creative activity and accept their illness and aging, who have creative activity and accept their illness and aging and don't, who want creative activity and accept their illness and aging and don't, who don't have creative activity and don't accepted their illness and aging. 4. The four elderly who experienced both self-actualization and self-acceptance had the social support of family, friends and volunteer in the community in addition to welfare services provided by the health care system.

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