End-of-life care should be considered a part of the nursing profession, specifically in intensive care units [ICUs]. Although various definitions of end-of-life care have been proposed by nursing academies and associations, a clear definition of end-of-life care in ICUs is yet to be determined. Thus, in this concept analysis, we aim to define end-of-life care in the ICU. In this study, we utilized Walker and Avant's concept analysis method, which is designed to identify the structure and definition of a concept like end-of-life care in ICU. In this concept analysis, two antecedents, four attributes, and three consequences of end-of-life care in ICU were extracted, and its definition was thereafter clarified. These results are highly useful and can support critical care nurses, as they are the ones who provide optimal care for dying patients and their families in the ICU; they also form a basis for further research with regard to end-of-life care in the field of critical care nursing. The prominent features of end-of-life care in ICU are as follows: a high dependency on medical equipment, short-term care, and focus on care for families as most patients are unconscious. These features reflect the definition of end-of-life care in ICU. End-of-life care in ICU were defined as intensive and short-term care for patients who are facing imminent death and their families, to help them live out their lives with dignity.

Comprehensive homecare assessment has been determined to be essential in the context of care management for community-dwelling older adults. However, the effectiveness of assessment tools for adherence and health outcomes is yet to be fully elucidated. Thus, in this systematic review, we aim to evaluate the effects of comprehensive homecare assessment tools on adherence and other health outcomes among community-dwelling older adults. Database searches were performed using CINAHL Plus with full text, PubMed, EMBASE, CENTRAL, and Ichushi. Randomized controlled trials search were conducted until September 2020. Studies comparing interventions using comprehensive homecare assessment tools were assessed using the Cochrane's risk of bias 2 for quality; in randomized trials, a meta-analysis was performed. Nine articles, including eight studies, were included in this review. All interventions involved comprehensive homecare assessment tools such as CGA, SEISAR, RAI-HC, TARGET combined with interRAI-HC, MDS-HC, and the Omaha system. As per the results of the meta-analysis, no difference was observed with regard to adherence (p =.11), hospital admission (p =.29), nursing home admission (p =.70), and mortality (p =.96) compared with the non-use of the assessment tools. The mental quality of life showed a significant effect in the comprehensive assessment group (standardized mean difference = 0.26; 95% confidence interval = 0.06 to 0.46; p =.01); however, certainty of the evidence (GRADE) was assessed to be moderate. Comprehensive homecare assessment tools may be particularly useful for enhancing the psychological quality of life beyond a comprehensive assessment. This review presents insufficient evidence to support adherence to homecare and the enhancement of other health outcomes for community-dwelling older adults.

Objective: This study aimed to examine the effectiveness of facial massage, as a nursing technique, in alleviating stress in healthy women using physiological and psychological indicators. Methods: A crossover design was employed; participants were 22 healthy females between the ages of 20 and 22. Participants were assigned to Sequence 1, wherein they received a 3-minute facial massage in Period I and 3-minute rest in Period II, or Sequence 2, which employed the reverse order. Participants' blood pressure (BP), pulse rate, salivary alpha-amylase (sAA), Profile of Mood States (POMS), "Relaxation level," "Comfort level," and "Wakefulness level," as measured by the Visual Analog Scale (VAS), were assessed before and after the facial massage or resting intervention. Results: Between the two groups, changes in systolic BP increased in the facial massage group, but there was no difference in pulse and sAA. While there was no difference between the two groups in the POMS, VAS scores revealed an increase in the "Relaxation level" and "Comfort level" in the facial massage group. Facial massage participants reported feeling "refreshed," whereas the control group reported feeling "sleepy." Conclusions: The 3-minute facial massage increased relaxation with respect to psychological measures; however, BP change could not explain stress reduction. (This study was enrolled in the UMIN as an intervention study and as a prospective randomized crossover trial. The trial registration number is UMIN000033939.)

Objective: We developed a suctioning catheter control sensing device given the increasing demand for skilled home-based healthcare techniques, such as tracheal suctioning. This study evaluated the proficiency of the entire tracheal suctioning process between expert and novice groups via the suctioning catheter control sensing device and a motion capture system. Our hypothesis is that motion capture can measure the proficiency of tracheal suctioning despite the biological reactions of the simulator and the characteristics of participants. Methods: Nine expert nurses, each with more than three years of clinical experience in tracheal suctioning, and 13 nursing students from an urban university nursing department participated. The performance time, pelvic forward bending angle, travel distance, posing time, posing frequency of bilateral dorsum manus, and suctioning catheter control between the two groups with/without simulated biological reactions were analyzed. Results: The two-way analysis of variance demonstrated that the biological reactions (or lack thereof) and the proficiency level did not interact. The main effect of performance time, posing time, and posing frequency was statistically significant; experts performed tracheal suctioning more expeditiously and skillfully. The sensing device could detect hesitance or rough catheter control. Conclusions: Our results indicated that performance time, posing time, and posing frequency could serve as proficiency criteria with/out biological reactions. Additional studies are required to establish a quantitative education evaluation method to determine clinically reliable proficiency levels of tracheal suctioning.

Objective: Footbaths are employed in nursing practice in East Asian countries. Assessing the effects of footbaths based on the findings of multiple physiological responses is relevant to ensuring evidence-based nursing practice. This study aimed to investigate the effects of thermal stimulation by a footbath on prefrontal cortex activity and autonomic nervous function. Methods: This study was a randomized controlled crossover trial conducted on healthy participants from a college student population. Each participant underwent a footbath in warm water and a control condition for 10 min on two different days. The order of the two treatments was randomized. The oxygenated hemoglobin concentration in the prefrontal cortex, laterality scores of the oxygenated hemoglobin concentration changes, and autonomic responses were evaluated. Results: A total of 17 healthy participants were recruited. A footbath in warm water significantly reduced both the prefrontal cortex and sympathetic nerve activities 7 min after the start of the footbath compared with the control condition. Moreover, a footbath in warm water tended to activate the left prefrontal cortex rather than the right prefrontal cortex. Conclusions: The changes in the prefrontal cortex activity and autonomic nervous function were associated with the relaxing effect of the thermal stimulation by the footbath. Furthermore, this effect was highest at 7 min after the start of the footbath. This study has the potential to contribute to the evidence-based use of footbaths. Trial Registration: UMIN-CTR Clinical Trial: UMIN000033735

Objective: Hospital-based specialist nurses (clinical nurse specialists and certified nurses) are increasingly conducting patient home visits along with homecare nurses due to the increasing necessity of home care for persons with multiple medical needs. However, not much is known about such visits. Thus, this study examines collaborative visits by specialist nurses. Methods: A web-based questionnaire survey was sent to specialist nurses in Japan specializing in (1) wound care, (2) cancer palliative care, and (3) chronic disease care. Multiple logistic regression analyses were performed to identify the factors involved in collaborative visits, focusing not only on the individual but also on hospital/community characteristics. Results: Data from 1,027 specialist nurses were analyzed. Among them, 45.6%, 21.4%, and 18.3% of wound care, cancer palliative care, and chronic disease nurses, respectively, conducted collaborative visits. For nurses specializing in wound and cancer palliative care, holding managerial positions was associated with providing collaborative visits. Wound care nurses from hospitals in municipalities with fewer hospital beds per capita tended to conduct collaborative visits, whereas cancer palliative nurses in communities with a higher aging rate provided more collaborative visits. For chronic disease nurses, more working hours as specialists, lower participation rates in community-based multidisciplinary gatherings, and working in hospitals with open community consultation services promoted collaborative visits. Conclusions: Hospital and community factors are associated with collaborative visits, suggesting a need for hospital-wide and policy-supported efforts to further increase collaborative visits.

Objective: This study aimed to investigate the contents of communication between breast cancer survivors and their adolescent children and to develop a reliable and valid communication scale on maternal breast cancer. Methods: The items were extracted from expert and cognitive interviews. The pilot test comprised self-report questionnaires distributed among 97 adolescents aged 12-18 years whose mothers were diagnosed with breast cancer; a retest was conducted on 34 adolescents. Validity was confirmed by testing factorial, known-groups, convergent, and discriminant validity. Reliability was confirmed by measuring internal consistency and test-retest reliability. Results: The mean age of the participants was 14.8 ± 2.0 years, and 51 (52.6%) of them were female. The average age of being informed about maternal breast cancer was 12.5 ± 2.7 years. Confirmatory factor analysis supported 14 items and a 3-factor model, which included expression of negative feelings (first factor), sharing information about breast cancer (second factor), and relationship with the mother (third factor): χ²/df = 1.21, goodness-of-fit index = .892, comparative fit index = .973, root mean square error of approximation = .047, and Akaike information criterion = 154.074. For convergent validity, the family adaptability, partnership, growth, affection, and resolve scale confirmed weak correlations for the total, second factor, and third factor scores. Cronbach's α for the total, first, second, and third factors were.863, .764, .882, and.810, respectively. Conclusions: The reliability and validity of the communication scale were confirmed. The scale can help nurses understand and evaluate mother-adolescent communication and devise interventions for facilitating informative, effective, and open discussions regarding maternal breast cancer.

Objective: The purpose of this study is to investigate the mental health status of public health nurses (PHNs) in public health centers (PHCs) and to clarify its related factors during the coronavirus disease 2019 (COVID-19) pandemic in Japan. Methods: Participants were 1,320 full-time PHNs in PHCs, and self-administered structured questionnaire regarding individual factors, work environment factors, and mental health status measured using the 12-item General Health Questionnaire (GHQ-12) was surveyed. The survey period was from June 10 to July 15, 2021. We asked the respondents for a response regarding the situation during the fourth wave of COVID-19 infectious spread. For analysis, participants were divided into two groups according to a cut-off point of the GHQ-12 score, and the χ² test was conducted. Afterward, stepwise logistic regression analysis was conducted. Results: The data of 640 participants were analyzed (valid response rate: 48.5%). Of the 640 participants, 64.2% worked in the infectious diseases section. Among the participants, 63.6% reported working overtime every day, and 38.3% reported working every weekend. Regarding the mental health status, the mean GHQ-12 score was 6.3±3.4, and 75.5% of the participants had a higher level of psychological distress. As shown in the result of the logistic regression analysis, the items "belonging to the infectious disease section" (OR = 1.73), "frequency of working overtime" (OR = 2.23), "frequency of working on the weekends" (OR = 2.11) and "workplace social support" (OR = 0.31) affected the PHNs' mental health. Conclusions: This study revealed that the mental health status of PHNs was at a critical level during the COVID-19 pandemic, and the needs for immediate mental health support for PHNs was suggested.

Objective: The reason behind the constant denial to accept any kind of behavioral changes among non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) patients even after counseling and why behaviors that lead to disease progression are maintained is unclear. This study aimed to describe the daily living behaviors of NAFLD/NASH patients and elucidate the reasons behind their inability to change their routines, which are problematic as they lead to disease progression. Methods: A qualitative study was conducted using an ethnographic design. The data collection methods included participatory observation, field note-taking, and semistructured interviewing of eight NAFLD patients in their daily lives at their homes and workplaces. SpradleyJINRJJ-15s Developmental Research Sequence method was employed to analyze the data. This paper conforms to the standards for reporting qualitative research. Results: Four themes were generated: (1) health beliefs built in the family, (2) difficulty in systematizing health knowledge, (3) dependence on food, and (4) social disadvantages. Conclusions: NAFLD patients had negative influences from the family environment from childhood, lacked integrated knowledge about the risk factors, and developed food addiction. Furthermore, social disadvantages, such as a stressful environment, an environment where there was less chance to have significant others to support their treatment, financial difficulties, and lower educational background, influenced all factors.

To improve health literacy (HL) regarding cervical cancer prevention, a health program for females in their 20s was previously developed. The present study aimed to examine the effectiveness of that program. We conducted a quasi-experimental study (with control groups) on female undergraduate students in a private university in Japan. In total, 15 and 60 students were categorized into the experimental and control groups, respectively. Intergroup pair-matching using the identified variables yielded a final assessment population of 28 students (n = 14 in each group). The data analysis consisted of group comparisons of the participants between baseline and final assessment using the Wilcoxon signed-rank sum test and McNemar's test. Experimental group comparisons revealed a significant difference in median HL scale scores (baseline, 57.0; final assessment, 66.0; p =.002), median women's health knowledge test scores (baseline, 14.5; final assessment, 16.0; p =.029), and the percentage of participants who felt confident explaining their own body to a medical practitioner (baseline, Y = 14.3, N = 0.0; final assessment, Y = 100.0, N = 0.0; p<.001); however, no significant difference was found for cervical cancer screening behavior. No changes were seen in any of the variables between baseline and final assessment in the control group. These results indicated that our program was effective for improving HL, confidence in explaining one's own body to a medical practitioner, and women's health knowledge test scores, but not for changing cervical cancer screening behaviors. Further research is needed to determine how to provide more appropriate health programs for females in their 20s.

Trial Registration: University Hospital Medical Information Network Clinical Trial Registry (Trial No.UMIN000032444).

Parenting support and abuse prevention are pressing agendas in Japan. In the 1980s, open dialogue (OD) has emerged as a treatment option for mental illnesses in Finland. We held six training sessions using the OD approach at a child guidance center from 2017 to 2019. Each session consisted of a lecture and role-plays, and participants' reflections were gathered through a feedback sheet after each session. Moreover, we interviewed one staff member after the training. Our OD training with the child protection staff is reported, and the possibilities and challenges are discussed. The participants were 104 staff members of the child guidance center, and in total, 73 feedback sheets informed us regarding the achievements and concerns of our training session. The categories of awareness, new experiences, and trust to therapists emerged as achievements, whereas categories of questions, difficulties, uncertainty, and the need for further learning emerged as concerns. From a 102-min interview with one child guidance staff, we acquired his interest in dialogue, impressions, and feedback on our training. He informed us of the difficulties in dialogue between the families and facilities with authority, necessity of early contact, possibilities of OD in child protection, and suggestions for OD training. Our training was part of an exposure program. However, the participants deepened their understanding of the dialogic approach. As per our findings, we realized that OD and its training were suitable for the field of parenting support. The conditions of organizational training, such as costs, timing, location, and resource availability, should thus be improved.