Purpose: The purpose of this study is to analyze the difference in incidence of uterine inertia and prolonged labor between pregnant women with hiesho and those without hiesho and to estimate the causal effects.
Method: The study design was a retrospective cohort study. The analysis was conducted on 2,540 women in hospital after delivery, over the approximately twelve months between October 19, 2009 and October 8, 2010 (response rate: 60.8%). The research methods employed were a self-administered questionnaire and data extraction from medical records. In this analysis, confounding factors were adjusted by carrying out analysis of covariance and stratified analysis using propensity scores.
Results: Of study respondents, 41.9 percent had hiesho. The regression coefficient of hiesho was 0.69, p<0.001 and the odds ratio was 2.00 for uterine inertia (analysis of covariance). The regression coefficient of hiesho was 0.83, p<0.001 and the odds ratio was 2.38 for prolonged labor (analysis of covariance).
Conclusion: The incidence of uterine inertia was twice as high among pregnant women with hiesho than those without hiesho, and the incidence of prolonged labor was 2.3 times higher. It was inferred that hiesho may have causal effects on uterine inertia and prolonged labor.

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Purpose: This study sought to clarify the concept of family-centered care in perinatal and pediatric healthcare to use as a guide for more effective provision of family-centered care for children and their families in Japan.
Method: Using Rodger's concept analysis method 40 articles were analyzed and categorized identified from four databases: CINAHL Plus with full text, MEDLINE, PsycINFO, and Ichushi-Web, using the keywords “family-centered care” or “family-centred care” matching with “perinatal” or “neonatal” or “pediatric.”
Findings: Attributes were: 1) respect and dignity for children and families; 2) information sharing about child's care; 3) supporting empowerment of families; 4) supporting decision-making and 5) partnership and collaboration between families and healthcare providers. Antecedents factors were: 1) social (paradigm shift from traditional, healthcare provider-centered care to patient- and family-centered care; 2) healthcare receivers (diverse values and differing needs for healthcare) and 3) healthcare providers (discrepancies between actual and ideal practices of family-centered care). Consequences were: 1) greater satisfaction with care; 2) greater psychological health of parents and improvement in parental competencies; 3) strengthening family bonding and function; 4) improvement of physical and psychological health of children and 5) health professionals' greater job satisfaction and competencies.
Conclusion: Thus concept of family-centered care was defined as “a continuous and comprehensive care process, including information sharing about child's care, supporting decision-making and empowerment of families, based on a partnership and between families and healthcare providers, carried out with respect and dignity.” The proposed model can contribute to the improvement of nursing education, practice, and research in the fields of perinatal and pediatric healthcare in Japan.

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The aim of this study was to explore factors associated with perineal pain and disruption of daily life during early the postpartum period. A questionnaire survey was distributed to 503 women who had a vaginal and full-term delivery prior to their discharge from the hospital: 425 responded(85%). One-way analysis of variance, analysis of covariance and structural equations model were performed. Mean age was 32.7 (SD=4.8) and 206 (48.5%) women were primiparous. Episiotomies were performed on 141 (33.2%) women, 121 (28.5%) women had a second-degree laceration, 109 (25.6%) women had a first-degree laceration and 54 (12.7%) women had other perineal trauma. Factors associated with early postpartum perineal pain included: “over age 35,” “primiparous,” “supine position at delivery” and “episiotomy.” Women with an episiotomy felt significantly less pain relief from the day of delivery to the fourth day postpartum than those with a second-degree laceration (p<.05). The structural equation model revealed that three factors disrupted women's daily life in the early postpartum period: “primiparous,” “perineal trauma,” and “perineal pain.” “Primiparous” and “disruption of daily life” were the factors that increased their anxiety about resuming of sexual intercourse. However, “psychological support” reduced anxiety about the resumption of sexual intercourse and also enhanced satisfaction with perineal care.

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Objective: The present study aimed to clarify the expectations that expert managers have of visiting nurses performance based on the involvement of expert visiting nurse station managers in utilizing and training visiting nurses.
Methods: Using a grounded theory approach, continuous comparative analysis was conducted on data collected through participant observation and semi-structured interviews of 16 expert visiting nurse station managers throughout Japan.
Results: Expert managers' expectations of visiting nurses comprised “approachable, close nursing”; comprising two sub-concepts of “performing role as a life-supporting medical expert” and “individualized nursing.”
Conclusion: “Approachable, close nursing” as expected by expert managers involves nursing from between a 2.5 person perspective, and is patient and family-driven with appropriate role execution by the nurse as a medical expert.

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Purpose: This study aims to describe how mid-career generalist nurses perform autonomous clinical judgments.
Method: Nineteen Japanese generalist nurses were interviewed about their experience in making autonomous clinical judgments. The modified grounded theory approach was used for data collection and analysis.
Results: Participants reported a goal of “bringing out patients' true selves, and preserving their hope and choice” in making such judgments. Then, they made judgments that involved “reviewing orders from medical doctors and complementing them if necessary” and “providing treatment with respect for the patient's life.” In making judgments, they determined means of “complementing and supplementing each other's judgments” and “capturing minute changes in patients' status and predicting their prognoses.”
Discussion: Mid-career Japanese generalist nurses appear to exhibit professional autonomy, aiming for a clear goal, making independent judgments, and utilizing their intuition to the maximum.

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The purpose of the study is to clarify the subjective experiences of patients with hematological malignancies during recuperation of over one year and their decision making processes used with these phenomena. Semi-structured interviews were conducted on 7 participants, and a qualitative and inductive approach was employed to analyze the descriptive data.
The results showed that, during the course of recuperation, patients experienced: “the recognition of being alive value,” “the recognition of everyday life value,” and “the enhancement of emotional experience,” “the loss of control of bodily functions.” In the early stages of the medical treatment, patients responded to these experiences negatively. Accordingly, they maintained stability through “decision-making activities of daily life” under the medical treatment. These decision-makings made to act independently to “decision-making of therapeutic activities” in a stepwise manner. Finally they responded to these experiences positively. These findings suggest that nurses would need to support patients in their “decision-making activities of daily life” for stability under the medical treatment and “decision-making of therapeutic activities” independently.

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In this study, nurses working in a digestive surgery ward used the Japanese version of the NEECHAM Confusion scale to screen 84 elderly patients (>65 years) for delirium and confusion on days 1–7 after gastrointestinal surgery. Subsequently, 31 nurses completed the questionnaires about the possibility of introducing the scale as a strategy for prevention of postoperative delirium. As a result, 22.6% of the nurses reported that using the scale improved their observation and judgment skills, and 76.7% reported that the burden of its implementation was very heavy. Furthermore, regarding the possible introduction of this scale, 35.5% felt that the scale could not be introduced in current busy wards (units), but would like to it to be introduced if they had sufficient time. Another 38.7% did not wish the scale to be introduced, and 22.6% chose “Anything can be said about it.” As future subjects, the necessity of prior training, environmental management such as the amount of business, and supervision/case conferences with a viewpoint how to use the NEECHAM efficiently in patient care were suggested.

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