Seven nurses took part in semi-structured interviews to clarify the stressors of pediatric oncology nurses. The results of the semi-structured interviews were analyzed using a qualitative descriptive research method. Nurses considered the following stressors related to children. Nurses saw their children get sick with cancer and become confused by changes in their lives. They saw their children suffer from the side effects of treatment and tried to prevent recurrence. The children could not voluntarily deal with the treatment. Nurses saw the following as stressors regarding families: The families were concerned about the child and their mental state deteriorated. The families had anxiety about life due to outpatient visits, the child’s relapse, and the unstable mental state of the family due to loss of energy. Nurses saw the following as stressors regarding care: the complex management of chemotherapy, lack of support to treat children, provide pain relief at the end of life, and the inability to meet the hopes of the children and their families at the end of life.

 This paper focuses on parents who have lost children who required medical care due to severe motor and intellectual disabilities (SMID). The study aims are (a) to clarify parents’ experiences through talking with each family member about how they viewed and spent their daily lives, from the time they lived with their children at home, to after their death, and (b) to consider the ideal forms of support and assistance. Semi-structured interviews were conducted with parents of children with SMID who were primarily treated at one pediatric hospital in eastern Japan, and had passed away before the age of 20 after spending more than one year at home while receiving medical care. In the interviews, we mostly asked about the circumstances of their children’s bereavement, their life from the loss to present, their lives spent with their children while they were at home, and their thoughts and feelings regarding their children. Their responses were analyzed based on Giorgi’s phenomenological approach. Despite exposure to events that would be expected to cause a prolonged state of grief, participants proactively confronted their sorrow of having lost their child and experienced re-tightening of their bonds with their children in a new way. This form of strength appeared to be based on a high degree of resilience developed through the time spent at home with their children, as well as the solid relationships built during that period.

 This study aimed to clarify the process by which fathers of children with severe mental and physical disabilities who need medical care create new lives at home. Nine fathers underwent semistructured interviews, and their responses were analyzed using a modified grounded theory approach. Fathers felt “confusion regarding their new lives” and spent their time running around not knowing left from right and experiencing a strong feeling of burden while “feeling overwhelmed with what they are currently experiencing.” While relying on the mothers to raise the children, their “acquisition of self-confidence” of being able to deal with their children themselves turned into a sense of security that formed the foundation of their everyday lives. Furthermore, they demonstrated a “wider range of actions based on feeling less pressure” and started “searching for the right lifestyle for their own family.” These observations depicted the process in which the support of those around the fathers, and the fathers’ own convictions, became the strength to support them in going on living with their children, and as they got over numerous experiences, this support resulted in mental growth that enabled them to “accept things” and establish a life wherein the right pace has been created for their family.

 This study describes the perceptions that nurses have regarding the thoughts and feelings expressed by parents who are obtaining hospital services for their children. Four focus group interviews were conducted with six nurses who had more than four years of hospital experience and who were currently working with children. Based on the interviews, three categories emerged: (1) Nurses try to listen to parents’ thoughts and feelings, but parents cannot always express themselves sufficiently although it might be better for them to share their concerns; (2) Nurses view the parents’ concerns as being important when determining the services and care needed by the child, while parents judge the nurses professional abilities; and (3) The nurses had their own emotional responses to the parents’ thoughts and feelings. The findings indicate that owing to the parents’ concerns, nurses felt strong pressure when determining the services and care to be given to the child. Thus, nurses should communicate with one another when they feel overwhelmed by the parents’ shared concerns to help them determine whether such concerns required further attention and credence. Further, nurses should recognize the parents’ need for empathic listening and sympathy from nurses when they share their thoughts and feelings. Nurse should also consider why parents might have these thoughts and feelings the need to express them.

 Our qualitative and inductive research aimed to clarify transitional support for the home care procedures for mothers and family members of infants with severe motor and intellectual disabilities. These infants were first transferred from NICU and admitted to the general hospital pediatric ward which provides an interim facility. We conducted semi-structured interviews with nine nurses working in the pediatric ward at the general hospital. We analyzed the results using the Modified Grounded Theory Approach. The results indicated that the support provided for transitioning from an interim facility to home care consisted of the following four categories; removing the gap of mother-infant separation, implementing transitional support strategies, intensifying transitional support to promote adaptation to home care, and evaluating the objectives for each mother and family members. Interim facilities improve home transition support, including home health and living care functions. It is crucial to develop family bonds focused on the mother-child relationship with seriously handicapped children and ensure that support is individually calibrated to the needs of each mother and family members’ mental and physical wellbeing.

 Secondary abstract The purpose of this study was to clarify, while examining experiences of mothers, the process of announcing characteristics and diagnostic names to their children, who had Autism Spectrum Disorder (ASD) not having intellectual disabilities and subsequently to obtain suggestions for nursing care. A semi-structured interview was conducted with research participants consisting of ten mothers who had children diagnosed with ASD, adopting a qualitative-descriptive analysis. This analysis of the results extracted the following six categories: “wavering in accepting children with characteristics”, “facing the characteristics of their children”, “approval and suggestion of children”, “coordination with their family and people around them”, “disease notification and mental conflicts”, and “stay by their children, with consideration, who would grow in self-reliance”. It was clarified that the process of announcement had six stages. Nurses being involved with empathy through an understanding of the mothers’ experiences, nurses are required to support mothers so that they could retrace the path of the process for the notification of characteristics and diagnostic name. Furthermore, it has been suggested that continuous nursing cares are imperative to support emotional wavering due to experiences and the decision making of mothers, where mothers notified their children of the characteristics and diagnosis.

 The present study aimed to clarify the relationship between the actual condition of infants’ and parents’ electronic media contact and daily lifestyle with how many siblings infants had. An anonymous survey was conducted by mail of parents of infants attending authorized nursery schools. Responses were received from 150 households. Data on electronic media contact time were collected, and question items were analyzed using IBM SPSS. Infants’ average electronic media contact time was 61.2 minutes on weekdays and 87.0 minutes on holidays. Seventy percent of infants’ electronic media contact was within one hour, which is the time recommended by the World Health Organization. About 50% of the infants without siblings were exposed to electronic media for more than two hours. Concerning parents’ smartphone use during child-rearing, regardless of the number of siblings, 80% was for taking pictures, and 50% was for searching for information. The use of smartphones to keep children quiet increased as the number of children increased. Infants without siblings tended to be exposed to electronic media for longer periods of time, suggesting the importance of educating parents of infant-age children about the importance of avoiding prolonged exposure to electronic media from an early stage in their children’s lives.

 This study aimed to identify signs of infants receiving intensive care that could alert caregiving nurses to “something out of the ordinary”. We conducted a semi-structured interview with 11 nurses and analyzed the information that was gathered qualitatively and inductively. We constructed three large categories, 9 categories, and 29 subcategories. The first large category is constructed of four categories, which is [signs of infants perceived by nurses] from the current temporary situation of the infants. The second is constructed of three categories, which is [signs of infants captured while interacting with and caring for the infant] identified in light of experience and knowledge. The last is constructed of two categories, which is [signs of infants that are captured by using indications and information from others, e.g. family members, medical staffs, as clues]. Results suggested that, in reality, rather than relying on any single type of sign, nurses use combinations of a variety of signs to assess when “something is out of the ordinary” and the infant may be at risk.

 Pediatricians’ Experience of the Process of Interaction with Patients’ Families During End-of-Life Care in the Pediatric Intensive Care Ward The purpose of this study is to clarify the process of interaction between doctors of pediatric intensive care and the families of children entering end-of-life care. Five pediatricians were interviewed using the modified grounded theory approach. The following processes of interaction between doctors and families of children in end-of-life care were identified: trying not to let the family down while the patient’s condition looks hopeless; seeking ways to explain to the parents that the treatment is no longer focused on survival but is now headed toward end-of-life care; determining how the family wants to address the child’s QOL and supporting their decision. Based on their experience of past cases, doctors can make educated assumptions and estimates regarding their patients’ prospective condition and what treatment outcomes are possible for the patient. However, when providing prolonged intensive care, doctors frequently waver in determining the limits of treatment as they question their own judgment and are faced with new dilemmas in response to the evolving situation. Because families entrust the doctors with the treatment of their children, the period in which intensive care is carried out is an essential turning point for the medical team as a whole in which to rethink the meaning of treatment for the patients and their families and how they intend to proceed.

 The purpose of this study was to clarify the actual condition of stress relief support for children in outpatient care, which is the early stage of hospital care, among mixed medical departments for children and adults (excluding pediatrics). A total of 690 respondents, including 152 doctors, 192 nurses, 151 medical radiologists, and 195 clinical laboratory technicians were surveyed. The results showed that all four professions were more aware of the necessity of stress-relieving support for children; however, the implementation of this support tended to be low for the pre-diagnosis period, with less than 70% of the respondents implementing five pre-diagnosis activities, such as “confirmation of prior explanations”. Nurses were significantly more likely than the other three professions to recognize the necessity for support to alleviate children’s stress and implement the support. The medical professions’ perceptions of the need for support to alleviate stress in children were from the child’s perspective, communicating to the child in a way that was easy to understand, collaborating with the parents, and understanding the child’s reactions. Nurses need to prepare the child psychologically before medical treatment with language and attitudes from the child’s perspective, with taking into account the roles and duties of other professionals and collaborating with parents.

 The aim of the current study was to elucidate the process by which a visiting pediatric nurse earns the trust of a child's mother. Subjects were 8 visiting pediatric nurses who were observed while providing visiting care and who underwent semi-structured interviews, responses to which were analyzed using a modified grounded theory approach. Results revealed the process by which a visiting pediatric nurse earns a mother's trust. The visiting pediatric nurse begins by “Confirming [the mother's] wishes”. The visiting pediatric nurse then attempts communication “Bearing the mother in mind”, which primarily involves “Obeying the family's rules”. Ultimately, the visiting pediatric nurse becomes “Someone close” who facilitates a child's convalescence at home.

 The purpose of this study was to clarify the aspect of communication between children and mothers who underwent tracheostomy. For data collection, semi-structured interviews were conducted with nine mothers of children aged under 18 who underwent tracheostomy before the preschool period. The data were analyzed using Modified Grounded Theory Approach. Twelve concepts and five categories emerged. Mothers recognized all expressions that their child made as “(audible)voices uttered in his/her own way”. After tracheostomy mothers devised a way ‘to talk to their child who tried to say what he/she wanted to say, and to understand it from his/her expressions’, ‘starting, in a voice with a meaning, to repeat back sounds that their child made efforts to utter’. Mothers were moving forward citing that “it is a recognizable feeling because my child was in my belly” while feeling the sounds and being uncertain. Our findings suggest the importance of close nursing involvement and support for these mothers and their child to re-recognize each other even after tracheostomy, and for mothers to give meaning to each one of sounds and gestures that their child make.

 This study aimed to describe the process of information perception regarding disease explanation in mothers with children until school age who had congenital heart disease and to clarify the methods for medical professionals to provide support. A semi-structured interview was conducted with six mothers of children with congenital heart disease aged 10-12 years. We transcribed the interviews verbatim, and the Steps for Coding and Theorization (SCAT) method was used to analyze them. The results showed that in order to transform the mothers’ information perception from “inadequate understanding” to “enabling the implementation of an explanation”, three processes need to be implemented. These were identified as “recognition of necessity”, “improvement of understanding”, and “establishment of a method after trial and error”. To recognize necessity, it is essential to understand what information each mother and child consider important and add the perspective of medical professionals where needed. Furthermore, “improvement of understanding” must be balanced with “recognition of necessity”, and it is required be prepared to conveying information to the child at any time, in case of a demand. In addition, for “establishment of a method after trial and error”, even though the opportunities of contact are limited, it is necessary to provide resources according to individual needs, while paying attention to the mother-child relationship.

 This study aimed to identify “good nursing care” for school-aged children concerning mothers’ perception while attending hospitalized children. A semi-structured interview was conducted with 23 mothers accompanying their children in the hospital. The data was thematically analyzed. Consequently, six themes were identified: (1) calling out children instead of just providing treatment and children’s “whereabouts” can be created in the ward, (2) finding out what children like and talking about their favorites as a starting point opens up children’s mind, (3) children can receive treatment at their pace and rhythm by proposing a wide range of options and allowing children to choose the timing, (4) in any situation, nurses can convince children as they wait patiently and concretely explain so that children can understand, (5) supporting children to face the procedure may require employing not only kindness, but sometimes strength, and accepting the desire of children to escape from the procedure, and (6) by internalizing the situation, and not only considering the children’s age, may help children feel affirmed. The results suggest that it is essential for nurses to accurately grasp children’s situations in their ways as the children spend their time in the ward.

 Chronic functional constipation is a common childhood health problem and places a heavy burden on the child’s parents. To manage constipation, not only is giving appropriate medication vital, but it is also important to change the child’s behavior that avoids defecation. However, the distinct defecation behavior of children confuses their parents, making it difficult for them to deal with it. This study aimed to explore how parents shifted their perceptions and coped with their child’s constipation following nursing intervention. The subjects included four children with constipation and their parents. The study was multiple case study, using interviews, and observation to discover the effects of nursing intervention. Parents tried to cope with child’s painful defecation without appropriate medical support. With prolonged constipation, parents had negative perceptions of constipation, blaming themselves or their children for the causing constipation. In contrast, parents with not much experience in dealing with their child’s constipation were unconcerned and insensitive to the needs of the child. These interfered with the child-parent interactions about defecation. Nursing interventions were intended to share the child’s learning process regarding their sensation and perception of defecation with their parents. Through these interventions, the parents acquired the skills to capture their child’s cues in defecation and how to cope with them. This resulted in a gradually more responsive interaction between parents and their children’s defecation.

 The aim of this study was to clarify the content of discharge support provided by neonatal intensive care unit (NICU) nurses through a review of the literature from 2014 to 2018. ICHUSHI (Web Version) was used to conduct a search using the key words “NICU/neonatal ICU” and “discharge support”. As the result, 16 papers were analyzed. The papers were published at a rate of between 2 and 6 papers per year, except for 2014, and the largest number of relevant papers in a single year was 6, published in 2016. Only one study examined nurses in the community. Content analysis of “discharge support provided by nurses to children in the NICU and their families” led to the formation of three core categories: “Direct support for children and their families in a view of their lives at home,” “Interdisciplinary coordination and cooperation for the transition to the community,” and “Attitudes and practices based on the philosophy of Family-Centered Care.” Moving forward, It will required clarification NICU discharge support-related needs from the perspectives of the children and families receiving support and the nurses in the community, and will compared this studies results.

 Promotion of integrated community care is important so that children requiring constant medical care and their family members can continue to live at home. It was thought that clarifying the efforts of visiting nurses to cooperate with multi-disciplinary positions would help create a system for more effective functioning of the community-based integrated care for children. In this study, a semi-structured interview was conducted with four managers of a visiting nursing station for the purpose of clarifying efforts aimed at cooperation between a visiting nursing station and relevant community professionals. As a result, the managers’ approaches were found to include “relationship building,” “introduction to the functions of visiting nurses,” and “invitation to consultations.” In other words, there was a “transmission” to convey information such as the role and function of visiting nurses to professionals by capturing opportunities. Managers were then found to receive a “reception” as they responded to “participation requests” and “inquiries” by professionals who understood the function of visiting nursing through the “transmission” of the managers.