The objective of this study was to elucidate visiting nurses’ perceptions of deficiencies in knowledge and skills related to pediatric home-visit nursing according to the presence or absence of experience in pediatric home-visit nursing in Prefecture A. The subjects were nurses working at home-visit nursing stations in Prefecture A. The nurses were surveyed using an anonymous self-administered questionnaire, which asked them to rate items related to knowledge and skill deficiencies on a five-point Likert scale. In total, 190 valid and completed questionnaires were recovered. Of the nurses who completed the survey, 131 (68.9%) had no experience in pediatric home-visit nursing, 33 (17.4%) had less than 3 years of experience in pediatric home-visit nursing, and 26 (13.7%) had 3 or more years of experience in pediatric home-visit nursing. Nurses without experience perceived deficiencies in their knowledge and skills in assessments of children and mothers, and providing information and offering guidance on treatments and social resources than nurses that have more than 3 years of experience. These findings suggest that pediatric visiting nurses without experience in pediatric home-visit nursing must learn consultation skills to acquire knowledge on social resources and skills for assessing children and mothers.

Purpose: This study aims to determine what care to provide for parents to have infants with asthma acquire self-care skills.

Methods: Semi-structured interviews were conducted with 10 pediatric allergy educator nurses and the data obtained from the interviews were analyzed by a qualitative descriptive research design.

Results: The analysis showed the following: ‘Explain to parents so that they can acquire the knowledge necessary for managing the asthma’, ‘Provide care for parents to understand the necessity of taking care of infants’, ‘Provide care with an awareness of the QOL of parents’, ‘Evaluate the development of infants and instruct parents in how to deal with infants’, ‘Give parents instructions on how to have infants acquire selfcare skills’, ‘Show parents practical methods by demonstrating the way nurses provide infants care’, ‘Assess the skills of parents while observing them caring for the infants’, ‘Provide care for parents and infants so that they can acquire the ways required to perform the necessary care’.

Discussion: The findings suggest that in the involvement with parents and infants, nurses need to provide care for parents, and that continued care may enable infants to acquire self-care skills as the skills of parents improve.

 The objectives of this study are to reveal the current status of educational methods for pediatric cardiovascular nursing from experienced nurse' narrations, and to obtain suggestions for establishing an educational support system. A semi-structured interview about education of the field was conducted with 10 nurses having at least 5 years of nursing experience. The narrated educational methods were classified into 5 categories and 17 subcategories. The 5 categories were as follows: 1) teaching how to acquire the knowledge of complex pediatric cardiovascular diseases, 2) providing OJT, 3) learning gradually in consideration of the safety of the patients and the learner, 4) instructing physical assessments specific to cardiovascular diseases, 5) giving the basic knowledge of pediatric nursing. The nurses at educational positions elaborated educational methods, e.g. they educated inexperienced ones in a step-by-step manner. Our results suggest the needs to hold practical workshops and develop educational tools for inexperienced nurses of pediatric cardiovascular nursing.

 The purpose of this study was to clarify the concept of “End-of-Life Care for children with cancer”. Sixty studies, 42 in English and 18 in Japanese, were analyzed using the method Rogers et al. developed for concept analysis. Constructed from the analysis was a conceptual model of “End-of-Life Care for children with cancer”. The attributes' core theme was “Child- and Family-centered care that continues to support children and their families to live together in a strong bond with hope until the last moment”. It consisted of 6 categories and 28 subcategories. The antecedents' core theme was “The context of ambiguity, unpredictability, and uncertainty surrounding children, parents and healthcare professionals”. It consisted of 6 categories and 27 subcategories. The consequences' core them was “Keeping hope afloat in the experience of living together”, and it consisted of 6 categories and 19 subcategories. This study resulted in a conceptual model that suggests the following focus for caregivers: End-of-Life Care allows children with cancer and their families to have “hope” and to enable “a real life” together as a family even during the child's dying process.

 The purpose of this study was to identify the factors contributing to resilience in families that raise handicapped children needing medical care, caring for them for 10 or more years, until adulthood. The study was conducted on 7 visiting nurses providing care for such families, using a qualitative approach. Inductive analysis identified 59 codes, 29 subcategories, and 10 categories of factors. Sorting the categories according to Grotberg's concepts regarding the sources of resilience yielded 2 “I AM,” 3 “I HAVE,” and 5 “I CAN” categories. “I AM” factors were related to the family's being attached to the child and desiring to keep the child with them at home. “I HAVE” factors were related to the support family members received from one another and those around them who were not health care professionals, and a variety of social support. “I CAN” factors were related to the family's ability to get psychological support, manage day-to-day living, and feel psychologically grounded and contented. These results suggested that support that took these factors into account made it possible for families to raise their medically handicapped children and to provide long-term care at home.

 We conducted semi-structured interviews with 10 mothers of 7-17-year-old children with cyanotic congenital heart disease. The aim was to clarify the perception and involvement of these mothers in nurturing their children's self-care during early childhood and school age. A qualitative and inductive analysis showed that mothers learned from both healthcare professionals and other parents. They recognized the need for nurturing self-care from early childhood and were engaged in fostering control in their children. They taught their children about the need for treatment and therapeutic actions via communication as well as via their actions as part of daily life. Further, the mothers comprehended their children's level of understanding, their abilities, and their development of free will, and they effectively nurtured responsiveness in their children. However, although mothers realized the effects of nurturing self-care, they were concerned about child rearing. This suggested the need to understand the concerns of mothers and to encourage them to correctly recognize their children's level of understanding, abilities, and development of free will. The results further emphasized the need to support mothers in balancing control and responsiveness and in utilizing others to help them foster self-care in early childhood and school-going age of children with cyanotic congenital heart disease.

 This study aimed to create behavioral indicators for nurses working in neonatal intensive care units (NICU) to provide support for the parents of preterm infants with a high risk of cerebral palsy, and to shed light on the content validity of such behavioral indicators. The support is focused on the adjustment process of parents, with a view to helping fathers fulfill their parental role. Based on the results of a qualitative descriptive study and the results of a literature review, I created indicators of nurses' behavior. Subsequently, an expert panel of six nurses with five or more years of experience in the NICU examined content validity and amended the items. Following their evaluation, 21 items were revised, 8 items were added, 1 item was integrated, and the panel finalized a total of 64 items. Indicators of nurses' behavior provide nursing support based on the stage of adjustment process in the performance of a father's role. Therefore, I believe that using these indicators will support the family system and help families overcome crises that may arise in response to cases of cerebral palsy that may develop after discharge from the NICU.

 The purpose of this study was to reveal the association between workplace child care supports directed at the fathers of infants hospitalized within NICU settings and fathers' parenthood after their child's discharge from the NICU. The participants were 115 fathers of children discharged from NICUs within the preceding year. We conducted an anonymous self-administered questionnaire survey using the Scale of Early Child-rearing Parenthood (SECP: 3 sub-areas, 33 items). A total of 48 (41.7%) responded. We compared the SECP score between fathers with and those without workplace childcare supports and found a significant between-group difference. During the multiple regression analysis, several factors appeared to influence SECP scores: “workplace childcare supports,” “frequency of visiting the NICU” and “personal views on male participation in child rearing.” Medical healthcare workers should provide support for fathers as well as mothers as they assume parental roles. In addition, it is necessary to understand gender-based differences that emerge during the early child-rearing period, to advocate for both maternal and paternal rights related to childcare support, and to support the creation of workplace environments where childcare supports are easily used.

 Objectives: This study aimed to determine the aspects of experiences through which new graduate pediatric nurses acquire the motivation to continue working. Methods: Four second-year pediatric nurses were subjected to semi-structured interviews, and a qualitative descriptive study was conducted. Results: The following 10 core categories from 55 conceptual categories were extracted: [ideals and expectations regarding pediatric nursing]; [being in an uneasy position]; [changes in values]; [support from understanding colleagues]; [gaining peace of mind by divulging every emotion]; [psychological burden of being in tension-filled settings]; [determination to continue working gained from self-inspiring experiences]; [motivation gained from regaining composure by stopping one from quitting work]; [acquiring confidence and establishing one's own position through accumulated experiences]; and[establishing specific goals based on actual experiences]. Conclusions: For new graduate pediatric nurses, the key to acquiring motivation to continue working is the difficult experiences that shake these nurses' core values, and their resilience and intrinsic motivation are also important.

 Purpose: To clarify the process of parental empowerment that supports the social lives at home of their severely disabled children with medical complexity.

 Subjects and Methods: Ten mothers of children participated in a semi-structured interview. Verbatim records were analyzed by the modified grounded theory approach (M-GTA; Kinoshita Y).

 Result: Eleven [categories] and 46 were extracted.

 Short story-line with categories: Two categories related to pre-discharge to the early stages of family life were extracted: [Preparation and resolution for discharge and home life] and [Recognition of limitations of the care support system and hope for flexible service usage]. While receiving [Professionals' attention and support to parents and siblings], the parents showed [Collaboration as a peer and demonstration of abilities]. Through parenting, they sought an [Education and environment to promote child development]. At the risk of falling into an extreme state due to burden of medical care, parents fell into conflicts such as reviewing their own lives. Even so, parents gained confidence and overcame themselves by [Parent's social participation and child-rearing ability under conflict]. Along with [A sense of security that there is a multifunctional facility as the last fort], [Utilization and coordination of social resources] was linked to [Satisfaction with parenting role and enhancing family life].

 Discussion and Conclusion: From the discharge preparation stage to life at home, parents support their children's social lives and have become gradually more empowered. Support and coordination from professionals and [Desire and action as a parent] are the major sources of parental empowerment.

 This study aimed to qualitatively clarify the awareness of nurses on the current use and promotion of research findings in pediatric nursing care practice. As a result of the Focus Group Interview (FGI) with 9 nurses in a pediatric ward of a university hospital, 3 categories that suggested the awareness of nurses on the current use of research findings were found. In addition, as their awareness on the promotion of the use of research findings, 2 categories were found: “there would be the need to prepare an environment for the use of the research findings,” and “there would be the need to improve the problems about availability of the research findings.” It was clarified that in order for nurses to provide best nursing care for hospitalized children and their families based on the application of research findings in the future, it will be necessary to prepare an environment, to raise the awareness of nurses, and to discuss how to present research findings.

 The purpose of this article was to introduce “Precious life” Workshop to high school students that would make them consider childbirth, child rearing, and parental obligations and responsibilities for raising children. It would clarify the students’ learning and examine the class design. We provided 11th and 12th grade students of a senior high school with “Precious life” Workshop, as an optional joint Sex and Life subject, which dealt with the theme of baby hatches. It focused on a baby hatch called “Kounotori-no-yurikago”. The workshop was an opportunity for students to consider, in a multifaceted way, through their discussion about the baby taken to “Kounotori-no-yurikago”, the parents who leave the child, the social context, and to realize there are arguments for and against such facilities and there are different opinions than their own. From the space provided for free comments it became clear the students thought about the parental responsibility involved in childbirth and child rearing and keenly felt that they had been lovingly taken care of. It is assumed that the class was an educational practice where students could learn the importance of life.

 When children with cerebral palsy arrive at adolescence, joint deformation such as arthrogryposis appears due to the physical growth associated with the secondary sex characteristics, and physical strength gradually declines with secondary disorders. To better understand this, the study here aimed to determine how nurses involved in activities of daily living of adolescents who are hospitalized in long-term wards with cerebral palsy, using the ethnographic nursing research approach of Leininger. The results identified four themes and one major theme. Nurses assist adolescents even if ‘it is a movement the adolescents can do by themselves’ by assessing timing, to help the adolescents maintain the movement acquired in the growth process as long as they are able to, while protecting their self-esteem. When adolescents maintain silence, nurses reserve ‘time to communicate in speaking’. This is assumed to be a unique aspect of the nursing because it is nursing of adolescents with cerebral palsy who live in a world where they cannot move as they wish due to the paralyzed body.

 The purpose of this study is to clarify the behavior of infants who are reluctant to take oral medications, when they are supported to take oral medications. The authors observed five infants when they were orally given medications, interpreted and coded their understanding and perception of oral medications, taking into account their developmental stages at different ages. The code analysis revealed that the infants showed unpleasant feelings by crying and using their libs and oral cavity to the fullest. However, in some cases, they overcame unpleasant oral medications when they were given their favorite “pleasure” stimuli, such as favorite picture books or sucking their fingers. Furthermore, 4-month-old infants could differentiate the taste of medications from breast milk and understand the medications by their taste in the mouth or with the sense of the object in the mouth. Furthermore, 9-month-old and older infants could sense very bitter medications in the mouth. Their responses also indicated that they could understand oral medications by looking at the objects that are used for oral medications or the person who helped them take oral medications.

 The objective of this study was to elucidate the cognitive structure of parents with a child with congenital heart disease regarding what parents can do to enable the child to understand their illness and exhibit a positive attitude in their behavior. The subjects were 72 parents affiliated with four chapters of a patient advocacy group for children with congenital heart disease. A program for parents was implemented to strengthen the elements of resilience in patients with congenital heart disease that were identified in a previous study: an understanding of the illness by the child and a child’s ability to exhibit a positive attitude in their behavior. A questionnaire was then created based on the statements of the program participants. A factor analysis of the 41 valid responses showed that the child’s understanding of the illness consisted of three factors: parental support for independent self-care behavior by the child, the parents explaining the illness to the child, and the parents compensating for the child’s deficiencies in understanding and behavior. The child’s ability to exhibit a positive attitude in their behavior consisted of three factors: the parents showing a positive attitude toward the child, the parents acting in ways that showed they were conscious of the child’s autonomy, and respect for the child’s independence on the part of the parents. The results showed that the parents explained the illness in a way that enabled the child to view it positively and were conscious of the need to focus on the child’s autonomy.

 Introduction This study was conducted to clarify the current state of and issues surrounding support by outpatient nurses involved in the immunization of pediatric patients. Methods An anonymous, self-administered questionnaire was distributed to 1,650 pediatric outpatient nurses providing outpatient care for chronic diseases. The questionnaire asked about the respondent’s characteristics, the characteristics of the respondent’s affiliated institution, support for immunization of pediatric patients, and answers to open-ended questions. Results In total, 417 questionnaire forms were recovered, of which 415 (25.2% valid response rate) were subject to analysis. The mean age of the respondents was 43.2±8.4 years and 413 (99.5%) were women. Immunization was performed at the affiliated institutions of 404 respondents (97.3%). Outpatient nurses provided support such as monitoring physical changes in pediatric patients and answering the questions of guardians, and also coordinated schedules according to the treatment plans of pediatric patients. Support by outpatient nurses for immunization of pediatric patients was influenced by the frequency of support. Discussion Immunization of pediatric patients was provided at almost all the respondents’ institutions. Moving forward, outpatient nurses need to both manage chronic diseases and interact with guardians and pediatric patients in a way that promotes understanding of immunization.

 Toilet training is an important developmental task for preschoolers and a milestone in child rearing. However, some caregivers feel that it is too much of a burden to toile train their children. The aim of this literature review was to investigate the current research findings regarding toilet training and to consider the issues involved with nursing intervention. Nineteen studies were analyzed. These studies discussed caregiver assessment of when to best facilitate toilet training with their child. Caregivers have to consider when to introduce and start toilet training, how much time to give the child to successfully void when they are trying to use the toilet or potty, how often to take them to the toilet or potty, and when to and where at to transit their child from a diaper to underwear. The studies took into account the child's age, language skills, and motor development, the child's willingness to learn toileting, the season, the parents' experience, and social expectations. Parents also need to manage any negative feelings when they have conflict with their child and deal with pressure from social expectations. Learning independence in toilet training is the development of self-regulation, in which the child learns to see others' perspectives through reciprocal interaction with their caregivers in daily living. This review suggested that nurses need to support caregiver's ability to deal with and negotiate in order to mitigate conflict with their children in toilet training. More studies are needed to reveal socio-cultural perspectives on toilet training in Japan.