Purpose: To clarify why patients with Hansen's disease have repeated wounds and how they coped with these wounds until Promin treatment.
Method: Narrative data were obtained from 10 survivors of Hansen's disease and were analyzed using a qualitative and inductive method.
Results: The loss of pain sensation that serves as a caution against wounding and having to work owing to poverty were found to easily induce wounds; further, the poor medical system and hygiene, lack of infrastructure, and superstition contributed to deteriorating wounds, thereby creating a negative spiral for worsening wounds, leaving patients feeling that they had a collapsed and disfigured body. Patients thought that non-aggressive treatment could not cure perennial wounds and they tended to obtain primitive care strategies. Owing to poverty, they had to treat most wounds themselves, except for severe wounds. Further, patients opted for amputation easily because they had to work to sustain themselves and their family and they felt that the amputation would cure the disease. Patients who lost their eyesight did not undergo amputation because they were unable to work.
Discussion: The poor medical system and hygiene were among the several causes of overlapping severe disabilities among patients with Hansen's disease.

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The purpose of this study was to develop an Educational Needs Assessment Tool for Clinical Instructors, which had wellestablished reliability and validity. Forty-nine items for the total were created, based on 7 aspects. These aspects were identified through qualitative and inductive research findings that indicated clinical instructors’ desirable behavior as perceived by other clinical instructors. The 49 items were grouped into 7 subscales corresponding to the 7 aspects. Content validity of the assessment tool was established by a panel of experts and a pilot study. The instrument packets, including the assessment tool and a demographic questionnaire, were distributed to a total of 1,309 clinical instructors who worked at hospitals all over Japan.Seven hundred and fifty three（ 57.5%） clinical instructors responded, of which 726 valid responses were analyzed. Item analyses were conducted, and the original 49 items were reduced to 35 items. Cronbach’s alpha, a reliability coefficient of the assessment tool was .937. Test-retest reliability was .769（ p＜.001）. These results suggested that the assessment tool has high internal consistency and stability. The results of a factor analysis and a known-group method showed that the construct validity of the assessment tool was generally ascertained.

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Aims: The aim of this study was to clarify the relationship between self-stigma and self-esteem of hospitalized schizophrenics.
Method: Personal interviews were conducted with approximately 104 schizophrenics hospitalized in three psychiatric hospitals in Y Prefecture. Assessment was conducted using a Perceived Devaluation and Discrimination Scale (PDD), Self-esteem Scale (SE), and Center for Epidemiological Studies Depression Scale (CES-D).
Results: there were 97 effective respondents (effective response rate 93.3%); 51 males (52.6%) and 46 females (47.4%); 91 persons with working experience (93.8%); average age (SD) 52.9 (±13.5) years; average age of onset 27.5 (±11.5) years; average disease duration 25.0 (±14.7) years; and average hospitalization 6.1 (±7.2) years. The mean total score was 30.5 (±8.7) for PDD, 31.9 (±8.9) for SE, and 14.3 (±10.3) for CES-D. Path analysis was conducted to clarify the relationship between self-stigma, self-esteem, and depression.
Conclusions: The results suggest that self-stigma does not have a direct effect on self-esteem but has an indirect effect on it through depression.

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The purpose of this study was to consider the relationships between factors affecting the satisfaction of husbands present during delivery and the level of intimacy with wives.
The subjects were 174 fathers who were present during delivery and responded to a questionnaire (total response rate = 26.6%). The results indicated that satisfaction of husbands present was affected by the support they gave their wives, the wife's attitude towards them and their contact with newborns. The satisfaction of these husbands also related to intimacy levels with their wives. The implications for nurses show the importance of the nurse's guidance about giving wives necessary support and how best to inform wives about giving appreciation for their husband's support.

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To clarify the aspects of individual empowerment including cultural aspects of old-old people living in hilly and mountainous areas, we conducted a semi-structured interview on nine elderly persons aged 75 or over and a health nurse in District B, Town A. In this survey, we used ethnography to collect data for analysis.
The old-old people living in the hilly and mountainous area 'recognized their age-related changes and the changes in the community' in their daily life. They found 'ways for coping well with aging', and 'created their own roles in the community'. In other words, they made efforts to "continuously present themselves as members of the community". Aspects of 'What support the aging persons' and the 'effort to coordinate aging self with changing community' interacted with each other and promoted "their effort to continuously present themselves as members of the community". The results of the present survey suggested that nursing professionals play an important role in empowering old-old people and helping them continuously present themselves as indispensable members of the community.

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The purpose of this study is to create a nursing intervention protocol that supports the re-construction of the lives of stroke patients with physical disabilities. Study subjects have physical dysfunction including paralysis that was caused by primary stroke.
The protocol of nursing intervention was made from preliminary study was "experiences" of patients living with physical dysfunction caused by the event of stroke was explored through patients' narratives. Cooperation for participation in this study up to discharge from hospital was obtained for 7 cases, all of whom were males between the ages of 49-70 years old. Interviews during hospitalization were carried out according to the protocol, and consisted of 3-6 sessions per person for 5-111 minutes per interview. The contents which subjects narrate changed into a meaning of illness from negative feelings. However, as the number of interventions progressed, subjects discovered future prospects with each slight recovery. Moreover, narratives to a researcher could be interpreted as ordering of thoughts because of the presence of a listener. The protocol created by the preliminary investigation is useful because intervention objectives were achieved at each phase.

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This study was conducted with the purpose to clarify the emotional and mental growth process of Certified Nurse Specialists (CNS) in Japan in acknowledging their roles as CNS. Semi-constitutive interviews were conducted with eleven CNS who cooperated in this study. Contents of the interviews were analyzed qualitatively.
The emotional and mental growth process of the CNS's interviewed, were categorized into the following four time based stages: 1) conflict period, 2) refining period, 3) creation period, 4) development period. The subjects are loaded with their ambiguous acknowledgement of their roles during the initial stage. With support from their colleagues/superiors, they repeated the process to reflect on their own roles as CNS, and through this process they were gradually able to grasp their own understanding of their roles. Approximately 3 years were necessary for this stage. With 6 to 10 years of experience and continued efforts, they were able to firmly acknowledge their role as CNS.
Through this growth process, following implications in the nursing field was obtained; discussion on the appropriate state of graduate education for CNS, necessity of support for newly appointed CNS, necessity for construction of relationship between the entire organization and CNS.

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It has been pointed out that there is a generation gap concerning child-raising methods between mothers and their parents who help their daughters with child-raising. The present study, involving females whose daughters were in the perinatal period, was conducted to examine the relationship between their experience of raising children and attitudes toward raising their grandchildren. An anonymous self-completed questionnaire survey was conducted. Survey forms were distributed to 651 mothers of pregnant women, and 180 valid responses were collected. Data were analyzed using a single aggregation method and the chi-square test. The mean age of the subjects was 57.1 ± 5.5 years old. Significant relationships were noted concerning the following between their experience of raising children and attitudes toward raising their grandchildren: the use of pacifiers for babies, cold drinking water provided for babies after taking a bath in a baby bathtub, baby food chewed by adults and broken into pieces in advance, timing of starting to provide fruit juice and termination of breast-feeding, the theory that babies should be raised by their mothers before they reach three, and awareness of the division of the roles played by males and females. There was no significant correlation between their attitudes toward the use of baby formula when babies did not stop crying and their experience of raising children. However, there was a significant relationship between the use of baby formula and whether or not the baby was their first grandchild, which suggests that the birth of grandchildren causes changes in the attitudes of their grandparents toward the use of powdered milk.

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