[Purpose] The purposes of this research were to grasp the arrangement of professionals, the structure and management of each ward in hospitals by its functional type, and to verify their relationship with training needs.

[Methods] Anonymous self-registered self-return questionnaires were sent to nursing administrators at 8,270 hospitals. The investigation period was from February to March 2014. Responses were analyzed according to the functional type of the ward, using χ²-test on occupational categories capable of specialized approach regarding dysphagia, certified nurses for dysphagic care, the system and measures to cope with dysphagic patients, and the relationship between these with the request for training focused on prevention of aspiration by patients with dysphagia. This study was conducted with the approval of the ethical review board at Yokohama City University.

[Results] The total number of responses was 510, and of them, 473 (92.7%) were analyzed. Regarding the functional type of wards and the system/care for dysphagic patients, there were significant differences in the items, “experts in hospital capable of evaluation,” “experts in hospital capable of dysphagic care,” “actively accepting patients with gastrostomy/feeding tubes,” “NST (nutrition support team),” “existence of support team for dysphagia,” and “evaluation by VF.” (p ＜ 0.05)

  Additionally, whether or not there was a need for training was examined according to the functional type of the wards. It was found that there were significant differences in the items, “there are no certified nurses in hospital” and “not actively accepting patients with gastrostomy/feeding tubes” as a whole; and “there are no doctors or social workers who can handle dysphagic care in hospital” in general wards and “there are no experts outside the hospital to consult with” in the medical care wards.

[Conclusion] The support system for dysphagia in hospitals has not yet reached a satisfactory level, and there is a strong need for training. Thus, it is important to enhance the provision of education.

  A pure tone audiometry was conducted for inpatients above the age of 65, followed by semi-structured interview tests. The sample was categorized into two groups: seven with normal hearing and 8 with hearing loss. Using KJ method, the authors deepened interpretation of the hidden meaning of the interview findings. Discussion was focused on the nurse-patient communication expected from the elderly with hearing loss by comparison with that of the normal hearing group.

  The normal hearing group strongly felt that they were separated from their daily lives and experiencing “difficulty adjusting to ‘non-everyday’ living due to hospitalization, in which a nurse played a central role.” They expressed their “deep gratitude for the compassionate support of nurses.”

  The hearing loss group experienced “difficulties due to limited body movement”, which they accepted with “resignation accompanied by a sense of helplessness.” The situations included “experiencing confusion with the frequent nurse rotations”, “managing to get along without assistance” or “pretending to be unconcerned about the inconveniences.”

  Patients well recognized that they were obliged to “bear the burden of undesirable consequences” and, therefore, the accumulated communication failures due to hearing difficulties lead to their unconscious adoption of strategies such as “contriving to overcome difficulties” or “staying concerned with what is important.”

  In order not to be physically and mentally exhausted, the patients expected “sensitive care from the patients’ perspectives” as well as “frequent confirmations of nurse-patient conversations” with deep concern for the hearing-disabled elderly people. Elderly with hearing loss expect “communication which can be interrupted midway through conversation” by their own initiative.

  We examined the characteristics and factors influencing the severity of burns. 130 patients were categorized into two groups: “younger elderly” (aged 60-74) and “older elderly” (aged 75 or more). We retrospectively investigated the medical and nursing records of the 130 elderly burn patients and categorized 81 of them as younger elderly and 49 of them as older elderly. As underlying medical conditions, ‘peripheral neuropathy’ is significantly higher in the younger elderly, and ‘dementia’ or ‘ocular disorder’ are significantly higher in the older elderly (p<0.05, each). The most frequent burn cause was found to be “high-temperature fluid”, accounting for three out of ten. A greater share of older elderly than younger elderly had burns on their back, and the burn area was greater in the older elderly than in the younger elderly at a median 13.5 (range: 1.0-45.0)%. In addition, a significantly greater share of older elderly [22.4% (p<0.05)] than younger elderly had severe burns. Multi-regression analysis with Burn Index score as the dependent variable showed that “flame” “chest” “right lower leg” “face” and “perceptions of burn” had greater impacts on the younger elderly group (R²=0.593) and that “back” and “flame” had greater impacts on the older elderly group as an environmental factors (R²=0.649).

  We speculate that burn injuries in the elderly could be mitigated not only by raising awareness of burns in daily life but also focusing concern on the living environment including the persons who have a loss of sensory function or dementia.

  The objective of the present study was to elucidate the actual conditions of cooperation between nurses and other professionals and the support for confirmation of intention regarding end-of-life care, as well as whether these factors are related to end-of-life care, at special nursing homes in Ehime prefecture. A questionnaire survey was conducted on nurses working at 94 special nursing homes in Ehime prefecture, and responses were obtained from 37 facilities. The most common timing of confirmation of intention regarding end-of-life care was following worsening of condition (91.9%), followed by the time of admission (70.3%). Nurses participated in the confirmation of intention at the time of admission at only 24.3% of facilities. As for relationships to end-of-life care, significant differences were observed based on physicians’ attitude toward end-of-life care, cooperation among nurses, and working arrangements of nurses. Specifically, at facilities with a high rate of end-of-life care, physicians had a positive attitude toward end-of-life care, nurses actively engaged in exchange of opinions among each other, and nurses worked late shifts. These results suggest that in order to promote end-of-life care at special nursing homes, it is important for nurses to cooperate with physicians and to support night-time care workers.

  This study aimed to clarify situations in which elderly individuals with dementia require advocacy in their daily lives and advocacy practices for them provided by nurses at elderly care facilities. After conducting a semi-structured interview survey with nine nurses certified in dementia-nursing at elderly care facilities, we performed a qualitative analysis. Situations in which the elderly residents with dementia require advocacy were “an inability to make decisions”, “a lack of respect for their dignity”, and “having difficulty communicating in a group living environment”. With regard to advocacy, the nurses practiced “support for the decision-making process”, “protection of residents’ interests”, “respect for residents’ dignity”, and “adjustments to improve group living”. Our results showed that the nurses practiced advocacy for elderly individuals with dementia in order to enable them to live with dignity. It is crucial for nurses to understand the various dimensions of the residents’ environment while achieving an adequate balance between decision-making support and the protection of residents’ interests.

  To find predictive factors of Behavioral and Psychological Symptoms of Dementia (BPSD) for elderly dementia patients, this study examined the relation between prospective one-year falling of 32 older adults with dementia in a dementia ward of a psychiatric hospital and BPSD. In this study patients with prospective one-year falling experience were 56.3% and those with BPSD were 84.4%. The average number of BPSD was 1.9±1.3. Examination of the relation between prospective one-year falling experience and BPSD suggests that older adults with dementia suffering insomnia of BPSD show a high value of prospective one-year falling experience. The results suggest the necessity of nursing intervention for insomnia to prevent falls by elderly dementia patients in dementia wards of psychiatric hospitals.

  The purpose of this study was to find specific characteristics of isolated elderly caregivers that are recognizable by visiting nurses. Twenty visiting nurses were asked about isolation in caregivers in semi-structured interviews from December 2013 to February 2014. A qualitative and inductive approach was used for analysis. Six categories and seventeen subcategories were derived from thirty-three cases as follows: “personal characteristics of the caregivers”, such as excessive absorption in caregiving, “emotional transaction between a caregiver and care receivers”, “decrease in social participation”, “lonely care with an insufficient support system”, such as inadequate psychological or practical support, “stress reaction with caregiving”, such as feeling alone or anxious, or providing inappropriate caregiving, and “the living environment in which social relations are not built”. Personal characteristics of caregivers, emotional transaction, social participation, support systems, stress reaction and environment can be indicators of isolation in caregivers for the elderly. These characteristics can be used as keys to predict isolation and can also be used to find caregivers who need help and to provide support for them.

  In Japan, there is no law to regulate the physical restraint of patients in general beds, but there is “guidance for zero physical restraint” for long-term care facilities. Because staff members prefer offering treatment without imposing any physical restraint in general beds, it is difficult to implement the “guidance for zero physical restraint.” The judgment of the Supreme Court of Japan on January 26, 2010 is the only legal judgment by the Supreme Court regarding physical restraint in general beds in Japan. The purpose of this study is to examine the viewpoint and specific contents considering physical restraint in general beds by reviewing the literature assessing “the judgment of the Supreme Court of Japan on January 26, 2010” and the physical restraint guidelines that have been created in each hospital. As a result, we obtained categories such as “making sure of imminence,” “alternative to restraint,” “restraint time,” “participation of doctors,” “status check during the restraint,” “accountability,” “written consent,” and “record.” Hospitals’ guidelines showed similar viewpoints with reference to specific nursing contents. These findings revealed that, when considering the physical restraint of patients in general beds, many complicated procedures conforming to the “guidance for zero physical restraint” need to be followed, and that nurses are expected to fulfill diverse responsibilities in this regard.

Objectives : The purpose of this study was to clarify the relation between frequency of going-out and self-efficacy for going-out among older residents of a cold snowy region in the non-snowy season, and to clarify the factors to raise self-efficacy for going-out.

Method : We randomly selected 382 older people from the inhabitants of a city in a cold snowy region, and mailed a questionnaire.

Results : A total of 192 older people were analyzed (response rate 50.3%). Of these people, the proportion of going-out at least once a week was 90.1%. The factors affecting self-efficacy for going-out were “age”, “presence of body pain”, “self-rated health”, and “frequency of going-out”. Relationship between frequency of going-out and self-efficacy for going-out showed moderately positive correlation (r_s=.531, p=.000).

Conclusions : From the results of this study, it can be seen that going-out frequency is related to self-efficacy for going-out. The results of this study were supported by a survey in Tokyo as well. As for factors to raise self-efficacy for going-out among older residents of such regions, it was suggested that nurses should intervene to support the rise of self-rated health and control of pain of the body.

  In long-term care facilities, the users’ conditions are often severe and are likely to get progressively worse, leading to the need for more care services. Bathing care is one of the services that put a heavy burden on the caregiver, as it is performed in a high temperature and high humidity environment. The purpose of this study was to clarify the actual conditions of the bathing care system and examine the issue of burden of care in long-term care facilities.

  A questionnaire was mailed to the care administrators of 342 institutions. The survey content was on the bathing care time and system. Replies were obtained from 156 institutions (45.6%). We found that a high percentage of welfare facilities for the elderly (Tokuyo) had bathtubs for individual bathing. Also, these places were providing more one-to-one bathing care services than the geriatric health service facilities (Roken) or medical long-term care sanatoriums (Ryoyo-gata). Independent of the type of the facility, about half of them replied that the time caregivers spent on bathing care per shift was less than 200 minutes, but there were facilities that said it was more than 300 minutes. The results suggest that the caregivers at all types of long-term care facilities are required to spend a long time doing bathing care. This may be due to the severity of the users’ conditions, and may lead to a heavy physical and mental burden on caregivers.

  This study was conducted to clarify the need for nursing education related to respiratory arrest confirmation and end-of-life care for elderly people near death. Data were collected from responses of 62 nurses to a questionnaire administered to nurses working at health care and welfare facilities for elderly people requiring long-term care.

  Among respondents, 54.8% reported agreeable agreement with the need and recognized the importance of enhancing pre-graduate or post-graduate nursing education related to philosophical and nursing ethics, thanatology, family nursing, and collaboration with an end-of-life care team. Only two nurses described education related to skills to confirm respiratory arrest. Many nurses might recognize holistic care as much more important.

  These results reveal the need for enhancing ethics, philosophy, and family nursing concepts of end-of-life care education related to respiratory arrest confirmation.

  However, the need for post-graduate education and the role between pre and post-graduate education enhancements must be clarified.