The purpose of this study was to investigate the relationship between self-regulated learning and self-efficacy in the clinical nursing practice of nursing students at university and the changes in self-regulated learning depending on the students' year. The Self-Regulated Learning Scale in Clinical Nursing Practice (SRLS-CNP) and the Generalized Self-Efficacy Scale were administered to 776 nursing students at university. The analysis of data from 376 responses indicated that the first learning strategies factor comprising the SRLS-CNP, "Integrated Knowledge and Clinical Nursing Skills", is the principal factor to enhance self-efficacy and hard to visualize motivation. Moreover, the result that 4th year students' total scores on the SRLS-CNP were significantly higher (p<.001) compared to 2nd and 3rd year students indicates that self-regulated learning in the clinical nursing practice is acquired through the experience of clinical nursing practice.

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A semi-structured interview was conducted with 10 fourth year students of nursing colleges in the Greater Tokyo area clinical training. Using M-GTA, based on the results of analysis on the theme "formation of ‘personal characteristics’," 27 concepts and 8 categories were extracted. The results indicate a process by which the student goes from a state of "self in a hurry" to a state of regained composure within the confines of the relationship between "fellow students" and "other assisting persons," then delves deeply into questions on nursing implications through the mutual interaction of "achieving balance" and "know what patients want" by "orienting towards the same goal as the patient", and gains self-perception about "becoming a nurse anew" by "contemplating about true meaning" and rethinking about nursing implications as a student. Personal characteristics are motivated by "accurate self-evaluation" and "self-recognition of feelings" and constitute the abilities of "maintaining beliefs" and "self-control". In acquiring the outermost peripheral knowledge and skills, the results suggest that proceeding to develop "self-study/learning ability" is likely as the "introspection ability" increases.

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This study was conducted to define the experiences long-stay Japanese living in the Philippines underwent when consulting physicians. We conducted semi-structured interviews with 20 Japanese who had lived in Cebu, Philippines, and had experienced utilizing healthcare services. Qualitative content analysis method was used. Participants were 65.7 years old on average and 12 had lived daily life without trouble communicating in English. A total of 404 comments were obtained. Numerous examples of medical examination were expressed including "Health consciousness and actions to reduce visits of local medical facilities" (22.5%). At the hospital visit, the participants had "Diverse experiences of receiving medical examination depending on the quality of medical staff" (32.9%). Some stated distrust of healthcare providers, but some praised healthcare services. They expressed "Difficulties in receiving desired services" (20.0%) and "Difficulties in communication" (12.6%). The experience of visiting hospital had brought "Awareness of need to form a new patient-doctor relationship" (6.4%). The participants also articulated "Needs of an appropriate medical treatment based on current situations" (5.4%). Nurses should provide Japanese living there with information regarding difficulties in receiving desired services and advice on improving their self-management for the health promotion, as well as fostering desirable patient-doctor relationships.

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The aim of this study was to examine a mothers' way of thinking for understanding her child participating in rehabilitation class from the standpoint of circular interaction. We also suggest the role of nurses in this way of thinking. Data were collected through fieldwork involving participative observation and discussion between mothers and the first author. The mothers' way of thinking and changes were described. The mothers experienced conflict for several viewpoints, but became flexible on changing their views to understand their children based on the mother-child relationship. The perspectives were "relationship with child: parents, classmates and classmates' mothers," "primary mother-child stance and hopes", and "the process of changing one's point of view to understand the child". Moreover, nurses need to rethink their understanding of the learning process through discussions with mothers.

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Purpose: To integrate the results of qualitative research on the experiences of how mothers feed their babies.
Methods: The information in forty qualitative research papers published in Japan from 2000 - 2015 was extracted to create a meta-summary.
Results: The findings were summarized as thirty statements, with the following nine topics of experience identified: demonstrating the autonomy needed to make the choice as to method of feeding their infant; independently choosing the method of feeding; making efforts to breastfeed; projecting the mother-child relationship onto the act of breastfeeding; projecting oneself as a mother onto giving breast milk; coping with weaning at different rates; being negative about feeding; feeling happy with the support provided; and feeling disappointed with the support provided. The highest-frequency effects (effect sizes 20-38%) included experience of physical and mental pain associated with breastfeeding and pumping; questioning of one' s self-worth as a mother; and demonstrating maternal autonomy and determination.
Conclusions: Further studies need to be conducted on addressing problem situations surrounding breastfeeding mothers, such as physical and mental suffering caused by breastfeeding and their self-worth being shaken, and on creating appropriate support that respects mothers' autonomy and wishes.

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The present study examines healthy adult women who engaged in equipment-aided expiratory muscle training to determine whether this exercise technique can prevent postoperative atelectasis by affecting respiratory muscle strength and ventilatory function. Participants performed four training sets daily for 14 consecutive days. A training set was defined as 10 breaths, with a single breath consisting of one sequence of inspiration and expiration. Measurements of forced expiratory volume in one second (FEV₁), forced expiratory volume in one second percentage (FEV₁%), peak expiratory flow (PEF), maximum expiratory pressure (MEP) and maximum inspiratory pressure (MIP) were taken before the experiment and on days 7 and 14. It was consequently found that the experimental group exhibited a significant chronological rise in PEF and MEP. Because the change occurred within a time span shorter than for the onset of muscular hypertrophy, it is postulated that training mobilized normally unused respiratory muscle fibers. The findings suggest expiratory muscle training may be effective for preventing postoperative atelectasis.

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This study aimed to clarify the attitudes towards and knowledge of dementia and related factors among dementia prevention behavior, focusing on middle-aged people. The study was conducted on 971 citizens above 40 and below 65 years old who were randomly extracted; 299 people who gave effective responses were analyzed. The results showed that 70% of the people were interested in dementia prevention; on the other hand, the percentage of those who practiced such preventive behaviors was only 20%. By examining related factors of knowledge on dementia, the higher the knowledge and recognition of concern and susceptibility, the more positive were the attitude towards people with dementia. Through Multivariate analysis, the following items were identified as significantly related factors of dementia prevention behavior: "The age range is the fifties", "Breslow's health habit score is higher than the average value", "they have interest and knowledge in dementia prevention", and "they have a positive attitude towards people with dementia". Therefore our findings suggested that the necessity of support for the younger generation especially centered on those in their forties. Additionally, it was suggested that promoting the dissemination of knowledge and having a positive attitude towards dementia could lead to dementia prevention behavior.

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Objective: To clarify the disease process as experienced by malignant glioma patients during the treatment process from onset through to craniotomy, chemoradiotherapy, and outpatient chemotherapy following hospital discharge.
Method: Data from semi-structured interviews of 10 patients with malignant glioma who underwent postcraniotomy chemoradiotherapy were analyzed based on a grounded theory approach.
Results: The core category "Ray of hope that the lingering brain tumor would be eradicated", and nine categories were identified. The disease experience included making decisions amidst a lack of treatment option, and physical experiences unique to brain tumors; contending with patchy alopecia in the irradiated areas and sequelae that prevented a return to their former selves, and relationships with others, the patients holding onto the ray of hope that the lingering tumor could somehow be removed.
Discussion: In the context of nursing care practice, our findings highlight the need to establish systems to support patient decision-making and education and to provide ongoing support from before admission to after discharge.

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[Purpose] The present study investigated the spouses of patients with advanced cancer whose lives had been extended due to chemotherapy in order to clarify the characteristics of these spouses' experience from the start of treatment of the patients until after their death.
[Methods] Semi-structured interviews were conducted with the spouses of deceased patients, and the obtained data were analyzed in a qualitative and inductive manner.
[Results] The analyses revealed that the spouses of patients "desired to maintain the patients' conditions" before their death. Later on, spouses who began to realize that the patients' death was unavoidable "made an effort to live their lives alone" after the patients had died. However, spouses who continued desiring to maintain the patients' conditions believed in the possibility of continued survival and, after the patients' death, they became fixated on the patients' past and pretended that they were leading a normal life.
[Conclusion] The results of our study suggest the importance of understanding the expectations spouses have of therapeutic effects before the patients' death and supporting them.

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Objective: To elucidate the experiences of family members providing homecare for individuals with dementia with Lewy bodies (DLB) from the time they noticed the first signs to diagnosis.
Methods: Semi-structured interviews were conducted with seven family caregivers with experience of providing homecare for individuals diagnosed with DLB. The collected data were analyzed through qualitative inductive analysis. Questionnaire survey conducted from January, 2015 to August, 2015.
Results: The study participants were six women and one man in their 20s to 60s. Family caregivers noticed the individual's "unusual behaviors in everyday life" and sought early medical consultation while doing "the adjustment for the individual's"; however, they were told that the cause was unknown, and thus consulted multiple hospitals. They were "baffled by the affected individual's hallucinations and the misdiagnoses". Consequently, the family caregivers researched the cause of the signs themselves, which led them to "realize the possibility of dementia". Diagnosis of DLB for the first time after consulting a dementia specialist led to "expectations for the treatment by the dementia specialist".
Discussion: There is a need to disseminate knowledge of DLB to family members and professionals to diagnose early DLB without baffling by the affected individual's hallucinations and the misdiagnoses.

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Objective: The aim of this study was to clarify the consciousness that novice nurses obtain through their experiences in clinical settings three months after entering employment after experiencing integrated nursing practicum in undergraduate education.
Methods: We conducted semi-structured interviews with eight novice nurses three months after they had started working at a university hospital after taking an integrated nursing practicum course. The context of the nurses' narratives that matched the study objective was categorized so that no content was distorted.
Results: Five categories were generated: "anxiety, confusion, worry, frustration and nervousness felt after entering employment", "self-growth perceived after being allowed into the team", "moving from being followed-up during one's university days to making decisions independently", "peace of mind arising from experiences of integrated practicum", and "perceiving the significance of nursing through starting work".
Conclusion: While the nurses had a negative consciousness, which was a similar to the findings of previous studies, the results of this study demonstrated that nurses also had a positive consciousness. The nurses were in a stage of growth where they were expanding their consciousness in the period of transitioning from student to nurse.

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Purpose: The purpose of this study was to clarify experiences related to "life and death" among terminal cancer patients receiving home palliative care.
Methods: The subjects were five patients with cancer who were receiving home palliative care and had predicted survival periods of no longer than six months. Data were collected through semi-structured interviews and participant observations, and were analyzed with reference to the phenomenological psychological approach of Giorgi.
Results: Experiences related to "life and death" among terminal cancer patients receiving home palliative care consisted of "longing to live, even though they realized their limited life", "hope for a ‘natural death’ if death is inevitable", "thinking about family and others who provide support", "awareness of a being beyond the self", and "wavering between life and death".
Conclusion: This study suggested that asking questions that reflect on the patient's life and holding conversations that involved the patient's family were important for communication between patients and nurses.

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Purpose: This study aims to clarify novice preceptors' difficulties in providing clinical instructions to newly graduated nurses, their behaviors to overcome these difficulties, and the support they require, in order to consider various measures for supporting preceptors.
Methods: We performed semi-structured interviews with 11 novice preceptors and qualitatively analyzed the data.
Results: The main difficulties experienced by novice preceptors were strenuousness in grasping the comprehension level of newly graduated nurses, lack of self-confidence in their knowledge and teaching, and complications in cooperating with their colleagues on particular educational subjects. The preceptors attempted to overcome these difficulties by consulting with supervisors and senior co-workers, sharing their concerns with nurses who began working in the same year, and other behaviors involving support, such as forming better associations with colleagues and achieving greater self-awareness of being an instructor. The support they required included understanding from teammates, placement of mental health supporters, and more instruction on the teaching-learning content and methodologies.
Conclusions: Novice preceptors' support needs for overcoming difficulties included an education system, greater mental health support, strengthening bonds with colleagues, and more positive management of their experiences.

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The aim of this study was to examine factors related to the change in quality of life (QOL) between prehospital and 3 months after discharge in middle-aged male patients with ischemic heart disease. The QOL was evaluated using SF-12. The related factors were evaluated using multiple linear regression analysis. Physical, mind, and role scores showed no significant difference between prehospital and 3 months after discharge. "General Health" score among subscales significantly increased. As factors related to changes in scores, physical score was related to "family constitution" "amount of alcohol at each drinking after discharge". Mind score was associated with "anxiety against symptom development after discharge". Role score was related to "satisfaction with income after the discharge".
These results suggest that in the cares after discharge in middle-aged patients with ischemic heart disease, it is necessary for medical staff to follow the progress of support from family, getting back into business including "satisfaction with income" and mental condition including "anxiety against symptom development" attentively and continuously from in-hospital day.

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A national questionnaire survey was conducted regarding the current situation of healthcare safety education at medical institutions with more than 300 beds. Education regarding clinical risk management (No. 7) had the highest rate of implementation among 25 internationally recommended content areas medical institutions. Lectures were the most frequently adopted method of education, and exercises, such as PBL, group work, and simulation, were adopted in some educational contents. Infection control (No. 23) had the highest rate of educational content targeting all occupations, and physicians and nurses were in charge of all educational content. Furthermore, depending on the educational content, the results revealed that not only pharmacists and clinical engineering technicians, but also patients' families, lawyers, enterprises, and others, were responsible for healthcare safety education. It is necessary to systematically teach knowledge of healthcare safety, and to demonstrate expertise among patients/families and other healthcare professionals regarding their roles, as part of the in-service education, in order to promote cross-sectional hospital education that contributes toward healthcare safety management.

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This study aimed to clarify factors associated with personal information leakage predominantly involving nursing staff. Personal information leakage events occurring in medical facilities prior to enforcement of the amended Personal Information Protection Act were investigated and analyzed. Such leakage events that were publicly announced or reported in the media between April 2005 and May 2017 were reviewed to identify those involving nursing staff and to thereby allow classification according to the causes. Subsequently, the causes of leakage events were compared with those involving physicians to investigate the tendencies for different professions. The results revealed the following to be the main factors contributing to leakage events caused by nursing staff: mislaying or loss (36.8%), inappropriately being taken out of medical facilities or other relevant actions (27.9%), and posting/distribution/delivery errors (20.6%). As to the events involving physicians, the main causes were: inappropriately being taken out of medical facilities or other relevant actions (50.5%), mislaying or loss (28.6%), and theft (14.8%). These results indicated that the causes of leakage involving nursing staff were often associated with errors made by the staff themselves, whereas in many cases involving physicians, actions despite awareness of breaches led to information leakage.

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The Publication Manual of American Psychological Association (APA manual, 2009) indicates that all articles must report the effect sizes in the "Result" section of the study. However, few nursing research articles report the effect sizes as a study result. This study investigates whether nursing research articles in Japan report the effect sizes for results of statistical analyses. The subjects of this study were 186 articles published from 2012 to 2016 in "Journal of Japan Society of Nursing Research" I investigated whether articles using t-test in this journal reported the effect sizes of d-family (i.e., the effect size for t-test. For example, Cohen's d, Hedges' g, g_adj, and Glass' Δ) as a result of analysis. A total of 25 articles performed the t-test for statistical analysis. However, none of these articles reported the effect size of d-family. Only one study reported the partial correlation ratio (η) as the effect size. This result suggests that Japanese nursing researchers do not recognize the importance of reporting effect sizes in their studies. To accurately discuss the results of nursing research, all researchers need to understand the properties of effect sizes and report them in articles.

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Purpose: This study was carried out to summarize the trend of research on nurses' decision making based on intuition and clarify research subjects for the future.
Methods: I searched studies published by September 2017 through PubMed, MEDLINE, CINAHL, and Ichushi-Web (the Japan Medical Abstracts Society) utilizing "intuition", "intuitive", "decision-making", "nursing", and "nurses" as keywords, and selected 22 studies for review.
Results: According to analysis of the 22 studies, we extracted three categories: decision making based on intuition and the experience; decision making based on intuition in nursing practice; and strategy to cultivate decision making based on intuition. Only exploratory and descriptive studies were available. No intervention research was identified.
Conclusion: It is necessary to collaborate with other disciplines in order to explore the thought process of the decision making based on intuition, and to present the structure concretely and concisely.

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