Aims: This paper describes a collaborative system between the midwives and public health nurses who provide continuing care to mothers and children to prevent child abuse.
Methods: Qualitative descriptive study.
Results: The midwives and public health nurses collaborated to provide continuing relief to mothers and children from the prenatal to the postnatal period. There were duple supporting methods, “midwives and public health nurses collaborating to build trust relationships with mothers” as personal support and “the creation of a safety net by professionals to prevent mothers and children who need assistance from falling through the cracks of the care system” as organizational support. The intermediary method that “exchange information on daily communication and utilize the information for the support.” The collaboration between the midwives and public health nurses necessitated their “increased awareness of the need for collaboration to prevent abuse” and “their mutual trust and support in the process of assisting the mothers and children.”
Conclusions: In order to prevent abuse, it is important to sustain the relationship between mothers and specialists and to enable the exchange of information that cannot be fully communicated by documents. This can be realized through a trusting relationship between the midwives and public health nurses. This finding indicates the necessity of building trusting relationships among the specialists involved in child abuse prevention systems.

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Aim: The aim of this study was to identify the factors that are involved in the feelings of school avoidance of high school students in order to develop an effective early support method for preventing refusal to attend school.
Methods: A total of 3,985 10th grade students from all the public senior high schools in “A” Prefecture in Japan agreed to participate in the study. They were asked to complete the Feelings of School Avoidance (FSA) Scale (“bad feelings toward school,” “friendlessness” and “aversion to attending school”), as well as provide information relating to their demographic details, living environment, lifestyle, and physical, psychological, and social factors.
Results: The “bad feelings toward school” subscale of the FSA Scale was significantly correlated with experience of smoking, anthropophobic tendency, the support from homeroom teacher and feelings of maladjustment in the study setting. The “friendlessness” subscale of the FSA Scale was significantly correlated with anthropophobic tendency and the support from school friends. The “aversion to attending school” subscale of the FSA Scale was significantly correlated with anthropophobic tendency, unidentified complaints, feelings of maladjustment in the study setting and the support from school friends.
Conclusions: It was supposed that the students who had anthropophobic tendency, unidentified complaints and who were not future oriented had repulsive feelings toward school. In addition, it was supposed that not being able to become part of the group by themselves and not having any friends in school intensified the sense of friendlessness. These findings suggested that anthropophobic tendency and unidentified complaints can be an important index in identifying a latent group of students who would avoid school attendance. The findings also suggested the importance of appropriate support from the yogo teacher and the need to develop a consultation system.

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The purpose of the present study was to articulate what was the essence of the nurse's experience in end-of-life care who cared for the child with congenital heart disease and the family. The nurse “A” who worked in the ICU of the children's hospital was interviewed, and its biographical narrative was analyzed using the phenomenological method developed by Giorgi.
As a result, six clusters of the most invariant meanings were identified: 1) getting involved in the situation that nobody knows when the child's condition will take a sudden turn for the worse; 2) waiting and seeing the process of decision making by the family directly connected with the child's life; 3) practicing end-of-life care while providing active medical treatment to the child; 4) improving environment to practice end-of-life care in the field of saving life; 5) sustaining the relationship between the family and the child who has been in a life crisis ever since he was born; and 6) talking about the deceased child with the bereaved family, concerning over their feelings.
Furthermore, the essence of the peculiar experience based on all those meanings was emerged: The nurse “A”, in an uncertain period of end-of-life care for the child with congenital heart disorder directly connected with his life, was always close to family's feelings though continually being in dilemmas, and managed to create a best environment for them on the limited condition so that they can strengthen the bonds each other.

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Purpose: This study aimed to establish a definition of the concept of “mimamori” as it relates to community-dwelling elderly people by clarifying the components that comprise “mimamori.”
Methods: The concept of “mimamori” was defined using Rodgers' concept analysis method. A literature review was conducted by searching the Ichushi-Web, PubMed and CINAHL databases.From among the 257 identified articles, 55 were randomly selected for analysis. Attributes, antecedents, and consequences were analyzed qualitatively.
Results: The attributes of “mimamori” for community-dwelling elderly people included the following three categories: “maintaining distance by considering the feelings or circumstances of elderly people,” “confirming the safety of elderly people by observation and/or measurement,” and “understanding the needs of elderly people by cooperating with people and institutions in the community.” In addition, both antecedents and consequences were found to comprise four categories. The antecedents were roughly divided into factors related to the elderly people and factors that surround elderly people. Consequences were found to comprise the involvement of the family and community in addition to the effects on the elderly individual. Subsequently, the concept of “mimamori” was defined based on the attributes.
Conclusion: The present results indicate that the concept of “mimamori” can be utilized in the development of research and education contributing to the support of community-dwelling elderly people. Furthermore, this concept can be used to promote preventive measures and the community health nursing activities of regional organizations.

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Objectives: The purpose of this study was to characterize the self-care agency that knee osteoarthritis patients receiving conservative treatment in ambulatory practice need in order to remove or relieve factors that may worsen the disease course and to improve the quality of life by appropriately managing symptoms and disease-associated dysfunction.
Methods: Data were collected from 18 outpatient participants with primary osteoarthritis of the knee through semi-structured interviews and content analysis was performed.
Results: Self-care agency in patients with primary osteoarthritis of the knee can be classified into the following 12 categories: “responsibility for oneself and self-determination,” “ability to acquire knowledge about the disease,” “understanding the necessity of adherence to treatment,” “ability to be aware of and analyze one's weakness,” “prioritizing going at one's own pace,” “ability to recognize and accept the positives in one's current situation,” “ability to motivate oneself to achieve a better life,” “ability to continue self-care and be patient while waiting for its effects,” “paying attention to information necessary for disease management,” “maintaining an active approach to prevent deterioration,” “adjusting one's life style to reduce joint loading,” and “ability to request support from dependable sources in one's life.”
Conclusions: These findings inform the nurse's understanding of self-care agency in patients with primary osteoarthritis of the knee and contribute to efforts to improve self-care agency in patients.

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Aim: To describe the actual condition of care toward patients with deliberate self-harm (DSH) by emergency department nurses (EDN), and to reveal the correlates to the care recommended in previous literatures.
Methods: A self-administered questionnaire was distributed to 1,000 Japanese EDN with a year or longer of experience and 262 (26.2%) responded.
Results: The EDN tried to save DSH and to listen to them carefully, although they often avoided contact with DSH. Half of the EDN inquired into the reasons for self-harm, and 30% confirmed the presence of suicidal thoughts. The amount of effort to increase help-seeking tendencies among the EDN was associated with the experiences in DSH care, the experience of training in DSH care in emergency departments, motivation towards DSH care, feeling less anxious about DSH, and the ability to disclose their own feelings to their coworkers in DSH care.
Conclusions: Learning skills previously recommended and improving the conditions of DSH care in hospitals will reduce anxiety with inducement to DSH care. In addition, it may also promote more appropriate care to DSH from EDN.

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Objectives: This study aimed to identify the process of nursing practice among expert nurses in relation to long-term patients with schizophrenia, from the time when the nurses started to consider patient discharge and provide discharge support to the completion of such support.
Methods: We conducted semi-structured interviews with 13 nurses who consented to participate in the study. The data obtained were analyzed employing a qualitative and inductive approach.
Results: The following 7 categories were extracted: 〈the possibility of discharge presented and facilitated by an ongoing understanding of the patient〉, [bringing out the patient's hope for discharge that lies deep in his/her mind], [sharing intentions with the primary physician who is reluctant to provide discharge support], [understanding the feelings and backgrounds of the patient's family members who disagree with discharge], [developing networks by adopting a primary nurse-centered approach], [fulfilling the roles of a primary nurse to provide peace of mind], and [engaging with the patient on a one-on-one level to foster his/her confidence]. 〈The possibility of discharge presented and facilitated by an ongoing understanding of the patient〉 was observed to be a central phenomenon affecting all other categories, and, thus, was identified as the core category.
Conclusion: The process of nursing practice to provide discharge support for long-term patients with schizophrenia should include: flexible clinical judgment to enhance the probability of discharge by performing ongoing assessment of patients; and, the implementation of nursing interventions to help patients restore their hope for discharge that is diminishing, and respond immediately to any slight changes in them.

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Purpose: This retrospective study describes public health nurses' competency in their practice of client-centered health guidance for lifestyle-related diseases prevention.
Methods: Data were collected using semi-structured interviews from 7 public health nurses and practice was assessed by qualitative analysis.
Results: Public health nurses co-create lifestyle changes for not only disease prevention but also the client's life. Three categories were identified from review of thematic interview data. The first category involved the theme of “Accepting the client to live his own life and find the direction to live as such.” The second category involved “relationship-building.” In order to better understand the client's life, public health nurses should create an atmosphere that encourages the client to broaden his/her perspective and elicits the appropriate narrative. Public health nurses can then utilize this to build a relationship which enables the free exchange of ideas. This relationship leads to the third category involving “co-creating optimal lifestyle interventions for disease prevention.” Our findings makes health guidance client-centered. In addition the client is proactive in changing continuously life-style for lifestyle-related diseases prevention.

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Objectives: The present study aimed to clarify the effects of fall-related experiences in community-dwelling elderly on fall threat, which is a parameter of fear of falling.
Methods: A questionnaire survey was conducted on 289 community-dwelling elderly regarding their fall-related experiences and 24 fall threat items developed by the authors. Relationships, effects of experiences on the five fall threat factors and the predictive capability of the conceptual model of this research were investigated using t-test, one-way analysis of variance and multiple regression analysis.
Results: Injury experience had a greater effect than the act of falling itself on the factor of “physical pain” and stumbling experience significantly affected the two factors of “loss of independence” and “trigger for a serious terminal phase.” Information from family and acquaintances had a positive effect on “physical pain” and “psychological burden of dependence on others,” while educational opportunities such as community health classes had a negative effect on “trigger for a serious terminal phase.” However, multiple regression analysis revealed an R² of ≤0.1 for all factors and fall-related experiences alone were unable to predict and explain overall fall threat.
Conclusion: Although fall-related experiences have a characteristic effect on fall threat, the condition of “experience” alone has a limited capacity to explain fall threat. Further investigation involving other factors is required.

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Purpose: This study was aimed at clarifying the actual condition of the research conducted by nurses at hospitals in order to develop a way of conducting nursing research which is suitable for clinical settings.
Methods: For this study, 3000 hospitals were randomly selected from those with more than 100 beds, all over Japan. A questionnaire was mailed to the nurses who promote nursing research at the hospital, and they were asked to answer the questions and mail it back.
Results: Answers were received from 1130 hospitals (collection rate 37.7%), and 1116 hospitals with more than 100 beds at the investigation were analyzed. Most hospitals (88.4%) had organized nursing research. ‘Staff education’ was highly prioritized as the purpose, and was followed by, ‘improvement of patient's service’ and ‘business improvement.’ The survey questionnaire on the actual clinical conditions was most frequently used as the method, the study period was usually one year, and there was a shortage of time and funds. A few (14.8%) had published a paper about their research outcomes. To promote research conducted by nurses at hospitals, they required the knowledge and skills of data analysis and research methods, and they would like staff members who instruct nursing research at the hospital. Though the percentage of literature review by using a database was not high (37.0%), a few (22.3%) required the means to obtain literature.
Conclusion: The present study has clarified the issues of nursing research in clinical settings, and the results suggest that the purpose of organizing research at hospitals should be carefully considered in future studies and recourses outside the hospitals should be utilized.

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