This study was carried out to identify the factors influencing a subjective evaluation of gait by female subjects undergoing total hip arthroplasty (hereafter THA), and to understand the extent to which each of these factors affects gait in these patients. A survey was administered to 112 female patients before and after THA. A stepwise multiple regression analysis was performed using gait as dependent variable and factors influencing gait as explanatory variables. The following factors were found to influence the subjective evaluation of gait by female subjects undergoing THA: pain (β=0.420), leg length discrepancy (LLD) (β=−0.271), walking ability (β=0.240) and self-esteem (β=0.131). These variables explained 57.9% of the variance. Findings from the present research suggest that a proper understanding of a subjective evaluation of gait requires the evaluation of pain, LLD, walking ability, and self-esteem of each patient. This understanding will, in turn, help us motivate THA patients for their rehabilitation taking into account their subjective concerns, which at the same time will allow us to provide nursing interventions that encourage patients to become more active in their own recovery process.

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Purpose: This study sought to elucidate the reasons why a specific health guidance system is not used by some individuals.
Method: Ten individuals living in an unnamed town were questioned using semi-structured interviews as to why they had not used the specific health guidance system. Three questions were asked regarding the reasons for nonuse, and the interviews were qualitatively analyzed using the KJ method.
Results: Three factors that constituted reasons for not using the specific health guidance system were clarified: “presence of ‘territory, me,’” “things other than ‘good health’ are important to me,” and “I hope that the activity is provided to people who need it without limiting it to myself.” The factor “presence of ‘territory, me’” represents the right to self-determination with regard to health matters and provides support to the other factors as their basis. In addition, these people generally recognize that good health is a condition in which people may live their everyday lives without difficulty, and such views regarding health formed the basis of the factors. The 3 factors influenced each other, thereby reinforcing the reasons for not using the specific health guidance system.
Conclusion: The provision of support with consideration of the health-related views of people not using specific health guidance might be important for solving the problem of nonuse.

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 Aim: The present study was conducted to clarify the appropriate needle insertion depth for intramuscular injection based on assessment of BMI.
 Methods: The participants were 553 individuals more than 18 years old. We measured their height, weight, subcutaneous tissue thickness over the deltoid and gluteus medius, and muscle thickness of the deltoid. We clarified the association between BMI and subcutaneous tissue thickness, with reference to muscle thickness, we clarified the appropriate needle length for intramuscular injection.
 Results: Subcutaneous tissue thickness over the deltoid was 0.04×BMI−0.25 in males, and 0.04×BMI−0.17 in females. However, in individuals with a BMI of <18.5, there was a risk of hitting the bone because the deltoid muscle was thin. Therefore, the appropriate needle length was 1.5 cm for BMI ≤18.5−<30.0, and 2.0 cm for BMI≥30.0. Subcutaneous tissue thickness over the gluteus medius was 0.05×BMI−0.38 in males, and 0.05×BMI−0.03 in females. However, in individuals with a BMI of ≥30.0, there was a risk of subcutaneous injection because of thick subcutaneous tissue over the gluteus medius. Therefore, the appropriate needle length was 1.5 cm for BMI<18.5, and 2.0 cm for BMI≥18.5−<30.0.
 Conclusion: The appropriate needle insertion depth for intramuscular injection into the deltoid is 1.5 cm for BMI<18.5−<30.0 and 2 cm for BMI≥30.0, whereas that for the gluteus medius is 1.5 cm for BMI <18.5 and 2.0 cm for BMI≥18.5−<30.0.

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Purpose: This study was conducted to confirm the effects of foot care performed by elderly persons by observing changes in the structure and function of their feet, and testing balance and walking performance. Additionally, we examined the validity of foot care for health promotion and disease prevention.
Method: Foot-care methods, such as foot baths, keratin removal, foot massages and exercises, were taught to elderly persons living at home. In addition, we compared the three changes in the structure and function of their feet, testing balance and walking performance before and after these foot care interventions were conducted.
Results: The subjects consisted of seven elderly persons living at home. Instrumental Activities of Daily Living （IADL） and the Falls Efficacy Scale （FES） were unaltered. However, the patients’ self efficacy was slightly altered. Problems with their feet, including blood circulation and muscle fatigue, improved. Keratinized and callused soles were replaced by normal, healthy skin. The sensation of touch and pressure was sensitive. The surface temperature of the skin and peripheral blood flow significantly improved, as well as balance and walking performance.
Conclusion: Maintaining balance and walking performance is necessary for elderly individuals to accomplish daily living activities. It was proved that foot care performed by elderly persons, themselves, may contribute to health promotion and disease prevention as well as improve the condition of their feet.

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Objectives: To investigate the effect of maternal smoking on anthropometric measurements (body weight, height, head circumference, and chest circumference) of newborns and their postnatal growth, with the aim of obtaining fundamental data for future considerations on maternal and child health.
Methods: A database containing the results of health checkups for four-month-old infants in A City was analyzed by removing personal information.
Results: A total of 3,494 infants were analyzed. The rate of maternal smoking during pregnancy was 2.9%, while that of paternal smoking was 34.9%. Maternal smoking during pregnancy affected all anthropometric measurements of infants at birth: newborns of smoking mothers were significantly lighter (P=0.013) and shorter (P<0.001) and had a significantly smaller head circumference (P=0.004) and a significantly smaller chest circumference (P=0.045) than those of non-smoking mothers. Differences in newborn size without chest circumference between the two groups remained significant after adjusting for factors influencing the above measurements. Maternal smoking during pregnancy affected height and head circumference measured at the four-month-old checkup: infants of smoking mothers were significantly shorter (P=0.004) and had a significantly smaller head circumference (P=0.023). Differences in infant size between the two groups remained significant after adjusting for factors influencing the above measurements.
Conclusion: Maternal smoking during pregnancy affects body weight, height, head circumference, and chest circumference of newborns, as well as height and head circumference of infants at four months old. These results demonstrate the necessity for stronger guidance on smoking cessation during pregnancy.

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Aim: The aim of this study was reveal acquisition process of the motivation for job continuation in new graduate nurse.
Method: Semi-structured interviews were conducted with 6 new graduate nurses. Data were analyzed using The Modified Grounded Theory Approach.
Results: New graduate nurses were familiar with nursing techniques and had adapted to working arrangements. In addition, they felt “capable” based on evaluations made by senior nurses and patients and on changes in their perception of patients. The graduate nurses had already entered a phase of self-realization and started the process of “becoming an ideal nurse.” To reduce stress, they reminded themselves of their reasons for choosing nursing, changed the pace of their work, and reminded themselves to “accept the normal challenges of the job.” Colleagues and friends supported the new graduate nurses in going through the process of evaluating their jobs, and the graduates also “rebuilt their motivation” through discovering the professional advantages that nursing offers.
Conclusion: These results of the study suggest that, to facilitate the acquisition process of the motivation for job continuation required to remain in nursing, new graduate nurses need to smoothly establish a foundation for their role as a nurse and to view nursing as an occupation.

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Purpose: The aim of this study was to develop an instrument to assess self-care agency in patients with primary osteoarthritis of the knee.
Method: The participants consisted of 386 patients with osteoarthritis of the knee. Scale development involved several phases, including item development, reliability testing, criterion-related validity testing, and construct validity testing.
Results: Confirmatory factor analysis was conducted in order to assess the extent to which the Self-Care Agency in Patients with Knee Osteoarthritis Scale (SCAKOS) structure fit the present data. The fit indices were approximately satisfactory (GFI=0.927, AGFI=0.907, CFI=0.919, RMSEA=0.045). The SCAKOS comprises five factors with 20 items. All standardized coefficients in the model were moderate to high and all t-values were acceptable (p<0.01). The factors are as follows: “ability to acknowledge and understand the disease and its severity,” “ability to adhere to a treatment strategy,” “ability to modify daily life to reduce load on the knees,” “ability to proactively adopt information and methods useful for preventing disease exacerbation,” and “ability to seek effective support and apply it to improving quality of life.” Cronbach’s alpha for the total SCAKOS score was 0.813. The SCAKOS score was correlated significantly with SCAQ score and self-care one’s health score (p<0.01).
Conclusion: We developed the SCAKOS to measure self-care agency in patients with primary osteoarthritis of the knee. These findings suggest that the scale is suitable for model building, and can also be effectively used to assess self-care agency in patients with knee osteoarthritis, particularly those in Japan.

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Objective: The aim of this study was to elucidate how the intuition of expert nurses affected support for the families of patients with consciousness disorder urgently admitted to the intensive care unit.
Methods: Semi-structured interviews with six expert nurses working in an intensive care unit were conducted. On the basis of Bergson’s notion of intuition, we extracted words indicative of intuition along with the associated thoughts or actions and analyzed these qualitatively and descriptively. We also chronologically arranged entire scenarios of nursing support and analyzed their effect on intuition-based support for families.
Results: We found that the intuition of expert nurses allowed them to instantaneously understand a family’s situation. This intuition enabled the nurses to unconsciously infer the feelings of the family based on each family members’ expressions, such as movements of eyes and mouth. The expert nurses used their intuition to also recognize insecure and fluctuating feelings of the family to provide support in the form of observation or communication in accordance with the recognitions. Another finding was that the initial intuition of the nurses on meeting the family influenced subsequent thoughts and actions.
Conclusion: The expert nurses understand the family members’ fluctuating feelings using their intuition and consequently provide sensitive support based on their interpretation of these feelings. The findings of this study also indicate that the nurses’ thoughts influenced by intuition are associated with their actions for support.

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Objective: To investigate the reliability and validity of the Japanese version of the Managing Uncertainty in Illness Scale-Family Member form (MUIS-FM-J).
Methods: A questionnaire survey was distributed to 204 family members of patients hospitalized with cranial nerve disease. The contents comprised the MUIS-FM-J, the State-Trait Anxiety Inventory-Form JYZ (STAI), and basic subject attributes and recognition of a family member’s illness. Concurrent validity was determined based on the correlation between the MUIS-FM-J and state anxiety, whereas construct validity was determined mainly using the factor structure of the MUIS-FM-J. Distinctiveness was determined by differences in MUIS-FM-J scores for subject recognition of a family member’s illness.
Results: The MUIS-FM-J was confirmed as having the same single-factor structure as the original version. Cronbach’s alpha was 0.91. Positive correlations were obtained between the MUIS-FM-J score and trait anxiety (r=0.34) and state anxiety (r=0.66). MUIS-FM-J scores showed differences according to kind of disease, number of days since onset, levels of disturbance of consciousness and activities of daily living, predicted prognosis, and other variables.
Conclusion: The present findings for internal consistency, concurrent validity and construct validity suggest that the MUIS-FM-J has reliability and validity.

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Aim：This research aimed to clarify the sense of coherence (comprehensibility, manageability, meaningfulness) of family caregivers of persons with mental disorders living in the community.
Methods：Twenty-four family caregivers participated in this research. Semi-structured interviews were conducted and the descriptions of interviews were analyzed by content analysis.
Results & Conclusion：The “family members’ onset of mental disorders” was regarded as a painful experience in the caregivers’ lives. Caregivers’ manageability repeated ‘the trial and error’ in the progress of a time, and “the attitude for having feeling” of relationship and life with patients changed while receiving “support from the others”; these caregivers acquired “the strength to face the patients.” Concerning comprehensibility, at first caregivers comprehend that “the family member was a mental disorder.” And some caregivers felt that “there is no prospect of improvement in their lives” due to “the difficulty of predicting and understanding the circumstances.” For meaningfulness, the caregivers felt they “acquired significance or value” in their life due to caregiving. However, some of the caregivers had “the feeling of insufficiency of their lives or caregiving.” A “sense of mission” to continue the caregiving was an important strength.

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Purpose: This study is to find out how the siblings who live with autistic spectrum disorder individuals（ASD）develop their life process.
Methods: Continuous comparative analysis based on the Grounded Theory Approach was undertaken.
Results: Study participants were 10 siblings aged between 12 and 22 years. The life process created by the siblings were found to be composed of the following concepts: approach to others in order to protect their siblings with ASD; interaction with siblings by keeping a distance from their autistic experiences; uncertainty about their own existence; consideration for parents; thoughts for their own future life inseparable from that of their siblings with ASD. The overriding concept of protection was identified by the analysis.
Discussion: Participants were found to approach others so as to protect their siblings with ASD while continuing to interact with them by keeping a distance from their autistic experiences and to show consideration for their parents. They grow up by experiencing uncertainty about their own existence and their life process through a sense of protection for life and existence, considering their own future life as being inseparable from that of their siblings with ASD.

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Purpose: Uncertain prospects of life with Implantable Cardioverter Defibrillators (ICD) are one of the major concerns in life among patients, but this has not been examined in Japan. This study aimed to identify cognitive and behavioral processes of how middle-aged patients receiving ICD manage to cope.
Methods: Semi-structured interviews were conducted involving 8 subjects (6 males and 2 females), and the obtained verbatim transcriptions were analyzed using a modified grounded theory approach.
Results: A total of 18 concepts were generated, and they were classified into 6 categories: 〈become aware of the necessity of forging relationships〉, 〈forge trusting relationships with others〉, 〈try to view constraints from different perspectives〉, 〈create personalized guidelines〉, 〈become used to the use of ICD〉, and 〈brace oneself again〉 and 1 core category: [forging relationships with others and ICD].
Conclusion: The results suggest that middle-aged Japanese patients receiving ICD follow the process of forging and reforging relationships with others and ICD in order to manage their lives.

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Purpose: This study aimed to elucidate the recognitions of public health nurses (PHNs) during preceptorships for novice public health nurses.
Methods: Semi-structured interviews were conducted with nine PHNs, who had experience acting as preceptors. Interview data were analyzed qualitatively and subjected to descriptive analysis.
Results: Recognitions experienced during preceptorships for novice PHNs were divided into two major types: (1) perspective transformation as a PHN, and (2) perspective transformation as a member of the organization. The first type of perspective transformation was the process of: “noticing the necessity of accepting the role of fostering novice PHN” and then “noticing the importance of matching the teaching to the developing novice PHN,” “noticing that fostering the novice PHN is their learning task,” furthermore, “by learning from novice PHN, noticing the necessity to exceed their own limitations.” The second type of perspective transformation was the process of: “noticing the necessity to work on the organization” and so “noticing the necessity to learn among staff,” “noticing the importance of re-recognizing the PHN roles among the organization,” moreover, “noticing the necessity of working on improving the organization as a member of the organization.”
Conclusion: Adopting the PHNs’ preceptor role resulted in perspective transformations as a PHN, and as a member of the organization, namely, transformative learning.

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Objective: To investigate the influence of various factors on the development of professional autonomy in certified nurse specialists (CNSs).Method: We conducted a questionnaire survey on 545 CNSs. In addition to CNS Autonomy Measuring Scale, the questionnaire included CNS-related items on the following: job positions; specialty fields; confidence towards the profession; eagerness towards the profession; sense of satisfaction; career awareness; human relations in the workplace; and support recognition. For comparisons, we used t-test, partial correlation, and multiple regression analyses.Results: Among the 545 CNSs surveyed, responses were received from 212 (response rate: 38.9%), among which 205 were valid (valid response rate: 96.7%). Scores for “collaboration with other specialists and consultation ability in management” were higher in executive and managerial CNS posts, such as Chief/Manager, than in staff; in both cancer and psychiatric mental health nursing CNSs than in critical care nursing CNSs; and in CNSs with higher as opposed to lower scores in support recognition. Scores for “critical care management and general judgment ability” were higher in cancer nursing, chronic care nursing, and critical care nursing CNSs than in psychiatric mental health nursing CNSs. In addition, strong associations were observed between confidence towards the profession, eagerness towards the profession, sense of satisfaction, career awareness, and human relations in the workplace, irrespective of the nursing field or the number of years of working experience. Moreover, confidence, eagerness, and human relations in the workplace were shown to have a strong influence on all lower level items of the CNS Autonomy Measuring Scale.Conclusion: Our results suggest that confidence and eagerness towards the profession are essential for promoting the development of autonomy in CNSs. In addition, these results suggest that professional positions should enable CNSs to exhibit their specialties, and that the workplace environment should provide adequate support and maintain good human relations.

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 Objective: To explain recovery from depression in the elderly in relation to the life-world.
 Method: Unstructured interviews with eight elderly people (>65 years old) were conducted. All had been diagnosed with clinical depression and had been receiving psychiatric treatment. Symptoms were either in remission or in a temporary lull. The interview results were analyzed using Giorgi’s phenomenological method.
 Results: From the start of depression until the acute stage, the mind and body of the participants were subject to isolation and oppression in the life-world and were unable to live without any inhibition. As such isolation and oppression worsened, they were preoccupied with the impulsive desire for death due to pessimism. These experiences served as the impetus for treatment, and the participants were able to realize the catalyst to bring themselves back to the life-world through the psychiatric treatment. Reintegration into the life-world suggests remission of depression; for the participants, reintegration into the life-world meant return to familiar relationships and daily lives and liberation from the impulsive desire for death and acceptance to live out their natural lives.
 Conclusion: Nurses need to provide an environment which emphasizes return to familiar relationships and daily lives and liberation from the impulsive desire for death and acceptance to live out their natural lives to facilitate the recovery of elderly patients from depression.

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This study aimed at identifying how the concept of excellence in nursing practice relates to experience of nurses, primarily in child and adolescent psychiatric inpatient care. Quantitative research was conducted with 234 nurses who work in child and adolescent psychiatric wards. The excellence of their nursing practice was evaluated via a “Hospital Nurses’ Self-Evaluation of Their Excellence in Nursing Practice” scale. The scores in total and of 7 subscales were compared with the length of the nursing experience of the participants, and whether experience was in pediatric or adult psychiatric nursing, or not. Nurses with more than 6 years’ experience in child and adolescent psychiatric inpatient nursing scored higher than those with less experience in 6 subscales. There were no significant differences in the subscales for pediatric nursing, and there were significant differences in the only one subscale for adult psychiatric nursing. In conclusion, the findings show that child and adolescent psychiatric nursing has its own degree of excellence and aspects of know-how which make it difficult to utilize the experience of nurses across specializations.

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The purpose of this study was to describe caring of nurses provided to children and their families at the pediatric outpatient department of a community hospital. An ethnographic approach was employed for data collection and analysis. The data were obtained by participant observation and interviews. Eleven female nurses and other medical professionals working at the pediatric outpatient department participated in the study. Children and their families were also important participants. Caring of nurses at the pediatric outpatient department in the community hospital was comprised the following; Identifying critical children and their families and transferring them to consultation rooms, providing the families with reliable information and giving them support and encouragement, empowering families to raise children, resolving differences between children and their families, and identifying families with prevalence of child abuse and trying to keep the relationship with them. The pediatric outpatient department in the community hospital was a chaotic place; children in various developmental stages and of varied physical levels visited the hospital daily with their families. Nurses were always nervous because the behavior of the children and their families was unpredictable. The nurses found it difficult to understand the children’s condition and take care of them because time was extremely limited at the department and they did not know the usual conditions of children. The nurses stated that they “put up the antenna” to identify the needs of children and their families and judge what type of help they needed, and provided them appropriate nursing care within limited time.

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Purpose: The purpose of this study was to examine differences in physical responses after arousal at different sleep stages to promote better physical reactions after awakening and efficient daytime activities.
Methods: Fifteen healthy women were monitored for three nights. On night 1, the subjects were aroused at different sleep stages [non rapid eye movement (NREM) and REM sleep]. After arousal, P300 and simple reaction times were measured in each subject. In addition, P300 and simple reaction times were measured before noon in 5 subjects. Analyses were performed comparing the measurements obtained immediately after arousal under NREM and REM sleep and those obtained immediately after arousal and before noon under NREM and REM sleep.
Results: There was a significant difference in P300 latencies immediately after arousal under NREM and REM sleep. Comparison between the measurements immediately after arousal and before noon under the same conditions showed that arousal during REM sleep was associated with significantly shorter push-button (auditory stimuli) and jump reaction times, and arousal during NREM sleep was associated with significantly shorter push-button reaction time (photic stimuli), both before noon and at arousal.
Conclusion: Arousal during REM sleep was associated with faster cognitive and attentional reactions than arousal during NREM sleep, suggesting that arousal during REM sleep could improve physical reactions after awakening and promote efficient daytime activities.

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Purpose: To clarify the current state of ethics review in nursing programs at universities and discuss the ideal state of ethics review for nursing research.
Methods: Self-administered questionnaires were distributed by postal mail to full-time faculty members at schools of nursing in all regions of Japan. The faculty members selected were those who had thorough knowledge of ethics review in nursing research.
Results: Out of 89 faculty members of schools of nursing that responded to the questionnaires (44.5% response rate), two faculty members indicated that their school did not have an ethics review board; therefore, data on 87 schools were analyzed. Ethics review boards that were managed by a nursing college, school of nursing, or department of nursing all had a small number of committee members, many of whom were qualified with a nursing specialty. Most of the schools had an official ethics code. Forty-six schools (52.9%) had a budget for an ethics committee, 28 schools (32.2%) had a review system that continues even after a study has started, and 11 schools (12.6%) provided new committee members with a training course. Expedited reviews were performed at 50 schools (57.5%).
Conclusions: The present findings demonstrate the importance of the following considerations in ethics review in nursing research: organizing an interdisciplinary ethics committee with a pluralistic perspective; introducing an appropriate expedited review system and allocating a budget to reduce the burden on members; monitoring the progress of applicants’ research; and improving each member’s ethics qualifications.

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Purpose: To clarify the current state of ethics review for young researchers, conflicts of interest, and compensation of subjects in nursing research.
Methods: Self-administered questionnaires were distributed by postal mail to each chairperson of a nursing program with a bachelor course at a university in Japan. Each chairperson chose a respondent who was knowledgeable and experienced in ethics review for nursing research.
Results: Out of 89 schools of nursing that responded to the questionnaire, two schools did not have an ethics review board; therefore, data from 87 schools were analyzed. The mean number of ethics reviews conducted for young researchers was 21.9 (SD=38). A support system for young researchers had been developed only in universities with a doctoral program and an interdisciplinary ethics review board. A management policy for conflicts of interest existed only at national universities and universities with a doctoral course and an interdisciplinary ethics review board. Compensation of subjects for participation in research was only carried out in universities with a doctoral program.
Conclusion: As the issues related to the research ethics of young researchers depend on the individual researcher’s background and research environment, it is necessary to provide opportunities for researchers to study independently. Compensation of subjects in nursing research and conflicts of interest depend on the research environment at each university. Therefore, these issues should be improved immediately at all nursing universities in Japan.

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Objectives: This study aimed to theoretically explain the psychological processes of women who underwent cesarean sections experienced from during pregnancy to one month after delivery and to determine influential factors for providing appropriate nursing care.
Methods: Semi-structured interviews with 18 Japanese women who had undergone cesarean sections were analyzed using a grounded theory approach in order to construct a theory.
Results: Women who had undergone cesarean sections could make up their minds to have cesarean sections through the process of “preparing for a cesarean section.” They could also consent to cesarean sections through “finding meaning in a cesarean section.” However, there were factors inhibiting or promoting these two psychological processes, which often began with an “awareness of a possibility of a cesarean section.” “Being afraid of surgery” and “still feeling attached to a natural birth” were inhibiting factors, while interactions with health care workers and other women who had had cesarean sections were promoting factors. The process of “finding meaning in a cesarean section” continued after delivery. An emergency cesarean section sometimes meant that a woman could not complete both of these processes. In such cases, a woman would follow the process of “finding meaning in a cesarean section” after delivery, in order to arrive at a point where she could consent to one.
Discussion: Based on the dual process theory of “making up my mind to have a cesarean section” and “consenting to a cesarean section,” nursing interventions that accelerate the two psychological processes were suggested.

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Objective: The aim of this study was to find out what effects nurses experienced when working with nursing practicum students in clinical training. The study was conducted at a psychiatric hospital.
Subjects and Methods: Face-to-face interviews with 4 nurses who participated in practice unit and a group interview with other medical staff in the ward were conducted and data was analyzed qualitatively. In addition, self-report questionnaires asking about job stress and burnout responses were given to 30 nurses in the ward and the results were analyzed and compared with results from 14 nurses in the control group.
Results: The changes nurses and other medical staff expressed were: “increased learning,” “improvement in service quality,” “increased tension,” “increased enthusiasm,” and “more effort toward improvement in patient care.” No significant changes were seen in job stress or burnout scores between nurses in the subject group and those in the control group.
Conclusion: The results suggest that working with nursing practicum students could contribute to improved nursing competence of clinical nurses without increasing their stress.

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Purpose: To clarify the influencing factors and strategies in practicing a diabetes education program (hereinafter called education program) for the elderly by expert nurses by making a comparison with the adult.
Method: We made a mailing survey using an unsigned, self-writing questionnaire in the period of September–October 2009. For the influencing factors of the education program, the reply was requested to be made from 4 choice questions in the order of frequency, and, for the strategies that were practiced by expert nurses, the reply was requested to be provided in a free-style writing. Regarding the former, we made a comparative analysis using a statistical analytical method such as the Fisher’s exact test, and regarding the latter, we arranged and categorized the replies based on similarity in the contents.
Result: As a result of 93 valid replies, the following findings were obtained: (1) As the influencing factor in practicing the education program, the numbers of respondents about levels of understanding, circumstances of the family members, and the disease except diabetes in case of elderly were significantly more than those in case of adults. (2) As the strategies in practicing the education program by expert nurses, a category peculiar to the elderly such as “Ensure individuality and QOL,” etc. was extracted.
Discussion: The expert nurses provided intentional care such as “Ensure individuality and QOL,” because they understood in abundant clinical experience that there were strong needs for continuation of independent life in case of the elderly.

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In order to determine the factors that influence the discharge support toward home care provided by ward nurses to their terminally ill patients, as well as to detail the interactions between them, we administered self-reported questionnaires to 428 duty nurses in a hospital ward. Discriminant analysis revealed that the most important factor for terminal patient discharge support was the degree to which nurses could talk with their patients about death, rather than a nurse’s years of work experience or the extent of cooperation with the discharge unit. A proactive approach to terminal patient discharge support was implemented, so that more nurses could talk with patients openly about death. The findings also showed that the majority of nurses were not comfortable talking about death with patients; in order to provide discharge support for terminal patients toward home care, we considered providing nurses with better education concerning death.

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Objectives: The objective of this study is to determine relationships between work life balance (WLB) and burnout of hospital nurses.
Methods: A self-rating questionnaire survey was conducted with 1,030 nurses who were working in five general hospitals. We selected one hospital from each of five management types; national medical institutions, public medical institutions, social insurance organizations, medical corporations, and general private companies. The questionnaire devoted 22 items to burnout (Japanese version of MBI-HSS) and 24 to demographic details and WLB indexes.
Results: Valid responses were obtained from 798 subjects (77.5%). The mean age was 33.8±8.1 years, and the average total scores of WLB and burnout were 10.2 and 10.9, respectively. The total score for WLB of nurses in the hospital managed by a private company was significantly higher than the other four (p<0.01). Results from hierarchal multiple linear regression analysis showed significant relationships between burnout and the following factors: occupation type, overtime, having children or not, awareness of WLB, switching on and off working hours, working with a clear purpose, having persons with whom they can consult, and WLB.
Conclusion: The results of the analysis by management type of hospital show that hospitals operated by companies have a good potential to realize WLB. It was also suggested that nurse burnout can be prevented by switching between working and off-work hours, making the effort with a clear purpose, and aiming to improve the level of WLB.

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Purpose: The purpose of this study was to ascertain the characteristics of activity care (AC) at special nursing homes for the elderly (nursing homes) and long-term care health facilities (care facilities) and elucidate the roles and learning awareness of nursing professionals with regard to AC.
Methods: Questionnaires were sent to nursing professionals at 255 nursing homes and 135 care facilities (total 390). Fifty-five valid responses from nursing homes and 49 valid responses from care facilities (total 104) were received and used for analysis.
Results: Eighty percent of AC tasks that nursing professionals at both nursing homes and care facilities were in charge of involved “checking health status” and “observing AC in progress.” “Assistance with ambulation” accounted for a significantly high proportion of tasks managed by nursing professionals at care facilities. Ninety percent of nursing professionals at both nursing homes and care facilities said they “understood both the mental and physical state of elderly individuals participating in AC,” which is an aspect of AC that students should learn about as a part of their basic nursing education. The proportion of nursing professionals at care facilities who were aware of the need for nursing education for “the purpose of AC and the role of nursing professionals” and “practicing AC via on-site training” was significantly higher than that at nursing homes.
Conclusion: In general the role of nursing professionals in AC is limited mainly to health assessment, but at care facilities, nursing professionals are expected to play a central role in the implementation of AC. In addition, a high percentage of nursing professionals at care facilities were aware that the role of nursing professionals in AC and the practice of AC via on-site training were aspects of basic nursing education that should be learned.

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Purpose: The purpose of this study was to examine visiting nurses’ cognition and practical knowledge of play activities for children with severe motor and intellectual disabilities and to obtain suggestions for nurses to improve their practical knowledge.
Method: Participants were 10 visiting nurses that had experience with play activities for children with severe motor and intellectual disabilities in need of medical care. Participants responded to semi-structured interviews, allowing them to express their cognition of the practical situation of play activities for children with severe motor and intellectual disabilities. A qualitative and inductive method was applied to analyze responses.
Results and conclusions: We found that visiting nurses recognized the need for play activities with children with severe motor and intellectual disabilities in order to make a connection between visiting nurses, children, and mothers. Visiting nurses reported recognizing that all children need play and based their play activities around the needs of the children with severe motor and intellectual disabilities.
Visiting nurses reported repeatedly selecting and adjusting play activities to suit the children’s needs and stimulate their bodies and minds. Nurses reported grasping the children’s communicative expressions during these activities. Suggestions for visiting nurses regarding play activities for children with severe motor and intellectual disabilities are that the nurses must actively get the children to engage with them, and that they must also correctly grasp the signs children use to express themselves during play. Lastly, visiting nurses must develop play activities to form a good relationship with the child’s mother.

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The purpose of this study was to describe the nursing care for school aged children with developmental disabilities experiencing difficulty in social interaction hospitalized in a pediatric psychiatric closed unit. The study incorporated Leininger’s theory of the ethnonursing research method and used a qualitative design of observation-participation and interview data. Nine key informants included nursing staff at the pediatric psychiatric hospital. Seventeen general informants included six school aged children with pervasive developmental disorders (PDD) or attention deficit hyperactivity disorder (ADHD), six fathers and mothers, and five medical staff. Six main themes and one core theme emerged from the analysis of the data. The core theme was that nurses accepted children as they are and responded to their desire to relate with others, which is represented in closeness. The meaning of nursing care for them was that nurses supported them to be able to learn how to relate with others and restored their trust in adults and attachment. They became able to play with other children and express their thoughts to others through the nursing care. The findings suggest that it is necessary for nurses to understand the reasons and meaning of their closeness to identify their desire, and to respond to the desire to relate to others, which is manifested in closeness.

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Purpose: This study promotes the performance of a written task called role lettering among nursing students, and then examines the differences related to empathy by means of the characteristics of imagination activity and variety of descriptions.
Method: Targeting 118 (first study) and 75 nursing students (second study), we provided a written task in which they described an imaginary dialogue between a patient and a nurse, and measured empathy using a multidimensional empathy scale before and after the task. We created groups for high (H) and low levels (L) of affinity to imagination activity, as well as large and little groups according to the variety of descriptions.
Results: A decrease in total empathy score and the “emotional susceptibility” factor, were observed in the H group, and an increase in “other-orientated emotional reactivity” in the L group. A certain level of descriptive variety was observed with higher levels of other-orientated emotion. The “emotional susceptibility” decreased in the group with little descriptive variety. A decrease of self-orientated emotion was shown irrespective of the breadth of description. Moreover, the cognitive aspect of empathy did not change.
Discussion: In the group with little descriptive variety, the decrease in empathy was understood as an expression of absence of confidence, stress-coping, or reality-based presence of mind. It was suggested that the framework of the role lettering technique possibly worked supportively for the students in the L group, who were thought as weak in imagination so they could more easily feel the emotion of another person. Additionally, even if a rich description was not possible, it was confirmed that the result of expressing a distinction between oneself and others could be observed.

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Purpose: The purpose of this study is to reveal how aspects of the recovery process of women who have suffered from domestic violence by their partners (DV) during the perinatal and childrearing periods changed in their recognition toward victimization.
Method: Adopting qualitative and descriptive research design, we conducted semi-structured interviews with 21 female DV victims.
Results: 4 categories were extracted as recovering processes for female domestic violence victims during their perinatal and childrearing periods: Stage 1 “suppressing recognition of the damage caused by DV below the consciousness level,” Stage 2 “expectations of partners changing to disappointment when beginning to recognize DV damage,” Stage 3 “escaping a DV relationship with ambivalent feelings,” and Stage 4 “both the mind and body escaping a DV relationship.” Also revealed was a core category, “recovery process from domestic violence by getting a sense of oneself.” In their perinatal period, many victims do not recognize the damage DV causes due to their unstable condition in regards to mood swings.
Conclusion: During their perinatal and childrearing periods, women often expect changes in husbands’ or partners’ attitudes due to their desire for family stability, causing them to suppress DV recognition. It is suggested that nurses understand the recovery process of DV victims and support them in order to enhance victims’ regaining a sense of themselves and the overall recovery of women suffering from DV.

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Purpose: To clarify the relationship between realizing self worth, nursing work empowerment and personal accomplishment of mid-career nurses working in an acute care hospital setting.
Method: A questionnaire was completed by 533 mid-career nurses working in an acute care hospital setting. The concept of realizing self worth was identified by Gregg (2005). Here, we have developed a scale for realizing self worth that was composed of seven items. The reliability and construct validity of this scale were tested by confirmatory factor analysis, and the relationship between realizing self worth, nursing work empowerment and personal accomplishment was investigated using structural equation modeling.
Results: The questionnaire was returned by a total of 270 nurses, with 269 valid responses (valid response rate: 50.5%). Structural equation modeling (n=259) showed that the direct effect of nursing work empowerment on personal accomplishment was .10, and that of the indirect effect through realizing self worth was .21.
Conclusion: These results suggest that the indirect effect through realizing self worth was greater than that of the direct effect. Realizing self worth is therefore important for the implementation of nursing work empowerment in an acute care hospital setting.

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Purpose: Verify the effectiveness if Healing Touch works for fatigued nurses after work.
Methods: The study was executed based on RCT (Randomized Controlled Trial). Targeted people were consisted of 76 full-time nurses who were working at a hospital in Tokyo, after day-time work. Nurses were randomly grouped into Healing Touch group or Placebo Healing Touch group, and intervened 20 minutes. Estimation was done on subjective and objective perspectives. As subjective estimation, tiredness (based on VAS: Visual Analogue Scale) and fatigue feeling (based on POMS: Profile of Mood States) were observed before and after the intervention. As for objective evaluation, plethysmogram of fingers was applied to measure Autonomic Nervous Activity such as Heart Rate, HF, LF/HF before, during and after the intervention.
Results: 1. Variance of VAS showed Healing Touch effected significantly against relaxing the fatigue (p<0.01). 2. Variance of POMS showed Healing Touch significantly improved TMD Score, which represented overall feeling status (p<0.05). 3. Healing Touch also worked for Autonomic Nervous Activity, showing significant increase in HF, resulting in improving Parasympathetic Nerve Activity (p<0.05). There was no significant move on Heart Rate and LF/HF.
Conclusion: Healing Touch was proved to be effective on relaxing fatigues of nurses who were after work.

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This study clarifies the transformation process of self-concept in mentally disabled individuals residing in local communities and enrolled in a group nursing-therapy program on the cognitive behaviour of self-esteem recovery. Ten participants, who attended the programme, were questioned using a semi-structured interview about their self-concept in the past, present and future. Thereafter, the collected data were analysed qualitatively and inductively using the modified grounded theory approach (M-GTA). As a result, eight categories were extracted with ‘hatching of mind from its own shell’ being identified as the core category. Two categories, labelled ‘stagnation in a whirlpool’ and ‘worthless self,’ were perceived after the mental disorder, and they underwent ‘relief from stress through interaction with people who understand you,’ and thereafter transformed into ‘pride in one’s own lifestyles’ as well as ‘a sense of not being bothered by people.’ In addition, the realisation of a ‘newborn self’ has led to the realisation of the present ‘solid sense of a fulfilling life’ and discovered a ‘description of an ideal image’ geared towards the future self. The negative self-concept resulting after the onset of illness has changed to a positive one, after meeting people who understand the illness. This shows that mentally disabled individuals need a place where they can speak out about their true selves and be accepted in a secure atmosphere with people sharing similar experiences or understanding the illness.

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Purpose: The purpose of this concept analysis was to define the concept of “nurses’ role transition” by reviewing the literature and examining its characteristics within the context of the nurses’ new role.
Method: Searched were nine databases: CINAHL Plus with Full Text, MEDLINE, PsycINFO, SocINDEX, ERIC, Ichushi Web, Saishinkangosakuin Web, JMEDPlus and CiNii. Search terms were: “role transition” “nurse” and “yakuwari-ikō” (relating to role or duties). Forty published articles meeting the criteria were analyzed using Rodgers’ evolutionary method of concept analysis.
Results: Seven attributes of the concept “nurses’ role transition” were identified: 1) the meaning of activities in new nursing fields; 2) approach to acquiring new activities; 3) expectations for new activities and desire for success; 4) searching for their professional identity; 5) emotional responses; 6) difficulties faced and 7) timeframe. Similarly, seven antecedents and four consequences were identified.
Conclusion: The nurses’ role transition was defined as a process of continuing to acquire new behavior patterns through new nursing activities or functions, which continued over a period of time and where nurses, committed to develop as nursing professionals, had found meaning in the activities and functions of new nursing fields.

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Aims：The purpose of this study was to clarify what factors influenced graduates with non-nursing majors (bachelor’s degrees in other fields) in returning to school to become nurses in their selection of the nursing educational institution.
Methods：Purposively targeted were 13 universities and 16 nursing schools having special entrance exam system for adult and/or 2nd degree students and randomly selected were 10 vocational schools. A self-administered questionnaire survey was sent to a total of 1255 students from those schools. Returned were 606 (48.3%), of those 576 were useable representing 275 nursing students with bachelor’s degrees and 301 students without bachelor’s degree.
Results：Among the influential reasons extracted for school selections were: “possible to commute from home” and “suitable entrance exam system.” Of high importance for employed students was: “possible to commute from home.” Regardless of the presence of the bachelor’s degree, “smaller school expenses” was a big influencing element.
Conclusion：Entry of students with various knowledge bases may strongly contribute to nursing. The entrance exam system greatly influenced their selection of the educational institution. Transformation of the entrance exam system and provision of social and economical support are needed to promote the entry of these more mature and experienced learners into nursing.

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Objective: Physical activity as an element of the treatment for patients with childhood cancer is important to improve patients’ muscle strength and quality of life (QOL). However, the effects of including physical activity as part of the treatment for children with cancer are largely unclear. Hence, this study aimed to clarify the effects of physical activity as part of the intervention for patients with childhood cancer.
Methods: First, we examined the contents of four relevant and published review studies. Next, a search was conducted on five databases to identify relevant studies. The search term revolved around the combination of key words such as “children” AND “cancer” OR “oncology” OR “leukemia” OR “lymphoma” OR “tumor” AND “physical activity” OR “exercise” OR “daily activity” OR “life activity”. Of the 823 studies found, we identified six studies that met all the criteria. Effect size (Hedges’ g) regarding physical activity was estimated using a random effect model with 95% confidence intervals (CI).
Results: In patients with childhood cancer, physical activity had an impact on QOL [g=0.17, 95%CI=−0.48 to 0.57], fatigue [g=0.25, 95%CI=−0.16 to 0.67], hemoglobin [g=0.11, 95%CI=−0.32 to 0.75], sleep quality [g=0.22, 95%CI=−0.32 to 0.47], activity [g=0.14, 95%CI=−0.95 to 1.23], ankle dorsiflexion active range of motion [g=0.47, 95%CI=−0.32 to 0.75], body mass [g=0.16, 95%CI=−0.76 to 1.07], and BMI [g=−0.12, 95%CI=−1.04 to 0.80].
Conclusion: These results suggested that physical activity as part of the treatment regimen for children during the treatment of childhood cancer was not effect. For future studies, it is need to measure the effectiveness of physical activity during the treatment of childhood cancer.

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Purpose: We conducted a survey of psychiatric nurses to verify a postulated model for the psychological process leading to anger and aggressive behavior due to poor and insufficient social and related factors.Methods: The analysis was conducting by applying a causal model (postulated in my hypothesis) of confirmed validity explaining the relationship among the process of anger expression and the factors. Using this model, a structural equation (path diagram drawn using the causal model) was generated and path analysis was conducted by applying a structural equation model (SEM) and using the model’s goodness-of-fit index. We also used nine different types of questionnaires, including questionnaires on social support, stress, and sympathy.Results and Conclusion: On analyzing the answers of the 1,001 surveyed nurses (final response rate=70.0%), we observed that the results of the analysis indicated that the model best-fit occurred at the following parameters: GFI=0.94, AGFI=0.91, CFI=0.92, and RMSEA=0.063. Furthermore, it was revealed that the following model is the best fit for the process that leads to the expression of aggressive behavior and the factors that affect the process: inability to receive social support → accumulation of stress concerning the workplace environment, human relations at the workplace, and job contents → arousal of anger → expression of aggressive behavior. In addition, the results of multiple group analysis indicated clear gender differences regarding several factors, including a partial correlation between sympathy and job-related stress, etc.

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Purpose: The purpose of this study is to clarify the daily life experiences of head and neck cancer patients suffering from multiple problems following hospital discharge.
Methods: We conducted semi-structured interviews with 11 head and neck cancer patients who were being seen on an outpatient basis at least 1 year after discharge from hospital following completion of treatment (surgical therapy, chemoradiotherapy) and who gave their consent to participate in this study. The semi-structured interviews were based on an interview guide (inconveniences in their daily lives, how they overcame these inconveniences, etc.). Data were qualitatively and inductively analyzed.
Results: Five categories were extracted as daily life experiences of head and neck cancer patients suffering from multiple problems following discharge. These were “altering the diet to make food easier to eat and maintaining physical mobility,” “enduring pain and protecting one’s body,” “communicating one’s current intentions and experiences,” “doing what one can because one has support for the pain,” and “living one’s life normally.”
Conclusions: Head and neck cancer patients wish to live in their own way but find it difficult to express their intentions. The results of this study reaffirmed the importance of nurses providing support that allows patients sufficient opportunity to express their own intentions and to take actions that are acceptable to them.

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Objective: To determine effects of reminiscence using nostalgic songs on community-dwelling elderly with declining cognitive function.
Method: Using nostalgic songs, a reminiscence trial was conducted in the Health and Welfare Center of Town A once a month. The study was conducted for six sessions, each session lasting two hours, from September 2012 to March 2013 (except February). Participants were 11 community-dwelling elderly residents who demonstrated declining cognitive function and a tendency to seclude themselves in their rooms (average age: 82.9±6.3 years old). Hasegawa’s Dementia Scale-Revised (HDS-R), Mini-Mental State Examination (MMSE), the 15-item Geriatric Depression Scale (GDS-15), Philadelphia Geriatric Center Morale Scale (PGC) and subjective health VAS were used for evaluation. A statistical analysis was performed using Wilcoxon signed-rank test for differences.
Result: Following all the session, both the total HDS-R and the subjective health VAS scores were significantly improved compared with pretrial scores (p<0.05). Among the subscales of HDS-R and MMSE, only “delayed playback” was significantly improved following the sessions (p<0.05).
Conclusion: We demonstrated the possibility that reminiscence using nostalgic songs may effectively enhance retention and subjective feelings of health among the elderly with declining cognitive function.

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Purpose: Apathy is one kind of frontal lobe dysfunction, and patients who suffer from apathy tend to be misdiagnosed as being “lazy” by medical staff and families. Recently, apathy-measuring scales have been developed, such as the “Clinical Assessment for Spontaneity (CAS)” to try to evaluate this disability as objectively as possible. CAS consisted of five subscales to measure multiple viewpoints of apathy. In this study we used the CAS3, the scale for assessment of spontaneity about patients’ ADL. The purpose of this study was to investigate the characteristics of evaluation between families and nurses in assessing patients’ apathy.
Method: Thirty-nine pairs of families and nurses were interviewed and evaluated concerning patients’ apathy using the CAS3 scale.
Results: A significant correlation was observed between the total CAS scores of families and nurses. However, the subscale CAS3 scores for specific categories, especially “grooming,” “bathing,” “medication,” “greeting,” “communication with others,” and “hobbies” did not correlate significantly.
Conclusion: When the results of CAS3 were analyzed, the total score of CAS was correlated, but there were evaluation gaps between nurses and families for some items because of the difference of observation opportunities. These results suggest that if families participate in patients’ assessment, nurses can evaluate apathy in more detail based on information about patients’ characteristics and lifestyles before a stroke occurs.

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