Establishment of systematic continuing education programs based on actual competence is needed. This study aimed to clarify practical competence for public health nurses. 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 1,829 responses were obtained, of which 1,614 (53.4%) were analyzed. The practical competence scale consisted of 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 in "community activities", "policy-making" and "administrative and educational performance". Practical competence developed with career novice.IHCC developed rapidly in beginner nurses, and gradually after that. For CHCAC, "community activities" developed in a manner similar to IHCC. "Policy-making" and "administrative and educational performance" developed slowly with experience. The nurses evaluated IHCC items higher than CHCAC items. The self-evaluated average of practical competence differed significantly in four career groups. From these results, we consider that, in systematic continuing educational programs for public health nurses, developing IHCC is important for novice nurses, and developing policy-making competence is for middle-level nurses.

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Objectives : The purpose of this study was to identify whether the personal growth of the bereaved elderly women due to loss of their husbands and their acceptance of social support are related to life satisfaction or not. Methods: A cross sectional study was conducted on 351 women aged 60 and older in F prefecture. The survey questionnaire included demographic data, Life Satisfaction Index K (LSIK), the personal growth scale for the bereaved, the emotional and instrumental social support provided when they had experienced loss of their husbands and participated the survey, self reported status of health and income, the depressive mood and difficulties for living when husbands died. Among 279 eligible subjects for analysis 153 bereaved women and 126 not bereaved were statistically compared. Results : No significant difference in LSIK scores was observed between the bereaved and not bereaved. However, self reported status of health and income were positively related to LSIK. Among bereaved women those with emotional support from the family significantly high scored in LSIK than those without. However, no correlation of LSIK with the personal growth was observed. Those having experienced depressive mood and been emotionally supported, and had difficulties for living when husband had died showed more personal growth than the bereaved who had not. Conclusions : Keeping good status of health and income, and having emotional supports are important to improve life satisfaction of the bereaved elderly women. Coming over the difficulties with social support when they experience loss of husbands will encourage the personal growth.

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Purpose: The purpose of the present study is to develop a long-term care risk assessment scale for the elderly to identify young elderly individuals who are at a higher risk for requiring long-term care. Methods: Reexamine the items defined in earlier studies, a draft scale consisting of 8 concepts and 46 items was prepared. In order to determine the attributes and concurrent validity of the draft, a mail-in questionnaire survey was conducted using the following two groups of elderly individuals living in municipalities with populations between 30,000 and 300,000 : elderly individuals aged 65-74 years who had been certified as requiring support by the current Long-term care insurance system; and gender-matched elderly individuals in the same age group but with an age difference of within three years who did not require long-term care. Results : A total of 339 valid responses were analyzed (valid response rate : 38.3%). Based on correlated items, total correlations and factor analysis findings, a scale consisting of 7 factors and 28 items was obtained. The cumulative contribution ratio following factor extraction was 53.6%. The validity of the scale was mostly confirmed by a comparison of the scores between two groups and the correlation coefficient with the Japanese version of the EuroQOL scale. As to reliability, Cronbach's alpha coefficients was 0.887 and ρ coefficients in test-retest findings was 0.958 for the entire items, but some problems remain with the subscale items. Conclusions : While there are limitations in the reliability and validity of the subscale and in the range of use, the results suggested that individuals at a higher risk for requiring long-term care could be differentiated using all items.

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The objective of this research is to study the structure of the empowerment of individuals belonging to a community organization. The methodology applied was ethnography, and data were collected by observing and interviewing a group of 12 individuals who were affiliated exclusively with two different community organizations and had given their informed consent to participation. The data were analyzed focusing on revealing the nature of the changes in individual actions. The following results of analysis were obtained. 1. The theme of individual empowerment can be resolved as 're-design of life', which means reconsideration and reorientation of one's lifestyle through belonging to a group. And 're-design of life' is the most important category. As a result of redefining their relationships with the theme, they reveal two aspects of the process and outcome. 2. The process of individual empowerment until re-design of life: (1) The five elements that influence individuals are 'form of activity', 'roles', 'networks', 'changes in community organization' and 'people'. (2) The transformation process in individual actions involves 'significant experience and emotion effect', 'continuance of actions', 'a partial behavior modification' and 'self-rediscovery' as a part of their own change, and 'conversion of belief' as the basis for one's overall self; and, finally, 're-design of life, oriented by one's 'experiential knowledge' and 'proactive posture', which can serve as the driving forces in becoming proactive. 3. The outcome of individual empowerment after re-design of life: (1) The posture is characterized by one's own approach to activities. (2) 'The expansion of one's field of activity' involves three areas ; <community> <help someone with something however small> <at home>. Also 'broadening of horizons' meaning expansions <to home> <to the organization as a whole> <from the organization to the community> <to society>. The whole results show the structure of the empowerment of individuals belonging to a community organization. From them, it is suggested that there are three relationships among the individual, community organization and community in the structure. This gives positive meaning to belonging to a community organization. The meaning of community organizations was discussed within this perspective.

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The purpose of this study was to clarify the resolutions made by public health nurses (PHNs) towards defining the health needs that require development of public health project and policy, based on the activity examples of expert PHNs. The targets of this study were 14 PHNs who work at public health centers and who were recommended by multiple community nursing science experts or respective superiors. The PHNs were reputed with an excellent ability to make decisions related to the health needs. For the data collection, individual interview surveys were conducted using a semi-structured questionnaire. The obtained data was transcribed into a verbatim record, and the contents of the resolutions were distilled by qualitative descriptive analysis. As the result, 19 categories were extracted, for example recognizing the existence of health needs, proving the essence of health needs, estimating the power of the people with health needs, estimating the power of care givers, predicting the result of public health activities, predicting the effect on the people having health needs. These categories were classified into the three aspects. Moreover, the resolutions made by PHNs were premised on PHNs' stance as case-oriented, orientation of their activities targeting the whole community, and their missions.

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The purpose of this study was to explore the feelings of terminal cancer patients under home care from the patient's viewpoint. Ethnonursing was employed in data collection and analysis. Three terminal cancer patients under home care were the key informants. Seven general informants included two members of patient families, three visiting nurses, and two home-helpers. The data analysis produced six findings. Theme 1 : Patients feel they will somehow be able to survive using various means at their disposal. Theme 2 : Patients repeatedly experience the conflict of wanting to live, but having to accept death, and in the midst of this conflict they prepare for death. Theme 3: Patients compare hospital and home care, and wish to have an ordinary life in the home and contact with others just as before. Theme 4 : Patients are searching for meaning by fulfilling some role in society. Theme 5 : Patients are aware they must receive some form of medical treatment even if at home. Theme 6 : Patients needing assistance from others try to continue the relationship by maintaining a passive relation with them. The overall finding elicited from above is that while accepting their situation, terminal cancer patients under home care wish to live like an ordinary person in society, right up until the end at home. From these results, it considered that terminal cancer patients under home care, and suggestions for nursing were obtained.

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The purpose of this qualitative study was to describe the characteristics of the project processes employed by public health nurses engaged in new planning and administrative projects. Five projects in three municipalities in which public health nurses were engaged in planning and administration were studied. A qualitative descriptive method was employed for semi-structured interviews and analysis. As a result, nine categories of activities were specific : grasping the actual situation and the health problems of the inhabitants and determining the necessity of new health services; considering the validity of project to be necessity for that community ; understanding the organization and judging the opportunity to carry out a new project ; carrying out trials of new projects ; positing municipal, prefectural, and national policies ; coordinating ; networking among sections of a municipality or other agencies ; encouraging the independence of the inhabitants or self-help groups and supporting their activities to continue and develop them ; and organizations evaluating the effects of a new project and planning the development or expansion of a project. At the time a new project is initiated, public health nurses have already grasped the needs of the inhabitants and are prepared to begin the new project immediately. In addition, public health nurses have always been consciously collecting information about policies, model measures and auxiliary measures of the government or the prefecture, and they have been prepared to position a new project within the policies and activities of their municipalities. In addition, under constant evaluation, these projects, while spreading throughout the community, are being developed and expanded.

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Descriptions of the research : People who live in mountainous areas tend to be weak and elderly. The purpose of this research is to clarify the characteristics of elderly people, living in mountainous areas, who are housebound and who have little opportunity to venture out of their homes. The study examines the support systems available for these people. As regards methodology, the research utilised a questionnaire and data analysis. The questionnaire was sent to 721 elderly people, aged 65 and over. Effective replies were received from 541 respondents. These 541 persons were classified under the headings Totally Housebound and Having Access to Out-of House Experiences. Consideration then was given to physical, social and mental comparisons between these subgroups. Results: It proved to be characteristic of the totally housebound respondents that those who were able to live independently within the confines of their homes also needed the care of an assistant when going out on foot. The consequent embarrassment which these people felt when going outside their homes, and their sense of being a social burden, was experienced almost as a physical pain, a pain of which they needed to be relieved. Although the totally housebound group expressed themselves as happy and satisfied with their lot in life, their feelings of satisfaction rated at a lower level than the feelings of the non-housebound group. The totally housebound group were able to enjoy closing relationship with a significant person, this relationship giving pleasure and a sense of fulfilment and meaning in life. However, for the housebound group overall, there was a decline in their relational patterns with wider society and in their autonomy with respect to day-today social norms. Conclusions : Elderly people in mountainous areas might be obliged to move to cities, to live with children, or to live in nursing-homes, when they have reached the point where they no longer can look after themselves. Many of those still living in mountainous areas are weak and elderly people. They are able to look after themselves but need assistance when leaving their homes. An exchange with a reliable friend might afford a way of saving the elderly from becoming totally housebound. To make this approach effective, not only must the opportunities be created. But suitable arrangements must also be work through, and put in place. Overall, the aim, in relation to the housebound elderly, must be to prepare an environment affording these people a quality of life as close as possible to that which they enjoyed when they were healthy. A policy, therefore, should be generated and implemented which creates out-of-house experiences for the totally housebound elderly, thus extending their lives and enhancing their quality of life.

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[in Japanese]

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Aims : This research identifies and relates from the community activities of middle-aged and elderly workers living in one town to their work, life goals, and desire for permanent residence in the community. Methods : An anonymously self-completed questionnaire was used to collect data from 1,801 subjects aged between 40 and 64 years living in the hilly-mountainous region of Japan. The questionnaire was designed to gather information concerning residents' demographics, working conditions, community activities, desire for permanent residence, and general life goals. The instrument was distributed by health workers, After completion, they were returned by the regular mail. Those who participated and those who did not were compared. Relationships between several variables were evaluated by chi square tests. Results : Seventy percent of the subjects who participated in community activities desired to live in the community permanently. Regardless of daily commuting, community activities are related to one's role within the community, one's occupation, and one's wish for permanent residence within the commuting. Male community members tended to participate more in community activities than females. However, in their 50's the ratio of male to female reversed by those who participated in community activities and desired a permanent residence in the community. Notably, "work" is the most important of the appropriate life goals for both genders. Based on a diversity of appropriate life goals, results suggest that, in order to promote health of middle-aged and elderly residents, it is important to link both spheres of "work" and "community". Also, linking strategy to form community activities by residents' organizations such as town-block association is important.

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This study, which focuses on the identification of elderly who are in need of preventive care of a bed-ridden, presents possible ways of case finding by public health nurses (PHNs). The subjects of this study were ten PHNs who had been recommended by their supervisors to participate in a preventive care program in seven cities and towns in the Kinki District. Each subject was interviewed using a semi-structured questionnaire. The interview records were used to obtain data regarding the steps followed by the PHNs to identify prospective elderly care recipients (PECRs). The information collected was organized into categories. Each subject had an average of 20 years of experience as a PHN. The average age of the subjects was 43.3 years old. Case finding by PHNs was conducted in two possible ways : 1. through various types of information about individuals ; and 2. through information related to the population to which PECRs may belong. The former includes information of certain and potential problems related to PECRs, while the latter includes information about high-risk individuals, potential PECRs, and other community residents. Elderly needing preventive care of a bed-ridden were screened and picked up from the above groups. The PHNs collected information about the PECRs directly from individuals in need, from referrals from PECRs' family members, community residents and groups, and relevant health institutions, and through activities hosted by PHNs. Current studies on case finding by PHNs are very limited, as they only focus on certain aspects of this issue, such as the route through which PECRs may be referred to PHNs. This study focused both on the referral route and on specific methods used by PHNs to identify PECRs as well as the quality of the information gathered. In addition, the manner to conduct case finding presented here enables the identification of certain as well as potential problems of PECRs. A uniform method would be desirable to identify various kinds of individuals who need care.

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[in Japanese]

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