Objective: This study aimed to identify the process of obtaining effective results of nurses’ practice in diabetes mellitus care using an action research (AR) method. Methods: Kemmis and McTaggart’s model, one of the AR methods, was adopted. Participants were recruited from a medical ward for diabetes and education, and five nurses participated. Data collection was performed through an interview, and the researcher participated as a facilitator and described the process of obtaining effective results. The transcripts were analyzed by an inductive coding approach. Results: Their efforts to obtain effective results were evaluated through a process comprising three cycles and ten stages. The stages included four reflections that were central to the AR model. Each reflection conducted by the facilitator revealed a new figure of the participants, and the figures became the driving forces to execute each cycle. In the first cycle, “a state of surprised reaction to the efforts and thoughtfulness of their colleagues” appeared. In the second cycle, “a state that could not be left untreated” appeared. In the final cycle, “a state of decision making” appeared. The actions and observations were remade on the grounds of revised plan. As a result of the final reflection, the participants reached “a state that obtained effective results.” Conclusions: The process of obtaining effective results of nurses’ practice in diabetes mellitus care suggested the usefulness of AR methods. This study showed the necessity of sharing experiences and the concrete role of a facilitator in AR.

Objective: To apply a model of psychological safety to the work situation of nurses in Japan, we developed the “Japanese version of Team Psychological Safety for Nurses” (JPSN) scale, measuring an individual’s perception of psychological safety for a team of ward nurses, and evaluated its reliability and validity. Methods: First, we translated the “Team psychological safety” scale developed by Amy Edmondson (1999) after obtaining permission from the author. The scale was back translated and reviewed by a team of researchers to design a preliminary version. Next, we conducted an internet-based survey, using a self-administered questionnaire, among nurses working in ward teams across the country. Results: The data of 515 nurses were analyzed. In the exploratory factor analysis, seven items, including one factor similar to the original version, were extracted; the confirmatory factor analysis showed a good fit. After examining the construct validity and the Cronbach’s alpha coefficient (.787), we confirmed that the scale retained a certain level of reliability and validity. Conclusion: These findings suggest that the JPSN can be used to measure the psychological safety perception of Japanese nurses. Further research may explore the relationship between the nurses’ perceptions of psychological safety and their nursing practice.

Objective: This study aimed to clarify the nursing management practices that minimize the use of physical restraints for older patients in acute settings. Methods: We interviewed ten nursing managers who had experience working to eliminate or reduce physical restraint use. We conducted a content analysis of the obtained data. Results: Regarding nursing management practices that minimize the use of physical restraints for older patients in acute settings, we extracted eleven categories including: “organizational decision-making about physical restraints,” “collecting and sharing of know-how for minimizing the use of physical restraints,” “developing nursing and ethical perspectives as a basis for considering the implementation of physical restraints,” “promoting departmental initiatives based on ward characteristics,” and “creating opportunities for professionals from multiple related fields to discuss alternatives to physical restraints”. Conclusions: This study suggests that nursing managers are required to apply management processes to build a culture with positive ethics and also create an environment to promote positive coping skills among nurses entrusted with ensuring safety while maintaining patient dignity.

Objective: This study aimed to clarify nurses’ experiences of psychiatric inpatient suicides, focusing on the organizational and cultural contexts of the ward team. Methods: This study used ethnography and predominantly collected data from interviews and fieldwork conducted at two wards in two hospitals, where there had been cases of suicide by inpatients. Results: Four themes, including “surprise and shock” and “guilt and regret” were identified for nurses’ experiences and three themes, including “experience not shared among nurses” and “deepening feeling of isolation and inferiority” were identified for the situation of Ward Team A. Five themes, including “surprise” and “searching for convincing reasons” were identified for nurses’ experiences and two themes, including “information and experiences shared among nurses” were identified for the situation of Ward Team B. Conclusions: Inpatient suicide affects individual nurses and the entire ward team. This problem should be regarded as not only concerning individuals, but also the entire group. Furthermore, support measures including the utilization of third parties are necessary, and a consciousness of the team dynamics should be regularly maintained.

Objective: This study aimed to examine the changes in mental health, fatigue accumulation, and oxidative stress among nurses when work schedules are changed from 16 to 13-hour night shifts. Methods: Sixteen nurses participated in the study (eight in each group) working 13-hour night shifts (intervention group) and 16-hour night shifts (control group). Their mental health, fatigue accumulation, and oxidative stress markers were examined pre-intervention as well as three months and one year post-intervention. A questionnaire survey was administered after completion. Results: Mental health was significantly better in the 13-hour night shift group compared to pre-intervention. The questionnaire survey after the intervention showed that nurses in 13-hour night shifts were more physically and mentally at ease. The oxidative balance biological antioxidant potential (BAP/d-ROM) ratio decreased significantly over time in the 16-hour night shift group compared to pre-intervention; however, there was no change in the 13-hour night shift group. Conclusions: Adopting a 13-hour night shift schedule increased the levels of subjective mental health and led to a sense of work and life fulfillment. In addition, the oxidative stress balance, which indicates antioxidant power and is an objective index of physical fatigue, deteriorated over time in the 16-hour night shift group, whereas no change in this balance was observed in the 13-hour night shift group.

Objective: The objectives of this study were to examine the process by which smokers become habituated to using heat-not-burn tobacco products, identify changes in their attitudes and behaviors regarding smoking, and offer guidance for health promotion. Methods: Semi-structured interviews were conducted with the participants and analyzed using a modified grounded theory approach. The data were collected from May to August 2019. Results: Regarding smoking behavior, participants always showed an awareness of their relationships with non-smokers. They were frustrated at being unable to smoke without hesitation, which led them to seek alternatives. They also experienced guilt at harming the health of those around them as well as their own. To assuage this guilt, they chose to use heat-not-burn tobacco. Heat-not-burn tobacco proved to be freeing, ultimately turning the use of tobacco into a lifestyle. In general, the number of cigarettes smoked increased, and motivation toward smoking cessation decreased. Conclusions: In an environment where it is difficult to smoke, heat-not-burn tobacco products provide an alternative for smokers and an opportunity to change their behavior in future. It is important to provide adequate health guidance while keeping in mind that the use of heat-not-burn tobacco products may increase nicotine dependence.

Objective: This study examined the factorial structure of nurses’ perspectives to determine the appropriateness of allowing post-acute stroke patients to continue to independently transfer after falls during bed-from/to-wheelchair transfers. Methods: A nationwide questionnaire survey was conducted, which involved nurses playing a leading role in post-acute rehabilitation wards (1 nurse from each ward). Exploratory and confirmatory factor analyses were employed for the analysis. Results: The questionnaire was mailed to 857 facilities, yielding 319 valid responses (valid response rate: 89.6%). The studies resulted in the development of a model comprising the following two factors and eight items, which represent the perspectives for nursing judgment: “stable movements for safe transfer” and “learning experience to prevent recurrent falls.” Conclusions: The results suggest that nurses should determine the appropriateness of allowing stroke patients to continue to independently transfer after falls from two viewpoints: “stable movements for safe transfer” and “learning experience to prevent recurrent falls.”

Objective: To identify the cross-cultural experiences of family members, including foreigners, who support patients. Methods: We conducted a literature review using seven databases. Results: Three articles from Japan and seven from other countries were reviewed. From these articles, 23 descriptions of the experiences of family members because they had a different lifestyle or culture from the country in which a patient was receiving medical care were grouped into nine categories and then classified into three themes: Difficult experiences due to differences in religion/customs, Difficult experiences due to differences in language, and Experiences of personal/social support. Conclusions: It was clear that the cultural competence of nurses, the establishment of a system for family caregivers to provide a sense of accomplishment and satisfaction when providing care, and the creation of a cooperative community regardless of nationality and culture are important. We believe that nursing support measures that involve communities for family members who are supporting a patient in the family including foreigners, are necessary to maintain mental and physical health.

Objective: The aim of this study was to look into prior research on evaluation methods regarding color information and conduct a literature review to better understand the current situation and issues. Methods: Using a combination of keywords such as “Nurse,” “Color,” and “Objective Evaluation,” the Ichushi Web and PubMed databases were utilized to find literature on color information evaluation methods. Ultimately, 5 foreign and 23 domestic papers were sampled. Results: The retrieved papers were classified into three categories. As a result, papers examining the “color comparison method using the color scale” were the most prevalent, accounting for 17 of the total. In addition, there were six papers that examined the “color comparison method using equipment such as spectrophotometers” and five that examined the “color expression method in clinical settings.” Conclusions: Previous studies in Japan and overseas have reported many color comparison methods using scales. Because of the influence of the observation environment and individual differences, objectively evaluating color information may become more difficult in the future. Therefore, a method that can evaluate color information without being affected by the clinical settings is needed.

Objective: This study sought to refine the items of an intensive care unit (ICU) Sleep Evaluation Scale (ISES) for easy and accurate evaluation of sleep in ICU patients and examine its validity and reliability. Methods: We evaluated the sleep of 20 patients who were admitted to an ICU for more than 2 days using the ISES. The nurses in charge evaluated the patients’ sleep using electroencephalography and a sleep observation sheet, whereas the patients evaluated their sleep using a self-evaluation sheet upon waking up. Item analysis was performed using data from both sheets, and the sheets were modified. We also performed a correlation analysis between the total score of both sheets and the assessed sleep variables and calculated the Cronbach’s α. Results: The correlations of the total sleep observation score with sleep efficiency and rapid eye movement sleep were r=.31 and r=.48, respectively. The correlations of the total sleep self-evaluation score with sleep efficiency and N3 were r=.46 and r=.42, respectively. The Cronbach’s α was .71 for responses in the sleep observation score and .72 for responses in the sleep self-evaluation score. Conclusions: The ISES can evaluate the sleep of ICU patients who are capable of self-evaluation.