The purpose of this study is to describe the prenatal and postnatal process of women's decision-making regarding their childbirth experiences. The subjects of the study were 419 women outpatients at hospitals, maternity hospitals or birth centers. Questionnaires were used to collect data before and after childbirth.
The factors which influenced the process of decision-making are classified into three groups: medical care which needs professional medical judgement; care which needs professional advice; activities which can be conducted only with appropriate knowledge. Decisions made before and after childbirth are different because of these factors. Variables such as quality of care facilities, interest in childbirth, knowledge, and age are also highly related with the capability of decision-making. Combinations of decisions made before and after childbirth are categorized into four: made a decision by themselves before as well as after childbirth; given chances to make a decision; made a decision with reluctance; no decision by themselves. These combinations were significantly correlated with the three factors of childbirth experiences.

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The purposes of this study were to develop a mental health scale for use in assessing mental health in postnatal women (MHPW), and to determine the relation between the score and related factors. A quantitative approach was used.
The study population comprised 301 women who delivered live-born babies, and who consented to cooperate in the study at 2 weeks to 5 months after delivery. The originally developed MHPW was confirmed as to internal consistency and concurrence.Without the factors of unwanted pregnancy, there were correlations between MHPW score and daily life stress after birth, positive perception of birth experience, difficulty in caring for the baby, past history of psychiatric disease, and negative life events. ANOVA showed significant difference in MHPW scores between primipara and multipara, except vaginal delivery and cesarean birth, whether participate to mother's class.
These results suggest that nursing care to reinforce positive perceptions about the birth experience and reduce life stress may promote women's mental health.

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The purpose of this study was to examine the influence of stress sources (such as operations) on a patient's state of anxiety, the relationship between patient anxiety and arousal, and the influence that stress sources or the times of receiving stress have on arousal. In the investigation, the following points were examined. (1) Changes in states of anxiety before and after operations, (2) The relationship between states of anxiety and arousal (tense arousal, energetic arousal) before and after operations, (3) The different effects that separate types of stress (operations, injections) and different times (before, after) have on arousal. Twenty-five patients filled out the Japanese UWIST Mood Adjective Check List (JUMACL) and the State Trait Anxiety Inventory (STAI) before and after having operations. Sixty-eight patients filled out the JUMACL before and after receiving injections. The following results were obtained.
1) State anxiety was lower after operations than before. This indicates that stress affects states anxiety.
2) State anxiety was related positively to tense arousal and negatively to energetic arousal. In patients with high anxiety, tense arousal increased while energetic arousal decreased.
3) Tense arousal resulting from stress before both operations and injections was higher than that resulting from stress afterwards. In addition, although energetic arousal showed a tendency to increase more as a result of stress after operations than before, the same was not true in the case of injections.
The results indicating that stress affects state anxiety and that state anxiety relates to arousal partly agree with Scott's stress-coping model. Also, the ways that stress influence arousal support the resuluts of Kitamura. Thus, nursing seems to be needed based on these results.

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The purpose of this study was to elucidate the change in self concept of patients with breast cancer, and nursing intervention focused on this change. The interview method and participant observation were used to assess the self concept and its change in 8 patients during hospitalization and 3 months after discharge. The data were analyzed by an original method based on qualitative data analysis of ethno-nursing.
The results indicated the change in self concept of participants meant they were shaken by their experience; they felt they and other patients with breast cancer influence each other; they wanted to defend themselves against others; they not only wanted to live for other people but for themselves as well as from now on; and they thought they could live by themselves as they were. These results suggest that the patients with breast cancer may struggle to regain their self respect and form a new sense of values while they are in a condition of low self-esteem. Key strategies used by the nurse to support patients include: facilitating decision-making by patients, their self respect, personal relationships, and acceptance of reality.

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The purpose of this study was to discover the transformation in elderlies who experienced the cardiac surgery. Based on M. Newman's theory, transformation was explored as expanding consciousness. The subjects were 10 elderlies, 8 male and 2 female. Their age were from 68 to 83 and the mean age was 72.5. Using the Grounded Theory Approach, data were gathered from interviews and participant observations and were analyzed by the constant comparative method.
The transformation in elderlies was clarified as a process of developing “sense of own himself or own herself” which was how elderlies see themselves and their way of interaction with environment. This process advanced interacting with 3 dimensions, which are 'awareness of physical condition', 'deceleration of life rhythm' and 'awareness of others' harmonious change'. Also this process included 3 stages and created 'life energy'.
These findings suggest that even though the physical decline seems to give the only negative effect on elderlies, it has possibility to influence on them in a positive way as an opportunity for the developmental transformation. Also it was suggested that considering their individuality and diversity and assisting their developmental process are needed.

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The purpose of this study was to explore helpful teaching approaches when students faced difficulties in nursing judgment during clinical practicum. Twelve baccalaureate students were interviewed using open-ended questions after clinical practicum in adult nursing. Data was transcribed and each episode was coded according to the teaching approaches and students' responses.
Findings indicated that there were three types of difficulties in nursing judgment, 1) understanding patients' responses and how to cope with them, 2) decision-making in nursing care, and 3) the interaction with a patient who is difficult to communicate with, Three categories of teaching approaches which helped students understand the clinical situations and cope with them were identified, 1) supporting the student's ideas and experience, 2) assisting the student in recognizing the patient's situation, 3) presenting various perspectives. On the other hand inappropriate teaching approaches were seen. These were: 1) not listening to student's ideas, 2) giving no advice and 3) giving answers without explanations. There were also sub categories associated with these teaching approaches. The relationship between the types of difficulty and teaching approaches were identified. “Assisting the student in recognizing the patient's situation” was helpful in overcoming “difficulty in understanding patients' responses and how to cope with them.” “Presenting various perspectives” and “supporting the student's ideas and experience” effectively overcame “difficulty in making decision in nursing care.” To cope with “difficulty in interacting with a patient who is difficult to communicate with,” “Assisting the student in recognizing the patient's situation” and “presenting various perspectives” were more important.
In helpful cases clinical instructors approached the case so that students could establish their independence. These results suggest that clinical instructors should assess the type of the student's difficulty in nursing judgment and choose the appropriate teaching approaches to assist them.

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