The purpose of the present study was to evaluate the factors relating to satisfaction of mothers on health checkup for their infants based on the theory of quality evaluation by Donabedian and service management. The study was performed on 1,812 mothers, whose infants had been examined in health checkup for infants at seven cities in Y Prefecture. The items of investigation included : basic attributes, evaluation of outcome of health checkup (overall satisfaction, difference between satisfaction and expectation on health checkup (S-E), loyalty for health checkup), evaluation of structure of health checkup (overall environmental conditions of the place of checkup, environmental conditions for medical examination and consultation, and setting conditions of heath checkup), evaluation of process of health checkup (affirmative association ; negative association). Path analysis was conducted by using "the evaluation of the results of health checkup" as dependent variable. The results were as follows : Factors to increase "overall satisfaction" of mothers were that physical conditions of mothers were good, "S-E", "setting conditions for health checkup", "environmental conditions for medical examination and consultation", evaluation of "affirmative association" was good, and "negative association" was low. The factors to increase scores of "S-E" included : the fact that it was health checkup for the second child and after, that evaluation of "overall conditions of the place of checkup" was good, and that "negative association" was low. The factor exerting influence on "recommendation for health checkup" was "overall satisfaction".

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Objectivities : The present study assessed the state of attendance at clubs for senior citizens, clarified related factors, and considered the role of clubs for senior citizens and methods for supporting them. Methods: Subjects were 921 members of 17 clubs for senior citizens in Aichi Prefecture, of whom 728 members completed self-reported questionnaires. One-way layout analysis of variance (ANOVA) and a χ²-test were carried out to investigate the relationships between the frequency of members' attendance and the following member attributes : health status/instrumental activities of daily living (IADL) score, social activities and group activities outside the senior citizens' club, involvement in residential area/environment, role in the club, and degree of satisfaction with the club. Results and Considerations: 1. The frequency of members' attendance was indicated as follows. Of the 728 members, 182 (25.0%) members indicated they "always attend", 249 (34.2%) members indicated they "sometimes attend" and 297 (40.8%) members indicated they "don't attend". 2. Those who were less involved in social activities and group activities outside their senior citizens' club were found to be less involved in club activities. This indicates that IADL is an essential factor of senior citizens' attendance at social activities including club activities. 3. Analysis of the relationship between the frequency of members' attendance at club activities and IADL revealed two types of members who do not attend ; the first type of members were those who were unable to attend because of their low IADL, and the second type of members were those who had high IADL, but could not see the benefit of attending club activities. 4. Other important factors of attendance included having a role in the club, and actively participating in club activities. Survey results also indicated the possibility that only fixed members attend club activities. Conclusions : It is necessary to support members who are frequently absent due to low IADL in order to facilitate their attendance at club activities in their own community. Further, it is important to review the administration of senior citizens' clubs and the contents of club activities with the aim of motivating non-attending members to participate in club activities.

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It has been reported that even though many of the middle-aged stroke survivors at home have regained most of their functioning, they tend to be physically inactive and unsatisfied with their daily lives. The purpose of this study was to identify the desires of the middle-aged stroke survivors at home and obtain implications for supporting them. In this study, I used a qualitative approach, and collected data from 10 patients 40-59 years old. I led them to express their desires in the interviews about their daily lives, and analyzed the contents using an inductive method. Their desires were classified into 6 categories, including "getting better", "playing some role in society", "doing hobbies or something they are good at", "going out freely", "obtaining information", "expressing opinions and suggestions for medical and welfare services". The results of this study have implications for nursing practice as follows, even though there are some limitations derived from the facts that many of them have little problem with ADL. (1)The survivors tend to have desires to do something actively. (2)Their desires are expressed in relation with hobbies and activities that were once enjoyed. (3)Their desires are highly individual and some of them are difficult to realize in the existing services. In order to meet their desires described above, it is required to discuss the specific supporting measures with the patients.

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Purpose : The present study was undertaken to identify the types of intervention that would help the elderly and the family members improve their self-care agency and continue home care even under unfavorable circumstances to receive home care aid. To this end, factors of unfavorable circumstances and optimal methods of intervention under that circumstances were analyzed. Subjects and Methods : The subjects were 8 elderly clients receiving care under unfavorable circumstances, and their family members and caregiver (visiting nurses and home helper). Their cases were reported at the session from 2001 through 2003 in the visiting nurses' conference in K Prefecture. We extracted descriptions pertaining the unfavorable circumstances and the improvement of self-care agency and intervention, and made a qualitative analysis of them. Results and Discussion: Factors of unfavorable circumstances identified in this study were "deteriorated mental functioning," "deteriorated of family relationships," "disturbed rhythms of daily life," "difficulties of building the relationships necessary for receiving support," "the fragile basis of daily life" and "uncontrollable sickness." Also the interventions that gained the improved results of self-care agency were "building trust," "expressing emotions," "improvement of their organization's activities," "adjustment," "listening," "sympathy," "acceptance," "devotion," "guaranteeing patient peace of mind and safety," "getting involved," "remaining involved," "clinical judgment," "willingness to take chances," "keeping distance," "approving," "environmental adjustments." Improvement in self-care agency was seen in 7 of the 8 cases. One possible factor responsible for failure to make improvement in self-care agency was inadequate adjustment of family relationships. Improvement in self-care agency observed in this study was often difficult to recognize in terms of simple numerical improvements from the viewpoint of enhancing outcome. Detailed analyses as to the improvement of self-care agency and the methods of intervention by examining individual cases will be effective in identifying the optimal methods of provide support to the elderly and the family members who are under unfavorable circumstances to receive home care.

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The purpose of this study was to investigate actual conditions of exercise and health consciousness in employees in 20s and 30s, and to identify factors influencing the exercise motivations. Subjects of the study were 433 employees working for an electronics manufacturer. We developed the questionnaires, and distributed them to the subjects at their medical check-up in April, 2002. The questionnaires included subjects' attributes (age, sex, living with family or alone, BMI), actual conditions of exercise, exercise motivations, and health consciousness. We analyzed the data of 372 of 382 respondents (effective response rate : 85.9%). Of the respondents, 31.2% reported that they "do regularly exercise," and 16.7% engaged in exercise more than twice a week. For motivations, 57.8% reported that they "want to exercise," while women (73.3%) were significantly more motivated than men (58.0%) (p<0.01). Women were found to be less active in exercise although they were motivated. As a result of multiple regression analysis, factors influencing exercise motivations were sex, age, BMI and health consciousness (p<0.001). These results suggest that health conscious people have higher motivations for exercise than those who regularly exercise.

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Over the past decade, the several articles have been reported which describes the group support practices by public health nurses (PHNs). This article reports a synthesis of these studies. The purpose of the synthesis was to provide an organized viewpoint for group support practices by PHNs and to clarify a direction of the practices. Methods were based on Miles & Huberman's text on qualitative data analysis. Results of the synthesis indicated that group support practices by PHNs can be divided into the three directions, i.e., practices for the formation of the groups, practices for the autonomy of the groups, and practices for the expansion of group activities towards the community. Among these directions, the second and the third directions seemed to be typical of PHNs' group support practices. It was indicated that PHNs work on these practices not only from the group perspectives but also from the community empowerment perspectives.

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The health, the medical treatment and the welfare activities which a student experience in community nursing practice are diversified, and it came to cross broadly. The community health nursing activity model which aims at an understanding of a student was developed, and by systematizing various community health nursing activities focusing on healthy subject examined the validity. Various community health nursing activities were systematizes focusing on healthy subject, the community health nursing activity model which aims at an understanding of a student was developed, and the validity was examined. Based on practice record of the student of community health nursing course in S nursing junior college, it analyzed about the contents of community health nursing practice experience, and the degree of practice target achievement. Consequently, the contents of the health, the medical treatment and the welfare activities which the student experienced by nursing practice were classified into the small classification of 96 items, 21 medium items, and 7 major items. Experience of the production of health covering the whole life of people of an area occupied a little less than 70 percent of the whole. Especially, the item of child-rearing support of an inside classification, old-man public health service and healthy Japan 21, and a handicapped child and a disabled person had many small classifications. The degree of achievement of the following three practice targets suited the low tendency. 1. An understanding of administrative organization and corporate finances which performs health, medical treatment, and welfare activities, 2. Consideration about the subject about environment, or a measure, 3. Consideration about the production of a place of work for a teacher's ability formation. This time, we clarified study subject which can be strengthened before practice, and the study subject which is hard to experience in community health nursing practice, moreover, in the process which classifies the contents of the health, medical treatment and the welfare activities which the student experienced, the community health nursing activity model centering on a healthy subject was developed.

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Purpose: The purpose of this research was to identify from the view point of occupational health nurses what issues managers feel necessary to learn about in order to provide care for workers with mental disorders and promote mental health care system in the workplace. Method : We examined 163 questions asked by 748 managers during 25 seminars on mental health care. The seminars were planned and held by occupational health nurses in 2000-2002. We classified the questions by similarities of their content and categorized them. Results : Five categories were identified based on the similarities of the managers' learning needs expressed in the questions : 1. Understanding mental disorders : causes of mental disorders, medical examinations and treatment of mental disorders. 2. Care for employees with mental disorders : care at work, during sick absence, after returning to work: cooperation with employees' physicians. 3. Problems of workplace environment : job stress factors, communication among employees, generation gap. 4. Mental health care methods: self-care, consultations by health care staff, preventive measures by managers, utilization of social resources. 5. Development of the mental health care system : return-to-work support system, protection of privacy, personnel management.

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Purpose : The present study evaluates the effects of a musical exercise program developed for fall prevention among community-dwelling elderly. In addition, we examined whether relationships exist among changes in physical function after the intervention period, changes in the level of fall-related self-efficacy, and the frequency of falls. Methods : Forty-five elderly people, mean age 75.6 years (SD 7.4 years), participated in a weekly 60-minute musical exercise program for 3 months. At the start of the intervention and immediately after the intervention period, nurses measured the participants' physical functions, and a self-reporting survey assessed fall-related self-efficacy (F-SE), confidence in physical exercise, experience of falls, and other fall-related factors. Results : Comparison of pre- and post-intervention data showed that 5 items related to physical functions, F-SE level, and confidence in physical exercise significantly improved after the intervention. In addition, the frequency of falls decreased. Changes in physical function were found to be positively correlated with changes in F-SE level concerning "getting dressed and undressed" and "getting out of bed." Positive changes in the level of fall prevention self-efficacy concerning "walking in dim light," "carrying things with both hands," "simple shopping," and "light housekeeping" were found to be related to reduced frequency of falls. Conclusions : These findings indicate that the musical exercise program positively contributed to the maintenance and improvement of physical functions and F-SE, and to a reduction in falls among the elderly. This suggests that supporting the elderly to acquire self-efficacy concerning walking and moving should be effective for fall prevention.

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Objective : This study explored the methods employed by public health nurses (PHN) to assess community's characteristics in the context of cultural background for example the effect of local climate, residents' disposition and lifestyle on the health status of residents, and how this knowledge is implemented by PHNs. Design: Three PHNs were asked the following research questions: 1) How did the PHNs assess the community's characteristics on their health status? 2) What were these characteristics? 3) How did the PHNs use these characteristics in practice? 4) What were the residents' reactions to nursing intervention? And, 5) How did the answers to the previous four research questions relate with each other? Data were collected using semi-structured interviews with PHNs and participatory observations of interactions between PHNs and residents were also undertaken. Results : 1) PHNs assessed the community's characteristics using six procedures. 2) The community's characteristics were classified into six categories. 3) PHNs matched the community's characteristics with six treatment procedures. 4) The residents' reactions were categorized into five and 5) the relationships with the previous four types of answers were classified into eleven. Conclusion : PHNs get their information on various situations using a combination of their intuition and familiarity with the local environment. PHNs then make one of assessments firstly, "how does the environment impact on residents health" and also, "how they can apply community's characteristics to intervention". In addition, PHNs were also able apply this knowledge when considering the most acceptable method of intervention and make use of community assets.

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The purpose of this study was to clarify the characteristic role of public health nurses at a health center involved in the process of a care management for patients with intractable disease in the nervous system. A semi-structural interview was conducted with four public health nurses belong to this health center about the contents of care management applied for a single patient individually. Using Okamoto's and others "incurable disease case needs with which a public health nurse is concerned", and "the index of care management activity" performed analysis. By analyzing the results it was clearly appeared the required nursing needs to be regarded as public health nurses and they were as follows. The characteristic roles of the public health nurses had performed were clearly appeared and they are introducing public services, offering educational support based on the professional knowledge about the disease in terms of the person, supporting the family to improve the QOL (quality of family life), and making adjustments to cooperate with the person when the meeting are concerned. The public health nurses had supported the patients to achieve a healthy life such as, preventing from the worsening of the disease, consulting the anxiousness with their functions of daily living activities and their future life, acceptance of the disease, enhancing self-care by improving the existing social services, by caring their families, arranging communication with others, and the corporation with the other medical officers.

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The purpose of this study is to examine positive aspects of family caregivers' perception and experiences of caregiving for the elderly people and to consider support for caregivers based on the results. The subjects were 17 family caregivers who were using home care services. The questionnaire asked about the process for coping with caregiving difficulties and about daily care activities. Data were collected at semistructured interviews and we made a qualitative analysis. Positive aspects were categorized as follows : 1) Acquisition of caregiving methods and skill applied to each care recipient; 2) Acceptance of family members' and relatives' support ; 3) Improvement of family caregivers' understanding about care recipients' physical capability, mental function and personality; 4) Change/promotion of family caregivers' awareness and behavior toward healthy lifestyle ; 5) Obtaining support in resources outside the family support ; 6) Deepening mutual understanding between caregivers and care recipients ; 7) Increasing caregivers' interest in social service policy. Our research affected examinees' perception. The results suggested that family caregivers had gained a profound awareness of caregiving by answering questions about the positive aspects of daily care. Understanding positive aspects of caregiving will be important for nurses who support family caregivers.

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