Objective: To understand the factors that allow older adults to promote self-care is important. The purpose of this study was to reveal important risks related to the self-care support needs of older adults with diabetes through multiple regression, and to describe recommendations to enhance their independent mobility and self-care through the assessment of support needs, with respect to self-care concerns and anxiety about vulnerability. Methods: We conducted exploratory factor analysis (EFA) with primary vulnerability-related covariates. The correlation between several clinical features and the risk of insufficient self-care was examined. Multivariate linear regression estimated the independent variables for understanding vulnerability. Results: A total of 632 older Japanese adults with diabetes excluding two incomplete responses were analyzed. The EFA established a valid five-factor solution with 18 items ([hope for group education], [barrier to meal preparation], [vulnerable life], [hope for personal education], and [emergency preparedness and response]). Predictors for the five-factor solution reflected individual-level factors and were female sex (β =.023, p =.022), living alone (β =.064, p =.000), absence of a contact person once a week (β =.042, p =.043), level of care need (β =.038, p =.008), and available emergency medical care (β = −.023, p =.001). Conclusions: Social support networks were significantly related to vulnerability and disease control in older adults with diabetes. Realizing the high diabetes risk associated with vulnerability is important for outpatient intervention.

Objective: This cross-sectional study aimed to investigate rehabilitation practices in intensive care units (ICUs) for patients with acute respiratory failure and other diagnoses and examine the association with specialist staffing and team activities, adjusting for patient characteristics and organizational structures. Methods: Nurse managers in ICUs across Japan participated in a questionnaire survey on rehabilitation practices for individual patients and organizational variables. The highest degree of rehabilitation practice (using the ICU mobility score >1) on the survey day was measured for each patient. Results: A total of 92 nurse managers completed the questionnaire, and data from 405 inpatients were analyzed. Approximately 40% of the patients did not receive rehabilitation on the survey day, and 50% of the patients admitted to the ICU for more than 2 days (n = 295) did not receive early rehabilitation within 2 days of ICU admission. Mixed-effects multivariate analysis showed that a higher degree of rehabilitation on the survey day was associated with the adoption of mandatory critical care consultation for patients admitted to the ICU by dedicated physicians (adjusted odds ratio: 1.88, 95% confidence interval: 1.06-3.30). The outcomes were not associated with the presence of dedicated physical therapists in the ICU, the number of nurses specialized in critical care per 10 ICU beds, or the measured team activities. Conclusions: Our results indicate that ICU rehabilitation practices may be insufficient in Japan. A higher degree of ICU rehabilitation on the survey day was associated with the participation of ICU physicians in the treatment of ICU patients.

Objective: This study clarified the difficulties of clinical reasoning (CR) and the support that promoted its improvement, as recognized by competent-level nurses (CLNs). Methods: Using a qualitative descriptive research design, this study recruited eight CLNs working at three general hospitals through convenience sampling. The participants were asked to recall "unexpected clinical situations they faced while interacting with patients in clinical practice or situations where they found it difficult to make a decision." In addition, participants were asked through semi-structured interviews to respond based on the specific circumstances of the cases they recalled. Results: Four categories of CR difficulty as recognized by CLNs were generated, and three categories of support that encouraged them to improve their CR were identified. Conclusions: Owing to the gap between ideals and reality, CR difficulty can cause CLNs to experience helplessness and low self-esteem, leading to an inability to provide high-quality care. CLNs often rely on the CR of their seniors. CR becomes particularly challenging when CLNs are inexperienced, when unexpected events occur, or when CLNs are busy. Support measures for improving CR included tracking and verbalizing thought processes and providing supplementary support for learning content. This study clarifies the specific support that CLNs need to improve their CR through experience.

Objective: This study aimed to clarify the current situation regarding the implementation of ultrasonography in home-visit nursing stations in Japan and to examine the issues involved in its implementation. Methods: A self-administered, anonymous questionnaire survey was conducted via mail to 1,034 home-visit nursing station managers in Japan. Results: In total, 266 managers responded (25.7%). Among them, 7 (2.6%) were using ultrasonography. Of the 259 respondents (97.4%) who were not using ultrasonography, 37 were considering implementation. Ultrasonography is desired in situations such as measuring residual urine, constipation, and ascites. The main barriers to implementing ultrasonography were the high cost of purchasing the equipment, difficulty in interpreting images, difficulty in capturing the images, and the lack of medical reimbursement for the examination. The intention to implement ultrasonography was significantly related to the experience of using ultrasonography before working in home-visit nursing, the experience of learning or training in ultrasonography, and the affiliated facilities. Conclusions: The challenges of implementing ultrasonography at home-visit nursing include the high implementation cost and the need to acquire the necessary skills. Hence, institutional support is needed to reduce the financial burden and to enhance educational programs that reflect the need for ultrasonography use.

Objective: Nursing care delivery models have diversified and evolved over time; however, there is no single superior model. This study aimed to clarify the constitution and meanings of paired nursing, a method uniquely developed in Japan, by analyzing nursing practice for patients with communication difficulties in neurology and neurosurgery wards. Methods: A qualitative research design using phenomenological research was employed. Data collection was conducted through participant observation and field note-taking in situations such as meeting and bedside care with two pairs as participants. This study adheres to the Standards for Reporting Qualitative Research. Results: Two themes were derived as components of nursing practice for each pair: 1) the care direction revealed by information sharing and 2) the interaction between patients and nurse pairs through physical care for patients. Within the theme of care direction revealed by information sharing, two subthemes emerged: sharing of future care plans and the manifestation of "difficulties." Within the theme of the interaction between patients and nurse pairs through physical care for patients, two additional subthemes were identified: sharing of past and future possibilities and paired nurses prompting each other's actions toward the patient. Conclusions: Based on situational observations and analysis, care provided by two nurses to the same patient facilitates information exchange and mutual empathy toward the patient and the partner nurse. This study improves the understanding of collaborative nursing practices and offers insights that may inform team-based care models in contexts beyond Japan.

This paper proposes a model for the effective utilization and deployment of registered nurses with an extended scope of practice (RNs-ESP), focusing on strategies to facilitate their integration into hospital settings in Japan. A two-phase approach was employed: first, a literature review was conducted to identify evidence-based approaches for integrating RNs-ESP in hospitals; second, the model was refined using interview data from managers to understand their perceptions of the roles of RNs-ESP and implementation strategies. The resulting model consists of two sub-models: a classification system that categorizes nurse activities into three distinct types based on their nature and an organizational deployment process model that identifies barriers to integrating RNs-ESP. The management-oriented model provides a structured framework and addresses the key considerations for the utilization and deployment of advanced practice nurses in Japan; this model has significant implications for the nursing profession and patient care, and it serves as a valuable tool for healthcare organizations to effectively integrate RNs-ESP. Furthermore, this model could assist managers in successfully introducing and evaluating RNs-ESP, addressing the current lack of awareness regarding this process.

Clinical nurse instructors (CNIs) play a crucial role in integrating theory with clinical practice in nursing education; however, the impact of CNIs' instructional time on the quality of clinical practicums remains unclear. This cross-sectional study aimed to examine the association between nursing students' perceptions of clinical practicum quality and the number of CNI instruction days in Japan. Participants included 60 third-year nursing students and 4 CNIs from two hospital wards. Following the completion of the practicum, students completed the "Student Evaluation Scale for the Teaching-Learning Process in Nursing Practicum (SESTLP-NP)," whereas CNIs reported their instruction days during the practicum. Logistic regression analysis revealed significant associations between CNI instruction days and total SESTLP-NP scores (odds ratio [OR]: 29.39; 95% confidence interval [CI]: 2.46-351.01). Key SESTLP-NP subscales associated with CNI instruction days included "CNI-Student Interaction (OR: 4.03; 95% CI: 1.59-10.18)," "use of clinical practicum records (OR: 2.58; 95% CI: 1.23-6.47)," and "Student-human resources relationship (OR: 3.07; 95% CI: 1.29-7.31)." The findings suggest that the more days a CNI provided instruction, the more likely students were to be satisfied with their practicum experience. Nursing managers should consider adjusting shift schedules to maximize CNI availability and instructional time during the practicum.