Purpose: The purpose of the present study was to develop a Burnout Causal Model, to verify the fitness of this model and to provide suggestions for improving work-related environments for nurses caring for patients with intractable neurological illness.
Methods: Subjects comprised 385 nurses working in the intractable neurological illness ward. The study was conducted by self-administered questionnaire sent by mail. A Burnout Causal Model was examined via Structural Equation Modeling.
Results and Conclusion: There were 248 valid responses. Job stressors influencing burnout were “Quantitative workload” and “Conflict with superiors.” Among nurses with less than 3 years of experience nursing patients with intractable neurological illness, “Verbal abuse” influenced burnout directly, whereas “Difficulty of involvement” influenced burnout indirectly. “Uncertainties regarding prospects of care” indirectly influenced burnout in nurses with 3 or more years of experience nursing patients with intractable neurological illness. Burnout led to turnover/reshuffle intention. “Conflict with colleagues” directly influenced turnover/reshuffle intention in nurses with less than 3 years of experience, compared to “Quantitative workload” and “Verbal abuse” for nurses with 3 or more years of experience. Among nurses with less than 3 years of experience nursing patients with intractable neurological illness, turnover/reshuffle intention is strengthened if workplace supports are weak. Supports in the workplace are thus important for nurses with little experience. These findings indicate that measures need to be based on years of experience nursing patients with intractable neurological illness.

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This research aimed to clarify the process in which a family with a disabled child links him/her to society. This research employed a continuous comparative analysis which is based on the Grounded Theory Approach. The subjects included 33 parents (15 pairs of parents and 3 mothers) with physically disabled children of school age.
Four categories found in this research were “acceptance* of my child,” “reality-orientation towards the society surrounding conditions of disability,” “formation (reformation) of ‘our own family,’” and “strategies which link disabled children to the society.” (*in this research “acceptance” specifically means that parents with disabled children understand their children not only notionally but actually understand with the feeling that “my child is what my child is, and it is convincing enough”). The core category was “the process to step out into society as a family not with only healthy members but also with the disabled child.” During the period of rearing disabled children, the parents gradually experienced “the acceptance of my child” and “being reality-orientated towards the society surrounding conditions of disability,” while they were undergoing the “formation our own family.” During these processes the parents gradually have come to recognize the relationship between their children and the society and to use the “measures which link disabled children to the society.”

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Various questionnaires examining physical and mental factors have been used to determine tiredness severity, although tiredness also has cognitive and interpersonal aspects. From this perspective, we propose a multidimensional inventory covering physical, mental, cognitive, and interpersonal dimensions for evaluating the severity of tiredness in middle-aged workers. Using this inventory and a general self-efficacy scale, we investigated the correlation between severity of tiredness and degree of self-efficacy. We examined 395 married study subjects (194 men, 201 women;age range 40–59 years) and determined the dimensional structure statistically using confirmatory factor analysis. The hypothesized four-factor model appeared to fit the data for all samples tested (root mean square error of approximation = 0.067) and had good internal consistency, with a Cronbach's alpha of 0.945. There was a significant negative correlation between the total scores for the severity of tiredness and degree of self-efficacy. Canonical correlation analysis was used to examine possible correlations among factors on the two scales (4×3 factors), revealing a significant canonical variable (λ=0.801): “fear of failure” strongly correlated with mental, cognitive, and interpersonal factors. Our findings suggest that our multidimensional questionnaire is a useful tool for evaluating the severity of tiredness in middle-aged workers and that the degree of self-efficacy may play an important role in alleviating the severity of tiredness.

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Purpose: To provide a basis for improving hope, for amyotrophic lateral sclerosis patients who depend on tracheostomy invasive positive pressure ventilation during home health care, by investigating sources of psychological support and happiness as a coping resource. These factors followed by assessment of relationship to hope as an indicator of successful adaptation to the illness experience.
Method: Initial surveys were conducted from which we developed a questionnaire that was mailed to respondents and returned anonymously. We obtained valid responses from 121 subjects for the written survey to ascertain sources of psychological support and sources of happiness. The level of hope was assessed using the Herth Hope Index (HHI), which measures desire to live and meaningfulness of life.
Results: A majority of patients (90%) identified someone who provided psychological support or some source of happiness. Only 13% of patients reported help from both “family” and “medical staff or professional caregivers,” “friends or acquaintances” and other “supporters,” while 22% of patients described not only “environmental comforts,” but also “human interactions,” “learning information about ALS” and “activities.” Users of computer communication reported more sources of support and happiness. Patients describing more sources had higher levels of hope.
Conclusion: This research reveals that psychological support and happiness as coping resources are structured from near sources such as family to outside sources such as activities and patients describing more outside sources had higher levels of hope. These patients will be able to promote the quality of life. These results show that care should include providing these effective resources such as relating to the outside and using a computer. This approach has the potential to help patients recovering or promoting a life-sustaining sense of hope.

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Purpose: To investigate the current difficulties, desires and their meanings in amyotrophic lateral sclerosis patients who depend on tracheostomy invasive positive pressure ventilation at home. Difficulties, desires and meanings were assessed in relationship to hope as an indicator of a will to live.
Method: We performed interview surveys, then used the results to craft a questionnaire that was mailed to potential respondents. We obtained valid responses from 121 anonymous subjects for the written survey. The level of hope was assessed using the Herth Hope Index (HHI), which measures desire to live and meaningfulness of life.
Results: Most patients suffered multiple kinds of daily emotional/spiritual, physical and social difficulties. Eighty percent of patients suffered frustration due to: difficulty communicating, fear that both family's burden of care and surrounding's burden, and physical pain due to remaining in the same physical position for prolonged periods of time all of which correlated with lower levels of hope. All patients described desires in some form. Eighty percent of patients described desires to: live at home, have a cure for ALS and decrease the burden of care on their families. These factors didn't correlate with higher levels of hope.
Conclusion: These results show that care should focus on coping difficulties and desires, not only which most patients describe, but also which correlated with the levels of hope. This double-pronged approach has the potential to help these patients living at home maintain or recover a life-sustaining sense of hope.

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The purpose of the present study is to identify the experience of pulmonary dyspnea by school-aged children with bronchial asthma. Ethno-nursing methodology has been adopted throughout this research: 11 school-aged children with bronchial asthma participated as main informants and among 39 general informants are main informants' mothers or fathers, nurses working in a pediatric ward or emergency room, doctors, nursery teachers and others. The data were collected using participant observation and interviews. As a result, five sub-themes and one main theme were identified. Briefly put, the main theme includes the following: school-aged children sensed that pulmonary dyspnea was coming from outside; if dyspnea was severe they sensed howling from their chest as their soul went out; they were frightened in severe dyspnea like that;and they were waiting for help from adults (especially from their mother), trying to settle down as soon as possible. These findings suggest that it is imperative for nurses not only to provide treatment for the resumption of their normal breathing, but also to give particular attention to their experience of asthmatic attack, ‘life-threatening’ pulmonary. The children had a tendency to experience less dyspnea if adults (mothers in particular) were nearby. In conclusion, it is suggested that parents' staying nearby after the transmission of this knowledge from nurses to parents might lead to an immediate reduction of the children's pulmonary dyspnea.

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Objectives: The objective of the present study was to elucidate the current condition of nurses' stress and to examine the support that nurses require from clinical psychologists.
Methods: A survey was conducted on nurses using a questionnaire that combined original question items and the following existing scales: Stamps et al's “nurse job satisfaction scale” Kikuchi and Harada's “nurse autonomy measurement scale,” and Shimazu et al's “workplace stressor-stress reaction scale.”
Results: The results showed an association between excessive stress and “hypersensitivity.”
Regarding support required from clinical psychologists, the most frequent responses were “psychological support for the patient” (62.4%), “consultation between the nurse and the patients” (14.6%), and “psychological support for medical workers” (13.2%).
Conclusion: In future, it will be necessary to conduct stress-screening investigations for nurses, and provide stress management training in order to continue to provide patients with high quality care assisted by clinical psychologists.

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To improve the quality of nursing care for patients with profound multiple disabilities, the present study was conducted in order to investigate the process of changes in the recognition and practices towards parents by nurses who work at the facilities for patients with profound multiple disabilities. Semi-structured interviews were conducted on 20 nurses working at the facilities for patients with profound multiple disabilities, and interview data were analyzed in accordance with the grounded theory approach. The nurses' recognition and practices towards the parents changed with their experience as follows: ‹Taking good care of the patient› ‹Understanding parents' need› ‹Trying to reach a consensus with parents and nurses› and ‹Seeking the equality of nursing care›. Although nurses' recognition and practices were different at each stage, all the participants held a common view on the purpose of nursing care «Providing good care so that parents can leave their children without worry». This view promoted the change of their recognition and practices.

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Purpose: The purpose of this study was to determine the effectiveness of footbathing for inpatients suffering from sleeplessness.
Method: Heart rate, high frequency power (HF), ratio of low frequency to high frequency (LF/HF), and subjective sleep quality was measured in ten inpatients (mean age 55.4±8.6 years) who complained of sleeplessness. Each inpatient experienced footbathing treatment (FB) as well as a non-footbathing treatment (CT). CT and FB were performed on different days. In this study, the nurse remained at the bedside engaging the inpatient in conversation for the duration of footbathing. Footbathing was performed before the inpatients went to bed.
Result: Patterns of heart rate and LF/HF over time differed significantly between CT and FB. In CT, heart rates decreased after sleep, and the decrease was mild. In contrast, in FB, heart rates decreased remarkably, after the lights out. In CT, LF/HF did not decrease during sleep and remained high. In FB, LF/HF decreased significantly after sleep and remained low while inpatients slept. Inpatients reported better sleep quality following FB than that following CT.
Conclusion: Our results suggest that footbathing prior to sleep effectively ameliorates inpatient sleeplessness.

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Objective: The purpose of this study was to examine the acceptance processes of family members dealing with the discharge of schizophrenia patients from psychiatric hospitals after long-term hospitalization.
Methods: We conducted semi-structured interviews with 10 participants and analyzed the data using a Modified Grounded Theory Approach.
Results: From interview transcripts we extracted 29 concepts and 6 categories related to the acceptance processes of family members dealing with the discharge of schizophrenia patients from hospitals. There were differences based on whether the family lived with or apart from the patient after discharge. For families living apart from the patient, the fact that the family would not be disrupted was an important factor leading to the discharge. However, family members felt happiness in that the patient's condition improved. For families living with the patient, the fact that the family was settled down was an important factor leading to the discharge. However, family members feared the distance between themselves and the patient and the potential breakdown of the family.
Conclusion: We found that families living with discharged patients required more support than families living apart from patients. This indicates that nurses need to be receptive toward family needs and provide continued support to improve patient and family QOL.

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This study was designed to clarify how the influence of a support group for women with depression aiming for reinstatement into the workplace may have enabled some of them to achieve reinstatement. Participants were five women with depression belonging to a support group. Data was collected through semi-structured interviews with participants and analyzed qualitatively and inductively.
Twelve categories were identified: [the environment surrounding depression]; [the knowledge provided in a support group]; [a support group as a place of catharsis]; [a support group facilitates supporting patients with depression]; [the presence of associates who sympathized with each other]; [the presence of associates who shared in the process of recovery and aggravation]; [encounters with staff and associates in a support group]; [acceptance of depression while feeling resistance]; [modification of recognition and behavior]; [modification of lifestyle]; [expectation of recovery]; and [reinstatement into the workplace while tackling conflict]. The results of this study suggest that reinstatement into the workplace support for women with depression is influenced greatly by the existence of comprehensive assistance provided by the environment of a support group, therapists, and companionship of others with depression who are seeking reinstatement back into the workplace and who have experienced a wide variety of clinical conditions.

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