The purpose of this study is to clarify and define strategies of public health nurses who are involved in supporting and empowering the community members in order to organize health promotion schemes. Semi-structured interview was used. The interviewees were 12 expert public health nurses on 10 groups of community organization. The data were analyzed by inductive and descriptive method. Specific contents of the support and empowerment by the nurses were divided into 7 steps. Twelve categories and 50 sub-categories have been extracted from the processes. Seven steps found as follows; Step I : To set up goals in order to solve individual and community health problems by supporting them in organizing. Step II: To take a leadership role in guiding community members to agreement for the goals. Step III: To delegate the community members leadership role for health promotion gradually. Step IV: To lay groundwork for the community members to achieve the goals. Step V: To promote sharing the needs for health promotion among community members. Step VI: To instruct the community members in achieving the goals. Step VII: To work in cooperation with the community members for the goals. Supports characterized through the processes of empowering community members by public health nurses can be described as follows; ・supports community members in identifying potential needs and taking action. ・supports community members in realizing the importance of organizing themselves. ・supports community members in launching and managing their organization. ・supports community members in establishing community care system. Community organization was expanding its health promotion activities by utilizing human and social resources offered by public health nurses. This study indicated that these supportive activities, which were characteristic of public health nurses, were very effective for health promotion. The suggestion here was that the characteristics were notable on each step and that the outcomes would give a kind of framework for the health promotion activities by the community members.

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Today, some men are taking part in providing elderly care, as Japanese society has many elderly people and more Japanese women work outside the home. This study is intended to help specialists in clinical care support male caregivers engaged in excretory care at home, and investigate what kind of hesitation and acceptance male caregivers feel in providing excretory care. This study was based on semi-structured interviews, which were analyzed in quality. The subjects interviewed were 11 male caregivers providing excretory care. Those interviews showed that their hesitation was derived from four types of feelings. They were "disgust related to excreta", "hesitation influenced by conventional ideas about excretory care", "unacceptable feelings in their relationship to the care-receiver", and "hesitation about excretory care itself". In further inquiry, conspicuous among male caregivers are the following : 'they have an impression that woman's genital areas are unclean', 'they think that excretory care is given by people of low status', and 'they think that excretory care is given by women.' These three are from "hesitation influenced by conventional ideas about excretory care." And 'they think it inappropriate to provide excretory care for women.' These thoughts arise from "unacceptable feelings in their relationship with care-receivers." It seems that these thoughts of male caregivers are deeply influenced by male chauvinism, which has been based on social standards and conventional thinking. Moreover, the kind of feelings that would facilitate male caregivers acceptance of giving excretory care were clarified. They are five kinds of feelings : "affection for care-receivers", "sympathy for care-receivers", "acceptance of inevitability of excretory care", "feelings of being rewarded for efforts in providing care", and "pride of the way they provide care". Although male caregivers provide hesitant care, they can accept excretory care, and are concerned about it. For future support, it is necessary to reduce the disgust and hesitation disclosed in this study by introducing deodorants into excretory care and by providing health education. It is also necessary to praise the efforts of male caregivers and to make them feel themselves appreciated in order to facilitate male caregivers acceptance of giving excretory care.

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We conducted the survey of child abuse case studies on 8 families whom we assisted in a public health center in Tokyo and 17 families of children institutionalized in a child care center in Kanto area. We analyzed family problems experiencing child abuse based on the framework of family living capacity. After analyzing each case by using Assessment Scale of family living capacity and family system theory, we described the summary in a short paragraph, and classified into 6 groups ; (1) abuse occurred due to mental disorder, results in living difficulty, (2) unhealthy couple relationship makes problem solving difficult, (3) weak living structure causes neglect, (4) birth without family formation, and abandon of child rearing immediately after the childbirth, (5) vague generation boundary makes problem solving difficult, and (6) abuse occurred because of unmature family. We prioritized child protection first, and then studied measures for various types of family problems. As a result of measurement of the family living capacity by using "Assessment Scale of Family Living Capacity," family experiencing abuse had lower family power, especially there were significantly lower scores in "role reassignment and complement competency" and "relationship control competency." There were 21 abuse-cases in which either of 9 areas of the scale was 0%. It suggests we need to study family living capacity to support an abuse case. Limitations of this study were a small number of cases, and biased abuse severity and selected agency. We need to accumulate data from community health and welfare agencies.

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Purpose : As the child health care community groups to transform the focus of its health checkups from merely detecting illness to promoting the health of children, there is also a great need for a system which properly deals with maternal anxierty and the underlying needs which manifest it during this stressful time for mothers. This research will utilize a model of "maternal anxiety" during the 4th month infant health examination to clarify the relationships between elements of this phenomenon and its structure. Method : 945 mothers of infants undergoing their 4th month health examinations who were living either in 12 cities were asked to complete a self administered questionnaire which asked questions about basic character traits, subjective symtoms of anxiety, parenting philosophy, coping behavior and social support. A structural model for "maternal anxiety" was established, and the distributed structure analysis software Amos 4.0 was utilized for analysis (SPSS11.0J). Results : The weighted coefficient for "maternal anxiety" was shown to be 0.97 (NH=0.871, RMSEA=0.043) based on the 4 latent variables in the hypothetical model. Almost all "maternal anxiety" experienced during 4th month infant health exams was determined by "parenting awareness and confidence". Whereas "child care support" did not directly determine "maternal anxiety", it did heighten "self affirmation" and "parenting awareness and confidence". Conclusion: The results of this research suggest that the most effective means of minimizing maternal anxiety and promoting self maturation through the child raising experience is to strengthen the mother's sense of self affirmation by teaching has to perceive child raising in a positive light and to heighten her confidence as a mother. It is additionally important to strengthen child care support in order to encourage appropriate coping behaviors.

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While importance of community-based activities for maternal and child health has been increasing, its developmental factors have not been identified. The purpose of this study is to clarify and identify these factors by analyzing findings through case study of community-based pioneer projects for maternal and child health. The study includes analyzing data collected through the reports of projects, the questionnaire survey and the interviews with the project leaders. The factors which are important for development for maternal and child health care, as this study indicated, are as follows ; 1) to discover potential needs in early stage, 2) to fully utilize present community organization, 3) to develop communication among the people concerned, 4) to assure human resources, 5) to encourage further involvement by community residents, 6) to promote further understanding by governmental administrators, and 7) to seek for financial support. Specific way to realize each factor is also presented.

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To investigate the physiological and psychological stress of a family caregiver providing home care, this study focused on intermittent waking to provide nighttime caregiving. Seventeen nighttime caregivers (eleven women and six men/66.2±8.4 aged) and eleven daytime caregivers (ten women and one man/62.6±13.0 aged) were investigated using a 24-hour self-reporting record, 24-hour circadian rhythm of rest-activity recorded by an Actigraph, 24-hour ambulatory blood pressure, and the Cumulative Fatigue Symptoms Index-Housewife questionnaire, and as well as direct interview. Many nighttime caregivers were elderly wives of the person requiring care, while many daytime caregivers were their daughters-in-law. Many nighttime caregivers helped the impaired elders urinate using a bedpan and woke two or three times during the night. These caregivers felt less rested than daytime caregivers. They also had less drop in blood pressure at nighttime than daytime caregivers. Especially, many nighttime caregivers taking medication had persistent high systolic blood pressure during the daytime and nighttime. Nighttime caregivers did not feel much fatigue. There were some nighttime and daytime caregivers who were not taking medication who demonstrated high blood pressure during the daytime or nighttime. These results suggested that nighttime caregivers need to become more aware of fatigue and regain physiological and psychological balance, and control of 24-hour blood pressure by giving careful consideration of nighttime caregiving in cases receiving anti-hypertensive therapy. Family caregivers providing home care need to monitor the potential for development of hypertension, preventing its occurrence if possible.

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This research aimed at identifying and clarifying the essential supports for occupational health nurses to enhance the quality of their nursing activities. The empirical result of this study is based on a questionnaire survey that was directed at 250 occupational health nurses, working in the Tokyo metropolitan area. The respondents were inquired about the problems and difficulties they have encountered in their daily nursing practices. The results gleaned from the 130 usable responses are as follows: 26.8% of the respondents are found to have 'extremely difficult' problems. Another 57.5% are faced with 'considerably difficult' problems. On the other hand, 13.4% of the respondents are observed to confront with 'not very difficult' problems. 2.4% of nurses have 'no problems at all'. Related factors were analyzed by a multivariate logistic regression model in which demographic data and learning opportunity were set as independent variables and the existence of the problems as a dependent variable. The existence of problems was related respectively to insufficient nursing experience, no in-house leaning opportunity or participation in the lecture held by the Occupational Health Promotion Center. Six core categories, 16 intermediate categories and 32 small categories along with 188 phrases were extracted from the content analysis on the comments that were made on 91 returned questionnaires. Core categories include following items : 1) difficulty arising from activity skills, 2) insufficient assistance and supports by peers at work, 3) lack of learning opportunity and supervision, 4) organizational restraint, and 5) insufficient scope and quality of the activities allowed, and so on. The findings of this research suggest that it is essential to enhance the quality of occupational health nursing to improve the working environment of the nurses, including systematic nursing skill education, to foster capable supervisors, and then to actively promote the social roles of the occupational health nursing, hence improving the public awareness of this particular issue.

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Purpose: This research is to make the self-efficacy evaluation index of the elderly people who became non-correspondence of long-term care insurance to participate in support care service which is one of the nursing prevention projects. Methods : We conducted a focus-group interview involving 16 people who participated in day-service programs, which formed part of a living-support project, in two regions of F Prefecture. Twenty-three items were extracted to be used in the self-efficacy. We then conducted to survey of 103 people who participated in day-service programs in F and H Prefectures, using the 23 items from the interview and general efficacy scales in order to evaluate reliability and validity. Factor structure of the evaluation index was determined using factor analysis and reliability was analyzed using the Cronbach α coefficient. Criterion-related validity was analyzed by determining the correlation to general self-efficacy score. Results : We analyzed the interviews with focus groups based on Bandura's study, and created self-efficacy context consisting of 23 items. We excluded six questions with factor loading of less than 0.5, as well as some similar questions, resulting in 16 remaining items. The coefficient of reliability of these 16 questions was determined as 0.92. The association between the criterion-related validity and general self-efficacy showed a significantly positive correlation (r=0.54, p<0.05). Based on these results, a self-efficacy evaluation index consisting of 16 items of questions was designed. The 16 items divided into two factors, and 7 items were named "self-efficacy of the life maintenance", 9 items "self-efficacy of the living activation" and the second factor items.

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This study attempted to elucidate the life feelings of the frail elderly living alone under home care services. A grounded theory approach was chosen for the research design, and the data were subjected to qualitative and inductive analysis. The participants consisted of 12 elderly individuals who receive services under a home-visit nursing care program. Semi-structured interviews were conducted to collect the data. The study yielded the following six categories : (1) Pride in one's past life, (2) The hardship of solitary living, (3) The guts to continue to live alone, (4) A feeling to accept present oneself, (5) Daily bonding with people in the surroundings, and (6) Encouragement through family existence. The relationship between some of these six categories is as follows: 1) The elderly swing between (2) and (3) and self-adjust their life through the feelings of (4) and (1). 2) Getting along with others as indicated in (5) is a supportive feeling in daily life. 3) The meaning of the family in regard to these feelings was brought out by (6). These results indicate that in nursing the elderly it is critical to have them recognize the role of family ties and that they themselves can make adjustments.

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The purpose of this study was to clarify how care managers' practice related to the active selection of services in the Long-Term Care Insurance. The subjects of the study were 20 care managers that belonged to agencies in H city. The care managers participated in semi-structured interviews about the explanations of their roles to their clients, the way of selecting services, the problems that could not be solved by Long-Term Care Insurance, and ideas for improving care manager's work. Regarding their roles, 14 care managers explained that they made care plans and coordinated services. They provided support to their clients about the selection of services based on the understanding the clients needs and their family's intentions and the clients' physical condition. They also advised their clients to observe the different services and use some pamphlets before choosing a service. Twelve care managers planned the care while they talked to clients. Ten care managers had some experiences of disagreement with their clients about the care plans. Eight care managers hoped for some chances to study Long-Term Care Insurance to exchange information about it. Care managers tried to encourage their clients to choose services actively. In this situation, it is very important to provide chances for care managers to discuss service selections with other care managers.

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The purpose of this study was to explore how the occupational health nurse develops her intervention in health promotion by analyzing her intervention. The method was that intervention by the occupational health nurse belonging to T Company for 26 years was analyzed qualitatively through interviews and the literature. Also, using the content codes of the interventions, the items were extracted in each of the five action strategies and the year-to-year changes were analyzed. The result was compared with cases, which were reported as the pioneering health care activity in the community. As a result of these analyses, we found the following : 1) 427 content codes were extracted from the nurse's interventions and 26 items according to the five action strategies. 2) By analyzing the year-to-year changes, it was found that the occupational health nurse's interventions grew from individual care to group care and further organizational approach consisted of the approach to the whole organization and that to the groups surrounding the individual. 3) As health leaders were fostered and transformed by these approaches, the occupational health nurse's interventions developed into those in cooperation with the health leaders. Furthermore, as the leaders had a favorable influence on the company workers, the occupational health nurse promoted the reciprocal action among them. 4) These interventions were similar to those of the community. It would appear that the occupational health nurse drew the company workers' needs and social needs, went hand-in-hand with the national polices, and embodied the personal and the organizational approaches. As mentioned above, we could present a model of the occupational health nurse's intervention in health promotion.

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