Objective: This study examined the relationship between SDM: shared decision making and self-management behavior in the selection of renal replacement therapy when introducing hemodialysis.

Methods: We conducted a survey by sending self-administered questionnaires to 61 hemodialysis patients. The survey items included personal attributes, the hemodialysis self-management behavior scale, the SDM-C-patient, the motivation scale for medical treatment behavior, and the self-efficacy scale for health behavior of patients with chronic diseases. We constructed a relational model of self-management behavior and SDM, self-efficacy, and motivation, based on the conceptual framework and the results of the univariate analysis, and conducted covariance structure analysis.

Results: SDM had direct effects on compliance with dietary restrictions and water restrictions and indirect effects through positive coping behavior against disease. Regarding the management of therapy and prevention of complications, SDM had indirect effects through positive coping behavior against disease and autonomous motivation. Regarding the adjustment of physical and psychosocial living, SDM had indirect effects through positive coping behavior against disease.

Conclusion: Self-management behavior of hemodialysis patients was influenced by SDM in the selection of renal replacement therapy.

Objectives: This study aimed to examine the practical wisdom of intensive care unit (ICU) nurses who respect the dignity of patients at end of life.

Methods: Questionnaire and Semi-structured interviews were conducted with eight nurses who had more than five years of experience and more than three years of ICU experience. The obtained data were qualitatively and inductively analyzed.

Results: Five categories were extracted as practical wisdom, including “Recognizing that it is difficult to obtain information from patients at end of life, combining knowledge, experience, and various information acquired, and reflecting the patients’ sense of value in support”; “Recognizing the situation of patients at end of life and their families who lack the time and space to spend time together owing to various limitations, and making creative efforts to reduce the psychological and physical distance”; and “Continuing to explore end-of-life care in ICUs by grasping the meaning of support for patients at end of life and their families.”

Conclusions: In ICUs, where the primary focus is on saving lives, and it is difficult to respect the dignity of patients. The practical wisdom of nurses in ICUs who support patients at end of life is reflected in the attitude of nurses who valued the personality of patients and how patients exist in nursing support.

Objective: This study aimed to investigate the actual situation of perinatal depression and related factors considering the social impact of COVID-19.

Method: This was a cross-sectional study using an online self-administered questionnaire in October 2020, and responses were obtained from 739 pregnant women and 1,603 mothers less than a year postpartum.

Results: Regarding the experience of crises related to the Coronavirus disease 2019 (COVID-19) pandemic, “experiencing criticism for taking the child to public places” was found to be 18.1%, “reduced income” was 38.0%, and “fear of COVID-19 illness” was 77.2%. The logistic regression analysis showed that factors associated with the high risk of perinatal depression were ‘history of mental disorders’, ‘academic background’, ‘maternal and infant health condition’ and ‘social impact of COVID-19, varied depending on timing and delivery history.

Conclusion: Depression among pregnant women and mothers increased in the COVID-19 pandemic, and it suggested the need for care considering the social impact of COVID-19.

Objective: To clarify the process of change in subjective experiences tied to values by a female patient in her 50s in the chronic phase of schizophrenia who participated in Acceptance and Commitment Therapy (ACT) and to obtain suggestions for personal recovery support.

Methods: A semi-structured interview was conducted with the female, and her subjective experiences, in which she had tied to values, and her personal recovery had been promoted, were qualitatively and descriptively analyzed. As another source of evidence for this case study, her value-directed behavior records created by herself were used.

Results: She experienced [a mental conflict due to hating to do housework while knowing that she has to do it] not to become dependent with aging. Her experiences after the initiation of ACT were represented by [repeating trials and errors and coping with anxiety to manage household chores with her respectful mother as a model] and [desiring to live well with other family members, modeling herself after her mother, and increasingly doing housework], which promoted her household behavior.

Conclusion: The results suggest the importance of sharing personal recovery as a process of change and focusing on subjective and individual experiences when supporting people with schizophrenia.

Purpose: The purpose of this study was to develop “situation-based educational program” for obtaining competency in accurate blood pressure measurement and to verify its effectiveness.

Methods: A randomized controlled trial was conducted with 23 second-year students of A-university in the intervention (situation-based education) group and 25 students in the control (conventional education) group. The effectiveness was compared between both groups using Objective Structured Clinical Examination (OSCE) with “Competency Checklist for Vital Signs Accurate Measurement (VSAM Checklist)” and the “Situational Response Competency Self-Assessment Scale (SRCS Scale)”.

Results: The results of the VSAM checklist tended to show effects of the intervention on 4 items regarding the competency of flexible response to patients’ needs and situations, including “explaining the measurement method” and “maintaining comfort”. The results of SRCS Scale in 8 items indicated significant main effect of education. In particular, the score of “I can response well to changes in the patient’s situation” increased by more than 1.1 out of 5 points in both groups.

Conclusion: This program has been shown potential effectiveness of enhancing the competency of flexible response to patients’ needs and situations, and could be an effective method in basic nursing education.

Objectives: To elucidate perioperative nursing care provided to oldest-old patients with femoral head fractures by experienced nurses.

Methods: Semi-structured interviews were conducted with 12 experienced nurses and analyzed the data using the modified grounded theory approach.

Results: Experienced nurses provided oldest-old patients with [preoperative care so that the oldest-old patient can undergo surgery without incident] and [postoperative care for the oldest-old patient to recover smoothly], which were based on [intentional involvement for oldest-old patients to pass their hospital stay with ease], [intentional involvement to prevent decline in physical functioning], and [intentional involvement to prevent decline in cognitive functioning]. Furthermore, from the early stage, [sharing of information among multi-disciplines and with the family according to the status of the oldest-old patient] led to [discharge support, taking into consideration the burden on the family members who will provide care for the oldest-old patient]. The basis of these nursing duties lies in [the consideration of preventing the elderly individual from exertion] and providing indispensable support to the oldest-old patient.

Conclusion: On the basis of these findings, it was suggested that nursing duties contribute to improving the quality of life of oldest-old patients.

Aims: This study aimed to develop an operational system based on the reinforcement principle for nurses to ensure proper functioning of the patient self-management program.

Methods: In the operational system, leader nurses provide differential reinforcement to the nurse’s feedback behavior on the correctness of the patient’s judgment. The system was incorporated into the self-management program and introduced to hospitals A and B, with Standard-care phase, Intervention phase (I phase), and Follow-up phase (FU phase) settings.

Results: During the I phase, the nurses’ feedback behavior execution rate increased and was maintained during the FU phase. The patient’s judgment execution rate also increased during the I phase. The feedback behavior adequacy rate of nurses at hospitals A and B increased to 78.0% and 70.9%, respectively, while the patient’s judgment adequacy rate increased to 69.5% and 74.7%, respectively.

Conclusions: These results demonstrate that this system increased not only the appropriate feedback behavior of nurses based on self-management program but also the patient’s appropriate judgment.

Objective: To clarify the thoughts of nurses before and after returning to work following infection with coronavirus disease 2019 (COVID-19) in the early stages of the pandemic, as well as the factors affecting these thoughts, and obtain suggestions regarding return-to-work support for nurses infected with newly emerging infectious diseases.

Methods: Semi-structured interviews were conducted with 13 nurses who had been infected with COVID-19 while working at Hospital A and consented to participate in this study. The data obtained were qualitatively and inductively analyzed.

Results: Before returning to work, the nurses experienced “conflicts about returning to work” between hesitation and anticipation. After returning to work, they had “a sense of fulfillment” while experiencing “continuing anxiety even after returning and dissatisfaction with the hospital’s responses.” The persistence of hesitation before returning to work was a factor that reinforced their anxiety and dissatisfaction after returning. The nurses working on an infectious disease ward were willing to apply their experience of being infected to the care of their patients.

Conclusions: Before returning to work, nurses experienced conflicts, and after returning to work, they experienced contradictory feelings of a sense of fulfillment and anxiety and dissatisfaction. These findings suggest that hospitals can help nurses maintain a sense of responsibility by understanding their suffering and improving their working environment, and that such support can help nurses to not only return to work, but also continue working.

Purpose: To develop a self-rated delirium care competency scale for shift leader nurses at acute medical wards.

Methods: Scale items were developed based on interview data from clinical nurses and the literature. Draft items of the scale were refined through the content validity evaluation by clinical nurses and a pilot study. Subsequently, a self-administered questionnaire survey was administered to 735 shift leader nurses at 68 acute hospitals in Japan to examine the reliability and validity of the scale.

Results: Exploratory factor analysis revealed 9 factors and 40 items in this scale. Confirmatory factor analysis revealed the degree of data fitness was very good, with a Cronbach’s α coefficient was .953 for the 40-item total score. The scale showed a significant positive correlation with the “Scale on Role Performance of Shift Leader Nurse,” showing concurrent validity. These findings suggested that this scale has a certain degree of reliability and validity.

Conclusion: Through self-assessment using this scale, it is possible to examine the shift leader nurses’ practical issues regarding delirium care.

Objective: To clarify the education and training-related factors associated with provision of end-of-life care by home-visit nursing agencies that did not calculate the medical expenses for function-enhanced home nursing management.

Methods: An anonymous questionnaire was administered to 2,000 randomly selected home-visit nursing agencies throughout Japan. It asked about the facility structure, training/education factors among nurses and managers, regional and cultural difficulties in implementing end-of-life care at home, and provision of end-of-life care at home.

Results: A total of 242 responses were analyzed. Logistic regression analysis was carried out, adjusting for the number of full-time equivalent nurses, the presence of an additional 24-hour response system and regional and cultural difficulties in implementing end-of-life care at home. It showed that the provision of end-of-life care at home was associated with end-of-life care training for managers (odds ratio: 4.17, 95% confidence intervals: 1.76–9.90), and support to increase the frequency of accompanied visits for nurses practicing end-of-life care at home for the first time (3.12, 1.33–7.29).

Conclusion: End-of-life care at home may be promoted by providing specific training for managers and ensuring that nurses who are practicing end-of-life care at home for the first time are accompanied.

Objective: This study develops a scale for measuring career plateau in mid-career nurses and examines its reliability and validity.

Method: A draft of a career plateau measurement scale for mid-career nurses was developed based on previous research. A questionnaire survey was administered to 1,409 non-positioned nurses with between 3 and 25 years of clinical experience working at 9 hospitals with 500 or more beds in the Kinki region, and the reliability and validity of the survey were verified.

Results: Valid responses were received from 497 respondents (35.3%). Exploratory factor analysis using the main factor method and promax rotation yielded 26 items and 4 factors. Furthermore, confirmatory factor analysis confirmed the robustness of the hypothesized model obtained in the exploratory factor analysis. The Cronbach’s alpha coefficient for scale reliability was .94; the intraclass correlation coefficient for the test–retest method was .82; and the correlation coefficients with the trait self-efficacy scale of criterion-related validity and job satisfaction measurement scale for nurses working in a hospital were –.47 and –.63, respectively.

Conclusion: A scale measuring career plateau in mid-career nurses was verified for reliability and validity.

Objective: To clarify the psychological and social issues of patients and families with drug-resistant bacteria who receive home care while having drug-resistant bacteria.

Methods: Semi-structured interviews were conducted with nurses working at a home health care station to understand the psychological reactions of patients and their families who receive treatment at home with drug-resistant bacteria and their perceptions of the impact on their social lives.

Results: The following psychological issues were identified: [feelings caused by uncontrollable situations], [optimism due to invisibility], [unanswerable questions], and social issues: [sense of not wanting to be discriminated], [psychological distance from family members who live apart], [limitation of access to day care and facility services]. The results of this study revealed that the following social issues existed in the patients

Conclusion: Patients and their families who have detected drug-resistant bacteria have feelings that arise in situations that are difficult to control and a sense of not wanting to be discriminated against by others. They are concerned about social isolation due to discrimination and prejudice, and they are concerned that their access to day-care/facility services may be restricted due to the detection of drug-resistant bacteria. The results suggest that the burden of caregiving by family members increases when they are restricted from using day-care and facility services due to the detection of drug-resistant bacteria.

Objective: This study aimed to describe the experiences of nurses working with ALS patients with frequent calls, focusing on a nurse who regarded caring for such patients affirmatively.

Methods: Unstructured interviews were conducted with four nurses working with ALS patients, and the data were described and analyzed using hermeneutic phenomenological method.

Results: Some nurses had difficulty in caring for ALS patients with frequent calls, while others tried to take an active role in nursing. A nurse who was actively engaged in nursing stated that it is possible to view this as a result of the illness and to think about what the patient would like them to do from his or her point of view. These nurses also stated that it is possible to respond to each call in such a way that it is not only a response to the immediate specific request but also a response to the patient’s anxiety and call.

Conclusion: These findings suggest a possibility for nursing care for ALS patients, who are often regarded as difficult due to frequent calls.

Objective: This study described the adaptive experiences of part-time home-visit nurses.

Methods: Semi-structured interviews were conducted with 17 nurses who had more than one year of experience and had worked part-time for home-visit nursing agencies in the metropolitan area for over a year. Data were analyzed using the conventional content analysis method.

Results: The study participants indicated that some experiences, such as “common sense of nursing care acquired through experience in hospitals that does not work” and “difference from the self that I should have been able to be,” led to “difficulties in adapting to home-visit nursing.” In order to “cope with adaptation to home-visit nursing,” the participants took measures such as “thinking about the meaning of events” and “finding ways to improve my work” in order to create “a sense of adaptation to home-visit nursing.”

Conclusion: Helping nurses adapt to home-visit nursing may require hosting an orientation that enhances their readiness and offering work arrangements that take the nurses’ capabilities into consideration.

Objective: The purpose of this study was to clarify changes in mothers’ living environments, mental health, feelings about child rearing and related factors, due to the spread of COVID-19.

Methods: From March to April 2021, a self-administered questionnaire survey was conducted among 479 mothers with children aged 1 to 5 years. The content of the survey included basic attributes, changes in living environment, mental health, and feelings about child rearing. Binomial logistic regression analysis was used for factors related to feelings about child rearing.

Results: 213 respondents (valid response rate: 44.5%) were included in the analysis. Regarding the living environment before and after the beginning of the spread of COVID-19, changes were observed in 34.7% of the respondents in terms of employment status, 19.2% in terms of economic status, and 50.7% in the use of nursery schools. GHQ-12, distress over childcare, change in employment status, satisfaction with instrumental support, and number of children were related to feelings about child rearing.

Conclusion: It was clear that Relationship between changes in mothers’ living environments and feelings about child rearing, suggesting the need for regular communication and new sources of support for mothers.

Purpose: This study aimed to identify the facilitators and barriers that influenced self-management behaviors among women with gestational diabetes mellitus (GDM).

Methods: This was a qualitative descriptive study. Semi-structured interviews were conducted with postpartum women diagnosed with GDM, and framework analysis was conducted.

Results: 8 women participated. Regarding facilitators and barriers, the following four areas were identified: individuals, inter-personal relationships, hospitals, and communities. Regarding facilitators, 11 categories were identified, including Acceptance and high motivation as a pregnant woman, Power of supportive family members, Professional guidance respecting individuality from multiple professions and reassuring attitude of health professionals, and Relief of isolation through peer support and information about GDM and medical treatment. Regarding barriers, 12 categories were identified, including Low self-efficacy in self-management, Difficulty in balancing treatment behavior with childcare of older children, and Lack of individualization and specificity of information and health guidance provided by health professional, Lack of social resources regarding GDM.

Conclusion: Various factors that promoted or inhibited self-management behaviors among women with GDM were identified in the four areas. Improvement of support at each level is required.

Purpose: The purpose of this study was to evaluate objective measures of sleep in leukemia patients undergoing chemotherapy and to determine the relationship between nighttime and daytime objective sleep measures.

Methods: The study participants were nine leukemia patients hospitalized for chemotherapy (five males, four females), with a mean age of 63.7 ± 9.2 (47–76) years. They were evaluated with objective nighttime sleep variables and the sum of daytime sleep (nap) for 16 days after the start of chemotherapy administration by a small 3-axis accelerometer.

Result: The mean ± SD of each nighttime sleep valuable and nap was 385.5 ± 65.8 minutes total sleep time, 10.6 ± 5.3 minutes onset latency, 76.9 ± 40.3 minutes mid-awake time, 8.2 ± 3.7 awakenings, 80.3 ± 9.7% sleep efficiency, and 379.3 ± 163.2 minutes nap. A positive and significant correlation was found between nap during the day and total sleep time, and nap during the day and sleep efficiency.

Discussion: Although leukemia patients undergoing chemotherapy experienced an average nap of more than six hours per day, the relationship between nap and sleep efficiency suggests that daytime sleep may not always negatively affect nighttime sleep.

Purpose: To identify obstacles faced by nurses (hereinafter referred to as promotors) in the promotion of care activities for dementia patients at an acute care hospital, and the process to overcome such obstacles.

Method: Focus group interviews targeting 11 promoters were conducted in groups of 3–4 persons. Results were analyzed using the qualitative synthesis method (KJ method).

Results: Promotors were aware of two obstacles, namely “conditions which relies on physical restraint to handle conflict” and “reaching a dead end due to varying degrees of enthusiasm” at the acute care hospital. This was due to an underlying sense of value of postponing dementia care. However, as a result of the activities that have the characteristics of both “activities based on the intentions of the promotor” and “activities based on the team”, “verification of organizational achievement” was eventually achieved. A support called “driving force to continue activities” was present in proof of the result.

Conclusion: Regarding obstacles, promotors expressed their own conviction with a driving force, and continued activities called team formation that spread to all, and verified achievement through phased implementation of a long-term plan. In this process, support for the promotors through an organization was essential.

Purpose: The purpose of this study was to investigate the effects of a footcare-programs intervention using thermography and blood flow meters on the self-care behavior for foot and the self-care ability of patients with type 2 diabetes

Methods: This study included sixteen outpatients with type 2 diabetes mellitus. The care program lasted for 60 minutes per session and was performed every 4 to 8 weeks for a total of four sessions. Subjective assessments of better understanding of the body prone to vascular disorders using the visual analog scale (VAS), self-care behaviors using the summary of diabetes self-care activities (SDSCA), self-care ability utilizing the self-care agency questionnaire 30 (SCAQ-30). All data were collected at baseline and postintervention.

Results: After the intervention, the subjective sensation (VAS) of “understanding one’s blood vessels and blood flow” enhanced significantly (p < 0.001), and self-care behavioral scores for foot care and self-care ability scores improved significantly (p < 0.001) compared to baseline. There was a significant negative correlation (r = –0.66, p < 0.001) between the degree of improvements in foot care behavioral score and disease duration.

Conclusion: Our results suggest that this foot care program is inferred to have greatly improved self-care behaviors regarding foot care, leading to the prevention of diabetic foot ulcers in patients at the early stages of diabetes.

Aims: This study aims to clarify the specific nursing practices in outpatient departments of cancer nursing (ODCN) in Japan. ODCN refers to an outpatient department run by nursing staff in collaboration with doctors and other professionals for cancer patients and their families to improve symptoms associated with daily life and support self-management. Cancer consultation support centers were excluded.

Methods: A cross-sectional questionnaire survey was administered to nurses in charge of ODCN at the 427 designated cancer care hospitals specified by the Ministry of Health, Labor and Welfare. The questionnaire was mailed to each facility’s director of nursing with a request for it to be distributed to the nurse in charge of the ODCN. It included questions about the operational status of ODCN, frequency of nursing practices, and awareness of issues. This study was conducted with the approval of the Research Ethics Review Committee.

Results: Of the 288 questionnaires returned (response rate of 67.4%), 116 were analyzed since 172 facilities do not have an ODCN. The ODCN are operated by qualified nurses, such as CNS in cancer nursing. Many are open daily and see patients by appointment. The ODCN nursing practice scale has a six-factor structure that includes “support for organizing the thoughts of patients and their families,” “cooperation with other departments to solve problems,” and “support for daily life under medical treatment.”

Conclusion: The specific nursing practices in ODCN included support for organizing the thoughts of patients and their families, and cooperation with other departments to solve problems.

Purpose: This study aimed to identify the process of realizing motivation for recovery in emergency patients admitted to intensive care units(ICUs).

Methods: Semi-structured interviews were conducted with nine adult emergency patients admitted to the ICUs, focusing on their experiences of recovery motivation. The interview data was analyzed, adopting the Modified Grounded Theory Approach.

Results: Emergency patients admitted to ICUs who experienced an initial <loss of autonomous self> during their helpless state had a lowered motivation for recovery.

Henceforth, the patients began to realize the motivation for recovery, changing to <recovery of the autonomous self> and <increase in the sense of autonomous self> under the influence of the <certainty of recovery> and other factors. The changes were shown to be a process of «restoring the autonomous self».

Conclusions: The motivation for recovery increases as an individual regains autonomy in «restoring the autonomous self». Therefore, promoting physical recovery is essential for facilitating the process of realizing motivation for recovery.

Objective: This study aimed to describe the living difficulties of adult children of a parent with a schizophrenia-spectrum disorder.

Methods: We conducted individual, semi-structured interviews with seven adult children of a parent with a schizophrenia-spectrum disorder. Data were analyzed using qualitative descriptive methods.

Results: The parents of six participants had schizophrenia and one had paranoid disorder. The participants reported the following living difficulties: “Relationship and thoughts with my mother became fetters in my own life,” “The after-effect of the ingrained behavioral and thought habits due to having had a mother with a schizophrenia-spectrum disorder,” “Lack of skills provided by parents,” “Being dragged down by traumatic experiences,” “A lack of understanding of true self, and what it means to live for myself,” “Feeling pain due to comparisons with other family environments.”

Conclusions: Various conditions which caused or reinforced the living difficulties of these adult children were recognized for each living difficulty. Society needs to become more aware of the living difficulties of children of parents with schizophrenia-spectrum disorders after they reach adulthood and promote support and treatment for them. Family support should be continuously provided to both parents with mental illness and their children ever since the latter’s childhood, and they should not be isolated from society.

Aims: The aims was to clarity the current situation of educational adjustment of clinical training at nursing universities and faculty members recognition of it. Educational adjustment refers to providing the necessary support for students with disabilities or some characteristics of disabilities in clinical practice education.

Methods: The questionnaire survey targeted representatives of nursing education at 277 member schools of the Japan Association of Nursing Program in Universities, and surveyed the recognition of educational adjustments of universities. The next questionnaire survey surveyed all faculty members from 15 universities regarding their recognition of educational adjustments. This study was conducted with the approval of the Research Ethics Review Board.

Results: Educational adjustment of students was examined by the Academic Affairs Committee and the Student Support Committee. The number of students who needed educational adjustments was relatively high the development disorders and mental disorders. Teachers were very interested in educational adjustment and thought that information and countermeasures could be shared among teachers. One the other hand, teachers felt a strong need to improve their teaching ability of practical training and management skills.

Conclusions: At nursing universities, committees and other organization examined educational adjustment, and faculty members were working on sharing information and considering countermeasures.

Purpose: To clarify the recognition and nursing for patients with end-stage liver diseases who have undergone liver transplantation (recipients) in the general ward.

Methods: We recruited nurses who cared for recipients in the general ward. We asked about their experiences with transplantation nursing in a semi-structured format. We also analyzed the contents and categorized them into subcategories and main categories.

Results: Seven nurses were included in this study. For recognition, seven categories and 26 subcategories such as “How preoperative nursing for living-donor liver transplantation differ from the other surgical operations” and “Concerns about the donor’s physiological and psychological condition, and the recipient’s life and its difficulty” were generated. Regarding the nursing practice, 11 categories and 32 subcategories such as “Ascertain people who were willing to support recipients’ self-management and the environment in recipients’ home from the admission, and guide to discharge and to support recipients’ circumstances if needed” and “Devise strategies to ensure immunosuppressants intake and strengthen the recognition about the importance of immunosuppressants intake” were generated.

Conclusions: The perceptions and nursing for recipients in general ward were cleared. Of the perceptions and nursing for recipients, some nurse perceived it’s difficulty. This study indicated that developing a systematized educational program to improve care for recipients might be needed to resolve these difficulties.

Purpose: The purpose of this study was to describe from a family perspective the experiences of families with members who required hospitalization due to acute exacerbation of a mental condition in Japan. It thereby aims to obtain suggestions for family nursing care in psychiatric emergencies.

Method: Unstructured interviews were conducted with six family members of people admitted to a domestic emergency psychiatric inpatient unit due to an acute exacerbation of a mental condition. The responses were analyzed using the thematic approach of Riessman’s narrative research.

Results: Seven themes were identified: “He/she has become someone I can no longer have a human connection with”; “If I don’t save my family, he/she will die”; “I want to get out of this situation, but I can’t”; “I don’t know how we can be saved”; “My family has gone insane”; “Why did ‘my family’ become ill?”; and “I can’t live my own daily life”.

Conclusion: The results of this study suggest a need for the expansion of early intervention services to support families who have been forced to deal with their family members’ mental health issues. In addition, nursing services should strive to work with families who have lost connections with their family members in hospitals. The difficulties that family members are forced to endure must be listened to, and they should receive support that focuses on their daily lives, while considering their feelings of regret and remorse.

Objective: This study aimed to verify the effectiveness of the training program in acquiring the key competencies of nursing managers.

Methods: The intervention group comprised 36 nurses who participated in the training program and the control group comprised 30 nurses who did not participate in the training program. A self-administered questionnaire survey was conducted at three points in time (before the training program, one month after the training program, and three months after the training program). The survey used the Key Competency Scale for nursing managers, and the analysis was performed using the Friedman test for the intervention and control groups.

Results: Three months after the training program, the key competencies of the nursing managers (situational awareness, metacognition, self-management, career support, and decision-making) in the intervention group significantly improved.

Conclusion: The findings demonstrate that participating in this training program has the potential to improve the key competencies of nursing managers.

Purpose: This study describes assessment and care processes of nurses used to avoid physical restraint at the onset of delirium in elderly patients.

Methods: Semi-structured interviews were conducted with eight nurses working in general wards and the interview data were qualitatively and descriptively analyzed.

Results: When the nurses ‘sensed unusual changes in symptoms and behaviors in patients’, they were ‘accepting the behaviors of patients in a manner to ease the mind of the patient, and trying to calm the patients’, and ‘observing the patients while being ready for a further immediate response’ to avoid employing physical restraints with elderly patients. The nurses provided care to ‘make the patient conditions closer to those of ordinary life by reducing the discomfort and distress’ based on the ‘interpretation that the changes in the symptoms and behaviors are caused by physical and mental distress’, while repeatedly ‘estimating the risks arising from the symptoms and dangerous behaviors’ and ‘focusing on the patient background and factors affecting the onset of delirium, to analyze the reasons for changes in the symptoms and behaviors’.

Conclusions: The findings suggest that nursing care practices to make patients comfortable from the patient view point without bias from medical safety concerns may be linked to maintaining avoidance of physical restraints.

Objective: This study developed a workplace management index intended to help retain human resources in community-based welfare facilities for older adults.

Methods: The validity and reliability of the index was examined using a questionnaire survey administered to 1,315 nurses and care staff working at 263 community-based welfare facilities for older adults in the Tokai region.

Results: Exploratory factor analysis of 204 participants (response rate = 15.9%; valid response rate = 98.1%) revealed that the index had a five-factor, 38-item structure. The five factors were “effective use of resources between the community and facility,” “efforts to leverage the strengths of community-based welfare facilities for older adults,” “leadership of the facility director,” “communicating information about the appeal of the facility,” and “interaction between community members and the facility.” Analysis of the index’s reliability and validity yielded Cronbach’s α coefficients of .836 to .948, a model fit of χ² = 1278.2 (p < .001), GFI = .749, AGFI = .716, CFI = .861, and RMSEA = .068.

Conclusion: Although the model’s fit index for construct validity was somewhat low, its internal consistency and reliability were confirmed.

Aims: To identify the effectiveness of advance care planning (ACP) for chronic obstructive pulmonary disease (COPD) by undertaking a systematic review and meta-analysis of relevant research findings.

Methods: The databases searched were CENTRAL, PubMed, CINAHL Plus with Full Text, Embase, and PsycInfo, from which randomized controlled trials were collected. Analysis was performed by qualitative and quantitative integration and GRADE evaluation.

Results: 4RCTs (918 participants) were included in this review. The intervention group showed significant differences in advance directive completion (risk ratio (RR) 1.29; 95% confidence-interval (CI) [1.04–1.59]; p = .02) and end-of-life discussion (RR 1.55; 95%CI [1.02–2.37]; p = .04).

Conclusions: The results suggest that ACP for COPD may improve documentation and end-of-life discussions, however, the certainty of the evidence is limited based on the risk of bias and small studies.

Objective: This study aims to develop a self-education scale for nurses.

Methods: Based on the attributes of nurses’ self-education extracted from the concept analysis, items on the self-education scale for nurses were created, and content validity was examined to create a questionnaire consisting of 62 items in the original scale. A questionnaire survey was conducted on 1,080 nurses working in medical facilities with 300 or more beds to verify the reliability and validity of the scale.

Results: Responses were obtained from 416 nurses . Of these, 259 were subjected to factor analysis. As a result of factor analysis, 27 items of the following three factors were extracted: the ability to learn independently, the ability to reflect on one’s, the interest in nursing and a sense of fulfillment in work. Cronbach’s α coefficient was .945, and the intraclass correlation coefficient by the test-retest method was .858.

Conclusion: A self-education scale for nurses was developed and the reliability and validity of the scale were tested.

Objective: This study aims to develop a Japanese version of the multiple sclerosis self-management scale-revised (MSSM-R) developed in the United States and test its reliability and validity.

Methods: A back-translation procedure was used to develop the Japanese version of the scale, a preliminary survey was conducted, and the primary survey was administered to 524 patients with multiple sclerosis. Reliability was examined for stability and internal consistency, and validity was examined for concurrent validity and construct validity.

Result: The ICC for the stability of the test-retest conducted 2 weeks after the primary survey was 0.93. Overall, the Cronbach’s α for the Japanese version of the MSSM-R was 0.85. The correlation coefficient with the external criteria scale was r = 0.64. An exploratory factor analysis revealed that the factor structure of the Japanese version of the MSSM-R was similar to that of the original version except for one item. The Japanese version of the MSSM-R had a goodness of fit of GFI = 0.84, AGFI = 0.80, CFI = 0.83, and RMSEA = 0.08.

Conclusion: The overall reliability and validity of the Japanese version of the MSSM-R were confirmed, and this scale was deemed usable. However, as only one item in the international comparison differs from the original version in terms of factors, international comparisons of subscales should be approached with caution.

Purpose: We aimed to examine the reliability and validity of the Human Caring Scale for Emergency Nursing (HCSEN), which was created from the results of semi-structured interviews conducted with emergency department nurses.

Method: We administered the HCSEN (60 items), which was examined the content validity and surface validity, as well as the external criteria (questions regarding job satisfaction) for coexistence validity examination through a web research company. Responses from 178 emergency department nurses (valid response rate 86.4%) were analyzed, and exploratory factor analysis, Cronbach’s α coefficient calculation, correlation analysis, and t-test were performed.

Results: Eight factors were extracted by exploratory factor analysis. Cronbach’s α coefficient was 0.982 overall, and that for each factor ranged from 0.723 to 0.941. A t-test comparing the HCSEN factor scores and the two groups were divided by the middle of the external criteria total score showed a significant difference between the two groups for all factors (ps < .002).

Conclusion: Internal consistency was confirmed for the subscales of each extracted factor. Moreover, the coexistence validity with the question items related to job satisfaction was also confirmed. Thus, the HCSEN was able to obtain a certain degree of reliability.

Objectives: This research will focus on people diagnosed with SAH of grade I & II, and I will clarify, in a longitudinal way, their experiences upon returning to society during the year after onset.

Methods: The research design used the phenomenological study method of Van Manen (1990/2011). The interviews were conducted five times including during hospitalization, one month after discharge, three months, six months, and one year after discharge.

Results: People with grade I & II SAH were found to have difficulties and suffered a great deal. There are two reasons for this: “Being influenced by unexpected events” and “That they do not know where and when something will happen”. Each of them gradually tested their body and tried to re-examine the capability of the body. As a result, they gained a sense of recovery. Since the process involves many difficulties and suffering, the presence of a person who continuously supports them is necessary.

Discussion: In order to facilitate their recovery, it is suggested that nurses, whose job it is to support health and living, will play an important role.

Purpose: This study was conducted to identify community empowerment (CE) processes and competencies of nurses employed in community-based care.

Methods: Semi-structured interviews were conducted with 16 nurses employed in community-based care. The processes of CE were analyzed using Trajectory Equifinality Modeling. Thereby, the competencies of the respective stages were assessed qualitatively.

Results: Processes of CE followed by nurses in community-based care include three phases: “aspiring community care,” “producing community care,” and “establishing community care.” The “aspiring community care” phase includes the “motivating” and “preparing a project” stages. The “producing community care” phase includes the “identifying care-needs” “building companionship,” and “repeating trial and error” stages. The “establishing community care” phase includes the “facilitating collaboration” and “continuing an activity” stages. The competencies of the respective stage include “competency to discover issues particularly addressing daily life,” “competency to take action toward new nursing activities,” “competency to empathize with diverse values,” “competency to build relationships through dialogue,” “competency to accept challenges of social resource creation,” “competency to coordinate care with respect for people’s autonomy,” and “competency to manage for business continuity.”

Conclusion: The CE followed by nurses in community-based care was characterized by flexibility of activities in collaboration with people of multiple professions and by the difficulty of project continuation.

Purpose: This study examined the current status of disaster preparedness at perinatal medical care facilities across Japan and supporting factors.

Method: An anonymous self-administered questionnaire was administered to the nursing supervisors of 2,909 facilities (hospitals, clinics, and birthing centers) that were on the list of birthing facilities participating in the Japan Obstetric Compensation System for Cerebral Palsy operated by the Japan Council for Quality Health Care. Mainly investigated disaster management in facilities and disaster education for perinatal women. Descriptive analysis, correlation analysis, and multiple regression analysis were performed.

Results: Seven hundred and ninety-five participants provided valid responses to the questionnaire. The mean number of disaster management-related items that were in place was 9.3 (0–22). The implementation rates of the items “Facility and Preparedness” and “Documentation” were high whereas those of the items “Training,” “Human Resources,” and “Regional Alliance” were low. Regarding disaster education for perinatal women, the mean number of items in place was 2.5 (0–18). Only about 30% of the facilities had implemented such education. Factors that promoted disaster preparedness included “The facility is a disaster base hospital,” “The facility previously dispatched nurses to disaster areas,” “The facility is well aware of natural disaster risks,” “Nursing supervisors have been trained to provide nursing care during a disaster,” and “Nursing supervisors are well aware of the post-disaster care needs of perinatal women.”

Conclusion: It is necessary to develop strategies for establishing a perinatal medical care system, implementing training to improve disaster management competency, strengthening disaster education, and enhancing awareness of disaster education among perinatal women.

Purpose: To develop and validate a family resilience scale for family carers of Parkinson’s disease patients (FRS-PD).

Methods: A draft scale was developed based on preceding studies and qualitative research. The validity of the scale content was verified. A questionnaire survey was conducted on family carers. Based on the collected data, the reliability and validity of the developed scale were tested.

Results: A total of 672 responses were collected (return rate 21.6%), and the 640 valid responses were analyzed (response rate 20.6%). The FRS-PD consisted of 38 items and the following 10 subscales: [positivity], [sharing emotions], [resources outside of the family], [relationships with extended kin], [problem-solving ability], [collaboration with fellow patients], [flexibility], [connectedness], [finding meaning in adversity], and [determining the situation]. The internal consistency and model fit of the scale were acceptable.

Conclusion: This scale serves as an evaluation index for family resilience in family carers of Parkinson’s disease patients, and can be used by professionals to promote family understanding and foster family resilience.

Purpose: To identify the challenges in carrying out the activities of branch health nurses in widely merged municipalities, including depopulated areas.

Methods: Semi-structured interviews were conducted with public health nurses in wide -area merged municipalities with branch office functions, after which the verbatim recordings were analyzed qualitatively and descriptively.

Results: The following issues related to the challenges of depopulated areas were identified: “Health services need to take into account the declining birthrate, ageing population and inconvenience of transportation,” “Dealing with the high number of developmental and psychological disorders amidst a lack of social resources and professionals,” In addition, the challenges of branch office operations in depopulated areas were identified: “Competence required for a single person to take responsibility for overall health and welfare work in depopulated areas,” “Remote branch operations and experience desired for mid-level public health nurses and above, but few personnel,” Finally, the challenges of the dual structure, where the operations of the main office differs from the operations of the branch offices in depopulated areas were identified: “Dealing with operations after transferring to a branch office where operations and local conditions differ greatly.” Overall, 8 categories were identified .

Conclusions: While there are issues that arise from the characteristics of depopulated areas, it is important to develop the competence of public health nurses with branch office work in mind, as a solution to the issues that public health nurses can deal with in carrying out the activities of branch office public health nurses.

Objective: To examine the spirituality of a middle-aged male with chronic respiratory disorder due to chemical inhalation at work.

Method: The method of descriptive phenomenology was used to analyze data obtained from unstructured interviews with an-adult male patient in his fortie.

Results: The participant experienced spirituality in the form of “fear of my body breaking down,” “shock of being confirmed as having a serious illness,” “questioning of absurd experiences,” “regret of having been optimistic about my illness,” “regret of having nowhere to go but to the medical profession,” “desire for survival,” and “live to fulfill my role as a mature man”.

Conclusion: The participant experienced the spiritual pain of having a disease that requires prolonged diagnostic time is associated with life-threatening physical pain, and can only be treated using coping mechanisms. However, he also experienced well-being in his spirituality in the form of wanting to live and fulfill his role as a father.

Objectives: We investigated the experiences of healthcare workers who felt apprehension concerning the rights and dignity of hospital patients, nursing home patients, and themselves during the COVID-19 pandemic from the perspective of “ethical issues related to labor,” and attempted to assess the actual circumstances.

Methods: A total of 13 hospitals, nursing homes and home nursing stations cooperated in the survey in which a web-based questionnaire was completed once every two months from July 2020 to May 2021.

Results: Eight categories and 28 subcategories were identified including “discrimination and prejudice against healthcare workers themselves and their families,” “conflicts among healthcare workers regarding the care of infected patients,” and “disadvantages faced by patients and their families due to visitation and care restrictions.”

Conclusion: Several ethical issues were continuously identified during the study period, suggesting the need to consider an organizational response.

Aim: To clarify the issues of special needs schools in the COVID-19 pandemic as perceived by nurses, and to make suggestions for future measures.

Methods: A questionnaire survey was conducted among nurses at 957 special needs schools in Japan regarding the issues faced by special needs schools during the pandemic.

Results: A total of 282 participants were included in the analysis. The following issues were identified: “children and students cannot take preventive actions on their own,” “the lack of supplies and equipment necessary for infection control,” “the lack of confidence that correct infection control measures are being taken,” “anxiety that they may be the source of infection,” “increased workload for nurses due to infection control,” “misunderstanding of infection control with teachers,” “delay in vaccination of nurses,” and “misunderstanding of infection control with parents.”

Conclusion: It is urgent to confirm infection prevention measures by outside experts, educate parents and faculty members, secure environments and materials necessary for infection control, and vaccinate faculty members, including nurses, and their families as soon as possible before new infections spread.

Objective: To clarify visiting nurses’ “being with patients”

Methods: Semi structured interviews with six visiting nurses were conducted and analyzed qualitatively and descriptively.

Results: Visiting nurses’ “being with patients” consisted of six categories and 14 subcategories; the categories were sympathizing by perceiving the atmosphere of the patient and home with all five senses; approaching patients and their families as a person and deepen trust with them; realizing a blueprint for home care together; supporting the bracing of the patient and family for what is expected to happen in the future; building up a shared history with the patient in their day-to-day life; and ensuring that the patient has a place to relax and a sense of security in daily life.

Conclusion: The findings of this study suggest that visiting nurses’ being with patients can be an opportunity for visiting nurses themselves to grow through forming relationships with patients of diverse backgrounds and their families. Morever, there are rfacilitating the formation of visiting nurses’ sense of values, motivation, and the development of their own view of nursing.

Aim: To clarify the status of Augmentative and Alternative Communication (AAC) recognition and experience among university hospital nurses working for patients with intractable neurological diseases.

Method: We conducted a questionnaire survey among 584 nurses in the neurology wards of university hospitals across Japan to ask about the recognition and experience of using 11 types of AAC. The sum-up number of AAC known was used as the recognition score, and the relationship with nurses’ characteristics was analyzed.

Result: Three hundred and thirteen valid responses were received from 27 hospitals. Only one nurse knew 11 types of AAC. The overall mean was 4.40 ± 2.38. Only 2.2% had experience with the Biological phenomenon method. Significant differences in AAC recognition scores were found for years of experience in hospital wards, disease notification attendance, training on AAC (p < .001), and home nursing experience (p = .005).

Conclusion: Nurses at university hospitals have a low recognition of overall AAC and little experience in its use. They must learn more to propose appropriate means of communication while considering a patient’s perception of their disease.

Objective: To clarify the structure of difficulties experienced by municipal public health nurses in forming relationships with involuntary caregivers in cases of child abuse.

Methods: Semi-structured interviews were conducted with five municipal public health nurses in Japanese prefecture A and the data obtained were structured using the KJ method.

Results: The difficulties faced by public health nurses were “uncertainty in response”, “difficulties in the caregiver’s personality”, “anxiety increases ahead of time”, “difficulty of being careful not to break the relationship”, “distress arising from the fact that ‘the best interests of the child’ are secondary” and “pressured and isolated.”

Conclusions: The following three points were suggested for the formation of the relationship between public health nurses and caregivers. It was necessary to understand the trauma of the caregiver, separating the conflicting mission of relationship formation and risk judgment, and to have the opportunity to receive a supervision.

Objective: To clarify nurses’ recognition of the current situation and issues surrounding the acceptance of children requiring medical care at After-School Daycare.

Methods: This was an exploratory study with a qualitative descriptive research design. Semi-constructive interviews were conducted with five nurses at After-School Daycare that accepts children requiring medical care.

Results: The current situation was categorized into medical safety and human resource management, and the problems were categorized into one theme. The medical safety aspects included “sharing care methods at home,” “observation from a preventive perspective,” “clarifying the division of roles regarding physical condition management,” and “crisis management.” The human resource system included “establishment of continuous care,” “cooperation with other professions,” and “establishment of a support system for nurses,” while the issues included “securing personnel for safe operation,” “difficulties in management,” “frustration that some children are difficult to accept,” “lack of a perspective on home care upon discharge,” and “lack of a perspective on long-term medical care and education.”

Conclusion: The nurses at After-School Daycare that accepts children requiring medical care, recognized the need to establish a system for infection control, disaster management, and medical safety measures, as well as for responding to sudden changes in medical conditions. They recognized the difficulty of securing personnel and management as issues.

Objective: This study aimed to understand the implications of life for people with HIV stopping their medication of anti-HIV drugs, through their narratives and focusing on their relationship with society and culture.

Methods: This study is based on an interview of an HIV-positive person who had discontinued his treatment. The context of what is “correct” from a medical and moral point of view in modern society was relativized to analyze the interviewee’s responses from the perspective of medical anthropology considering socio-cultural situations.

Result: To the interviewee, HIV infection meant a “disease that pushed him into a closed way of thinking and acting.” HIV drugs showed him two meanings: “drugs that prevent awareness of life and death” and “drugs that disrupt his life.” By eliminating these “drugs that disrupt his life” from his life and “living as if he was not sick,” he “regained the value of life.”

Conclusion: Although drugs are important to support human life, they form only a small part of the lives of the users. It is important to provide care for HIV-positive people not only considering the individual but also focusing on the relationships between neighborhoods and backgrounds of culture and society.

Purpose: To identify factors that promote and inhibit empowerment of nursing students as perceived by clinical nursing instructors.

Methods: Semi-structured interviews were conducted with seven nurses with three or more years of clinical nursing instructing experience who are currently active as instructors, and then categorized by content analysis.

Results: Seven categories of promoting factors were identified: “fostering a sense of unity in the clinical learning environment”, “understanding the situation and feelings of nursing students”, “support for individual nursing students according to their needs”, “learning opportunities which enabled them to experience the way people around them worked”, “continuous participation in nursing practice to learn from challenges”, “sharing of practice situations with peers”, and “giving back the outcome of their learning”. Three categories of inhibiting factors were identified: “burdensome work environment”, “insufficient time”, and “discrepancy in practice goals”.

Conclusion: Based on the development of a sense of unity in the clinical learning environment and an understanding of nursing students’ situations, the study suggested that the back-and-forth between learning and practice strengthens the nursing students’ problem-solving abilities.

Objective: To clarify the structure of the support provided by home-visiting nurses to chronic obstructive pulmonary disease (COPD) patients during the disease’s terminal stage.

Methods: Semi-structured interviews were conducted with home-visiting nurses in the Kanto region and the data analyzed using the grounded theory approach by Strauss & Corbin (1990/1999).

Results: With “supporting the will needed to live even if breathing is difficult” as the core category, the support provided by the participants during COPD patients’ terminal stage was classified into five main categories—“providing a prognosis by comparing breathing difficulty and systemic symptoms,” “watching over the process of forgiving oneself feeling the limitations placed by one’s physical decline,” “eliminating the pain arising from the disappearance of the meaning of one’s own existence and of life,” “reconstructing the desired medical treatment until the final moments,” and “aiming for a peaceful end by eliminating breathing difficulty and anxiety”—and 13 categories.

Conclusion: The support provided by the participants was a process of realizing a way of life in accordance with the patient’s wish to retain their independence even with death near.

Aim: The purpose of this clinical practice guideline is to provide and recommend methods of assessing aspiration and pharyngeal residue during eating and swallowing and methods of selecting and implementing nursing care for adults in order to prevent the development of aspiration pneumonia through early and appropriate management of oropharyngeal dysphagia.

Methods: In April 2018, Japan Academy of Nursing Science established the Supervisory Committee in Nursing Care Development/Standardization Committee to develop clinical practice guidelines for aspiration and pharyngeal residual assessment during eating and swallowing for nursing care. This clinical practice guideline was developed in accordance with Minds Manual for Guideline Development 2017, with the aim of providing a specific pathway for nurses to determine the policy for selecting management for oropharyngeal dysphagia based on research evidence and multifaceted factors such as the balance of benefits and harms and patients’ values.

Results: Based on 10 clinical questions related to assessment by physical assessment, the Repetitive Saliva Swallowing Test, Modified Water Swallowing Test, Food Test, cervical auscultation, observation using an ultrasound diagnostic device, and an endoscope, 10 recommendations were developed. Eight recommendations were evaluated as GRADE 2C, and the other two were evaluated as no GRADE.

Conclusion: We were able to produce the first reliable clinical practice guideline from an academic nursing organization that focuses on assessment for nursing care and incorporates the latest findings.

Many scientific associations hold annual meetings to which they invite the submission of abstracts. Most nursing associations require all co-presenters of an abstract to be association members. This study aimed to quantify the impact of waiving this requirement on the number of submissions, the number of new members, and the association’s revenue. We conducted a web-based questionnaire survey of first presenters of a meeting with the attenuation concerning their likely intention to submit if attenuation had not been implemented. The questionnaire was answered by 64 (86%) first presenters, who had 164 co-presenters. Nineteen abstracts (30%) would not have been submitted if not under attenuation. In contrast, 20 non-member co-presenters would have become members if not under attenuation. The estimated impact of attenuation was a decrease in the number of newly joining association members of 11 and an increase in meeting attendance of 40 attendees. Accordingly, the association’s revenue was estimated to have increased by 358,900 yen on a single-year basis. Attenuation was considered effective with regard to both the association’s finances and the meeting’s success. This paper describes this important experience and suggests the merit of evidence-based association administration.