This study describes the sleep patterns and subjective symptoms of fatigue of female family caregivers (age 50 and over) providing routine nighttime care to bed-ridden elderly individuals at home. Their sleep patterns were measured by electroencephalography during the two successive nights at their houses and were compared with those of age-matched female non-caregivers. Subjective sleep was evaluated by a self-administered instrument (the Japanese version of the Sleep Evaluation Questionnaire) for three successive nights. Fatigue was measured by a subjective instrument (subjective symptoms of fatigue) and physiological measurement (critical flicker fusion frequency). Data from nine family caregivers (65.2+/-4.8 y.o.) and nine non-caregivers (66.9+/-4.2 y.o.) were analyzed.
In the analysis of the percentages of sleep stages within sleep period time, the family caregivers had slightly more stage 1 (p<0.1) and less stage 2 (p<0.1). In the analysis of each sleep cycle of the caregivers, significant differences were found in the following variables as compared to those of the non-caregivers: more stage 1 (p<0.05) and less stage 2 (p<0.05) during the second cycle, and more of stages 3 and 4 during the third cycle (p<0.05). The family caregivers reported the fact of taking longer time to get to sleep (p<0.05), less quality of sleep (p<0.05), and less satisfactory physical and mental conditions in the morning (p<0.05) than did the non-caregivers. The family caregivers had higher levels of subjective and physiological fatigue both in the morning and in the evening than did the non-caregivers.
These results suggested that the sleep patterns with the higher incidence of stage 1 during the second cycle and the higher incidence of slow waves during the third cycle were correlated with the extent of the nighttime family caregivers' sleep needs and fatigue.

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The purpose of this research was to investigate the relationship between the self-care agency and the health of patients with chronic illness in mature adulthood. It used a correlational research design and, as research instruments, a self-care agency questionnaire (SCAQ) and a health questionnaire (HQ). The subjects consisted of 250 individuals with chronic illness in mature adulthood. Their mean age was 56.1 years (SD=6.3 years).
A significant relationship was found between self-care agency and health (r=.45, p<.001). Relatively strong correlations were also found between self-care agency and a sense of fulfillment on the HQ, as well as between health and the ability to manage and display interest in one's own self-care on the SCAQ. In the housewife cluster, a significant correlation between self-care agency and health was not found, but there were statistically significant differences from other clusters in terms of both self-care agency and adjustment of physical conditions.
The relatively strong correlation between self-care agency and health indicates the importance of focusing on both self-care agency and health in the case of chronically ill patients. On the other hand, it may be presumed that the lack of a correlation between self-care agency and health in the housewife cluster is connected to unease about their condition as represented in menopausal disorders and gloom about household chores. There is a risk that this may be excessively stressed in the adjustment of the physical conditions of housewives.

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The purpose of this study was to elucidate changes in symptoms, eating behavior related with changes in symptoms and principal factors influencing eating behavior associated with the return to the workplace of postgastrectomy patients. A self-administered questionnaire survey was conducted among 34 male postgastrectomy patients.
The results showed that dumping-syndrome-like symptoms (systemic symptoms and abdominal symptoms excluding diarrhea) and late hypoglycemia-like symptoms tended to persist, worsen, or occur anew after returning to the workplace. Many such patients complained that it was difficult to assume the supine position after meals at work and that their degree of caution during meals decreased. They also reported that the quantity ingested and small-stomach symptoms did not serve as a guide as to when to stop eating, and that they had been eating more. Late hypoglycemia-like symptoms after returning to the workplace tended to be associated with difficulty in assuming the supine position after meals, a decrease in rest time after eating, small-stomach symptoms that served as a guide as to when to stop eating, and a longer interval between meals.
The results of the survey suggested that support for health maintenance after postgastrectomy patients return to the workplace requires specific behavioral instructions, such as to take rests after meals, even at work, and not to allow the intervals between meals to increase, as well as to adjust the workplace environment by making it possible to take rests without feeling uncomfortable doing so.

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Based mainly on grounded theory analysis of interviews with 33 nurses, this study describes what kind of roles experienced pediatric nurses take with families who have children in the terminal stages of cancer. During the terminal stage, the nurses not only work to take care of a family's anxieties and uncertainties, but at the same time try to lead the family toward accepting the fact that they are losing a child and encourage them to make their decisions carefully. When a child is very close to dying, the nurses try to create a “good death” situation. They do this by making sure that all the appropriate people are at the scene, that the family members are able to have physical contact with the child, and that the setting is calm. The nurses evaluate their performance in terminal care situations on the basis of how well they were able to prepare the conditions for a “good death”. They modify their concept of a “good death” based on this evaluation. In this way, they could be seen a taking the role of a stage director, molding the situation according to their concept of a “good death”.

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This study proposes a teaching method for writing a nursing record based on findings in cognitive psychology. In the discussion; (1) we clarified how the concept of cognition could be conceptualized in a nursing record, (2) we attempted to identify factors that might influence a nursing record and thus locate problems that might occur in the cognitive process of writing a nursing record, (3) we investigated how to teach writing a nursing record.
In the first research, 18 nursing students and 12 nurses were selected as subjects and grouped into focus groups for interview. The obtained data were analyzed. The results of the analysis revealed the following three influential factors in the cognitive process of writing a nursing record; (1) communicating and sharing information with its reader, (2) what may be called “matacognitive activities”, (3) external problems caused by the writing format.
In the second research, 4 nursing students were selected and interviewed individually. The obtained data were analyzed qualitatively. We found from the data that there are three types of problems in recording during their clinical practicum; (1) problems caused in the process of understanding what the record actually means, (2) problems caused in the internal dialectical process, (3) problems caused in the recognition or comprehension of the record on the part of the reader.
As a conclusion, it is necessary to promote “metacognition” through reflection and monitoring. To effectively communicate through a nursing record, it is important to recognize how the reader of a nursing record may comprehend the record before the writer composes it.

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[in Japanese]

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