Organizational knowledge creation is a theory in business administration. It describes how the organization creates explicit knowledge from tacit knowledge of members who comprise the organization. The purpose of this paper is to describe public health nursing practice using this theory.
I propose a basic common framework based on this theory to explain all public health nursing activities. I address new viewpoints that include achieving an understanding of a community as a dynamic entity that changes in accordance with changes in its surrounding context and society. According to this viewpoint, the public health nurse (PHN) is a member of this community, and a public health nursing practice is considered a proceeding involving creative activities.
It is important for PHNs to understand their roles and activities in the context of new directions and perspectives, and to conduct their creative activities and achieve self-revolution without continuing their current policies.

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The purpose of this study was to clarify the relationships among delirium, sleep–awake patterns and urinary excretion of prostaglandin in patients after surgery. The subjects were 19 men (mean age, 64.7 years age) who had undergone total esophagectomy (with right thoracotomy) for cancer of the thoracic esophagus. Post-operative delirium was classified into 11 behaviors and the sleep-awake state was graded into four categories. Urinary excretion of prostaglandin E₂ was determined using an EIA kit.
The results showed a regular sleep–awake pattern in the non-delirium group (n=10). In contrast, the delirium symptoms group (n=9) showed irregular sleep–awake patterns on postoperative days 1–3. In addition, only nine of the symptoms of postoperative delirium occurred at the time, or before, the sleep–awake pattern changed. Urinary excretion of prostaglandin E₂ increased only on postoperative day one in the non-delirium group, whereas it increased throughout the observation period in the delirium symptoms group. These results suggest that a nocturnal sleep disorder and the presence of urinary prostaglandin affect the occurrence of postoperative delirium.

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The purpose of this study is to clarify how elderly disabled people are self-consciousness about aging and disability. I interviewed nine people living in a healthcare facility, collected the data and analyzed them by using comparative analysis.
The results show that their self-consciousness was categorized into seven types; they have “past consciousness about aging and disability,” and they feel like “their bodies get tangled up in the cobwebs” meaning they feel frustrated with their present physical and mental condition, and they are feeling like “a caged bird” meaning living in the facility. On the other hand, they feel at home with “their family which support them and they can go back to.” They also compare their present life with their past one, which they considered to be “a sparkling jewel in the crown.” Also, by comparing themselves with the other people in the facility they had “anxious thoughts about the future but feel better now.” All the while they think about “living and dying,” looking for the meaning of living their lives.
Because of this result I suggest through nursing practices that elderly disabled people may achieve self-realization and live positively if they can use their remaining abilities, form mutual relationships in the facility and try to make a comfortable place to live in.

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Purpose: The purpose of the study was to examine differences in the internal body water quantity between polydipsiacs and non-polydipsiacs using Bioelectrical Impedance Spectrum method (the BIS method, hereafter).
Method: The subjects of the study were a patient group of the schizophrenics in their 30's to 50's admitted to a mental hospital and their counter group of healthy males of the same age group. Those in the patient group were further divided into two groups, polydipsiacs and non-polydipsiacs, according to the researcher's criteria.
Results: The one-way ANOVA and multiple comparison among the three groups showed that the non-polydipsiac group had the lowest %ICF in the internal body water ratio, while the healthy group had the highest; there were significant differences between the healthy and the polydipsiac groups as well as between the healthy and non-polydipsiac groups. Thus, it was implied that the internal body water quantity of schizophrenic patients has a tendency of dehydration inside the cells and that the patients' thirst may be a physiological need accompanied with a decrease in the %ICF. The internal body water quantity was more widely distributed for the polydipsiac group than for the non-polydipsiac group.

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We carried our survey of relationship between factors of support from self-help groups (SHG) and ways of coping with stress in laryngectomees. A survey in the form of a mailed questionnaire was conducted on 710 members of Ginrei-Kai. The self-completing survey form with effective responses was recovered from 216 members (30.4%), who were enrolled in the analysis. They enjoyed the benefits of acquiring positive attitudes, acquiring specific skills, and receiving emotional support from SHGs. As their esophageal speech skills improved, the scores given for these factors of support increased. Their awareness of support was influenced by the status of accomplishment of the primary objective of joining SHGs, i.e., esophageal speech skills. The respondents overcame stress mainly by emotion-focused coping and problem-focused coping (Lazarus' stress inventory). Those laryngectomees showing a higher ability to cope with stress through emotion-focused coping or problem-focused coping were more aware of the support from SHGs. Laryngectomees showing a marked ability for emotion-focused coping were also more satisfied with emotional support as they accomplished an improvement in their esophageal speech skills. The group of responders indicating the stress coping pattern of “low scores of emotion-focused coping and high scores of problem-focused coping” was considered to expect satisfaction from the acquirement of an alternative means of verbal communication, whereas those in the “beginners” class were less aware of available support.

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The purpose of this study is to describe formal and informal support (FS and IS, respectively) from various sources, and to examine its relationship between psychological adjustment among the patients after laryngectomy (PAL). 450 patients after laryngectomy who were participating in self-help groups (SHGs) completed the questionnaire including items for social support and a modified Nottingham Adjustment Scale (“NAS-J-PAL”). We used a general linear model to examine the association between social support and psychological adjustment. As a result, insufficient FS from doctor, nurse and counselor as well as the lack of FS system was revealed, despite patients' needs. Social support influenced various adjustment indicators: FS on acceptance to lost voice, and anxiety and depression: in addition to these, IS on self-efficacy, self-esteem and locus of control. It is suggested the absence of continuing care for PAL from FS system might lead to psychological and social maladjustment. Specifically, FS could be effective to promote social integration and IS to accept lost voice.

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The purpose of this study is to clarify nurses' perceptions of their role in supporting children with eating disorders and their parents. Semi-structured interviews were conducted with 25 nurses with 3 or more years of nursing experience. Data were analyzed by qualitative induction.
The nurses responses indicated they recognize that their role as “member in a small safe society” consists of the following five categories: “preparation of the member”, “adjustment of the society”, “orientation of the society”, “empowerment of the family” and “necessary of the member.” The “small safe society” is circumstances like a secure base for children, in which the nurses became the “member” and rehearsed the children's social lives. The “member in the small safe society” required the nurses to prepare and perform their role while clarifying how to conduct a role-play for the children and their parents. These findings suggest that the role “member in the small safe society” contributes to improving the life skills of the children and their parents.

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The purpose of this study was to identify experiences of mothers whose babies are continually hospitalized from NICU to the pediatric ward. Ethnonursing was used throughout this study. Seven mothers, whose babies were continually hospitalized from NICU to the pediatric ward, participated in this study as the main informants. Seventeen general informants—nurses, doctors, hospitalized children's mothers, and main informants' husbands—also participated in this study. Data were collected using both participant observation and interviews. As a result, six sub themes and one main theme were identified from the data.
For mothers, their babies' transfer from the NICU to the pediatric ward implied not only escape from “the extraordinary place” but also the fact that their babies could now live on their own rather than being kept alive on support. Following their babies' transfer, mothers could actually feel their babies' life and relief by this. Thereby, the feelings of nurturing and caring began to develop among the mothers. In other words, they were on their way to becoming mothers in the real sense of the term;their feelings were augmented by their relationship with nurses and by being among other mothers.
These findings suggested the importance of caring for mothers whose babies were continually hospitalized from NICU to the pediatric ward. This care can be provided as follows: 1) cooperation between NICU and pediatric ward for the baby's transfer, 2) gradually shifting the role of caregiver from nurse to mother in consideration of the mother's pace of acquiring the requisite care skills, 3) providing a good environment to the mother for acquiring the requisite care skills, and 4) providing adequate space for communication among mothers.

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The purpose of this study was to observe the structure of postoperative symptoms of delirium. The method was as follows: (1) inclusive collection of symptoms which had been reported in connection with postoperative delirium in Japan; and (2) extracting samples of 81 items which nurses can observe. Finally, a questionnaire was drawn up consisting of the 81 items using a 5-point ordinal scale. The frequency with which 861 nurses had encountered the 81 items was surveyed, and the responses of 298 nurses were used for the data analysis.
From the results of factor analysis, the symptoms of postoperative delirium included nine factors composed of 51 items: “escape from restrictions,” “confused cognition and aggressive tendency,” “acceleration and decline of complaints,” “hallucinations,” “flat affect,” “apathy,” “exasperated action,” “sleeplessness,” and “decrease in the reaction.” Nine factors were contained in five features for delirium according to Diagnostic and Statistical Mannual of Mental Disorders (4th ed). Although Cronbach's alpha for “apathy to one's surroundings” was 0.58, each of the other eight factors indicated a certain level of internal consistency, over 0.7.

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In order to develop a health literacy measurement scale, this study aimed to identify the concept of health literacy based on a Hybrid Model of concept analysis. A review of health literacy literature was conducted and participant observation was performed in 5 health education classes for adults in health center settings. Finally, the literature review findings and fieldwork findings were integrated.
From the integrated findings, Functional, Interactive, and Critical categories of health literacy were identified. Functional health literacy consists of 1 stage, “reading and writing, numeracy.” The 4 stages of Interactive health literacy are “acquisition,” “perception, recognition, and comprehension,” “analysis, selection, and evaluation,” and “utilization.” The 2 stages of Critical health literacy are “application” and “offer to others.” Some persons studied new technical terms and acquired new information in order to apply and offer others the wisdom. Therefore, these 7 stages of health literacy followed a cyclical improvement process. Factors such as conversations with others, health education programs involving goal setting and problem solving, and physical fitness testing and body measurement facilitated the improvement of health literacy.
As each health literacy stage agrees with a health learning theory, present finding is useful for measuring the effects of education programs. The findings of this study will facilitate the development of a measurement scale for health literacy in clinical settings.

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The objective of this study was to describe the relationship between cognitive characteristics and symptoms in female patients with depression in Japan. Therefore, a gender-based comparative analysis of 10 male and female subjects was conducted. All subjects were interviewed, and open coding, categorizing, and theoretical sampling for category-refining purposes were conducted. As a result, “fixation on subject of dependence” was identified as the central category, and this category was found to comprise the following 3 characteristics in depressed female patients: “excessive role awareness in relationships,” “overdependence on receiving care,” and “loss of control in relationships or communication.” In addition, these characteristics were mutually related to symptoms of depression, and a vicious cycle. These results suggest that the development of effective caring techniques for depressed female patients should take into consideration the relationship that exists between female gender roles and depression, while also applying a cognitive therapy-based approach to breaking the mutual relationships and vicious cycle between the 3 cognitive characteristics and the symptoms of depression.

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So as to measure the value of hospital care, we conducted a survey using Conjoint Analysis in order to estimate the workload of nursing care. The survey asked questions about individual status and hypothetical situations used for Conjoint Analysis. These questionnaires were distributed by chief nurses to a total of 1,000 nurses working in general wards at five hospitals in Osaka which each had more than 500 beds. The hypothetical situation used in this Conjoint Analysis assumes four attributes, i.e. three different types of work: 1) giving complete bed baths, 2) giving intravenous (I.V.s), and 3) measuring vital signs, with payment as the fourth attribute. In the questionnaire, respondents were shown profiles of two hospitals with different hypothetical situations and asked which hospital they would prefer to work at.
The estimation results show that all attributes were significant. Assuming that a nurse's monthly income is 25 thousand yen, the value of one unit of “a complete bed bath” is estimated as 93.38 yen, an “I.V.” unit as 42.25 yen, and “measuring vital signs” as 35.98 yen.

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