Purpose : The goal of this study was to examine the factors involved in care giving, determined through self-evaluations by the caregivers. To clarify social service utilizations according to differences on the self-evaluation, and to consider the most adequate social support for family caregivers was also our goal. Method : The subjects were 85 family caregivers of elderly people at home who used visiting nursing services in "City A" in Yamagata, Japan. We conducted a questionnaire survey collected by mail. We analyzed the basic attributes of care, the caring situation, informal support, and a self-evaluation of the care giving. Visiting nurses described the ADL situations of the elderly in the questionnaire. Items on the caregiver's self-evaluation of caring were classified into seven categories. The caregivers evaluated the necessity of each item on a five point scale. We divided the results for each item into two groups : a "can do" group (do-group) and a "can not do" group (not-group). The examination of the various related factors was based on the mean values on the self-evaluation and analyzed separately for the do-group and the not-group. Result : For the items concerning "Walking and the Wheelchair movement help" and "Communication Devices" the average of the do-group was lower. Concerning informal support, the satisfaction ratings for "Family Caring Cooperation". "Friend's and Rotative's Cooperation", and "Emotional Support from Family Members" were significantly lower for the not-group. In regard to social services, the not-group indicated a lower desire for "Home bathing services", "Home help services" and "Respite care". However, the desire for "Loans and provision daily life tools" and "Caring allowance provision" was relatively high. Conclusion : The not-group only wanted to use the material and economical support side of social services. The not-group did not wish to use the human support services and did not feel as much satisfaction with the informal support. We found that it was necessary to give technical support to the not-group while preventing isolation.

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Objectives : The objective of this study was to examine the effects of reminiscence interventions by home care nurses on their elderly bedridden clients, with regards towards increases in self-esteem and positive self-expression. Methods : Home care nurses encouraged eighteen elderly bedridden clients to talk about their past positive experiences during their ten weeks of visits. The conversations between the elderly in the intervention group, the nurses, and those of another 16 elderly bedridden clients in the control group were recorded before and after the intervention. The frequency of both groups' verbal expressions were averaged at 10 minute intervals, then compared to verbal expressions both before and after the intervention. Both groups were measured concerning self-expressions of gratitude, their emotions, laughter, egos, pride, life views, acceptance of their present status, desires, demands, and symptoms. Nurses measured the level of self-esteem on both groups then. Results : After ten weeks, the intervention saw a significant increase in frequency for the intervention group's expression on "acceptance of their present status." The rate of improvement on subjects on the self-esteem scale, "being confident in myself with a variety of good nature" was significantly higher in the intervention group than the control group. The total score on the self-esteem scale for the intervention group increased significantly after the intervention, especially for the two items, "being confident in myself with a variety of good nature" and "being capable to do things as well as others." Conclusions : The reminiscence interventions by home care nurses for their elderly bedridden clients were effective on reacquiring positive self-recognition and the encouragement of conversations with their nurses.

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This study aimed to develop a way to measure practical competences for public health nurses working for local governments, and to establish systematic continuing education programs based on actual competence requirements. Public health nurses working for local governments in four prefectures were provided with self-administrated questionnaires by mail. A total of 3,024 questionnaires were delivered and the 1,614 responses were analyzed. Practical competence for public health nurses involved two factors : "Interpersonal health care competence" (IHCC) and "Community health care and administrative competence" (CHCAC). IHCC included individual and family support and means of group support. CHCAC included community activities, policy-making, and administrative and educational performance. For reliability, they had Cronbach alpha coefficients of 0.97 (total) and 0.96 for IHCC of CHCAC respectively. For criterion-related validity IHCC had a correlation coefficient of 0.54 and CHCAC one of showed 0.63. Therefore it was concluded that measuring practical competence for public health nurses had reliability and validity.

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Purpose : This study was undertaken to examine how families deal with difficult situations that arise while caring for a dying family member in the home. This study also examined the characteristics of strategies that family members employed, the path followed through this kind of experience, and the nursing interventions used for support. Subjects and Methods : The subjects of this study were the families of 6 patients who received terminal care at home and were discussed during case report meetings held from 1998 through 2001 by the K Prefecture Home Visiting Nurses Study Group. The six home visiting nurses in charge of these patients were also subjects of the study. Qualitative analysis of the care provided by the patients' families was performed by extracting those parts of the meeting case reports related to the family coping, as evaluated by the nurses. Furthermore, the nursing interventions which were made to support the families were also analyzed. Results and Discussion : 10 family coping strategies were extracted, including 'offering emotional support', 'improving capability for self care', 'playing the role of care providers', 'self-expression', 'giving up', 'dependence', 'uneasiness', 'accepting death', 'adherence to familial devotion' and 'accepting the patient's will'. The core family coping strategy was adherence'. The strategies, 'accepting the patient's will' and 'playing the role of care providers' were based on that core strategy. These strategies supported the other strategies mentioned above. Furthermore, 11 nursing interventions which promoted familial involvement were identified, including 'approval', 'assurance', 'acceptance', 'listening', 'waiting', 'reinforcing', 'remaining involved', 'receiving', 'sympathy', 'devotion' and 'instruction'. On the basis of the core coping strategy 'adherence' and 'expertise knowledge and skill', the nurses intervened with the others in support of 'balancing care', with the goal of 'remaining involved'. The families investigated overcame the difficult situation they faced (terminal care of a loved one) with various strategies and through the support of nursing interventions. Of the 5 families, 4 continued to care at home for the sick person until death occurred, and 1 continued caring for the sick person at home until a few hours before death.

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The aim of this research was to clarify the factors related to the abuse caregivers' inflicted on seniors at home in need of care, and to examine what relations existed between the personal distance that caregivers keep from the seniors and the abuse. The intended subjects consisted of fifty-three caregivers. Twenty-seven of them were abusers and the remaining were not. We conducted two types of researches; 1) a questionnaire about whether they have abused seniors or not and why they inflicted the abuse, 2) "Personal Distance Test for Caregivers" (called "Personal Distance Test" for short below) that grasps in the projective technique the psychological distance that caregivers keep from care-needed persons. The "Personal Distance Test" is practiced as follows: in the various situations of supposed care, the subject will arrange the "caregiver card", which has an image of the caregiver on it, in the most suitable position he/she thinks on a square plate. There is also an image of a senior in the center of the square. This square is representative of a room containing both the caregiver and senior. The examiner then measures the distance between the image of the senior and the caregiver card. As a result of the questionnaire, we found out that more of the care-needed seniors who were abused showed symptoms of dementia and were highly independent. More of the caregivers who had abused care-needed persons answered that they had heavy burden of caring and had poor personal relations to the care-needed seniors. As a result of the Personal Distance Test, we found subjects could be roughly divided into two groups according to how they kept their distance personally. The first group is the inside type who put the caregiver card inside the room (the frame) where there are seniors, and the second is the outside type who put the card outside the room (the frame). The inside type subjects tend to keep a distance to the seniors in the case that the subjects generally need to bear active relations to the seniors, and to approach them in the case that the subjects are stimulated emotionally. As for those of the outside type, we observed that many of them had committed the abuses, such as desertion of care and abuse through ignorance. Furthermore, we categorized the subject's patterns of keeping a personal distance into four types through cluster analysis ; 1) Senior-centered, 2) Caregiver-centered, 3) Close, and 4) Distant. In the group of abusers, the Distant type and the Caregiver-centered type were dominant. In the case of the spouse's care, the Close type was dominant, and in the case of the daughter-in-law's care, the Senior-centered type was also dominant. When we tried to understand the personal relationships between caregivers and care-needed seniors, which is one of the factors of senior abusing, the viewpoint of personal distance can be an effective way to grasp the relations between them, and also give clues to the early discovery and prevention of abuse.

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[in Japanese]

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In the society with the aging population and falling birthrates, what is required for the nurse engaging in community health nursing is primarily quick response, enhanced collaboration, ethics and moral and most importantly, self-discipline ability to response to drastically changing social demands. We have tried a learning method for improving the self-discipline ability of nursing student including integration of knowledge, skill, attitude, and moral. This learning Method mainly focuses on the curriculum of field work across all three year-terms. For the 1st grade students, we intended to improve the education of affective domain and deployed an early exposure to nurture the student's needs-orientation. This time we evaluated their early exposure, activity and revealed how it is effective to improve the self-discipline ability. Eighty-four students of Shimane Nursing College were chosen for that purpose. They submitted reports on the training in the course of the fieldwork, and we evaluated the education effect by categorizing, analyzing, and assessing the reports on each coursework using KJ method. The evaluation was carried out about 4 points : 1) Selection of coursework, 2) Learning situation : categorized into 10 iterms in term's of needs assessment, 3) Acquisition of affective domain : categorized into 3 items, 4) Self-disciplining coursework : categorized into 3 areas. As a results of the early exposure in the field, we found the following tendency : 1) The students learned about self-realization of people, necessity of mental assistance, and the detail of relevant institutions or social resources. This gave the students opportunities to learn the people's needs required to be met in local nursing care. 2) The student's learned much about the diversity of value senses. This improved the education effect on affective domain. 3) The self-discipline coursework the students selected was generally divided into 3 domains: the cognitive, psychomotor and affective domain, It is evident that through the early exposure intended for the students to acquire the affecive domain, they recognized the necessity of self-discipline in the other domains, too. Therefore, it can be said that early exposure is an effective learning method for student nurses to nurture self-discipline ability in community health nursing education.

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Purpose : China is undergoing an extremely rapid rate of aging of its society, but its present health care system is far from being perfect to satisfactorily support the present elderly society. It is our purpose to give a desirable prospectus of the health care system for the elderly through an analysis of the present status of health care, welfare and economic aspects of the elderly people in China. Methods : By collecting information from currently available statistical reports from Chinese government or academic organizations, we delineated an aging pattern of Chinese society, the health and economic status of the elderly, the burden put on the caregivers, and the consumption pattern of available social resources by the elderly. Results : The characteristics of the aging Chinese society can be summarized as follows : 1) prolonged average life span and low birth rates due to the one-child policy resulting in a drastic aging within the population structure ; 2) while the establishment of health care system was delayed due to the inadequate economic growth, a rapid aging, process emerged ; 3) a rise in the morbidity of chronic diseases and an increase in the number of disabled elderly in need intensive care ; 4) proportion of the elderly living with children has been decreasing due to the rapidly increasing nuclear family and the less positive attitudes toward supporting parents has resulted in a weakened informal support system for the elderly. Therefore, a desirable prospectus for the elderly health care system was considered to consist of 1) cooperation between the health, medical and welfare systems ; 2) abundant supply of the in-home care providers and construction of residential care facilities ; 3) education and support of the elderly for the prolongation of a healthy life expectancy ; and 4) prompt development of training systems for the personnel to coordinate the health care system in the community. Conclusions : For China it is necessary to develop a health care system of its own through an establishment of a social Security system taking the Japanese revolution of health, medical and welfare systems as a preceding model.

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