Objective: To investigate the factors associated with self-efficacy on health behavior among middle-aged and elderly patients with rheumatoid arthritis (hereafter RA).
Methods: A total of 262 RA patients aged at 40 years old and over who visited A Clinic, where an RA specialist provided healthcare services, in Tokai region. Each participant was interviewed with using a questionnaire. The questionnaire contained basic attributes, disease status (joint pain, general physical condition, disease activity, and degree of disability in activities of daily living), the scale of self-efficacy on health behavior in chronic disease patients (CD-SES), anxiety, depression, the social support scale for chronic disease patient (social support).
Results: There was no significant associations between basic attributes and CD-SES. All of the scores of disease status, anxiety, and depression in the low CD-SES group were significantly higher than the high group. The total score of social support of the low CD-SES group was significantly lower compared with the high group. Logistic regression analyses showed that disease status, anxiety, depression, and social support, significantly associated to CD-SES.
Conclusion: The self-efficacy of middle-aged and elderly RA patients for health behavior was associated by RA status, psychological factors, and social factors.

Objective: This study aimed to clarify moral sensitivity and related factors among outpatient nurses in advanced treatment hospitals and regional medical care support hospitals in Japan.
Methods: We conducted an anonymous self-administered questionnaire survey of 961 outpatient nurses at advanced treatment hospitals and regional medical care support hospitals. We calculated the scores of the subscales and items of responses to a moral sensitivity test (Japanese version). Of the subscales, “Understanding of a patient,” “Responsibility/safety,” and “Fidelity” had a Cronbach’s alpha of ≥0.5. Association between these subscales and individual and workplace characteristics was therefore analyzed using the Wilcoxon test or Spearman’s correlation coefficient.
Results: There were 560 responses and 443 valid responses (response rate, 58.3%; valid response rate, 46.1%). The surveyed nurses had an average 20.9 years of experience. “Understanding of a patient” yielded the highest score among the subscales. It was also found related to being married, family nursing experience, worries about ethical issues, being a certified nurse/certified nurse specialist, and the hospital having an ethics committee. “Responsibility/safety” was related to education, worries about ethical issues, and the hospital having an ethics committee. “Fidelity” was related to nurses’ sex, bereavement experience, job description, being a certified nurse/certified nurse specialist, nursing ethics training, need for ethics education, and the hospital having an ethics committee.
Conclusions: The results indicate that to enhance the moral sensitivity of outpatient nurses, it is necessary to systematically work on ethical issues, study sessions, and creating a system that facilitates consultation.

Objective: Inflammatory bowel disease (IBD) is evaluated based on its severity using a disease activity index; however, the existing index has limitations in understanding the patient’s condition to provide nursing help. Therefore, we developed evaluation items of disease activity from the view point of nursing and aimed to examine its content validity.
Methods: We extracted descriptions of disease activity from previous studies and obtained 967 codes. Then, 92 items were created based on the results of NVivo qualitative analysis software, and deductively aggregated to the domain of disease activity as defined by the author. The final items were presented to nurses skilled in IBD nursing, and their opinions were collected in focus group interviews, and the final items were those for which consensus was reached by the IBD nursing expert council.
Results: A total of 85 items were refined: 11 for inflammation, 9 for subjective symptoms, 34 for quality of life, 25 for the treatment, and 6 for IBD recognition. Subsequently, the surface and logical validities of these items could be confirmed.
Conclusions: The content validity of the IBD activity evaluation items captured by nurses was confirmed by FGI for nurses skilled in IBD nursing. The items in this assessment reflect the IBD characteristics, characterized by a discrepancy between findings on examination and symptoms, and their usefulness in clinical practice may help us understand the hidden needs of patients associated with the disease and to provide nursing help based on the goals of IBD treatment and individual patients’ own personal goals.

Objective: This study identified the challenges of post-discharge care, based on the status of awareness of nurses of acute-care hospitals in supporting patients’ ways of life after discharge.
Methods: We asked 1,658 subjects an open-ended question, “What do you feel about care provided to support patients’ ways of life after discharge?”, and qualitatively analyzed their answers.
Results: Responses were obtained from 122 subjects. The written answers were classified and categorized according to their similarities. The results were divided into the following seven categories, of which the first six impeded post-discharge support-provision: (1) Difficulty in predicting actual living situations after hospital discharge, (2) Difficulty in establishing rapid collaboration with different professionals in preparing for life post-discharge, (3) Difficulty in providing support due to the working environment in acute-care hospitals, (4) Difficulty in providing support due to problems related to aging society, (5) Difficulty in ensuring that the awareness and understanding of hospital discharge among the patient, their family, and healthcare personnel are at par, (6) Lack of knowledge and implementation capabilities among nurses themselves in terms of post-discharge support; and the final category positively acknowledged the support-provision, (7) Nursing skills and capabilities are essential to realize the provision of support.
Conclusion: Although nurses understood the necessity of support, they felt difficulties in the current situation of acute care hospitals where they could not practice as they wished and in their individual abilities. It is an issue to strengthen the cooperation among nurses and to examine the factors of difficulty.