[ Purpose] This study aimed to identify factors relevant to nursing practice for treatment and care policies (NPTCP) for terminal stage patients on maintenance hemodialysis, by developing and validating a causal relationship model with relevant factors.

[ Methods] We randomly selected 500 teaching facilities, certified by the Japanese Society for Dialysis Therapy, from the facilities providing maintenance hemodialysis throughout Japan. Thereafter, we conducted anonymous self-administered paper- and web-based questionnaire surveys among a total of 2000 nurses, comprising 4 nurses from the dialysis units of each selected facility, to collect data on basic attributes, organizational citizen behavior, career maturity, knowledge on ethics, organizational climate of the unit, NPTCP for end-of-life patients on maintenance hemodialysis, difficulties encountered in NPTCP, managing these difficulties, and ethical concerns of nurses. Structural equation modeling was used to examine the compatibility of the causal relationship model with the data.

[ Results] The compatibility of the developed causal relationship model was measured as a Root Mean Square Error of Approximation (RMSEA) of 0.035, and a Comparative Fit Index (CFI) of 0.938, which met the statistically acceptable level. NPTCP was significantly associated with organizational citizen behavior, knowledge of ethics, organizational climate of the unit, and difficulties encountered in NPTCP.

[ Conclusions] Organizational citizen behavior, knowledge on ethics, and organizational climate of the unit were significantly associated with NPTCP. Thus, increasing these relevant factors appears to promote NPTCP and help end-of-life patients on maintenance hemodialysis to live their lives their own way.

[ Purpose] This study aimed to analyze the concept of “family commitment” to supporting patients receiving end-of-life care at home and define the structure of this concept.

[ Methods] Using a web search engine, we searched the literature published between 2000 and 2022, and 15 articles were extracted. As a result of using Roger’s concept analysis.

[ Results] Family commitment was defined as: “the process in which families incorporate nursing care into their daily lives with a supportive attitude, while striving to develop their own caregiving skills and build a system of support from people around them, so that they can develop a sense of independence and fulfillment, which helps them confront the impending death and prepare for their last moments.”

[ Conclusions] Family commitment shifted to active engagement in care through the process of confronting the patient with emotional bonding as the core. The results also indicated that it involves decision-making at the end of the lives of patients.

[ Aim]　This study aimed to determine the meaning of Anraku to patients in end of life admitted to the palliative care unit.

[ Methods]　Data collection was through fieldwork and unstructured and semi-structured interviews. The analysis was conducted using hermeneutic phenomenology.

[ Results・Discussions]　For patient A, Anraku was not thinking about her upcoming death, but about “living in the moment.” For patient B, Anraku was “the preservation of his ideal self.” For patient C, Anraku was that “he could to comprehend and digest what he was.” For patient D, Anraku was “making it worthwhile to live.” Based on the above, the overall theme was set as “living while maintaining a integrity of one's authenticity.”

In addition, based on the Japanese view of life and death, we consider not only the existence of myself but also my existence as a spirit to be a part of me, and have chosen the theme of “living while maintaining the integrity as one’s authenticity” as the theme of “Anraku.”

[ Conclusion]　This study is suggested that the patient’s “Anraku” should be integrated into spirituality, as the patient’s “Mi.”

[ Purpose] This study aimed to explore breast cancer survivors’ attitudes toward advance care planning (ACP).

[ Methods] This study used a qualitative descriptive design. The data were collected through semi-structured interviews with breast cancer survivors. The reflexive thematic analysis by Braun et al. was used. Narratives of the survivors’ attitudes toward ACP were coded, and themes and subthemes were generated accordingly.

[ Results] The following three themes were identified based on the survivors’ attitudes toward ACP: “Making sense of ACP for me and my family,” “Hesitation toward ACP despite being interested in ACP,” and “Forming an ideal image of the end-of-life stage including my family members and taking actions I can take now.”

[ Conclusions] The breast cancer survivors considered ACP a part of their pursuit of survivor life and that it may help their family to avoid difficulties and lead a peaceful life. Although the survivors wanted to participate in ACP with their families, they hesitated because they felt it would be difficult and wanted to prioritize peace for themselves and their families. The survivors had an ideal image of end-of-life care based on their values and the burden on their families and wanted to take actions that were feasible.

[ Purpose] The objective of this study was to investigate difficulties in palliative care and relates factors of nurses who receive consultations from palliative care teams (PCT) .

[ Methods] A self-administered questionnaire was given to 1230 nurses who receive consultations (consultee nurses) from PCT. The questionnaire included feelings of difficulties in palliative care and IPW competencies.

[ Results] Difficulties in palliative care score and IPW competences score was negatively correlated ( r_s=−.392, p<0.01). On multiple regression analysis, total score of difficulties in palliative care was influenced by “integrated care interaction,” “frequency of attendance of workshops about palliative care,” “experience of cancer nursing,” and “frequency of consultation for PCT” (adjusted R²=.207). 〖Management of team activities〗 ability was negatively associated with difficulty in 【Relief of symptoms】 (β=−.081, p=.042) and 【Communication with patients and families】 (β=−.120, p=.003).

[ Conclusions] The results suggest that improving the ability to practice IPW reduces feelings of difficulties in palliative care. In the future, improving the 〖integrated care interaction〗 ability and encouraging active collaboration with PCT will lead to reduced feelings of difficulties in palliative care for consultee nurses.

[ Objective] This study aimed to determine the promoters and inhibitors of death with dignity among older people requiring care, based on the responses of professionals involved in end-of-life care.

[ Method] Semi-structured interviews were conducted with 14 professionals, including medical practitioners and visiting nurses.

[ Results] Four categories of the promoters of death with dignity were extracted: “older people’s declaration of intent and family’s agreement,” “family acceptance and cooperation in end-of-life care,” “professional knowledge and attitude in end-of-life care,” and “cooperation between the older people/family and professionals.” Four categories of inhibitors were extracted: “difficulties in supporting the older people in expressing their wishes,” “difficulties in providing decision-making support to family,” “choice of hoping treatment even in senility,” and “unclear medical care for senility.”

[ Conclusions] We were able to confirm the perspectives of the older people, their families, and those of professionals as promoting factors for realizing a death with dignity.