The purpose of this study was to evaluate the factors affecting sleep quality in winter and summer among the Japanese elderly, living with short daylight hours in winter. Overall, 149 participants who had joined the Citizen's College for the Elderly in Kyotango-city (Kyoto, Japan) were compared based on questionnaires filled by them in winter and summer. Sleep quality was assessed using the Pittsburgh Sleep Quality Index, and mood and daily activities were assessed by the "Profile of Mood Scale". The sleep duration in summer was significantly shorter than that in winter; the subjects had more sleep difficulties and significantly higher scores for "vigor" and "fatigue" in summer than that in winter. The proportion of participants who talked daily with someone was significantly lower in winter than that in summer. Multiple regression analysis revealed that their sleep quality in winter was related to factors such as "frequency of going out", "fatigue", and "mental disorders" and, in summer were "tension-anxiety" and "digestion disorders". The subjects lived in a snowfall zone; however, "daily going out in the winter" was suggested as one of the practical indicators leading to better sleep quality. Therefore, the appropriate nursing guidance for better sleep quality may vary between winter and summer.

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The aim of this study was to investigate factors that influence self-care behavior, particularly self-esteem, in chronic dialysis patients. We distributed self-administered questionnaires comprising the "Self-care Behavior Scale of Dialysis Patients" and "Self-Esteem Scale" to 188 patients undergoing outpatient treatment at hospitals offering hemodialysis. All variables that showed a significant difference with the Self-care Behavior Scale were designated independent variables and were subjected to stepwise multiple regression analysis. The results of this analysis revealed that self-esteem, age, and sex were influencing factors in all self-care behavior subscales. The presence or absence of role was also an influencing factor in the "physical and psychosocial lifestyle adjustment" subscale. From the above, it was suggested that it is necessary to support self-esteem raising and support role adjustment according to the situation.

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This study aimed to clarify the relationships of social networking service (SNS) usage and IT literacy education with moral sensitivity in nursing students. Students from ten nurse-training organizations in a prefecture anonymously answered self-report questionnaires. The question contents included basic attributes, details of SNS usage, experience with IT literacy education, and the revised-Moral Sensitivity Questionnaire Japanese edition. SNS were used by 92.8% of respondents; 82.3% used SNS every day, and 90.0% used LINE, which was the most commonly used tool for communication with classmates. Furthermore, 42.5% of respondents recognized having problems with SNS usage and there were associations between problem recognition and IT literacy education, and between problem recognition and problems caused by SNS. An analysis according to educational course suggested that IT literacy education influenced SNS usage after receiving moral education. Moral sensitivity became higher as students reached higher grades, suggesting a relationship with nursing students' growth stage. Respondents' moral sensitivity differed significantly according to their nursing educational course, but it was difficult to determine if this depended on educational background, experience, or living environment. The association between moral sensitivity and SNS usage remains unclear.

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Purpose: The purpose of this study was to explore the association between reality shock and workplace environmental factors in nurses in their second year after graduation.
Method: Participants included 270 randomly extracted, second-year nurses working in facilities in the Kanto, Kansai, and Chukyo regions of Japan. Participants completed a self-administered questionnaire on constituent factors of reality shock and workplace environment developed by Hiraga & Fuse (2007). The questionnaires were returned via mail by individual participants, and the results were statistically analyzed.
Result: Reality shock in second-year nurses was caused by six factors: (1) lack of support from senior nurses, (2) psychological burden, (3) physical burden, (4) caring for patients close to death, (5) workload per person, and (6) reduced motivation. Nurses who had a more negative perception of their workplace environment experienced greater reality shock.
Conclusion: The suggestion that reality shock in second-year nurses is associated with the workplace environment indicates that review and improvement of the workplace environment of second-year nurses could help reduce or avoid reality shock.

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To clarify the relationships of families of patients with schizophrenia, we applied family system theory to a qualitative analysis of the narratives of three mothers of such patients, focusing on the family subsystem power structure. Four stages representing the family's situation and 26 large categories indicating power structure were selected. In the stage where "the family was aware of the patient's symptoms and let them consult a doctor", conflicts and divisions occurred among family members, including grandmothers. In the stage where "the family was at the mercy of the patient's condition", the family reduced their contact with outsiders and their focus on the patient hindered their functioning. In the stage where "the family groped in anguish for ways to manage the patient", they regained their internal ties in the wake of a marital subsystem alliance and interacted with outsiders. In the stage where "the family reorganized the patient's home life", their relationships, including siblings, became harmonious. To ease the conflicts between family members and guide them towards harmony, we obtained suggestions for disease education for each individual family member, interventions to regulate the parent-patient relationship similar to the marital subsystem alliance, and support for siblings in vulnerable situations.

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Purpose: The purpose of this study was to describe and illuminate the practical knowledge of personal hygiene care provided by nurses in palliative care units to end-stage cancer patients by focusing on the thoughts, feeling and actions of nurses.
Methods: Semi-structured interviews and participant observations were conducted with five nurses and the data were subjected to qualitative descriptive analysis.
Results: Five themes were identified. Nurses planned care so as to "create circumstances that promote motivation toward activities of personal hygiene", and engaged in "provision of care that is based on the immediate situation". Nurses also provided care from the perspectives of comfort and safety, through approaches such as "building a relationship with patients by understanding their feelings and situation through various means" and "providing care while confirming patient and family responses", and engaged in "questioning the significance of care".
Conclusion: Personal hygiene care of end-stage cancer patients was provided through the thoughts, feelings and actions of nurses, who have a sensitive understanding of the changing conditions and feelings of patients. This provision of care represented significant acts for patients and their families.

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[in Japanese]

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