The aim of this study was to evaluate the effect of cognitive behavior therapy for self-efficacy and psychological stress.
The study subjects were gastrectomy patients with the early stage of gastric cancer, and interventions comprised of weekly counseling and journal writing. Conceptual framework of this study was based on Lazarus's Stress model (1984), and for the framework for Self-efficacy is based on the Social Learning Theory (Bandura, 1977, 1986). Three scales were employed to evaluate the effect of interventions: general self-efficacy (GSES: Sakano and Toujyou, 1986), mental stress response (SRS-18: Suzuki et al., 1997), and moods (DAMS: Fukui, 1997).
Subjects were allocated to either intervention group (IG (n=14)) or to control group (CG (n=12)) and of those twenty completed the study (9 and 11, respectively). Subjects were assessed at baseline, at the time of discharge, and 1 month after discharge.
Results:
1) Two sample t test revealed that IG had significantly lower SRS-18 total scores and SRS-18 subscale (depression-anxiety) scores than CG did at discharge. One month after discharge, depression-anxiety scores for IG remained significantly lower than that for CG (p<0.05).
2) Split Plot Design Repeated Measure ANOVA revealed that DAMS subscale scores (positive mood) for IG improved significantly from baseline to discharge (p<0.05).
3) Dunnett's test of multiple comparisons showed that IG had significantly improved moods than CG did at discharge, and the effects were sustained at 1 month after discharge (p<0.05).
4) Total General Self-Efficacy scores and any of the subscale scores between the two groups did not differ at discharge and 1 month after discharge.
In summary, interventions seemed to have contributed to the improvement of positive moods and depression-anxiety. However, interventions have failed to show any measurable impact on the general self-efficacy. Further research is necessary to confirm the findings.

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The purpose of this study was to develop a scale to rate the feeling of stability in daily life with a stoma. One hundred and thirty three patients with permanent gastrointestinal stoma responded. The questionnaire was consisted of a scale for feeling of stability in daily life and the ostomate's QOL questionnaire. The items of this scale were collected by preliminary interviews, and they were confirmed content and face validity.
Five factors, consisting of 24 items, by exploratory factor analysis and confirmatory factor analysis, were selected from 40 items, as follows:(1) recovery and expansion of activities,(2) acceptance of the stoma,(3) relief at having a place to go for consultation about stoma care,(4) absence of worry about peristomal skin trouble, and (5) perception of defecation and physical condition. Weighted kappa for each item and the intraclass correlation coefficient for each factor, based on the test-retest method, indicated the moderate level of reliability. Cronbach's a for each factor indicated a certain level of internal consistency. Correlation assessments between the scores for this scale and those for the ostomate's QOL questionnaire or some items confirmed the convergent and discriminant validity. We supposed an ordinal relationship among 3 factors, from the clinical viewpoint, that is, absence of worry about peristomal skin trouble, acceptance of the stoma, and recovery and expansion of activities. This relationship was supported statistically.
The results of this study suggested that this scale was reliable and valid, indicating that the scale might be used clinically.

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A qualitative study was conducted to identify an explanatory model which describes coping in family caregiving for relatives with mental illness. Thirty four family members provided written consent to be interviewed. Analysis of data revealed four coping styles in family caregiving.
a) Co-prosperous style: family caregivers empathically attend to needs of the ill relative in addition to their own.
b) Fused style: family caregivers are deeply involved with the ill relative, sometimes at the cost of their own needs.
c) Self-protective style: family caregivers are primarily concerned about their own needs.
d) Demoralized style: needs of both the ill relative and the family caregiver are disregard.
The four styles are explained by “family responsiveness” to the welfare of the ill relative and “family self-nurturing” of their own well-being. Responsiveness and self-nurturing are both high in the co-prosperous style and both low in the demoralized style. Responsiveness is high and self-nurturing is low in the fused style, while responsiveness is low and self-nurturing is high in the self-protective style. Family coping style is not static, and family caregivers move between coping styles to resolve conflicts between family responsiveness and self-nurturing. These findings suggest the need to assist families in finding a balance between responsiveness and self-nurturing. The findings also indicate the importance of improving the well-being of both the ill relative and the family.

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The purpose of this research was to explore the home care process for the elderly by families using the Grounded Theory Approach. Twelve families in process of caring for or waiting for caring were picked up for this research by this approach at the two general hospitals in Tokyo. Data were collected through interviews and observations on a continuous basis, being analyzed by the comparative analysis method.
In this research, the home care process for the elderly by family was clarified by focusing on the competing needs between or among the family members arose from the “Shiwayose”(the burden shifting) of caregiving at home. The process had 3 properties of 1) distress caused by the shared burden, 2) conflict between or among family members, and 3) mobility of work sharing by family members; and included 3 stages, that is,“The stage of harmony”,“The stage of provisional harmony”, and “The disharmony”. Also it was made clear that the family members used some strategies at the stages of provisional harmony and disharmony to avoid or reduce the needs' competition and continue the home care.
The findings suggest that the needs' competition among the family members caused by the Shiwayose of the home care was the critical issue in question. Even if the family members were placed in the worst situation of confusion caused by the needs' competition, they would still have potential power to live together in harmony while continuing the home care. The health provider needs to promote such potential power, supporting the strategies that family use.

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The purpose of this study was to examine the processes of reconstructing life in families with stroke patients, and to propose guidelines for family support. The sample comprised 11 spouses of stroke patients, living with their spouses either physically or nominally if the patient was still in hospital. Data was collected using interviews. Following qualitative analysis of data, 4 phases of life reconstruction in families were extracted: 1) definition of the situation; 2) the wisdom of families; 3) family prospects; and 4) reconstruction behaviors.
The wisdom of families represented skills originating with and developed by the family, based in the experiences and knowledge cultivated from life with stroke patients, and developing constantly. The wisdom of families includes the following 4 core items: 1) management of caregiving; 2) shaping attitudes towards the current situation; 3) maintaining family identity; and 4) deepening relationships.
When families with stroke patients struggle to reconstruct family life, supporting the wisdom of families for family nursing appears important.

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The purpose of this study was to investigate the relaxation response of subjects to footbath, foot massage, and foot massage combined with footbath compared with that of control.
Ten subjects (mean age 72.0, SD 2.2), physiological data (heart rate and foot skin temperature) were continuously measured and subjective comfort data were obtained before care, immediately after care, and 120m after care. The comparisons were performed with one way ANOVA, Tukey's test and the Friedman test.
Immediately after care, foot massage resulted in a significant decrease in heart rate in comparison with control (p<0.01). As for skin temperature immediately after care, all forms of care produced significant increases in comparison with control (footbath: p<0.05; foot massage and foot massage combined with footbath: p<0.01). Foot temperature following foot massage combined with footbath was significantly higher than that of control up to 30m after care. The results suggest that these forms of care generate the relaxation response as shown by the decrease in heart rate and the increase in foot skin temperature. Foot massage combined with footbath provided the greatest subjective comfort.
Although there were some differences in the relaxation response achieved with these three forms of care, our findings suggest that all of them, contribute to psychological and physiological well-being by generating and retaining warmth in the feet and legs, and promoting the onset of sleep.

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