The aim of this study was to elucidate the effect of physical body pressure on the destruction of the extracellular matrix (ECM) leading to pressure ulcers. Materials used were human normal skin fibroblast and umbilical endothelial cells. Following cultivation of both fibroblasts and endothelial cells in the presence or absence of physical pressure (50 mmHg), the change in cell morphology and ECM, levels of the degradation enzyme of ECM, such as MMPs, and alteration of gene expression were examined. In fibroblasts, in addition to the morphological change, down-regulation of fibronectin, up-regulation of versican, collagen, MMP3, and ADAMTS4 were observed, however, no prominent alteration was detected in endothelial cell morphology under the experimental conditions used. Therefore, it is suggested that physical body pressure of around 50 mmHg could be critical for dispersion of body pressure. However, physical pressure might also affect over all tissue, resulting in alteration of the ECM structure. It was suggested that nursing intervention based on not only the physical pressure but also the total over all tissue structure should be investigated.

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The aim of this study was to investigate the relationship between the molecular structure of the extracellular matrix (ECM) and the wound surface of pressure ulcers. Protein samples of excreted tissue fluid attached to the gauze surface of gauze from eight patients were extracted and subjected to examine for the presence of ECM-related molecules by utilizing specific antibody and ELISA to measure the enzymatic level of MMP3. It was revealed that i) western blot profiles differed from one another depending on the surface condition of the pressure ulcer; ii) a distinct immuno-staining profile was observed even in samples isolated from the same pressure ulcer; and iii) the MMP3 expression level also differed among protein samples. These results suggest that the molecular construction of the ECM around the wound surface of a pressure ulcer might differ from patient to patient. Therefore, it is important that nurses consider the nursing intervention based on the surface condition of pressure ulcers. In addition, MMP3-involvement in pressure ulcers is also suggested this enzyme has been detected in protein samples from the wound surface of pressure ulcers.

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In Japan, the donation of kidney for transplantation from the living donor occupies about 80% of kidney transplant. However the experiences of living kidney donors are little understood. Semi-structured interviews were conducted to illuminate the experiences of living kidney donors. Subjects were 15 donor-patients who were discharged from hospital shortly after donating their kidney using laparoscopy at university hospital in Tokyo.
A new core category was discovered using the grounded theory approach. It was the confirmation that one was irreplaceable as a donor, which deeply influenced their life even after the donation. When recipients were healthy, they regarded organ transplantation as a somewhat unrealistic issue. However, through sharing knowledge of the recipients' renal failure, obtaining medical information on renal transplantation, and hearing the recommendations of physicians, the issue became the donors own. The donors looked within themselves, tried to understand the situation that they were in and gave thought to other choices. Finally they underwent the operation in confirmation of the fact that each was irreplaceable as a donor, though they also experienced anxiety, fear, doubt, and other conflicts. Their minds certainly wavered, though the degree varied.
The donors also experienced 3 changes immediately following the donation:They felt that they had played the role of a family member to the recipients as well as donor-patients;they experienced a new understanding of the recipient;and they discovered a new understanding of kidney donation through observing the recipient's recovery process. Thus, the donors defined the meaning of the fact that they were irreplaceable as a donor even after the donation.
The findings demonstrated that kidney donation could be an experience to re-create a new realization of donor's self-concept.

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Nurses who are engaged in terminal care should be able to continue doing their job without distancing themselves physically and psychologically from their patients and families even when they touch upon topics related to death. The main purpose of this report is to discuss, among other related factors, the concept of “positive awareness,” which motivates nurses to maintain positive involvement in their work. Personal interviews were conducted with 30 experienced nurses engaged in providing terminal care. The results were analyzed based on the Grounded Theory Approach.
It was found that becoming involved in terminal care was difficult and demanding, but it also provided a good opportunity for the nurses to become aware that they themselves, in turn, receive care through their relationship with patients and families. This “positive awareness” encouraged nurses to become involved in their work without distancing themselves, and was fostered by “clinical experience,” “educational overtures” and “life history.” The findings indicate that nurses who are engaged in terminal care can be supported by helping them recognize this “positive awareness.” Consider whether you want to add any suggestions for how this can be achieved in practice?

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The purpose of this study was to clarify the process through which children with congenital heart disease (CHD) construct a body-image throughout their childhood. The research participants were 21 persons with CHD. The subjects were asked about their childhood recollections regarding their bodies. The taped and transcribed interview data was analyzed using a grounded theory approach.
It was found that the construction of body-image was a process of “creation of a natural sense,” involving a reconstruction of one's own natural sense from one's earliest recollections. This process was based in the “natural sense of one's earliest recollections.” When the subjects began moving into their peer groups, they found that their bodily sense was a new physical-mental-social experience of “experiencing dissatisfaction,” followed by a process of “attempting to assimilate,” “struggling with a dilemma,” and “exercising an embodied power of adjustment,” which was changed and modified into a “reconstruction of one's own natural sense.” The subjects created a self-image through their social life depending on a body-image based on an internal sense of their own body. It was suggested that in order for a child to develop a stable sense of self, it was necessary to understand one's own body appropriately, to be accepted by others, to gain a feeling of relief, to attain a sense of control, to carry out interactions with others, to move closer to one's own ideal image, and to have a feeling that one can adapt to the environment.

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Purpose: To examine the factors influencing the psychological adjustment to cancer among elderly patients, with specific focus on their perception of physical symptoms, physical condition, and self-efficacy.
Methods: The subjects were 52 elderly cancer patients (age, >65 years). The data were collected using questionnaires based on the following scales: the self-efficacy scale for advanced cancer, the Japanese edition of the Mental Adjustment to Cancer Scale, the Visual Analog Scale (VAS), and the Karnofsky Performance Scale (KPS). Kendall's τ correlation analysis and multiple regression analysis were performed to statistically assess the above-mentioned factors.
Results: A significant positive relationship was noted between the patients' “Fighting Spirit” and their physical condition and self-efficacy. However, a significant negative relationship was noted between the “Helpless/Hopelessness” and the patient's physical condition, perception of physical symptoms, and self-efficacy. In addition, “Helpless/Hopelessness” seemed to be influenced by the patient's physical condition and perception of physical symptoms (R²=0.55, R=0.74).
Conclusion: Our results suggested that to improve the feeling of hopelessness among elderly patients, nursing care should be designed on the basis of their physical condition and perception of their physical symptoms.

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Purpose: This study investigated mental stress responses in psychiatric nurses confronting their patients' suicides or suicide attempts, the progression of those responses, and the coping behaviors used by the nurses.
Method: An anonymous questionnaire survey was conducted among 267 nurses who worked in psychiatric clinics and had the experience of confronting suicides or suicide attempts among their patients. The study was conducted in the Chugoku region the nurses were asked about their age, gender, service years, the presence/absence and frequency of encountering suicides or suicide attempts among their patients, the presence/absence and duration of mental stress responses to these experiences, and the details of their coping behavior.
Results: 1) Nurses showed mental stress responses including remorse, tension, anxiety, and loss of spirit. Especially, some nurses had feelings of remorse and/or lethargy, for 10 or more years in some cases. 2) Among gender differences in coping behavior, alcohol or tobacco use and the presence of someone who would listen to them were significantly more common in men and women, respectively.
Conclusion: It is recommended that nurses who have confronted suicides or suicide attempts among their patients should be observed for any suspected responses, and these findings should be applied to long term support to help these nurses develop appropriate coping behaviors.

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The purposes of this study were to examine factors which influence the internal body water level from a perspective of the internal body water level and to examine a factor of polydipsia. The internal body water level was measured for 58 schizophrenic patients hospitalized at a mental hospital. Then comparisons were made between 35 patients with polydipsia (polydipsia group) and 23 non-polydipsia patients (non-polydipsia group), using the bio-impedance method (BI method). Analysis was made for the factors which were considered to influence the data and level of internal body water: plasma osmotic pressure, urine specific gravity, age, pathological history, antipsychotic drug dosage, anticholinergic drug dosage, sense of thirst, amount of smoking, presence of polydipsia and water intoxication episodes. Results indicated that there was no one that showed an increase in the plasma osmotic pressure among the polydipsia group and there were those who showed polydipsia even though they showed a decrease in the plasma osmotic pressure. A multi-linear regression analysis of the other factors showed that %ICF and %TBF were related to water intoxication episodes and that those with the episodes tended to show a high %ICF and %TBF.

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Purpose: The purpose of this study was to create and assess “A Psychiatric Liaison Nursing Intervention for Stress Management.”
Method: This intervention consisted of “a relaxation method,” “an interview using cognitive behavioral therapy,” and “nursing consultation centering on physical and mental stress management in recuperation” over six sessions.
Results: The four subjects had led social lives despite having inflammatory bowel disease; the average age was 36.8 years old. Trial results showed that the POMS scores of the patients declined after a relaxation intervention, indicating the iceberg profile commonly observed in a healthy group. Subjective assessment revealed some effects on physical sensations and mood, such as “awareness of physical tension and relaxation” and “sleep-promoting effects.”
Characteristic cognitions of the control group were “'should' thinking,” “negative thinking” and “labeling.” Stability was also observed in POMS and HADS scores from the fifth session, and the frequency of cognitive distortions occurring decreased.
Conclusion: After the intervention, the physical and mental health survey score by SF-36v2™ increased, suggesting that any intervention promoting awareness of the relationship between stress and physical and mental health could have positive effects on achieving peace of mind, stress management and QOL.

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Purpose: The present study aims to clarify findings about the features of the recovery-assessment scales obtained by a literature review, and to consider research challenges in Japan.
Method: A literature review covering the period from 1995 to 2008 was carried out using electronic databases (PubMed, CINAHL), by searching the following key words; recovery, scale, and mental illness. Twenty eight English-language papers including cited literature about recovery-assessment scales or about research using these scales were reviewed.
Results: The scales were classified into four types as follows: 1. to assess consumer's recovery by serial score, 2. to assess consumer's recovery by stage, 3. to assess one's orientation for, attitude toward, or knowledge about recovery, and 4. to assess recovery-oriented programs or recovery-promoting environments. And these wide-ranging scales have been used for various recovery-oriented programs.
Conclusion: Further studies in Japan were suggested to develop a Japanese-language recovery-assessment scale that can adequately measure the recovery of Japanese culture.

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