Purpose
The purpose of this study was to show how the concept of culturally congruent care can be used to guide provision of transcultural nursing care for people from other cultures in Japan.
Method
Thirty-one articles were analyzed using Rodgers's (2000) concept analysis model. Relevant literature was identified from four databases: CINAHL (1982-2006), MEDLINE (1966-2006), PsycINFO (1806-2006), Ichushi-Web (1983-2006) using the keywords "culturally congruent care" and "culture congruent care". Of the 61 articles deemed relevant, it was possible to obtain only 22. An additional 9 articles were located by manual search. Accordingly, 31 articles were used in the analysis.
Findings
The findings are presented in terms of the Rodgers's model. Five attributes of the concept culturally congruent care were identified: 1) people are the center of care, 2) inclusion of various perspectives on culture, 3) capacity to understand differences, 4) dealing with people flexibly, and 5) harmonizing with changing society. Four antecedents were identified: 1) social factor: multi-cultural and multi-ethnic society; 2) receiver's factor: frustration at lack of reciprocal communication; 3) receiver's and healthcare provider's factor: conflict with sense of values; 4) healthcare provider's factor: lack of focus on humans as humans with their own cultures. Four consequences were identified: 1) greater care satisfaction, 2) improved quality of care, 3) enhanced skills as a professional, and 4) decreased stress and problems. Lastly, one related concept, culturally competent care, was found. Based on these findings, the concept of culturally congruent care, originally identified by Leininger, was defined as "care that harmonizes with a changing society, deals with people's backgrounds flexibly by focusing on people as the center of care, and occurs in a context where care receivers and healthcare providers understand their differences."
Conclusion
Culturally congruent care takes different forms in accordance with how people's cultural background is recognized by healthcare providers. It is noted that the content of culturally congruent care is altered depending on how a culture is understood. The proposed model provides a guide for culturally congruent care in Japan where the number of people from other cultures is increasing. Thus, the model can contribute to the development of nursing education, practice and research in Japan. The concept of culturally congruent care needs to be discussed in order to provide a basis of developing such care in Japan.

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Purpose
To clarify the relationship between postpartum mother's psychological state by Profile of Mood States (POMS) and stress indicators in saliva (SIgA and cortisol concentrations).
Objects and methods
This subjects were 22 mothers in whom we measured the psychometrical status by POMS and the saliva concentrations of SIgA and cortisol as stress indicator within 2 weeks of delivery.
Result
The saliva concentration of cortisol was positively correlated with T-A (Tense-Anxiety) of POMS, and was also associated with some other POMS scores indicating negative feelings. It was not correlated with the V (Vitality) score, which indicates positive feelings. The saliva concentration of SIgA was not correlated with the POMS scores nor with the concentration of cortisol.
Conclusion
The POMS score for negative feelings was correlated with the saliva concentration.
As the saliva SIgA concentration was not correlated with either the cortisol concentration or POMS scores, SIgA and cortisol may be stress indicators of different stressful situations.

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Purpose
The purpose of this study was to clarify the nature of mother's distress and its related factors resulting from the crying of her one-month-old infant.
Subjects and Methods
The subjects were mothers who delivered children in hospitals/maternity clinics in the Hokuriku district and who gave consent to our survey at the time of health examinations for one-month-old infants. The contents of the questionnaire were: characteristics of the infant's crying, states of mother's sleep, feeding and receiving support related to her distress about her infant and its associated factors. Scores were obtained using a 4-point Likert scale.
Results
Effective responses were obtained from 630 mothers, who consisted of 298 primiparas (47.3%) and 332 multiparas (52.7%). About 50% of the mothers experienced distress because they felt at a loss when their infant cried and when the infant did not stop crying even when being held or lulled. New mothers who had no experience with infants were more likely to indicate distress. The distress was significantly associated with factors such as the way the infant cried and if the infant failed to fall asleep in a timely way. It also was associated with factors in the mother's life such as feeling burdened with childcare and lack of confidence in childcare.
Conclusion
In order to support mothers having a one-month-old infant, it is important to pay attention to the characteristics of infant's crying, states of mother's fatigue, mother's expression of depression, and to know how mother comprehends childcare and her infant's crying. For screening to be effective it must include both infant and mother factors.

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Purpose
This study investigated the experiences of Japanese women who underwent emergency cesarean sections (c-sections), including their experiences during labor before to the decision for surgery, during surgery, and during the first postnatal week.
Methods
Eleven Japanese women who delivered live babies by emergency c-section at a private maternity hospital were interviewed in a semi-structured manner on the second and seventh postpartum days. Interviews were tape-recorded, and transcripts and participant observation in the postnatal ward assisted the interpretation. Data were analyzed qualitatively and inductively.
Results
Eleven women (seven primiparas, four multiparas) participated in the study. The main reasons for surgery were fetal distress (n=9) and arrest of labor (n=2). The time between making the decision to perform surgery and birth ranged from 15 to 69 minutes. Six themes were evident from the women's experiences: shock of disappointed expectations, unavoidable fear and responsibility, release from pressure, re-experience of fear and pain, being "saved" by the baby, and getting out of a vicious cycle. Trying labor pain, shock, fear of their babies' or their own deaths, and feeling powerless and guilty contributed to the women's negative feelings about their birth experiences by emergency c-section. After surgery, however, women felt loving toward their babies, who had been born safely as a result of the surgery, and eagerly breast-fed or took care of the infants with midwifery/nursing support.
Conclusions
The findings suggest that prenatal childbirth classes need to include information on and discussion of possible emergency c-section and that emotional support from midwives and nursing staff in the operating room/postpartum unit helps to decrease a woman's negative feelings about birth experiences by emergency c-section and enhance her experiences as a mother. In addition, medical staff should be more aware of the birth trauma felt by the expectant mother surrounding emergency c-section.

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Purpose
The objective of this study was to measure the pressure on the fingers and palms of persons who assisted normal supine labor by protection of the perineum from expulsion of the fetal head to trunk, aiming at development of a midwifery technique that minimizes stress on the perineum. Experienced and novice midwives were compared, and skilled protection of the perineum was explained from the viewpoint of the pressure applied.
Subjects and Methods
Subjects who met the study conditions were primiparae and multiparae with an expected date of delivery between November 2005 and late October 2006. Seventeen primiparae, 17 multiparae, 4 skilled and 11 novice midwives gave consent to and participated in the study. For measurements, a compact pressure transducer (PSM-1KAB, Kyowa Electric Instruments) and sensor interface board (PCD-300A, Kyowa Electric Instruments) were used. The midwives assisted the labor with their hands attached to ultra compact pressure transducers at 4 and 6 sites on their right and left hands, respectively, as identified in a preliminary study. Data were collected from the appearance of the fetus to expulsion of the fetal trunk. Basic parameters of the pressure load on each palmar site measured on each palm were calculated and compared statistically.
Results
The experienced and novice midwives used the following regions differently: The right index finger pad (2), middle of the right index finger (3), medial side of the middle finger between the left first and second joints (6), and tip of the left little finger (9). [From 30 seconds before expulsion of the fetal head to its expulsion] The novice midwives loaded pressure on the right index finger pad (2) when protecting the perineum, and the maximum value (33 kPa) was twice that of the experienced midwives. The experienced midwives loaded pressure on the middle of the right index finger (3) to protect the perineum, and the maximum value (29 kPa) was 4 times higher than that of the novice midwives. The experienced midwives also loaded pressure on the left index finger (6), and the maximum value (18.8 kPa) was 3 times higher than that of the novice midwives. [From crowning to expulsion of the fetal head] The experienced midwives constantly loaded about 5 kPa on the tip of the little finger (9) to protect the perineum, but the novice midwives did not load any pressure on this site.
Conclusion
Pressure applied for protection of the perineum by midwives cannot be expressed and explained by words, but it could be measured mechanically for a further explanation. It was demonstrated that techniques of the experienced midwives could be presented as values by comparison with novice midwives.

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