This study aimed to characterize the support provided by mothers accompanying preschool children who undergo capillary blood sampling in the pediatric outpatient department to promote the collaboration between nurses and parents regarding the children’s self-regulation. The data were obtained by the participants’ observation during capillary blood sampling and semi-structured interviews of 10 mothers. The data were analyzed using a qualitative descriptive research approach. The analysis showed the following: “Embrace the emotions of the child,” “Constantly support the child as the secure base,” “Snuggle up, so that the child can express his/her feelings,” “Accept ‘this child’ who has the power to endure and tries to do it by himself/herself,” “Mediate between medical staff and the child so that the child can participate,” “Provide as much support as possible to the child” “Maternal confusion developed from the child’s anxiety, fear, and refusal of capillary blood sampling,” and “Recognize and trust that the medical staff are supporting the child’s prospects and participation in capillary blood sampling.” The findings suggest that it is important that the nurse explains to the mothers the procedure of capillary blood sampling and at the same time respect and observe their actions toward their children. Furthermore, nurses should help mothers recognize that they are providing support to the children in collaboration with nurses.

 Influence of limb-sparing surgery or amputation for treatment of childhood cancer on the school life of children who underwent such surgeries. Due to medical advancements in the treatment of childhood cancer, the number of cancer survivors has increased. In this study, we aimed to clarify the influence of limb-sparing surgery or amputation on the school life and career choices of children who underwent such surgeries. We conducted a semi-structured interview with 13 people visiting the outpatient department at A Hospital, and analyzed the interview data using content analysis. We obtained 3 categories and 8 sub categories on the influence of such surgeries on career advancement and career course, and 7 categories and 22 sub categories on difficulties experienced due to the illness or treatment, with reference to school life. Findings revealed that children who took care of their lower limbs considered the presence of an elevator during school choice, and they considered means and distances to the school according to their ability to perform activities of daily living. In addition, the restricted activities after treatment had a significant impact on physical education, thus suggesting the need to provide support for physical education after returning to school.

 The aim of this study was to determine the implications of mothers’ behavior when they accompany their children under two years of age for blood sampling, and to present a support model for such events. The subjects were three pairs of mothers and their children under two years of age undergoing blood sampling. Non-participatory observations of blood sampling situations and semi-structured interviews with the mothers were conducted. The study design used episode description as a method to approach others’ thoughts and intentions, which is essential in nursing. The mothers attending their children first played a “maternal role”. However, they shifted to a “helping role” when they were asked to restrain their children. Subsequently, however, they played these roles simultaneously, tightly embracing their children so they would not move. Thus, three scenes were confirmed in the mothers’ behavior: “maternal role”, “helping role”, and the combination of these roles. These results indicated the necessity of a support model for nurses to practice that would allow mothers to exercise the “maternal role” while playing the “helping role.”

 This study aimed to elucidate the structures that create difficulties in pediatric nursing by investigating the clinical experiences of nurses prior to their personal experience of childrearing. The subjects were six nurses who worked at a pediatric ward for at least five years prior to and after their personal experiences of raising children. They participated in semi-structured interviews, and the results were analyzed using the KJ Method. The results were organized into seven groups: 1) A sense of affection for children being an essential characteristic; 2) Failure to consider the children’s present environment; 3) Insufficient imagination regarding what it is like to be a mother; 4) Insufficient understanding of children’s individuality; 5) Weaknesses due to lack of childrearing experience; 6) Stance that does not allow mother and child to be prioritized; and 7) Lack of relationship building with mother and child. These groups revealed a structure that could be referred to as the extremes of the nurses’ sense of difficulty. The results suggested that nurses with personal childrearing experience need to play a major educational role in pediatric nursing settings by providing educational support to nurses without such experience, considering weaknesses arising from such a lack.

 Aim: The aim of this study was to clarify how visiting nurses understand the physical and mental condition of parents of children with severe motor and intellectual disabilities at home who need medical care, and the support provided by visiting nurses to maintain the physical and mental condition of parents. Methods: A qualitative descriptive research method was used. Study participants comprised 10 nurses who provide care for children with motor and intellectual disabilities who need medical care at home. Individual semi-structure interviews based on an interview guide were used to collect data. Results: Four categories about understanding the physical and mental condition of parents were extracted: “Understanding the amount of care parents have”, “Understanding the ease of fluctuations in parents’ physical and mental condition in daily life”, “Recognizing parents’ physical and mental condition by sensitively detecting unusual situations”, and “Discovering the story of parents’ physical and mental condition in a natural conversation”. Four categories about actual support were also extracted: “Rejuvenating parents physically and mentally”, “Encouraging parents to improve their physical and mental condition”, “Establishing a support system”, and “Respecting and being close to parents’ feelings”. Conclusion: Visiting nurses need to detect the physical and mental condition of parents of children with severe motor and intellectual disabilities and establish a support system to avoid parents having excessive care burden. Additionally, it is important for visiting nurses to help parents control their own physical and mental condition.

 This study aimed to clarify parents’ thoughts about their children’s friendship with peers with similar diagnoses during hospitalization for childhood cancer. A qualitative inductive study was performed using semi-structured interviews with seven parents of children with cancer who had been notified of their disease and were psychologically comfortable and able to communicate. Three categories, including “hope of helping the child fight their illness and stabilize their mental and physical condition,” “concern about the child and their peers’ burdens,” and “gratitude for connections with peers and their parents”; nine subcategories; and 172 codes were extracted. Results show that, in general, parents believed that their child’s friendship with peers in the hospital provided hope for helping their child fight their illness, thereby stabilizing their mental and physical health. Even though there was concern about the child and their peers’ burdens, both the parents themselves and their children were grateful for the connections with peers and their parents. Although the child and their peers are the main players in supporting their mutual relationship, cooperation with parents is invaluable. Parents were most concerned about the mental and physical burden that their child experienced and viewed their child’s friendships with their peers as a way to help the child confront and overcome their own illness and treatment. It is essential to further discuss the importance of friendships between children with childhood cancer and their peers taking their parents’ thoughts into consideration, as they continue to support them in their battle against cancer.

 The purpose of this study was to develop a nursing scale to enhance children’s self-care skills and parents’ care skills during hospitalization, and to examine its validity and reliability. Methods: The study comprised three processes: development of a nursing scale draft based on previous qualitative research and literature studies, refinement of the questionnaire items, and confirmation of reliability and validity. Reliability and validity were confirmed by administering the questionnaire to 300 family members raising children who had been hospitalized at a pediatric specialty hospital. The following is a summary of the results of the study. By item and exploratory factor analysis, 17 items and 3 factors were extracted. In addition, confirmatory factor analysis confirmed fit of the hypothesized model obtained in the exploratory factor analysis. In terms of reliability, Cronbach’s alpha was 0.961 for all 17 items of the scale, ranging from 0.902 to 0.927 for each factor. The correlation coefficient with the external criterion “nurse’s level of support” was 0.637. Conclusion: The scale has a certain level of reliability and validity, and can be used in future clinical practices.

 To improve nursing practice in dealing with sudden changes in the condition of pediatric patients, we investigated pediatricians’ expectations of pediatric ward nurses with the aim of identifying possible improvements in nurse education and cooperation with doctors. We conducted semi-structured interviews with ten doctors, qualitatively interpreted and abstracted the interview contents, and extracted the core categories. Relationships identified among the interviews were depicted in a conceptual diagram. We extracted four categories of physician expectation: 1) ability to acquire knowledge which facilitates anticipation of and response to changes in a patient’s condition; 2) ability to perform all examinations and treatments and adjust environmental conditions according to the growth and sudden changes in the condition of pediatric patients, based on the doctor’s instructions and protocols; 3) ability to communicate with the team during urgent situations; and 4) ability to actively listen to complaints and explain the pediatric patient’s condition to family members. These expectations strongly reflect the behavioral elements of nursing practice and the need to adjust the care environment in a manner consistent with the team’s communication practices, based on knowledge about sudden changes in the condition of pediatric patients. Our findings also suggest that pediatric nurses are expected to communicate with the children’s families to help them make the best decisions for the patient.

 The aim of this qualitative study was to reveal the feelings of mothers who participated in pain management in the NICU and to investigate care that supports mothers’ participation. We conducted a semi-structured interview, and analyzed the result with SCAT. The mothers’ feelings were categorized into three periods. Period of getting information about painful procedure: “Mothers lack knowledge about a painful procedure” and feel “a vague fear of the painful procedure”. Gradually, with “a sense of duty to understand the painful procedure”, they gain information and experience “reality shock about the painful procedure”. Nevertheless, the mothers “encourage themselves about the painful procedure” in order to tolerate it. Period when beginning participation in pain management: Mothers take “an interested in pain management” and participate in pain management, but on the other hand, feel “conflicts about pain management”. Developmental period of participation in pain management: Mothers feel “joy of participation in pain management” and “joy of participation of childcare”. The experience that mothers have gained through participation in pain management leads to “confidence in childcare after being discharged” from the hospital. It is necessary to support mothers’ participation in pain management by respecting their feelings in each period.

 The purpose of this study was to clarify the characteristics of the care for young children provided by nurses during blood collection at pediatric clinics. A qualitative, descriptive study design was adopted, and participatory observation during 11 blood collection sessions for 2- to 6-year-old children at 3 pediatric clinics was conducted. Semi-structured interviews were employed with 5 nurses in charge of blood collection for young children. We conducted the analysis along the time axis, and as result, the approaches were classified into 4 patterns: 1) performing the procedure alone, 2) requiring partial fixation, 3) requiring fixation by sitting astride the child, and 4) postponing. The nurses focused on treating the children sincerely, “involving parents”, “always with a smile”, and using effective communication skills, which also helped the children face the procedure. However, such effects were not achieved when fixation by sitting astride was chosen, as it reminded the children of their past painful blood collection experiences. When the time was tight before blood collection, the nurses allocated sufficient time to release tension in the children after blood collection. The results suggest the necessity of assessing children and parents before blood collection and converting a painful blood collection experience to a positive experience.

 The purpose of this study was to clarify how nursery nurses involved with children requiring medical care attending nursery schools considered their role based on their experiences of providing medical care. Semi-structured interviews were conducted with 10 such nursery nurses and analyzed qualitatively and descriptively. As a result, the following five categories were extracted: [to help children in medical care get accepted in nursery schools], [to enable childcare professionals to understand the health status and medical care of such children], [to provide medical care in consideration of the flow of childcare], [to enable seamless medical care between home and nursery school], and [to enable children requiring medical care to engage in it independently]. These findings show that it is important for the primary doctor and guardian to cooperate, as is involvement with other children including those requiring medical care. Furthermore, they also indicate the necessity of nursery nurses’ autonomous involvement in medical care to help children requiring medical care become independent.

 Objective: To clarify the exercise and health-related QOL of childhood cancer survivors (CCS) compared with general group. Methods: An anonymous self-administered survey was conducted on exercise and health-related QOL of adolescent CCS within 5 years after discharge who were outpatients, and we matched their age and sex with general group. We analyzed using wilcoxon signed rank test. Results: The median quantity of exercise per week was 90.0 minutes in the CCS group and 391.2 minutes in the general group (p<.001). Health-related QOL physical function scores were 90.6 points in the CCS group and 95.3 points in the general group (p=.001). Discussion: As the quantity of exercise of the CCS group was significantly lower than that of general group, it is necessary to support the continuation of exercise, and to take an approach from the time of hospitalization in anticipation of a decrease in exercise. CCS group tend to have lower health-related QOL physical function. Conclusions: CCS group was significantly lower quantity of exercise than that of general group; thus, it is necessary to communicate the need for exercise and support to minimize the decline in exercise and health-related QOL.

 Minor fecal incontinence or soiling can occur after restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) for ulcerative colitis. As these problems affect the lifestyles of patients, the present study aimed to identify lifestyle problems and coping behaviors among adolescent patients and to examine nursing practices for life after hospital discharge. A semi-structured interview method was used to identify lifestyle problems and coping behaviors among adolescent patients. Subjects were four adolescent patients who had undergone IPAA for ulcerative colitis within 3 years previously. The data collected during interviews were analyzed qualitatively and inductively. Analysis revealed the following lifestyle problems: “daily life with fecal incontinence or soiling, pain, and itching”; “feel bothersome to take health behavior”; “can’t spend the same school life as my friends”; “behind on study”; “difficulty in gaining an understanding from school teachers about themselves with disease”; “worries about the future”. Coping behaviors were “to act conscientiously to control symptoms”; “to spend life in recovery anticipating potential problems that could arise”; “to carry on with school life without forcing oneself, depending on symptoms,” and “to catch up on work that I have fallen behind on”; “act not to get noticed by a friends”; “to seek advice from others when in trouble”. Looking ahead to life after discharge, assistance with coordination with schools and provision of information is needed from the time patients enter the hospital for IPAA.

 This study aims to clarify the factors that affect the disaster preparedness of parents for children with disabilities at special needs schools. An anonymous self-reporting survey was conducted with the parents of children from elementary to high school regarding their disaster prevention awareness, level of disaster preparedness, challenges encountered during a disaster and how the parents coped with them, as well as the forms of necessary support they need. A total of 209 responses was obtained and analyzed using descriptive statistics, t-tests, and multiple regression analysis. Parents with a high awareness of disaster prevention were better prepared for disasters. It was also found that disaster prevention awareness and annual household income influenced disaster preparedness. It was revealed that these parents had higher disaster awareness than the general population. In addition, the parents tended to cater more to their children’s individual needs when preparing for a disaster. This study suggests that it is necessary to increase their imagination for disasters, in addition to strengthened collaboration with schools.

 This study aimed to determine the status of preparation implementation across Japan and clarify its relationship with nurses’ attributes, awareness of the need for preparation, and educational experience to understand challenges to preparation in the future. A survey using an anonymous, self-administered questionnaire was conducted from August 2017 to March 2018. Participants included 1,712 nurses who worked in pediatric wards and pediatric outpatient clinics in both nationwide pediatric hospitals as well as general hospitals with a pediatrics department and at least 400 beds. A total of 741 valid responses were collected (valid response rate: 43.3%). Roughly 80% of respondents had experience with implementing preparation, but less than 50% had implemented preparation in the last three months. Among the five levels of preparation implementation status, few nurses were implementing information gathering and assessment. Factors influencing implementation of preparation were workplace, the number of years of pediatric nursing experience, and educational experience. Challenges going forward include establishment of preparation into everyday nursing, promotion of information gathering and assessment.

 This study sought to identify factors that mothers of children with constant medical needs consider when deciding whether or not to request NICU discharge. We conducted semi-structured interviews with six mothers who were raising children that had been discharged from NICU etc. and that continued to receive medical care as outpatients. We analyzed interview data using the Qualitative Synthesis Method (KJ Method) which is an idea-generating and structure. We found six conditions that mothers experienced during their decision-making processes: (1) seeking coping: proactively searching for how to cope with their own anxiety caused by a constant life-threatening situation, (2) leave of responsibility: passively leaving decision-making to husbands because of feeling overwhelmed by their child’s life-threatening experience and by the weight of fulfilling their other family responsibilities, (3) acceptance of their child’s condition: acceptance by developing a greater appreciation for the preciousness of life, (4) acquisition of information: acquiring reliable information to be able to live with a child with severe medical needs, (5) feelings of happiness among family members: family members feeling happy by spending time with a child with severe medical needs, and (6) construction of a new lifestyle: constructing a lifestyle that provides intensive home-base care. Mothers experienced (1) and (2) as conflicting conditions, and transformed to feel (3). Through (4), mothers felt (5) and reached to (6). These six conditions circulated and developed to a point of decision-making regarding discharge.

 This study seeks to clarify coping and appraisal and describe stress coping in preschool children undergoing congenital heart disease (CHD) surgery and, thereby, obtain guidance for nursing support. A qualitative longitudinal survey was conducted consisting of participant observations. Through 85 observations of four children undergoing CHD surgery, their reactions to surgery-related stress during their ward hospitalization were observed. Qualitative analyses of observation records were performed. The children’s stress coping was divided into six experiences: new environments, additional restrictions, medication, painful procedure, painful examination, and invasive procedure. They showed strong defensive reactions to the following familiar experiences: medication, painful examination, and invasive procedure. However, they showed receptive reactions and only slight defense in the following surgery-specific experiences: new environments, additional restrictions, and painful procedure. The findings strongly encourage the development of useful educational interventions that focus on familiar experiences to promote each child’s stress coping.

 This study clarified the process of therapeutic behaviors until the independence of adult patients who developed nephrotic syndrome in their preschool period. We conducted a descriptive research to analyze five patients who had moved to an adult care facility. Based on analysis results, we generated the following descriptions: “faced the reality of being sick through an uncomfortable hospital stay”, “knew that the disease recurred”, “made a routine of taking a urine dipstick test and oral medicine”, “felt the recurrence was only an error, and were aware they were being sick”, “faced the illness through social life”, “prepared to live with the disease”, “asked questions regarding the treatment and express opinions of recurrence prevention”, and “thought specifically of living with the illness”. From these descriptions, we observed a series of processes for each period experienced by the patients: a period of being passive, a mixed period of being passive and active, and a period of being active. This study suggested that nurses need to help children build on their experiences during their growth and development.

 To clarify mothers’ perceptions regarding the development of school-age children with severe congenital heart disease, we conducted semi-structured interviews of 12 mothers of school-age children with severe congenital heart disease and analyzed the interview results qualitatively and inductively. The mothers had concerns regarding social developmental delays, such as [communication problems], and issues related to physical development, such as [inadequate nutritional intake]. Additionally, they felt that developmental delays and imbalances were [improving] as a result of receiving support in school life. After being worried about and accepting developmental concerns, mothers’ perceptions changed to [being suited to children’s personality] and [expecting that children will be able to reach their potential]. People involved in supporting children with severe congenital heart disease should consult the parents when they are confused and notice the child’s developmental delay, and they should work together to figure out how to interact with the child based on a relationship of trust developed through continuous developmental follow-up.

 The purpose of this study was to conduct cardiopulmonary resuscitation (CPR) education for 5th and 6th grade students to clarify their self-evaluation of basic life support (BLS) before and after the training, the changes in their thoughts on saving a life, and how they felt after the training. A total of 225 5th and 6th grade students were surveyed. The implementation of CPR education improved “self-evaluation of BLS techniques” and “the desire to save lives.” Among the participants, those who had received CPR education in the past had higher “self-evaluation of BLS techniques” and more “thoughts about saving a life” before the implementation of the training than those who had not received CPR education, but the differences between these two groups became smaller post the implementation. The participants’ willingness to learn CPR was high both before and after the education. Furthermore, their impressions after the education revealed that they were “excited about saving lives” and “more motivated to practice CPR,” but they also showed “sense of difficulty with practical skills” and “anxiety about practicing CPR.”

 Objective The objective of this study was to identify the care performed by nurses who support the “ganbatta” behaviors of young children aged 3 to 7 years who were undergoing blood sampling. Method A qualitative inductive analysis was conducted after observing, through observation logs, the “ganbatta” behaviors of young children aged 3 to 7 years during blood sampling as well as the nurses’ behaviors prior to observing the children’s “ganbatta” behaviors. Result The subjects were 20 young children (median age: 5 years and 4 months) who were scheduled to undergo blood sampling. Blood sampling was conducted by eight nurses with a median pediatric nursing experience of 16 years. The following categories were extracted as types of care performed by nurses that supported “ganbatta” behaviors: “creating an atmosphere that encourages young children to do their best”, “providing information that takes into consideration the feelings of young children”, “suggestions that encourage the independence of young children”, “asking questions that promote and confirm the understanding of young children”, “praising the efforts of young children”, and “distraction”. Discussion Based on “creating an atmosphere that encourages young children to do their best”, nurses efforts included making “suggestions that encourage the independence of young children”. Furthermore, “praising the efforts of young children” was suggested as a possible continuous form of support that fosters the children’s independence.

 The purpose of this study was to analyze the situation of “misunderstanding” between nurses and families regarding policies and methods of care for children with disabilities. It also examined nursing support. A questionnaire survey of families of children with disabilities who have availed facilities available for such children or home nursing stations and nurses working at such facilities or at home nursing stations was conducted. There were 55 responses (26.6% response rate) from families of children with disabilities, 109 responses (26.2% response rate) from nurses working at institutions for children with disabilities, and 72 responses (23.8% response rate) from nurses working at home nursing stations. The results suggested that misunderstanding between families and nurses of children with disabilities in care stemmed from the experience of both families and nurses but differed in terms of frequency and perception of content. To resolve the misunderstanding between the nurses and the families, it was proposed that the time spent on communication and conferences with family members and nurses be increased. It was also proposed that the nurses’ sense of difficulty, the “differences” between the families and the nurses, and the time and effort spent on resolving those “differences” be reduced, for the best possible care for children with disabilities and their families.

 This study aimed to describe nurses’ experiences in the pediatric ward by focusing on their perceptions of interaction with parents. Semi-structured interviews were conducted with six nurses. An inductive qualitative method was used to analyze the interview data, and a total of 16 categories were extracted, including: 【Feeling impressions of parents based on the daily situation】,【Feeling the psychological distance from parents based on the manner of speaking and eye contact】,【Thinking about the parents and what I will do for parents】,【Swaying between own role as a nurse and own feelings】,【Recognizing own characteristics】,【Modifying behavior to support parents and children】,【Changing the way I interact according to my psychological distance to parents】,【Sharing feelings with parents】. Nurses perceived mixed feelings and recognized their characteristics in nursing through repeatedly interacting with parents. This finding suggested that nurses had an inevitable subjectivity in consideration of parents. Their subjectivity seem to be related to nursing practice in the pediatric ward.

 PURPOSE: In the pediatric intensive care unit (PICU), there are children with life-threatening conditions, which results to end-of-life (EOL) consequences despite the administration of aggressive treatment. A conceptual analysis was conducted to determine the critical elements of EOL care in the PICU and to identify operative definitions. METHODS: The analysis method of Walker & Avant (2018) was used, and the databases searched included PubMed, EMBASE, CINAHL, PsycINFO, and Icyushi Web (Japanese database). A total of 57 references were included in the analysis. RESULTS: Attribute groups were categorized based on six themes: direct care for children, direct care for families, relationships between families and health care professionals, decision support, bereavement with children, and health care professional readiness. CONCLUSIONS: EOL care in the PICU involved child- and family-centered care that continuously supported the best interests of children and families with diverse developmental stages. Additionally, disease trajectories repeated the shared decision-making process and helped in building relationships based on mutual understanding between families and health care providers.

 The purpose of the present study was to make an assessment tool which assessed mothers who wavered in the process of notifying their children with autism spectrum disorder of characteristics and diagnostic name. In order to refine the assessment tool, semi-structured interviews were performed for nine nursing professionals who experienced nursing care of children with ASD to examine. The obtained data were categorized with perceptions of similarities. As a result of examining the appropriateness of “the trial of assessment tool”, it was confirmed that the perspectives and contents were appropriate for the understanding of mothers’ conditions and providing supports to mothers. However, some points were recognized as in need of improvement: clarification of usage in assessment, changing abstract expressions in assessment items, additional modification in nursing care,. and necessity of the consideration for development stage in the assessment tool. For further examination of feasibility, examination of appropriateness are required for “the assessment tool to support mothers who waver in the process of notifying their children with autism spectrum disorder of characteristics and diagnostic name”.