The purpose of the current study was to develop a Care Management Capability Self-Evaluation Form for Care Administrators at Special Elderly Nursing Homes in accordance with a mixed methodology. A draft self-evaluation form was created using a qualitative methodology, and the self-evaluation form was examined and pretested by practitioners and experts. The self-evaluation form was then completed by 3,000 care administrators (nurses) at special elderly nursing homes nationwide. The reliability and validity of the self-evaluation form were examined. The self-evaluation form consisted of 42 items evaluating 7 abilities such as The Capability to Help Improve Care Management, The Capability to Institute Systems that Highlight the Functions of Special Elderly Nursing Homes, The Capability to Institute Systems of End-of-Life Care, and The Capability to Institute Systems to Maintain Residents’ Lifestyles. Cronbach’s α overall was 0.974, so the self-evaluation form is reliable. Confirmatory factor analysis indicated that the self-evaluation form had content and construct validity. The self-evaluation form can be used to address issues and the expanded role of special elderly nursing homes and it evaluates the Capability of care administrators to achieve the intended goals of care. The self-evaluation form evaluates care in line with specific items and it can be used as an indicator of personal growth.
This literature review aimed to clarify the research trends and future research issues related to the surrogate decision-making by family members in Japan by focusing on terminal care for the elderly. Thirty-nine papers matched our study objectives and were analyzed. The oldest publication was from 2000, and it has been reported annually since 2006. The most adopted methodology, research design, analysis method, and location were “qualitative research,” “descriptive research,” “qualitative inductive analysis,” “descriptive statistics,” and “hospital,” respectively. “Family and bereaved families” accounted for about half of the research participants.
The results were summarized into the following six categories: “family’s feelings toward surrogate decision-making,” “family’s decision-making processes,” “support from experts during family’s decision-making,” “nurses’ perceptions about surrogate decisions by family members,” “elderly adults’ thoughts about surrogate decision-making,” and “differences in terminal care intentions based on position.” Future interventional studies should address how to reduce the mental distress that families experience during the surrogate decision-making process.
With a view to creation of a community general support system in one of the minor outlying islands, A in Okinawa (hereafter, A), the purpose of this study was to verify the relationship between participation in community activities and mutual aid of elderly people in order to help create such a system in A.
We carried out individual interview survey by questionnaire of 320 people all of whom were elderly people living on the island A. The resulting valid responses were 73.4% (N=235) and we performed a bivariate association analysis, a bivariate correlation analysis and an analysis of variance on them. In addition, we asked them about the presence or absence of participation in 15 items of community activities. After testing for reliability, we made a scale score divided into three stages such as “low cohort”, “middle cohort” and “high cohort” about the “number of items of community activities participated”.
As a mutual aid, four types were classified from the combination of presence or absence of dependence and support such as 1.“non-support and non-dependence”, 2.“non-support and dependence”, 3.“support and non-dependence” and 4.“support and dependence”. There were significant differences in the mean-value of the scale score between types of mutual aid and “number of items of community activities participated”. The types of 3.“support and non-dependence” and 4.“support and dependence” were significantly higher than 1.“non-support and non-dependence”, 2.“non-support and dependence” in the mean-value of the scale score of “number of items of community activities participated”.
Therefore, this suggests that proposing the community activities that integrate participation of elderly people in the community activities and support by themselves may be useful.
The present study aimed to clarify the details of pain assessment of elderly patients with dementia performed by general ward nurses. Semi-structured interviews with seven general ward nurses were conducted, and as a result, 8 categories and 30 subcategories were identified. In performing assessments, the nurses focused on the state of the individual concerning: (1) identifying changes in the expressions, speech, and behavior of the elderly patient with dementia, (2) identifying changes in the physical condition of the elderly patient with dementia, (3) identifying changes in activities of daily life of the elderly patient with dementia, and (4) identifying the presence or absence, and extent of behavioral symptoms specific to dementia. Furthermore, the nurses made assessments by using assessment methods such as (5) identifying the site and extent of pain by using verbal interactions and techniques of touching, and (6) evaluating changes in pain with the use of analgesics. The nurses also used information sharing for the assessment, such as by (7) evaluating pain by sharing information among individuals who are close to and trusted by the elderly patient, and (8) evaluating pain and predicting the development of pain by sharing information among nurses. It was suggested that these results are useful for the assessment of pain in elderly patients with dementia.
This study aims to elucidate components of care that elicit positive responses from elderly individuals in a persistent vegetative state and the process of changes that nurses undergo as they accumulate experience. This study comprised a qualitative inductive analysis of participant observations and semi-structured interviews. We enrolled 8 nurses with 9 or more years of professional experience and 3 or more years of experience in caring for patients in a persistent vegetative state. The results identified ‘initiating triggers and waiting for a response,’ ‘deciphering and predicting based on subtle reactions,’ ‘interpreting intentions and emotions and speaking for the patients,’ ‘sharing new responses with family and other staff members to involve them in communication with the patients,’ and ‘maintaining the family members’ interest’ as the components of care that elicit positive responses from elderly individuals in a persistent vegetative state. Nurses experienced a phase of ‘working mechanically out of duty as a nurse,’ but came to ‘reflect and reconsider when they experienced a sense of self-disgust’ and began to ‘incorporate hints obtained through nursing and personal life experiences into interactions with patients.’ These were then followed by gaining “faith in the patient’s strengths through each moment” as they ‘witnessed the patient or the family’s strengths.’ Therefore, the process of change that nurses undergo was demonstrated through these interactions that provided the ‘small sense of fulfillment that they relied on.’
This study examined relationships between geriatric nursing practice and excellence of nursing practice among 6 hospital settings in Kanto region. One hundred and one nurses assessed geriatric nursing practices based on the quality indicators of 15 categories with 72 items on 5-point Likert-type scales. More than 50% of nurses conducted actions in categories such as bed bath, oral care, and physical restraint. On the other hand, part of comprehensive assessment, dementia care, incontinence, and pain management items had low percentages. Moreover, all categories and excellence of nursing practice were correlated, especially between prevention of pressure ulcer and “multiple role finding and simultaneous progress as a team member” and delirium or physical restraint and “respect for patients and observance of dignity.” Although basic care was conducted, provision of specific geriatric care such as dementia was low; therefore, quality improvement and assessment of geriatric practice is needed in the future.
The purpose of this study was to examine the meaning of personal possessions brought to the hospital by elderly individuals undergoing orthopedic surgery of the lower limbs. Specifically, we sought to compare these possessions with semantic classification of “the meaning of things” as per the work of Csikszentmihalyi et al. pertaining to household items. We identified 11 semantic classifications associated with five categories as per Csikszentmihalyi et. al. There were three meaning classes including “things that incite compassion,” “things that help facilitate healing and are encouraging,” and “things that can have a connection with the outside” that were extracted as <things that bring mental stability>. Five meaning classes extracted as <things with which one’s lifestyle can be continued at home> included “things that continue to be used during hospitalization,” “things that help one sleep,” “things that can help keep the body clean,” “things that have been retained from a prior hospitalization,” and “handmade things.” Finally, we extracted three meaning classes including “self-help tools for compensating for pain and restricted range of motion,” “things that help comprehend the position and situation of other things when body motion is restricted,” and “things that help comprehend the position and timing of things at night” as <things for understanding the situation and movement restrictions>. Our findings suggest that when preparing for hospitalization, information should be provided in accordance with the characteristics of illnesses and hospitalized living. Furthermore, nursing assistance for recuperative environments is important and should be provided.