This study aimed to develop an education program for nurses to improve end-of-life care for older adults who are unable to communicate, and to assess the intervention effect on attitude formation. Components of the program, namely, “Views of life and death”, “Motivation for care”, “Meaning of care”, and “Emotional processing”, were set as performance indexes and assessed using existing scales before intervention, during intervention, and immediately and 2 months after intervention. Data from 40 nurses working on long-term care wards who participated in all 4 program sessions were analyzed using repeated-measures analysis of variance. Significant effects were found for “Anxiety about death” (p = .030) and “Death of the body and mind” (p = .010) on a scale measuring views of life and death in nurses (Okamoto et al., 2005) in assessment of “Views of life and death” and for the subscale “Motivation for current work” (p = .005) on a scale measuring work motivation in nurses (Sano et al., 2005) in assessment of “Motivation for care”. These results suggest that this education program was effective in deepening views of life and death and facilitating positive changes in nurses’ motivation for care.

  Potentially avoidable hospitalizations in acute care hospitals should be prevented to improve the quality of life of residents and to use medical resources in fee-based homes for the elderly efficiently. The purpose of this study is to clarify the perceptions of facility managers of fee-based homes for the elderly regarding the effect and feasibility of initiating interventions to prevent potentially avoidable emergency transfers and hospitalizations. A self-administered questionnaire was mailed to administrators at 150 facilities in a city of the metropolitan area; responses were received from 55 facilities (36.7%). The effectiveness of the interventions developed by the authors based on the literature review was generally highly recognized by the administrators (67.3〜87.3%). All interventions were perceived to be more effective than feasible. The interventions that were recognized as particularly effective were “communication tools for information cooperation between nurses and doctors” (87.3%), which were also recognized as more effective in facilities with a high average level of nursing care (p = 0.039). On the other hand, the intervention that was recognized as being less feasible was “employment of nurses with knowledge and skills in elderly care (20.0%).” These findings suggest that it is necessary to increase the feasibility of introducing interventions and conducting intervention studies in fee-based homes for the elderly in Japan to prevent potentially avoidable emergency transfers and hospitalizations.

  In this study, the frequency of night-time diaper changes conducted at fixed times at a single nursing care insurance facility was reduced from twice to once per night and the resulting changes in sleep variables were considered along with the characteristics of the elderly residents, with the goal of acquiring hints for diaper-changing methods that could improve sleep quality. The baseline and intervention durations were set at 2 weeks each, and Actigraph devices were used for 24-hour continuous measurement of sleep variables and environmental factors such as temperature. The participants were 13 elderly female residents aged 92.3±7.3 years, and Nishimura’s mental (NM) and activity of daily living (N-ADL) scale scores of 9.9±7.1 and 9.8±3.5 points, respectively. There were no differences in health status or environmental factors observed between the two periods. No differences in median sleep values were observed, but the range from minimum to maximum values within the sample was large. Based on the participants’ average age, duration of the standard estimated nocturnal awakening time was set as 80 minutes, and the participants’ characteristics were considered based on the number of days with decreases from this standard value during the intervention period. Of the reduction group, 7 participants had a significantly higher NM scale (p=.026), and had a higher tendency of N-ADL (p=.050). The intervention effect of reducing the number of night-time diaper changes was estimated to be related to cognitive functions or ADL levels. The results of this study suggest that cognitive function and ADL need to be considered in the examination of excretion assistance for sleep improvements among the elderly in institutionalized facilities.

  The purpose of this study was to elucidate the current daily lives and feelings of oldest-old people, those aged ≥85 years old, in whom hemodialysis had been introduced due to nephrosclerosis, compared with before the introduction of hemodialysis. Semi-structured interviews were conducted with three oldest-old people. A qualitative inductive analysis was then conducted and seven categories were obtained. In these oldest-old people, health status was stable after the introduction of hemodialysis and they “Enjoyed their daily lives with mental and physical tranquility.” The three categories of “I manage my life in my own way, without undue pressure,” “I fulfill my roles while giving and receiving support to and from those around me,” and “I accept public assistance with gratitude and humility” were mutually related in their daily lives. The subjects’ quality of life improved after the start of hemodialysis. Other feelings included “I feel sorry for the people around me and for myself, as we cope with my physical decline,” “I hold on to hope while feeling uncertain in the final stage of my life,” and “Part of me remains unchanged.” These are feelings people have toward themselves that are unchanged despite the changes in their daily lives, suggesting that they continue to grow even in the stage of very advanced age.

  The purpose of this study was to investigate how several factors—nurses’ attributes and experiences, individual characteristics, and practice environments—relate to nursing practice for elderly patients with cognitive impairment with the aim of person-centered care on acute wards. A multiple regression analysis was performed on data obtained from a questionnaire administered to 329 nurses working in acute wards at general hospitals. The dependent variable was nursing practice for elderly patients with cognitive impairment and on acute wards. The independent variables were nurse attributes, experiences, individual characteristics, and practice environments. The results revealed seven factors which related to nursing practice :moral sensitivity, followed by the frequency of self-reflection on nursing practice, nursing practice environment, experience participating in dementia or delirium training or study groups, experience consulting with a professional team, Certified Nurse Specialist in Gerontological Nursing or Certified Nurse in Dementia Nursing, frequency of reflecting on their nursing care with others, and recognition of persons with dementia. These variables explained 30.7% of the variance. These findings suggest the necessity of improving the quality of nurses’ ethics education and encouraging nurses to continuously reflect on their level of motivation and nursing practice. Furthermore, it suggests the importance of managing the organizational work environment that supports nurses’ motivation and positive behaviors which allow them to demonstrate their professional abilities, as well as nurturing a supportive and caring culture.

  This study aimed to explore the experience of hospitalization from the perspective of people with dementia. We used the databases Ichushi-Web, CiNii and CINAHL to search for articles from 2004 to August 2019 using the keywords “dementia”, “hospitalize”, “experience”, and their associated MeSH terms. Only primary qualitative studies were included. Data analysis was conducted using the qualitative inductive method.

  We selected two studies in Japanese and ten studies in English. Seven categories emerged from analysis to describe the experiences of hospitalization from the perspective of people with dementia. These categories were [Feeling comfortable or afraid of nurses’ responses], [Feeling anxious about unfamiliar situations surrounding the patients], [Being deprived of freedom and dignity], [Choosing their own social relationships], [Feeling unfulfilled and isolated from their daily life], [Actively seeking support for condition and/or care], [Relying on their relatives for comfort].

  These findings can help nurses understand the reasons behind the behaviors of people with dementia in hospitals.

  To investigate the daily life experience of elderly patients and their spouses living by themselves after bypass surgery for arteriosclerosis obliterans of the lower extremities, semi-structured interviews were conducted with three married couples, and the obtained data were analyzed using the Qualitative Synthesis method (KJ method). The patients realized [the effects of the surgery in daily life], and adopted [behaviors to protect their legs based on their decisions after surgery] being supported by [a foundation for future life], while they developed [anxiety about their future]. Their spouses [had a positive emotion toward the patient after surgery] and [maintained their household] by [changing their lifestyle] and [devising measures to manage their own health], while they had [concern about their future].

  The patients adopted measures for deterioration prevention, which were feasible for them in daily life, such as preventing injury, protecting the lower extremities, regularly receiving medical consultation, managing medications, and observing symptoms, with cooperation from their spouses. However, as patients cannot implement all necessary measures, it may be important to understand their emotions from their perspectives on daily life, and determine feasible measures for health maintenance with them through guidance during hospitalization.

  This study was conducted to examine statistically valid itemization of information used for prognosis by nurses practicing end-of-life care in nursing homes.

  The authors compiled a draft of 62 items supporting prediction of four timings of end-of-life care from literature and other sources, and refined the list in collaboration with several expert nurses providing end-of-life care. A total of 202 experienced nurses working in nursing homes were invited to take part in a questionnaire survey, with quantitative examination of content validity using the item-content validity index (I-CVI).

  A total of 72 valid responses (return rate 36.6%; effective response rate 97.2%) were received, with an I-CVI value of ≧0.80 for 43 items indicating content validity.

  The characteristic of an item is that it is information by which nurses capture changes in physical signs over time in the life of residents, and that information difficult to measure with objective figures is obtained by intuitive observation based on experience and knowledge. It was suggested that 43 items confirmed in this study were indicators of nurses’ judgments in prediction of timings and practicing end-of-life care.

  The purpose of this study was to evaluate the effectiveness of seminars aimed at improving basic knowledge related to behavioral and psychological symptoms of dementia (BPSD) on health professions’ understanding and own mental health.

  In this study, the 78 participants were all health professions who care for older people with dementia.

  Before and after the seminar series, they were checked by confirmation test about suitable care for BPSD, assessed on their mental health state by the Maslach burnout inventory (MBI) and the general health questionnaire (GHQ), and marked for subjective fatigue on visual analog scale (VAS). Each were analyzed by the Wilcoxon signed-rank test.

  After the seminar, there were significant improvements in basic knowledge of BPSD, the MBI emotional exhaustion and MBI personal accomplishment. On the other hand, no significant differences could be found in the GHQ or the fatigue level. Looking at the comparison between occupations (nurses, occupational therapists, social workers and caregivers), the improvement in basic knowledge of BPSD was found to be in nurses. All occupations showed improvements in MBI personal accomplishment, while only nurses and occupational therapists demonstrated improvements in MBI emotional exhaustion.

  In conclusion, it was shown that health professions’ participating in the seminars improved their understanding of the BPSD, MBI emotional exhaustion and MBI personal accomplishment. There were especially strong, effective results shown in nurses. These findings might indicate the benefits of having opportunities for self-learning and access to mental health care outside their workplaces.

  The purpose of the study was to clarify the strengths of environments of a small region that were understood by the elderly as a basic survey to develop an integrated community-care system. In the questionnaire survey for the elderly living in a small region of about 4,000 people, the study focused on the strengths of environments that the elderly realized, and analyzed them. As a result of the analysis, 93 key sentences’ 18 subcategories and seven categories were extracted in total. The strengths of environments of a small region that the elderly living there realized were related with resources and social relationships. The strengths understood to be resources were consisted of “a convenient living environment”, and had good aspects such as “a reliable and safe townscape”, and “school zones where it is easy to raise a child”. In addition, many generations gathered in the “community center as a base for residents” and did “abundant and lively activities”. On the other hand, the strengths of social relationships realized by the elderly were “diverse connections” and “rooted territorial connections”. In conclusion, the study suggests that it is necessary to establish the integrated community care system focusing on the strengths of environments as well as individuals in the future.

  This study focused on the nighttime on-call system of intensive-care home for the elderly and describes in detail the judgments and support of nurses receiving calls from healthcare workers. Semi-structured interviews were conducted with 6 nurses who had＞ 3 years of working experience in conventional intensive-care homes, and the contents were analyzed qualitatively and descriptively. The following two themes were identified : (i) nurses tended to make judgments and give support to ensure the safety and comfort of the care recipients ; (ii) nurses tended to judge and take action to support healthcare workers. Nurses sought the causes of sickness that were not clearly evident in the sick recipients, determined whether the sick care recipients could be monitored until the following morning, and prioritized their safety in cases where reaching a judgment was difficult. Simultaneously, nurses were careful to ensure a safe working environment for healthcare workers. In particular, nurses provided advice to ensure that healthcare workers could calmly respond and exercised consideration to ensure that they did not face inconvenience in performing their duties. The characteristics of the nurses’ judgment and response were that they made decisions to protect the safety and comfort of the care recipients by relying on information provided via telephone during the night on call and supported healthcare workers who actually took care of the care recipients.