The concept of "treatment engagement" has been used in many research articles to describe the behavior and process by which patients engage in treatment and medication. However, the term "treatment engagement" is often undefined and used ambiguously, with each researcher using the term, with a different, vague, or broad meaning. Given that many studies have shown that treatment engagement is directly related to clinical outcomes, the concept, should be defined more concretely. This study, therefore, aims to conduct a concept analysis of treatment engagement using Rodgers' evolutionary method of concept analysis. The antecedents of the concept of "treatment engagement" consisted of three elements: individual (i.e., knowledge regarding the disease and treatment, attitudes toward disease and treatment, and acceptance of the disease), situational (i.e., negative experiences in the past and conditions and circumstances that allow patients to focus on treatment), and environmental (i.e., connection with providers, social support, and adaptive treatment system). The attributes of treatment engagement had two elements: behavioral (i.e., initiation of treatment, continuation of treatment, and adherence to recommendations in treatment) and psychosocial (i.e., attitudes that indicate value and expectations toward treatment, cooperation with peers, and collaboration between patient and providers). Consequences of treatment engagement were treatment retention, better clinical outcomes, and coping with disease and treatment. Through this study, we developed the theoretical definition of treatment engagement as the process of initiating and continuing treatment, and adhering to treatment recommendations, in cooperation with peers and in collaboration with supporters, accompanied by a positive attitude toward treatment.

There has been an increasing number of people with heart failure (HF) and with diabetes mellitus (DM). The number of people with concurrent HF and DM (HF-DM) is also expected to increase because of the strong relationship between both diseases. Several systematic reviews and meta-analyses have evaluated nursing care for each HF and DM, but none have been retrieved on nursing care for people with HF-DM. This study reviewed and categorized the literature on nursing care for people with HF-DM and aimed to identify the scope of further research that is still required. A scoping review was conducted following the framework of Arksey and O'Malley (2005). A broad range of keywords was used to systematically search the PubMed, MEDLINE, CINAHL, and Ichushi-Web databases for topics on nursing care for people with HF-DM. A total of 957 articles were retrieved, and 11 papers were ultimately accepted. Three of the 11 papers were randomized controlled trials (RCTs), which used integrated program interventions for people with HF-DM to some efficacy. For the remaining papers, a qualitative synthesis of the data identified six categories. Although a program integrating HF-DM presented a certain level of effectiveness, many of the nursing suggestions lacked specificity. Moreover, few RCTs have been conducted, which indicates the need for further research. This study also indicated the importance of collecting practical knowledge from advanced nurse practitioners and developing guidelines on nursing assistance for HF-DM.

Objective: This study is aimed to identify how patients with type 2 diabetes perceive hunger using a questionnaire based on the results of a previous study and characterize how they perceive hunger. Methods: First, we drafted a 46-item questionnaire based on previous studies. Next, we subjected the draft questionnaire to exploratory factor analysis and assessed its reliability based on item validity and internal consistency. Finally, we confirmed the possibility of classification through hierarchical cluster analysis and determined whether the classified types were related to HbA1c and body mass index, which are indicators of diabetes control. The inclusion criteria involved participants who were 20 years of age or older, outpatients at a hospital or clinic, and diagnosed with type 2 diabetes for at least 6 months. Results: The participants were 147 patients with type 2 diabetes, with a mean age of 59.5 ± 12.7 years. We developed a 25-item, six-factor questionnaire to assess hunger perception in patients with type 2 diabetes mellitus. Afterward, the construct was compared with previous studies. The cumulative contribution of the six factors was 53.7%, with a Cronbach's alpha coefficient of reliability of 0.875 for the full questionnaire. A hierarchical cluster analysis based on the factor scores of the questionnaire showed that there were two groups, namely, an "all factors high score group" and an "all factors low score group." Notably, HbA1c was significantly higher in the "all factors high score group." Conclusions: In this study, a questionnaire based on previous research allowed us to typify how patients with type 2 diabetes perceive hunger.

Objective: The aim of this study was to develop and validate a scale to measure the positive experiences of men during their partner's pregnancy. Methods: Scale items were developed in consultation with the literature. The content and surface validity were assessed by experts and the public. Exploratory factor analysis, convergence validity, and internal consistency of the scale were analyzed. Data were collected using the Quality Marriage Index, responsibility and happiness numerical rating scales, and Center for Epidemiologic Studies Depression Scale. Multiple regression analysis was performed to identify relevant variables. Results: A total of 267 expectant fathers were sampled. The final scale was composed of 28 items and 3 factors, namely, 1, increased awareness of becoming a father; 2, self-growth through becoming a father; and 3, comprising positive emotional responses to pregnancy events. Cronbach's alpha was.98 for the entire scale and ranged from.88 to.97 for the three factors. Regarding convergent validity, a significant moderate positive correlation with other scales was found. Significantly related variables included number of weeks pregnant, age of wife, positive emotional response at pregnancy announcement, and risk of depression. Conclusions: The 3 factors and 28-item Prenatal Positive Experience Scale for Men were confirmed to have sufficient reliability and validity. More advanced gestational weeks, a younger partner, positive emotional response at pregnancy announcement, and no risk of depression were associated with more positive emotional experiences. On the basis of these results, nursing interventions promoting positive emotions should be provided for men during pregnancy.

Objective: Obesity is highly prevalent among people with intellectual disabilities (ID) and autism. Programs to reduce obesity, however, are currently underexplored. Furthermore, people with severe ID and autism are highly dependent on their family members for a healthy lifestyle; therefore, behavioral changes within the family, especially in mothers, are necessary to reduce their obesity. This study aimed to develop a diet-centered obesity reduction program by mothers that can cater to people with severe ID and autism. Methods: The study used an AB design, with A as the baseline and B as the intervention. An intervention based on "behavior analysis" and the "obesity acceptance process of mothers" was conducted with nine mothers and adults (age range: 20-46 years) with severe ID and autism from different day centers. The primary outcomes were weight and waist circumference. The secondary outcomes were the occurrence of desirable maternal behavior, the scores of the children's inflexible adherence to target foods, and target food intake. The outcomes were analyzed at the individual and group levels. Results: Seven adults lost weight, with five losing ≥3%. During the follow-up, six adults continued losing weight. The rate for implementing behaviors related to at least one target food was approximately ≥80% for all mothers. The adults' resistance scores were generally low, and six people scored 0 points. The Friedman test revealed significant decreases in weight and waist circumference. Conclusions: The program effectively decreased the weight of people with severe ID and autism through changes in maternal behavior. The children's low resistance reinforced maternal behavioral changes.

Objective: The need for mental health nurses (MHNs) to incorporate psychological techniques into their nursing practice has been recognised worldwide. Further evidence from real-world settings is necessary to demonstrate that MNH-led cognitive behavioural therapy (CBT) is an effective approach that can be used in clinical practice. This study aimed to explore the clinical effectiveness and predictors of MNH-led CBT for mood and anxiety disorders in routine outpatient care settings in Japan. Methods: This retrospective study collected data through a medical record review of 69 participants who underwent MHN-led CBT between January 2015 and December 2019. Results: Participants who received MHN-led CBT demonstrated significant improvements in depressive/anxiety symptoms, health-related quality of life and primary psychiatrists' impressions of condition severity (all p <.001). At the end of therapy, more than half of the participants (56.5%) showed positive clinical significance (recovered/improved) based on cutoff points and reliable change indices of validated depression and anxiety measurement scores. Furthermore, an increase in the baseline anxiety score predicted lower odds of achieving positive clinical significance (odds ratio = 0.87, 95% confidence interval = 0.79-0.96). Conclusions: Despite several limitations, mainly owing to its single-group retrospective design, this real-world evidence of MHN-led CBT bridges the gap between research and clinical practice, contributing to the widespread use of MHN-led CBT in mental health services worldwide.

Objective: This study investigated and described the learning needs experienced by family caregivers in the Japanese working generation who care for community-dwelling people with dementia (PWD). Methods: This qualitative descriptive study conducted semi-structured in-depth interviews to explore the learning needs experienced by the family caregivers of PWD. 18 family caregivers were recruited via purposive sampling (age range 30-60 years) from two medical facilities, two self-help groups, and 10 prefectural-sponsored counseling facilities in Japan. The collected data were subjected to a qualitative content analysis. Then, the derived learning needs were independently reviewed by two nursing researchers with expertise in qualitative research and family nursing. The Standards for Reporting Qualitative Research (SRQR) recommendations were followed. Results: Four main categories and 20 subcategories were derived to clarify the learning needs of family caregivers in the Japanese working generation who care for community-dwelling PWD. The four main categories included (a) increasing long-term care literacy, (b) dispelling the negative images associated with dementia and long-term care, (c) working on long-term care as a unified team that handles issues concerning caregiving for dementia, and (d) promoting an active role as a member of society. Conclusions: This study clarified specific learning needs that family caregivers in the Japanese working generation experience when caring for community-dwelling PWD, thus, contributing to a more thorough understanding of the associated challenges. In addition, the structured list of learning needs should aid health professionals when conducting assessments and planning interventions, especially when framing these issues from the cultural perspective.

Objective: Hospital organizational changes are known to deteriorate nurses' organizational commitment, and the support of frontline nurse managers is crucial in preventing this deterioration. However, the effects of the practical support provided by frontline nurse managers at different subordinate career stages during organizational change are yet to be determined. Thus, in this study, we aim to clarify the associations between nurses' organizational commitment and the two types of frontline nurse manager support (i.e., preparation for organizational change and personal counseling) based on subordinate nurses' years of experience. Methods: This cross-sectional study was conducted among nurses using a self-report survey method. Hierarchical multiple regression analyses were conducted, with organizational commitment as the dependent variable. Results: Responses from 1,603 nurses at 63 hospitals were analyzed. As per our findings, both types of frontline nurse managers' practical support were found to positively and significantly affect nurses' organizational commitment. The association of these two types of frontline nurse manager support with organizational commitment based on years of nursing experience was deemed insignificant. However, the results of a subgroup analysis per career stage based on years of experience showed that organizational commitment for nurses with more than 20 years of experience was not associated with preparation for organizational change. Conclusions: Both types of practical support provided by frontline nurse managers during organizational change are important to retain nurses' organizational commitment. However, the effectiveness of each type of support may differ according to the nurses' career stage. For expert nurses, personal counseling was found to be more important than preparation.

Objective: To develop a medication-adherence assessment tool for nurses to acquire greater understanding of autonomous medication self-management by older adults. Methods: This study was based on an exploratory sequential study design using a qualitative inductive study and pretest results from which we created a draft medication-adherence assessment tool containing 74 items. Then, to verify reliability and validity, questionnaires were sent to nurses with three or more years of clinical experience in randomly selected acute care hospitals or in home-visit nursing stations. The research was conducted with the approval of the Shimane University Nursing Research Ethics Review Committee. Results: From a total of 747 responses and following an item analysis, 40 items were selected and exploratory factor analysis was performed. From this, we prepared a "medication-adherence assessment tool for older adults" consisting of 40 items and 6 factors. The six factors were the following: 1) active participation in their treatment, 2) stable medication compliance, 3) medication behavior and stable lifestyle, 4) health control ability with continuous medication, 5) inhibitors of medication self-management, and 6) capability of medication record management. This assessment tool was proven to show internal consistency based on Cronbach's α coefficient, criterion-related validity, and constructive concept validity. Conclusions: The "medication-adherence assessment tool for older adults" allows nurses to systematically assess the status of autonomous self-management of medication by older adults from a medication-adherence perspective.

Objective: Families of patients in the intensive care unit (ICU) often experience severe stress, and understanding their experience is important for maintaining family functioning. This study aimed to determine the characteristics and factors associated with family functioning in families of patients admitted to the ICU. Methods: This cross-sectional study recruited all family members (N = 144) of patients admitted to the ICU at two teaching and advanced treatment hospitals, 77 (53.5%) of whom completed a questionnaire. Family members provided the demographic and clinical characteristics of the patients and completed the Family Relation Index (FRI), the Impact of Event Scale-Revised, the Center for Epidemiologic Studies Depression Scale, the State-Trait Anxiety Inventory (STAI) Form X, the Connor-Davidson Resilience Scale (CD-RISC), and the Social Support Questionnaire. Results: Ten (13.0%) and 37 (48.1%) family members had the "hostile" and "sullen" family functioning type, respectively. Multiple regression analysis revealed the presence of a significant negative relationship between the FRI and the STAI-state (B = −0.057, β = −0.36; p =.001) that the participants had experienced a stressful event within the previous month (B = −1.201, β = −0.276, p =.009), and that the participants' CD-RISC scores were correlated with family functioning (B = 0.021, β = 0.176, p =.049). Moreover, this model explained 23.9% of the variance in total FRI scores with regard to family functioning. Conclusions: In total, 61% of the family members had poor family functioning and required support. Among the family members of patients in the ICU, anxiety was associated with poor family functioning, whereas resilience was associated with good family functioning.

Objective: At the start of the coronavirus disease 2019 (COVID-19) pandemic, the Centers for Disease Control and Prevention and the World Health Organization recommended the use of face masks in public places to prevent the spread of COVID-19. Several mask types flooded the market with little information regarding their effectiveness. This study aimed to clarify the change in the fine particle protection rate (FPPR) of face masks reused after washing in an experimental study and to propose a method for reusing face masks that is suitable for nonmedical personnel. Technical Report: The FPPR was measured using a mask-fitting tester after one participant wore the new masks and after 5, 10, 15, 20, 25, and 30 washes. The dimensions of the masks were measured to determine whether shrinkage occurred after washing. The surgical mask had the highest FPPR, followed by the cloth, gauze, polyester, and polyurethane masks. Furthermore, all five mask types maintained the same FPPRs as those of new masks, even after washing 30 times. An interesting observation was that the FPPR of the surgical mask was higher even after the 30th wash, and therefore, it was more effective than the FPPRs of the other four face masks when they were new. Conclusions: Surgical masks were the most effective, even though all five types could be reused after 30 washes. The FPPR of the surgical masks showed better performance after 30 washes than the FPPRs of the other four types when they were new. These findings may start the discussion for the possibility to reuse face masks.

In this study, we aim to examine the feasibility of two guidebooks in Japanese healthcare services, which aimed to support parenting and child well-being in families with parental mental health illness. We sought and explored professionals' perspectives on the translated versions of the Finnish guidebooks, one for parents with mental illness and the other for children. 55 professionals providing support to parents and/or their dependent children were included in this study. Participants were asked to read the guidebooks and completed a self-report questionnaire as regards the necessity/helpfulness and utilization of the guidebooks. Berelson's content analysis method was utilized to analyze the participants' free description responses. As per our findings, around 70%-85% of the participants see the guidebooks necessary and helpful for family members and professionals. These guidebooks were assessed to provide parents and children emotional support, helping them to understand each other, and guide parents in finding ways to address their children's issues. Similarly, the guidebooks were seen to help professionals understand these families, in terms of how to support them and explain parental illnesses to children. Approximately 90%-95% of the participants shared that they would use these guidebooks, but half of them said that they would use them only to a certain extent. Many had worries about how and with whom to utilize them. Guidebooks are recommended for use in clinical training. In conclusion, this study suggests that guidebooks are feasible in Japan as resources in clinical practice and for training professionals to support families. They are likely to promote awareness of families and children with parental mental illness among professionals and within families.