Objective: This study aimed to clarify the elements of recommended practice from a literature review of interventional studies that promote advance care planning (ACP) in patients with chronic respiratory diseases.

Methods: This study performed a search of literature regarding studies on interventions that support ACP in patients with chronic respiratory diseases. The bibliographic databases PubMed, CINAHL with Full Text, and Ichushi ver. 5 were used to find related studies published until December 2017.

Results: The review of the interventional studies revealed the following recommended practice elements: targets of ACP, assessment of the potential needs of ACP intervention, number of meetings with ACP intervention practitioners, provision of information on ACP, provision of information on artificial respiration, and sharing records on ACP.

Conclusion: The results indicated way of thinking of subjects suitable for ACP as understood from the results of interventional studies, and significance of practice elements recommended for promoting ACP.

Objective: To obtain a definition of nursing judgment in home healthcare nursing practice as performed by home healthcare nurses in Japan.

Methods: A total of 33 literature references published in Japan were assessed. Rodger’s method was employed for concept analysis.

Results: The following four attributes were extracted: “understanding patients as individuals with their own lifestyles, opinions, and values”, “proactive perspective”, “discussing care for patients to meet their lifestyle needs”, and “careful patient-centered consideration”. In addition, 3 antecedents were extracted: “characteristics of nursing in daily life”, “intention to exercise professional judgment”, and “ability of each nurse”. Finally, 2 consequences were extracted: “contents of judgment” and “conduct of appropriate care for patients”.

Conclusion: Nursing judgment in home healthcare nursing practice by home healthcare nurses in Japan was defined as the process of understanding patients as individuals with their own lifestyles, opinions, and values and discussing the care required to meet their lifestyle needs with the patients as well as the people surrounding them. This process should be performed proactively and should be based on careful patient-centered consideration. Through this process, the patient’s condition, care, and involvement are determined, so that appropriate care for each patient can be provided in nursing practice.

Objectives: This study aims to determine the concept of “cultural sensitivity in healthcare professionals” and examine the applicability of this concept in Japan.

Methods: Rodgers’ approach was used for concept analysis. A total of 48 articles of literature (44 in English, 4 in Japanese) published by 2017 were included in the analysis.

Results: Five attributes ([Willingness to actively understand the people], [Awareness of differences from own culture], [Knowledge of culture], [Cultural understanding], and [Respect of culture]) and four antecedents, and six consequences including those of healthcare professionals and people were extracted.

Conclusions: The concept of “cultural sensitivity in healthcare professionals” was defined as emotional and cognitive ability to face cultural differences with attitude of respect, based on willingness to actively understand the people by being aware of differences from the culture of healthcare professional’s country and obtaining knowledge of the culture to understand the people and the culture of the people’s country. In Japan, where globalization is accelerating, this concept is considered useful for developing an educational program and evaluation of healthcare professionals.

Objective: The objective was to elucidate the concepts associated with involvement in the nurse-patient relationship.

Methods: The concept analysis method described by Rodgers (2000) was used to analyze English-language literature in the PubMed, CINAHL, Academic Search Elite, and SCOPUS databases.

Results: Thirty articles were analyzed. As a result, the following 5 attributes were extracted: dedicating her/himself to the patient, entering the patient’s world, understanding the patient, adjusting boundaries, and building a relationship. In addition, 4 antecedent conditions and 2 consequences were extracted.

Conclusions: Using the conceptual model of involvement enables involvement, which tends to be seen as a negative aspect, to be recast as a positive association within the framework of nursing rather than a personal problem. That is, the conceptual model of involvement can serve as a tool that enables the clinical nurse to utilize their unvarnished involvement developments that occur during nursing in subsequent nursing situations.

Purpose: The present study aimed to elucidate sleep states, sleepiness, and fatigue among nurses working 12-hour double, day, full day, and night shifts using subjective and objective indicators.

Methods: Sleep states, sleepiness, and fatigue during day, full day, and night shifts were measured in seven 22-year-old female nurses using the Kwansei Gakuin Sleepiness Scale (KSS), the Subjective Fatigue Questionnaire (Jikaku Sho Shirabe), the Psychomotor Vigilance Task (PVT), and an Active Tracer (GMS Inc., Tokyo, Japan). The nurses also wore an ActiGraph for four days at the end of their shifts for a total of seven days.

Results: A full day shift required more physical activity than day or night shifts. Fatigue and sleepiness did not change during day or night shifts. Fatigue and sleepiness increased during the full day shift and arousal linearly decreased at the end of the shift. Meanwhile, nurses on night shift had less sleepiness and fatigue at the start of the shift, but drowsiness, eyestrain, and fatigue were increased at the end of the shift. The nurses slept for shorter periods before a night shift than after a day shift. Furthermore, sleep-wake rhythms temporarily changed after night shifts but recovered on the following day.

Conclusions: The nurses were more active during 12-hour double and full day shifts than any other shifts, but fatigue was increased and arousal was decreased. The nurses slept for shorter periods before night shifts than after day shifts.

Purpose: The purpose of this study was to clarify the structure of motivation for growth of clinical nurses.

Method: Thirteen nurses with more than three years of clinical experience were interviewed using a semi-structured interview.

Results: Eight categories were extracted. Laying a “foundation for working as a nurse” facilitated nurses to “tackle nursing work”, and developing “awareness of immaturity as a professional” while working helped nurses to make an “effort to overcome immaturity”. As nurses developed relationships with others, they gradually strengthened their “interest in what I should be through relationships with others”, and they “reflected on themselves with consideration for others”. “Pride in nursing and a desire to contribute” was cultivated with accumulation of experience, leading to “fusion of autonomy and cooperation at work”.

Conclusion: These results suggest that motivation for growth of clinical nurses requires establishment of both cooperative and autonomous behaviors by maintaining a balance of thoughts for others and the inner self, with the aim of becoming a fully-fledged professional.

Purpose: The purpose of this research is to conduct a educational program based on the cognitive restructuring method in order to provide nurses with training in emotional coping, and to verify changes in emotional coping tendencies.

Method: Using a web-based version of cognitive restructuring, we conducted a educational program with 26 nurses who had less than 10 year’s nursing experience. Evaluation of the intervention was carried out at three stages: pre-intervention, post-intervention, and one month post-intervention, and was performed using scales of the ECSS-N (Emotional-Coping Strategies Scale for Nurses), STAI (State-Trait Anxiety Inventory), and SOC (Sense of Coherence).

Results: The results indicated increases in a “regulating both patients’ and one’s own emotions”, which is effective to mental health (F(2, 48) = 3.61, p = .035). These changes led to increased confidence with regards to emotional coping (F(2, 48) = 5.02, p = .010). Additionally, this effect was observed one month post-intervention rather than immediately after intervention.

Conclusion: The results of the conductance of educational program indicated its ability to change nurses’ emotional coping tendencies.

Purpose: To visualize operative nursing experiences of nurses in their first to third year after graduation.

Methods: We conducted a semi-structured interview of seven nurses and analyzed the data using narrative analysis methods by Riessman.

Results: We identified the following nine themes pertaining to the operative nursing experiences of the enrolled seven nurses: [Caring for the pain and anxiety of a patient] [Careful that understanding and trusting relationships of patient’s feelings are important] [A need for assistance with ethical considerations, identified from the patient’s point of view Sex] [Awareness of being a nurse] [The pain of not being able to issue the instrument, and the awareness that it is nursing to save the patient] [Responsibilities and responsibilities to fulfill their responsibilities to protect patients’ safety] [Feeling that operative nursing was able to be done] [Attraction toward operative nursing developed while providing operative nursing care] [Sense of achievement and encouragement resulting from relationship with patients].

Conclusions: Nurses 1–3 years after graduation perceive that nursing cannot be practiced adequately. This study explored the meaning of nursing through the experience of daily operative nursing, and was aiming at the improvement of the technique in the surgical nursing while feeling the satisfaction.

Purpose: The purpose of this study was to examine the correlations between daily physical activity and objective/subjective sleep variables in schizophrenic patients.

Methods: Twenty-seven schizophrenia patients (male 17, female 10, mean age: 58.3 ± 11.6 years, no change in medicine for one month of the study) were evaluated with regard to their physical activity and objective sleep variables for one week. Total sleep time (TST), sleep latency (SL), waking after sleep onset (WASO), and sleep efficiency (SE) were determined by wrist actigraphy. Daily physical activity (steps per day) was assessed with the help of a waist pedometer. Subjective sleep quality was also assessed using the Pittsburgh Sleep Quality Index (PSQI).

Results: Physical activity showed significant correlation with SE (r = .629, p < .01), TST (r = .406, p < .05), and WASO (r = –.615, p < .01). On the other hand, there was no correlation between physical activity and PSQI score.

Conclusion: Our results suggest that objective sleep quality index in schizophrenia inpatients may be more effectively improved by increasing the amount of daily physical activity.

Purpose: This study aimed to consider the reliability and validity of the Peer Coaching Scale for Nurses during the initial career-development period.

Methods: The researchers selected 55 items from an initial scale of 64 items based on peer debriefing and their content validity index. A questionnaire survey was conducted for nurses in the second and third years after graduation from 65 institutions nationally from September 2017 to March 2018. Data obtained from 318 nurses were analyzed. The reliability and validity were examined using item analysis, exploratory factor analysis, Cronbach’s α coefficient, the confirmation of correlation with external criteria, and the test-retest method.

Results: As a result of the exploratory factor analysis, four factors and 20 items were extracted. The four factors were “the act of building a reciprocal relationship,” “the act of co-creating a care method,” “the act of compensating a care method,” and “the act of accelerating self-transformation.” The Cronbach’s α coefficient for the overall scale was .93. The Cronbach’s α coefficients for the subscales ranged from .82 to .89. The correlation coefficient of the Peer Coaching Scale with the subscale “usefulness of cooperation” of the Belief in Cooperation Scale was .33 (p < .01), and with the Teamwork Measure for Nursing Teams was .33 (p < .01). Using the test-retest method, the intraclass correlation coefficient for the subscales ranged from .65 to .79 (p < .01).

Conclusion: The reliability and validity of the Peer Coaching Scale for Nurses during the Initial Career-Development Period were verified.

Purpose: To interpret the experience of elderly people with Charles Bonnet Syndrome (CBS) due to visual impairment from the perspective of embodied perception.

Method: Participant observation and unstructured interviews were carried out with Patient A, who had visual impairment complicated by hallucinations and depression. The patient’s narratives were then interpreted based on Merleau-Ponty’s theory and Ito’s theory of embodiment.

Results: By interpreting the experience of Patient A, the following six themes were derived as processes for accepting the characteristics of hallucinations accompanying visual impairment and the distress of experiencing loss: (1) “the impact of thoughts and feelings on vision and the onset of hallucinations,” (2) “invasive hallucinations and depression due to repeated experiences of loss,” (3) “sensory compensation,” (4) “an incipient ability to live vicariously through others,” (5) “the manifestation of what has been lost,” and (6) “acceptance of fate.”

Conclusion: These results suggest that vision is subject to the thoughts and feelings of those affected by impairment, and that hallucinations and depression can be transformed as a result of sensory compensation, connections with others, and the acceptance of impairment and loss. Thus, after understanding the distress experienced by those affected, it seems important to support the process of accepting impairment and loss while aiding in the reconstruction of lifestyles and the quest to find meaning in life.

Aim: This study aimed to investigate the status and factors of implementing respite care in a visiting nursing stations and adjoining office for children requiring medical care.

Method: A survey questionnaire was distributed to 1,154 visiting nursing stations for children between August and September, 2017. Statistical analyses were performed using χ² test and Mann-Whitney U test.

Results: There were 381 valid responses (response rate: 32.8%). The respite care implementation rate was 57.1% and there was a relationship between the adjoining of After-school day care service including child development support and respite care implementation rate (p = .004). The factors related to the implementation of respite care were the number of nursing staff, needs, standardization of the quality of nursing, recruiting personnel, staff's ability to communicate with children and family caregivers, and staff's ability to build relationships of trust with family caregivers (p = .00–.04).

Conclusion: As per this study, it was suggested that improvement of respite care implementation was necessary, based on factors such as personnel allocation, unified quality of nursing care, acquisition of basic nursing skills.

Purpose: To understand the relationship between ward nurses’ perceptions about the chief nurse’s transformational leadership at university hospitals and their sense of community

Methods: A self-administered survey was completed by 275 ward nurses at private and public university hospitals. The questionnaire items consisted of basic characteristics, a scale for sense of community among nurses, and a transformational leadership scale. Multiple regression was used to assess the relationship between these items.

Results: Multiple regression with sense of community score for nurses as the dependent variable showed a significant relationship between sense of community and transformational leadership (β = 0.515, p < 0.01). Furthermore, individual consideration, which is a subscore of the transformational leadership score, was also significantly associated with sense of community among ward nurses (β = 0.400, p < 0.01).

Conclusion: These results suggest that ward nurses’ perceptions about the chief nurse’s transformational leadership improves their sense of community.

Purpose: The purpose of this study is to analyze the experiences of mothers who raise severely disabled children at home and also to discover their ties with the outside world. Particularly, we clarify a chance and pattern of the connection to the community of the mothers.

Method: Semi-structured interviews were conducted with nine mothers of severely disabled children aged between six and eight years old. The data was qualitatively analyzed.

Results: The results are divided into twenty-one categories and five main categories.

The main categories are as follows:

[A] Mothers faced the reality of raising a child with a severe disability

[B] A frosty attitude from strangers led to [C]

[C] The mothers became blind to the possibility that they can raise their children properly

[D] They gained energy from positive experiences with others resulting in [E]

[E] The mothers got out and widened their horizons

Conclusion: We found several ways that mothers of disabled children connect to the community. The main way mothers did this was by their own efforts, and not just brought about by those close to them. Also, when the mothers faced difficulties in child-raising, they tried to gain sympathy from friends and acquaintances. In order for mothers of disabled children to widen their horizons, relationships with other mothers played a very important role.

Aims: This study aimed to develop a scale for quality of life (QOL) assessment in patients with inflammatory bowel disease.

Methods: Based on the results of our previous exploratory studies on factors associated with QOL, a survey was conducted among outpatients in two hospitals using a questionnaire. Reliability of the scale was verified by Cronbach’s coefficient alpha and retesting, construct validity by factor analysis, and criterion-related validity by correlation coefficient with the external criterion.

Results: A total of 460 questionnaires were distributed, and 319 participants (222 patients with Crohn’s disease and 97 patients with ulcerative colitis) were analyzed (69.3% effective response rate). Using item analysis and exploratory factor analysis, 19 items and five factors were extracted. Cronbach’s coefficient alpha for 300 participants with no missing values for the 19 items was .914, and it was within the range of .710 to .927 by factor. The intraclass correlation coefficient of retesting was .820. The correlation coefficient with the external criterion was .388 for the physical component summary and .711 for the mental component summary of the short-form 8. It was .731 for the 10-point scale life satisfaction ratings.

Conclusion: The results showed that overall reliability and validity of the scale were good; however, there were still unresolved issues with construct validity.

Purpose: This study aimed to describe the process of nurses’ preparing for sudden health deterioration in children with medical technology dependence in special needs schools.

Method: Semi-structured interviews were conducted with 18 nurses with work experience of more than 3 years at special needs schools, and obtained data were analyzed using the modified grounded theory approach.

Results: Nurses felt a strong sense of responsibility and expressed difficulty in assessing and responding to children’s sudden health deterioration; therefore, they tried to know each child individually. After getting to know the children, nurses could predict how a child’s health could change, including sudden health deterioration. Nurses were prepared to work together with teachers when sudden health deterioration occurred, and they made plans to prevent it. While preparing for sudden health deterioration, nurses faced conflicts because of accepting requests of parents and teachers and school rules. In such situations, nurses reconciled these requests while maintaining children’s health and safety. Nurses expressed the necessity of working with school staff as a team to address sudden health deterioration. Therefore, nurses built mutual relationships with school staff and parents, improved skills of teachers in caring for the children, and prepared to work together with teachers.

Conclusion: To prepare for sudden deterioration in a child’s health, it is necessary for nurses and teachers to learn by sharing their experiences.

Objective: This study aims to examine the current state of self-management behavior in elderly living donor-liver transplant recipients (LRs) and determine the factors correlated with such behavior.

Methods: We requested the transplant coordinators and doctors from 18 of the 67 transplant hospitals identified by Japanese Liver Transplantation Society for the enrollment of LRs. A total of 167 Japanese LRs aged ≥65 years were enrolled, who answered anonymous self-administered questionnaires at seven hospitals.

Results: We found that 91.6% LRs were administered with immunosuppressant medication, although 49.7% could not adequately comprehend the corresponding side effects. Female LRs gradually ignored the daily-life observation of self-management behavior following transplantation. Furthermore, females who experienced frailty exhibited lower “health-promotion scores.”

Conclusions: Although LRs could not adequately comprehend the side effects of their medications, overall, they performed self-management behavior. In female LRs, the factor that correlated with “daily-observation scores” was “the periods following transplantation” and the factor that correlated with “health-promotion scores” was frailty.

Purpose: The purpose of this study was to clarify perceptions of civility and incivility in the teaching-learning environment by conducting focus group interviews with undergraduate nursing students.

Methods: The study subjects were fourth-year students of 3 nursing colleges. From February 2016 until July 2017, 3 focus groups with 5 participants each were formed. Transcriptions from about 1 hour of semi-structured interviewing were analyzed through a thematic analysis using NVivo. In the interview guide developed by the researchers, civility was operationally defined as “scenes and circumstances where students are considered first as learners.” Incivility was defined as “scenes and circumstances where learning motivation has been reduced; for example, students have not been treated carefully or given poor respect.”

Results: The results of the qualitative analysis showed that civility consisted of the following 4 categories described by 11 sub-categories extracted from 28 codes: (1) preparation of the learning environment; (2) respect for intention and values; (3) sharing growth steps; and (4) expansion of relationships. Incivility consisted of 3 categories described by 11 sub-categories extracted from 36 codes: (1) negative behaviors; (2) behaviors with inconsistency; and (3) lack of competency.

Conclusion: Our findings suggested that the students perceived civility from the structure and process of the teaching-learning environment that prompted their own growth. They perceived incivility from situations that might cause discontinuation or interruption of the mutual relationship between learners and educators.

Purpose: The aim of this study was to investigate parenting processes led by feelings of mothers with depressed mood toward their children.

Methods: Semi-structured interviews were conducted with 12 mothers: six mothers who scored 9 or higher on the Edinburgh Postnatal Depression Scale at a 1-month postpartum checkup at their hospital or during a newborn baby home visit; other six mothers who exhibited high levels of anxiety about childrearing and who had received childrearing guidance. A grounded theory approach was used as the research method.

Results: These mothers, on a daily basis, “Did not understand their children and were irritated and distressed about them,” and over time experienced a variety of feelings while caring for their children. These feelings and behavioral processes resulted in the following consequences: “Impulsively resorting to violence,” “Neglecting or being incapable of attending to their child,” or, “Being thankful to their child.”

Conclusion: This study suggests that it is necessary to provide support not to lead the process to the negative consequences. To avoid worst-case scenarios where mothers with depressed mood are driven to extreme behaviors or isolation, having face-to-face meetings with mothers is significant.

Aim: This study aimed to study the services offered by function-enhanced home nursing agencies for different patient needs.

Method: We targeted nationwide function-enhanced home nursing agencies and 515 users. A survey was conducted on care implementation using a data input system developed in advance.

Results: Most frequently availed home-visit nursing care services are “explanation and guidance on diseases and treatments (odds ratio [OR] = 4.535) towards the final stages of cancer,” “assistance and guidance for dressing users with intractable neurological diseases (OR = 2.276),” “mental support (OR = 3.062),” and “decision making support (OR = 3.701) for pediatric users.”

Conclusion: The services frequently availed by users of home nursing care were identified. It is necessary to consider user characteristics to provide the care of home-visit nursing.

Objective: This study aimed to verify the validity and reliability of the seamless care for elderly dementia patients in community-based integrated care scale.

Method: A questionnaire survey was administered to 1,370 nurses at 137 hospitals for community-based care.

Results: We obtained 570 valid responses (41.6%). There were no question items indicating floor and ceiling effects. An exploratory factor analysis revealed that seamless care consisted of the following six factors: “utilizing the advantages of multiple occupations,” “considering the current state of a patient’s family,” “maintaining a patient’s gentle daily life,” “aiming to improve a patient’s daily living behavior according to cognitive function,” “medical management for a patient after being discharged,” and “cooperation with medical social workers from the beginning of hospitalization.” No question items had factor loadings less than .400. Because the α value of each factor was not less than .800, the internal consistency of this scale could be verified. In a confirmatory factor analysis, the comparative fit index values were .905 and above .900, and the root mean square error of approximation value was .065.

Conclusion: The validity and reliability of this scale were verified. This scale should be used to fulfill functions required for hospitals for community-based care to cope with elderly dementia patients.

Aim: This study aimed to identify actions that nurses take in acute care hospital settings to continue with care for elderly people.

Method: Sixteen nurses participated in semi-structured interviews. Interview data were analyzed using a qualitative synthesis method (KJ method) and then organized into groups representing the targeted nursing actions.

Results: The following six actions were extracted from the interview data. 1) Encourage your healthcare professional team to pay attention to elderly people’s hopes or values based on their everyday interactions. 2) Encourage collaboration between healthcare professionals by sharing information about elderly people from multiple perspectives and discussing possible treatments. 3) Gain a foothold for elderly care by respecting their own way of living and ensuring other healthcare professionals consider elderly people as human beings. 4) Gain a foothold for healthcare professionals’ work by respecting individual specialties and determining their area of responsibility. 5) Control the environment around elderly people by supporting caregivers, adjusting the relationship between an elderly person and his/her caregiver and informing general citizens. 6) Control the environment around healthcare professionals by creating a system to communicate smoothly.

Conclusions: Actions 1) and 2) represent “Encouraging”, actions 3) and 4) represent “Gaining a foothold” and actions 5) and 6) represent “Controlling the environment”. Furthermore, actions 1), 3) and 5) targeted elderly people and actions 2), 4) and 6) targeted healthcare professionals. Therefore, we found two axes of nursing actions: “Encouraging–Gaining a foothold–Controlling the environment” and “Elderly people–Healthcare professionals”.

Objective: To construct a scale for adolescent awareness of becoming a parental generation and to examine the reliability and validity of said scale.

Method: A preliminary survey was conducted to create a draft of a 48-item scale on awareness of becoming a parental generation. This survey was conducted on 786 high school students in four high schools in Prefecture A, and its internal consistency and construct validity were examined.

Results: The number of responses collected was 762 (recovery rate: 96.9%); the number of valid responses was 703 (valid response rate: 92.3%). Following a factor analysis and an examination of reliability, a scale was devised with 33 items and 6 factors. The factors were as follows: “awareness of relationships with children,” “awareness of the parent–child relationship,” “awareness of becoming a parent,” “awareness of parenting with a couple and within society,” “interest and feelings regarding children / child care,” and “anxiety about parenting”. Known population validity and a confirmatory factor analysis ensured a constant level of construct validity. The Cronbach’s alpha coefficient for each factor was generally good at 0.76 to 0.94.

Conclusion: The reliability and validity of the scale for awareness of becoming a parental generation that was constructed in this study was generally confirmed.

Purpose: Hypoglycemia affects the prognosis of diabetic patients. This study aimed to explore the hypoglycemic experience of older adults with diabetes.

Methods: Semi-structured interviews were conducted with 13 older adults aged 65 to 90 years with Type 1 or Type 2 diabetes. They had experienced hypoglycemia within the last year from the date when they agreed to participate in this research. Thematic analysis was used to analyze the data.

Results: The hypoglycemic experience of older adults with diabetes was revealed through twelve sub-themes and four themes: “Frustration from Losing Control,” “Controlling Hypoglycemia with Self-esteem,” “Understanding that Self-management is Needed,” and “Reconciling Hypoglycemia.”

Conclusion: We revealed that older adults with diabetes have not only negative but also positive feelings of “Controlling Hypoglycemia with Self-esteem.” From our findings, older adults may selectively “Reconcile Hypoglycemia” based on their lives and values.

Objectives: The present study aimed to examine the relationship between controllability, a key attribution about the causality of behavior, and intention to help adolescents with autism spectrum disorder (ASD) among nursing students.

Methods: A total of 351 students from different nursing schools and universities were included in the study. An online survey utilizing a hypothetical vignette was conducted among nursing students after they read a vignette depicting the behavioral problems of adolescents with ASD.

Results: In total, 227 participants completed the survey questionnaire (response rate: 64.6%), and 192 responses were analyzed. Results of the structural equation modeling showed that our hypothesized model adequately fits the data about the attribution theory (CFI = 0.943, TLI = 0.931, RMSEA = 0.072). Controllability was indirectly related to the intention of helping through sympathy and anger. Students who believed that the behavioral problems of adolescents with ASD are attributable to less controllable characteristics were more likely to have a stronger intention of helping.

Conclusion: The findings of the present study indicate that interventions that alter nursing students’ controllability of the behavioral problems of adolescents with ASD may foster feelings of sympathy and enhance the intention of helping.

Purpose: To identify the characteristics of nursing practice for mechanically ventilated and lightly sedated patients in critical care.

Methods: Semi-structured interviews were conducted with Critical Care Nurse Specialists and Certified Intensive Care Nurses. The data derived from the interviews were qualitatively analyzed by using an inductive approach.

Results: Responses were obtained from 13 subjects, which revealed the following six characteristics related to nursing practice in critical care: “integrating multiple data of individual patients and inferring their pain, and actively trying to ease the pain,” “making sure that patients are aware of the medical devices and wearable objects that are being used on them by letting them see or touch devices and objects repeatedly,” “repeatedly explaining to patients that there has been a sudden change in their condition and informing them of their prognosis,” “respecting patients’ voluntary behavior and at the same time determining if it could be a danger to the patients,” “leading patients to work on care and rehabilitation while obtaining the patients’ consent,” and “mediating between patients and their family and adjusting their distance.”

Conclusions: The present study suggests that nurses should try to empower patients under light sedation to provide better-structured and well-informed nursing care through collaboration with patients.

Aim: To clarify the use of research-based information and its relationship to critical thinking (CT) disposition among nurses.

Method: This cross-sectional study was conducted using a self-administered questionnaire delivered to unit managers and staff nurses working at various units across Japan. We collected data on the characteristics of the hospital/units and nurses, CT, and the frequencies of use of the information sources. We operationally defined research-based information as clinical practice guidelines and databases of research papers.

Results: Data from 68 unit managers and 986 nurses from 61 hospitals were analyzed. (valid response rate: managers 93.2%, nurses 72.1%). The percentages of nurses who used clinical practice guidelines and databases of research papers in the year prior to completing our surveys were 58.4% and 32.8%, respectively. Nurses’ CT was significantly related to the use of clinical practice guidelines (odds ratio [OR]: 1.97, 95% confidence interval [CI]: 1.30–2.99) and databases of research papers (OR: 2.47, 95% CI: 1.58–3.85). Another factor significantly related to the nurses’ use of clinical practice guidelines was higher numbers of participation of academic conferences. Other factors significantly related to database use were unit type (general), having seminars about statistics in the hospitals, nurses’ lower age, higher numbers of nursing research conducted, and higher numbers of participation of academic conferences.

Conclusion: Fostering nurses’ CT may promote evidence-based practice implementation in Japan.

Purpose: The aim of this study was to verify the relationship between structural empowerment, affective commitment, and work engagement among Japanese nurses, and to assess the mutual influence of Japanese nurses’ affective commitment and work engagement.

Method: Stratified random sampling was used. An anonymous self-administered questionnaire survey was conducted on nurses employed at hospitals in Prefecture A and ordinance-designated city B in the Tohoku region of Japan who agreed to take part in the study. Completed questionnaires were returned by postal mail.

Results: The questionnaire was distributed to 1,053 nurses at 12 hospitals; 594 questionnaires were returned (collection rate, 56.4%) and 508 contained valid responses (valid response rate, 48.2%). Structural equation modeling showed structural empowerment had a significant positive effect on affective commitment and work engagement, and structural empowerment had a significant positive effect on affective commitment via work engagement. However, structural empowerment had no significant effect on work engagement via affective commitment.

Discussion: Structural empowerment is suggested to increase the affective commitment and work engagement of nurses. Although high work engagement increases the affective commitment of nurses, high affective commitment does not necessarily increase the work engagement of nurses. The results of this study are expected to not only improve nurses’ affection for their organization, but also their work engagement.

Purpose: To describe how elderly patients experience and respond to the life changes after colorectal cancer surgery.

Methods: Semi-structured interviews of nine elderly patients, who had undergone surgery for colorectal cancer, followed by qualitative content analysis of the responses.

Results: Elderly patients experienced changes in life after colorectal cancer surgery. These changes were perceived differently by each patient. There are three types of recognition of the life changes in the post-operative period: experiences a decline in the life function, decrease in activity due to a decline in energy and physical strength, and no symptoms, or even if there are symptoms, the life does not change. During the recovery/adaptation and maintenance period, patients became aware of functional decline due to aging: some were aware of positive changes, such as life expectancy, while others became aware of the conflict between life and aging. Additionally, one patient felt both these changes at the same time.

Conclusion: In post-discharge support for elderly patients after colectomy, it would be desirably to provide support not only to evaluate disease and symptoms, but also in the continuous understanding of the life changes after surgery and the response of the patients themselves.

Objective: This study aimed to have nurse managers in emergency rooms evaluate the care provided for families of terminally ill patients and identify systemic organizational factors related to that care.

Methods: A 30-item survey on the care provided to families of terminally ill patients was conducted among nurse managers working in emergency room. Factor analysis was used to score the responses, and regression analysis was performed on factors related to how the organization systematically provided the care.

Results: Valid responses were received from 149 (51.6%) of the targeted sample participants. The range of the percentage of positive ratings on the 30 items was 53.3–96.6%. Regression analysis showed that the systemic factors significantly predictive of total scores were “annual number of patient mortalities in the emergency room” (β = –0.21), “systematic multi-disciplinary collaboration” (β = 0.25), “systematic evaluation of care” (β = 0.44), and “existence of a standardized care plan manual” (β = 0.24).

Conclusion: This study showed that nurse managers perceived that, in some cases, more needs to be done in the way of care for the families of terminally ill patients. The findings also suggested that to promote better practice, health organizations need to have in place systems for multi-disciplinary collaboration and for the standardization and evaluation of care.

Purpose: This study aimed to develop and assess the reliability and validity of a workplace environment evaluation scale for intensive care homes for the elderly.

Method: After the preliminary survey, a questionnaire-based survey was distributed to 1,800 nursing and care professionals working at 300 intensive care homes for the elderly across Japan.

Results: Reliability and validity were examined using data from 344 respondents (recovery rate: 19.1%; effective response rate: 95.6%). Factor analysis revealed that responses consisted of 34 items in the following 6 factors: “the supportive role of supervisors,” “creative work improvements,” “employee evaluations,” “duties of the facility director,” “education,” and “collaboration between nursing and care professionals.” As a result of examining the reliability and validity, the Cronbach’s α coefficient for the entire scale was .956, and the model’s goodness of fit was χ² = 1193.5 (p < .001), with GFI = .837, AGFI = .812, CFI = .925, and RMSEA = .059. The correlation coefficient with the external criteria was within the range of .204 to .916.

Conclusion: While the model leaves something to be desired with respect to the fit of the construct validity to the data, its internal consistency and criterion-related validity satisfied established criteria. The model can be used in the context of management that fully comprehends the workplace environment of intensive care homes for the elderly.

Aim: The aim of this study was to develop a scale that assesses the care ethical competence of students in nursing practice, and verify the reliability and validity of the scale.

Method: A self-administered questionnaire survey was conducted with 694 nursing students nationwide.

Factor analysis was performed and the construct validity was confirmed with AMOS statistical software using model fitness. The coexistence validity was confirmed using the “scale of professional autonomy in nursing.” The reliability was confirmed by Cronbach’s α coefficient to confirm the internal consistency, and a retest was used to confirm the intraclass correlation coefficients.

Results: As a result of factor analysis, 29 items of 5 factors were extracted.

Concerning the degree of data fitness, the GFI was .896, AGFI was .883, CFI was .977, RMSEA was .034, and correlation with the “scale of professional autonomy in nursing” was .453. For reliability, Cronbach’s α coefficient for all 29 items was .932, and Cronbach’s α coefficient for each of the five factors was between .837 and .887. The retest method showed intraclass correlation coefficients between .351 and .904.

Conclusion: The nursing student version of the care ethical competence scale consisted of 5 factors and 29 items. The reliability and validity of this scale were confirmed.

Purpose: To clarify the effects on father identity of Birth-Review for Couple in first time parents with fathers who attended their childbirth.

Methods: We randomly assigned the intervention group (22 patients) and the control group (23 patients) from first-time fathers who were willing to attend their childbirth in order to compared the two groups. In the intervention group, a Birth-Review for Couple (a 30 to 60 minute Birth- Review within 3 days of childbirth) was provided to the couple. The survey was conducted at three points: in late pregnancy; after childbirth; and one month after childbirth. The results were then statistically analysed.

Results: As a result of two-way analysis of variance, significant differences were found in subordinate concepts of fatherliness, heightened paternal awareness (F = 10.969, p < 0.001) and positive feelings triggered by the child (F = 5.848, p = 0.007). In particular, these subordinate concepts were significantly higher both immediately after and one month after the childbirth than before intervention at the end of pregnancy (p < 0.01~0.001).

Conclusions: The Birth-Review for Couple was shown to increase “the upwelling consciousness of being a father” and “a rush of emotion coming from the existence of a child/children” after the childbirth, which continued to 1 month after childbirth.

Aims: To develop a scale to measure genetics nurses’ practical ability and to examine its reliability and validity.

Methods: We developed a scale to measure genetics nursing competencies based on the previous research. The first survey assessed the content validity and surface validity, and the second survey assessed the reliability, coexistence validity, known-groups validity, and test of model suitability using data from 293 nurses.

Results: A 21-item scale comprising six factors was developed by examining content validity and surface validity. Factor analysis showed that the Cronbach’s α coefficient for the entire scale was 0.96, confirming its internal consistency. For known-groups validity, the “yes” and “no” groups’ responses to the question about participation experience in study sessions for genetic medicine and nursing were compared; “yes” group with participation experience had a higher overall score (at 1% significance level). The fit factor of the six-factor, 21-item temporary model was examined in the confirmatory factor analysis, which showed acceptable consistency.

Conclusions: This study developed and tested a scale to measure genetics nursing competencies, and there was a certain extent of validity and reliability.

Objective: This study aimed to assess the dilemmas experienced by nurses standing between individual and team norms and the factors influencing the classification of nurses’ reactions to such dilemmas.

Methods: An interview survey was conducted on 21 nurses with more than 2 years of experience. Data were analyzed via structural and thematic narrative analyses.

Results and Discussion: Five structural patterns in the participants’ stories were evaluated via a structural narrative analysis: a), the nurse took some actions conforming to team norms, b)-1, the nurse took some actions as far as possible based on individual judgment, b)-2, the nurse took some actions when she could find a small group of supporters, c)-1, the nurse took some actions conforming to individual norms but could not change team norms, and c)-2, the nurse took some actions conforming to individual norms and succeeded in changing team norms. The thematic narrative analysis identified five factors affecting nurses’ reactions: duration of experience in nursing practice, job displacement, avoiding conflict with others, acquisition of supporters, and roles assigned in the team. These results suggest the importance of cultivating organizational culture “to listen to small voices.”

Objective: Trial clinical interprofessional education (IPE) was introduced as part of the nursing practice for University A, involving joint clinical practice with pharmacy students at a different university. This study’s objective was to identify IPE’s effectiveness and issues as perceived by nursing students.

Method: Forty undergraduate students in University A’s School of Nursing (third year, n = 28; fourth year, n = 12) completed an anonymous, self-administered questionnaire before and after the IPE. Surveys included free-response questions, the Readiness for Interprofessional Learning Scale (RIPLS), and goal attainment items. Free responses were examined using Berelson’s protocol for content analysis. Quantitative items were compared between time points (significance: p < 0.05).

Results: Valid responses were received from 7 out of 12 fourth-year (58.3%) and 12 out of 28 (42.9%) third-year nursing students. Statistically significant changes in RIPLS scores after the practice were not observed for students in either year. However, fourth year students had gained professional attitudes for interprofessional work and cooperation. IPE relieved third year students’ awareness of barriers and tensions to other professions. Issues identified by the survey included the need to (a) ensure that goals are set according to students’ grade and (b) introduce modifications in practice methods.

Conclusion: This study showed IPE’s effectiveness to a certain degree. Further, several issues with the program’s operation and supervision were identified, requiring customization to suit nursing students’ readiness to learn.

Objectives: The purpose of this study was to explore the experiences of male workers whose wife and children voluntarily evacuated after the Fukushima nuclear power plant disaster (implementation group).

Methods: The sample was 2,209 male workers working for 32 companies of the Fukushima Prefecture. We sent an anonymous self-administered questionnaire to them.

Results: Among the 352 men (response rate: 16.0%), 80 (22.7%) were in the implementation group. Among the implementation group, more than 80% were concerned about the effect of radiation on their children. Additionally, 61.3% of the implementation group evaluated the evacuation of the wife and child as “good”. On the contrary, the evaluation of it as “not good” was significantly associated with “I could not trust the information released about radiation”, “I had to do housework by myself”, and “I could talk to nobody that my wife and children evacuating voluntarily”.

Conclusion: The results suggested that the person with low evaluation of voluntarily evacuation of their wife and children would feel that there was a problem in risk communication during disasters, and might have experienced increased household burden and social isolation.

We examined the effect and practicality of a preventive care program (including physical, psychological, and cognitive exercises) conducted to utilize the regional power of the elderly.

The participants used the “A-CYOKIN-KYOUSHITU.” The preventive care program developed to be conducted at home is called the “IKI-IKI TAISOU PROGRAM.” The participants engaged in physical exercise, song time, and tea time activities once a week in the “A-CYOKIN-KYOUSHITU.” The cognitive, physical, and psychological function of 32 participants measured using the Hasegawa Dementia Scale (HDS), handgrip strength and 30-second one-leg standing with vision, and the Geriatric Depression Scale (GDS), respectively, were appraised and compared before and after the preventive care program. The participants’ the physical functions stayed the same after the intervention.

The HDS score improved after the intervention from 27.9 ± 2.9 to 28.6 ± 2.4 (P = .02). The physical and cognitive exercises were performed by 87% of the participants. Further, the preventive care program “IKI-IKI TAISOU PROGRAM” can be conducted at home by the elderly.

We found that the “IKI-IKI TAISOU PROGRAM” can help to improve cognitive functions and maintain physical functions among the elderly. It is important to foster and use the strength that the elderly provide to their community.

Purpose: To identify the factors that are affected with the ability of nurses working in a convalescent rehabilitation ward (hereafter the “rehab ward”) to collaborate with an Interdisciplinary team.

Method: A questionnaire survey was administered to 245 nurses working in rehab wards in the Hokuriku area by using the Readiness for Chiba Interprofessional Competency Scale (CICS29). Binomial logistic regression analysis was performed by using the variables that had shown significant differences in a univariate analysis as independent variables.

Results: The following variables were extracted as factors affected with the ability of nurses working in rehab wards to collaborate with an Interdisciplinary team: “in-service training programs to encourage collaboration”, “appointment of a therapist as a team leader”, “communication ability”, and “ability to support co-workers”.

Conclusions: This research is to ensure that nurses working in the rehabilitation ward improve their ability to work with interdisciplinary teams, it suggests to build an in-service education program on collaboration, build a team with a therapist as a leader, in addition, improve communication skills and backup skills by deepening the understanding of other job types.

Objectives: The study conducted to reveal the situation of the globalization in nursing graduate school in Japan that may contribute to promote globalization in it.

Methods: An anonymous questionnaire sent to the 156 graduate schools have a master course in December 2015. It contains (1) acceptance of foreign students and teachers, (2) study abroad and overseas training of Japanese students, (3) International research and educational circumstances of teachers, and others. Data were analyzed descriptively. Study approval was given by the Nursing Research Ethics Review Board of University of Kochi.

Result: Seventy-two out of 73 responses were analyzed. About ten to twenty percent of schools accepted foreign students, but only one school had a credit exchange system with overseas universities. In addition, only half were actively communicating with overseas universities. Faculty members did not progress in joint research and international conference participation because of their language skills and heavy workload.

Conclusion: In Japan’s nursing graduate schools, the importance of corresponding to globalization has widely been recognized, and various attempts have been made, but further strategies to enhance the faculty’s language ability and overseas experiences are required.

Aim: This study aims to investigate the feelings of senior nurses working in the university hospitals toward postgraduate education from the perspective of years of clinical experience, participation in postgraduate education, and workplace environment.

Methods: We conducted a self-administered questionnaire survey, including individual attributes, feelings and participation in postgraduate education, and workplace environment, among 1,281 senior nurses in two university hospitals between March and June 2016. Data was analyzed using one-way analysis of variance with Bonferroni adjustment for multiple comparisons and t-test.

Results: We obtained valid responses from 746 nurses (58.2%). Senior nurses who have fewer than five years of clinical experiences exhibited anxiety and nervousness during education implementation. Regarding numerous participations in postgraduate education, senior nurses inclined to experience pleasure for the growth of newly graduated nurses, while also feeling the burden. In a workplace with effective praising action and team spirit, senior nurses inclined to experience pleasure for the growth of newly graduated nurses and satisfaction with their growth.

Conclusions: This survey establishes that the feelings of senior nurses working in the university hospitals toward postgraduate education differ with regard to the years of clinical experience, participation in postgraduate education, and workplace environment.

Purpose: To develop a linguistically validated Japanese version of the SURE (Sure of myself; Understand information; Risk-benefit ratio; Encouragement) test screening for decisional conflict in patients.

Methods: We translated the original version, consisting of four items, into a preliminary Japanese version through four stages: Stage I comprised forward translation by two people; Stage II, integration of the two translations generated previously; Stage III, back translation by two people; and Stage IV, consultation by researchers and establishing the preliminary version. Further, Stage V comprised a survey for the clarity of items among general citizens and medical professionals, and during Stage VI, the instrument was revised based on the results of discussions among the research members obtained throughout this process.

Results: The preliminary version of the instrument was developed during the first four stages. In the fifth stage, the result of a survey of 32 general citizens and medical professionals indicated that the percentage of respondents who answered “easy to understand” for each item was between 47% to 78%. In the sixth stage, we reviewed the linguistic validity, and the Japanese version of the SURE test was finalized.

Conclusion: Throughout the process of translation, we developed the linguistically validated Japanese version of the SURE test.

Aim: To elucidate the practice of home-visit nurses for promoting community development to ascertain the educational implications of community development promotion through home-visit nurses toward realizing a cohesive community.

Methods: Data were collected using semi-structured interviews with seven home-visit nurses who are pioneering community development. The practice characteristics were qualitatively and descriptively analyzed.

Results: The practice of home-visit nursing for promoting community development was based on the practices of “Focus on individual nursing” and “Working at one’s own pace based on a broad, flexible mindset”, and was connected to the practice of “Spreading community connections” while receiving the interactions of the practices of “Creating spaces where people can be themselves without worries” and “Working to bring out the best of one’s abilities”. This further fostered the development of the practice of “Watching over the residents’ process to achieve their goals”.

Conclusion: The study found that the practice of home-visit nurses for promoting community development is based on the “individual” perspective and flexible creativity that is unrestricted by systems, and clarified that this is structured around the central practices of expanding community connections and watching over resident-centered efforts.