Purpose: The purpose of this study was to clarify factors that affect the personal development of nurses who have experienced the death of a patient that left them with strong negative emotions, for example, sadness and remorse.
Method: Subjects were 192 nurses with 3 to 6 years of clinical experience who completed a questionnaire comprised of items from the Finding Benefits Scale and the Scale for Coping with Bereavement, which identifies factors related to the personal development. A multiple regression analysis was used.
Results: The analysis revealed that most nurses had experienced a patient's death that left them strong negative feelings. The multiple regression analysis revealed that nurses' personal development (evaluated by the Finding Benefits Scale) was significantly affected by the following factors: religious activity and existential meaning, acceptance and overcome, ruminative response, support-seeking behavior (evaluated by the Scale for Coping with Bereavement), and their beliefs about the ideal death. These factors explained 51.0% of the variance of responses.
Conclusion: These results suggested that in order to advance nurses' personal development, a various coping behavior was found to be effective.

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Aim: The purpose of this study was to develop an assessment scale of health care professionals' recognition of a successful interdisciplinary team approach in health care facilities for the elderly (HCFE).
Methods: We adopted a three-step approach to develop this scale. Firstly, researchers carried out concept analysis of interdisciplinary teams from a literature review. Secondly, 16 health care professionals who cared for the elderly with dementia were interviewed about a successful interdisciplinary team approach. Thirdly, the assessment scale was tested on 904 healthcare professionals who worked in HCFE and re-tested after four weeks. Explanatory component analysis with promax rotation and confirmatory factor analysis were performed.
Results: A total of 401 responses (valid response rate 44.4%) were acquired from the health care professionals in the test. From the results of the explanatory components analysis with promax rotation and maximum likelihood methods, three prescribing factors of recognition of a successful interdisciplinary team approach were extracted. In brief, the final scale consisted of 32 items and three factors: “flexibility of organization structure (α=0.93),” “care process and degree of implementation (α=0.93),” and “cohesion and competence of members (α=0.91).” Moreover, the hypothesis that was made from the results of the exploratory factor analysis indicated that the three-factor model of successful interdisciplinary team approach provided the best fit for the current sample (GFI=0.921, AGFI=0.891, CFI=0.955, RMSEA=0.065, AIC=301.792).
Conclusion: The developed scale may have possibilities that can measure health care professionals' recognition of an interdisciplinary team approach in HCFE.

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Aim: The purpose of this study is to develop the Japanese version of the Mental Health-Related Self-Care Agency Scale (MH-SCA) and to establish its validity and reliability.
Method: Using the committee approach, the MH-SCA was translated from English into Japanese. To ensure the semantic, conceptual, and normative equivalence with the original instrument, the committee included five translators: one adjudicator, two translation reviewers, one self-care specialist, and one experienced researcher in questionnaire design and pretesting. The steps were: prepare, translate, pretest, revise, and document. The finalized MH-SCA-Japanese version (MH-SCA-J) was conducted on 73 Japanese outpatients with depression to address reliability and construct validity for the MH-SCA-J.
Result: The Cronbach's alpha for the MH-SCA-J was 0.93, supporting reliability by determining internal consistency. The total score of the MH-SCA-J was significantly correlated to the scores of CES-D, −0.834 (p<0.01), and to the scores of daily activities, −0.690 (p<0.01). Therefore, concurrent validity was confirmed. Additionally, as a result of having compared a group of depressed people with a group of nondepressed people, the depressed people were clearly differentiated from the nondepressed people by this instrument. These mean scores of MH-SCA-J, 97.16 for the depressed and 131.83 for the nondepressed, were significantly different, t=−7.51 (p<0.01), therefore, clinical validity was confirmed.
Conclusion: In conclusion, the MH-SCA-Japanese version was developed and its validity and reliability were confirmed. These results show that the MH-SCA-Japanese version can be used to measure the self-care agency of people with mental disability.

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Aim: The aim of this study was to examine the applicability of a family intervention model for families of children with intellectual/developmental disabilities to clarify the influence of family's paradigm and facilitate the family resilience process.
Methods: For 1 year, I visited families of children with intellectual/developmental disabilities, for whom the intervention model was used. All communications with the families were recorded and transcribed. We analysed the changes occurring in a family using Reiss's family paradigm and examined the applicability of this model.
Results: In the adjustment phase, through interventions such as ‘encouraging expression of emotions’ and ‘following the advice of nurses,’ the families changed their views on intellectual/developmental disabilities and began to cope within the family. Accordingly, Reiss's family paradigm identified a shift from ‘Definition of the Event and Search for Additional Information’ to ‘Initial Responses and Trial Solutions.’ In the adaptation phase, interventions such as ‘offering alternatives’ forced the families to make decisions accompanied by increased anxiety and problems; however, through interventions such as ‘linking the family with the community’ and ‘encouraging expression of emotions,’ the families effectively improved their stress coping capacity. Because the family identified as coping strategies not only family's resources but also social resources. It was observed that Reiss's family paradigm shifted from ‘Initial Responses and Trial Solutions’ to ‘Final Decision or Closing Position and Commitment of the Family to This.’
Conclusions: The intervention of ‘offering alternatives’ was an effective turning point in the family resilience process. ‘Linking the family with the community’ improved the stress coping capacity of these families and ‘encouraging expression of emotions’ helped families obtain a more elastic coping capacity to face challenges.

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Purpose: To conduct a study of nurses to reveal the effects of quality of life (QOL) and self-efficacy on their intention to quit.
Method: A questionnaire was distributed to 625 nurses and data from the 300 nurses who responded to all of the questions were included in the study. The questionnaire was comprised of questions about the attributes of the respondents, the Japanese translation of the WHO/QOL-26 (as a measure of QOL), the General Self-Efficacy Scale (GSES; as a measure of self-efficacy), and the Intention to Quit Scale (as a measure of intention to quit).
Results: In a comparison by number of years of experience, nurses with three to five years of experience had the lowest QOL and GSES scores, while nurses with 20 years or more of experience had the highest scores (p<0.01). Furthermore, nurses with three to five years of experience had the highest intention to quit scores, while nurses with 20 years or more of experience had the lowest scores (p<0.05). Statistically significant correlations were observed between QOL, GSES and intention to quit (p<0.01), and the results of the categorical regression analysis indicated that QOL (physical health, social relationships), GSES (behavioral positiveness, anxiety about failure, social positioning of one's ability), and marital status significantly affected the intention to quit.
Conclusion: These results suggest the necessity to establish measures for preventing the intention to quit among mid-ranking nurses with three to five years of experience during their transitional period.

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Objectives: The purpose of this study is to examine health care policy in Japan from the adoption of neoliberal principles in 1982 until now. I clarified tasks involved in “independent patients” aspired in neoliberal health care policy on the basis of the debate over independence.
Methods: I selected literature on medical policy published from 1982 to 2010 as primary and secondary sources, and conducted literature research regarding “independent patients” in the multi-layered structure of politics, economy, and society.
Results: Japan's health care policy since 1982 aims for inducing patients to be indepedent, that is, the creation of independent patients who can make their choices on information gathering and medical treatment by their own responsibility. Yet, it is dangerous to place absolute trust in the policy of independence because it would exclude patients who cannot be independent from objects of protection and support. This policy change also widened inequalities in access to health care.
Conclusions: Independence is a double-edged sword. It is indispensable for making patients mature and dignified. It may, however, destroy human life. The policy of independence in health care policy must care about dependency relationship among patients and between patients and medical staffs and seek the establishment of independence based on the right to life.

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Purpose: To examine the current practices on secondary prevention care among HIV/AIDS outpatient nurses.
Methods: Self-administered questionnaires were distributed through nursing departments to HIV/AIDS outpatient nurses of 83 HIV/AIDS hospitals. The questionnaires, which were returned by mail on completion, consisted of 35 items related to nursing care (21 items), characteristics of nurses (7 items), and environmental factors (7 items).
Results: With regard to the nurses who recognized a responsibility for each individual care, the proportion of nurses who practiced a frequency of care greater than 60% ranged from 43–69%. Notably, the proportions related to care practice, such as confirming a patient's type of sexual activity, were lower than those of other types of cares. Full-time HIV/AIDS nurses more provided secondary prevention cares than nurses who treated both HIV/AIDS and other patients, also primary nurses more provided care than all other classes of nurses.
Conclusions: The result from this study indicates that the assignment of full-time HIV/AIDS nurses or the introduction of a primary nursing system may be useful for improving the provision of secondary prevention care among HIV/AIDS outpatient nurses.

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Purpose: The purpose of this study is to assess the cases that doctors and nurses work together coordinately for the treatment of chronic disease region patients to find out a desirable division of roles and coordination.
Method: We selected four cases and interviewed the doctor, nursing administrator, and nurse. We analyzed the features, contents, and characteristics of organization for understanding the coordination between doctors and nurses.
Results: Four preceding cases were assessed. The contents in the division of roles and the coordination between doctors and nurses were as follows: (1) assessment of dose arrangement by nurses based on the current status of patients and report the same to the doctors; (2) consultation during recuperation and psychological support; (3) receive instructions regarding medical examinations and medical prescription by doctors; (4) receive brief informed consent by doctors and detailed informed consent to adapt each patient's life by nurses; and (5) performance of examination, dose arrangement, informed consent, and observation by nurses. The effects of these aforementioned points were improvement in patient satisfaction and increase in the original business time of the doctors. However, the issue was that there was no agreement regarding the division of roles between doctors and nurses.
Conclusion: It is suggested that the division of roles and coordination between doctors and nurses in chronic disease region must be renewed. We have realized that it is necessary to structure protocols and risk control systems, and to train doctors and nurses.

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Purpose/Methods: The purpose of this study is to clarify how patients with chronic obstructive pulmonary disease (COPD) understand and manage their bodily condition in daily life, in reference to the cognitive models proposed in Schutz. The method used was a semi-structured interview conducted with 15 patients.
Results: The healthcare behavior of COPD patients identified in the interview was classified into the following 11 categories: [1] accepting their bodily changes caused by COPD, [2] carefully examining and comprehending their physical condition, [3] take in feeling to be alive and loss of reliance in the body, [4] trying to familiarize themselves with the way they stabilize their breathing, [5] learning how to achieve and keep physical and mental stability, [6] maintaining physical mobility, [7] implementing body therapy techniques in such a way as to steadily continue them in daily life, [8] adjusting their lifestyle in accordance with their physical condition, [9] finding ways to continue as a member of society, [10] acquiring sufficient knowledge concerning COPD, such as its treatment and future prospects, and [11] trying to fulfill their own roles and find enjoyment in daily life. In this study using the idea of Schutz, therefore, the daily healthcare behavior was able to be clarified from the aspects on the patients side.

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