This study investigated the diffusion of pressure ulcer care, an innovative strategy in nursing practice, in Japan by reviewing relevant literature and supporting evidence as well as through interviews. The study also analyzed the results on the basis of the theory proposed by Everett M. Rogers on diffusion of innovations to reveal the factors affecting the diffusion of pressure ulcer care. The first factor promoting the diffusion of pressure ulcer care was the presence of more than one change agents who were deeply interested in the relevant phenomenon and actively involved in practical care. Other factors related to diffusion were many local opinion leaders with the necessary skills carrying out practical care on-site along with change agents and the effective use of various communication channels such as mass media and scientific meetings. In addition, it was shown that both basic researches and clinical studies should accumulate scientific evidence in regard to this innovation of pressure ulcer care. Specific factors relating to pressure ulcer care were a longstanding feeling of inadequacy and tangible effects.

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　The purpose of this study was to investigate the effects of hot compress as an effective vasodilatation method for peripheral venipuncture. The subjects of this study were 25 healthy volunteers, and the effects of hot compression on the left median cubital vein were studied using cross-over trial. The hot compress was applied to the forearm for 15 minutes so that the skin surface temperature under the hot compress became 40±2℃. As tourniquet pressure affects vasodilatation, it was set constant at 60mmHg using a manchette.
　The results showed that the hot compress significantly increased skin surface temperature, blood flow rate, and venous cross-sectional area. The venous cross-sectional area was increased by 16.8% after the hot compress. Moreover, the increase rate of the venous cross-sectional area was greater in the subjects whose fingertip temperature was lower. The result suggested that appropriate assessment and selection of the subject was preferable for optimal vasodilatation by the hot compress.
　In conclusion, hot compress to the arm for 15 minutes at 40℃ was effective for vasodilatation.

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　A nano-mist shower (NMS) is able to remove foreign substances from the scalp by detergency action, making possible hair washing without shampoo. In this study, we examined the washing effects of NMS and compared the results with hair washing using tap water and shampoo (TS).
　There were 35 participants, whose mean age was 30.9 (±9.2S.D.) years. Each participant’s hair was washed again by either TS or NMS. Before and after the each hair washing, we checked the detergency effects on the scalp, including ATP level, sebum, and subjective assessment by visual analog scale into five grades. In addition, washing time and quantity of water used were measured. The level of significance assumed it 5%.
　The ATP level was significantly decreased by both NMS and TS. After NMS it decreased from 7381±7171RLU to 4317±3236RLU, and after TS it decreased from 7763±9977RLU to 5921±1782RLU. Sebum was also significantly decreased in both NMS (from66±30 to 11±9) and TS (from 93±25 to 4±2). Thus, comparison by ATP and sebum levels showed no significant differences between NMS and TS. Subjective assessment showed significantly reduced “tackiness” and “unpleasant smell” by both methods, while NMS was rated significantly inferior on “sound” , “refreshing” and “smell” . Mean washing time by NMS was 231±34sec, and by TS it was 524±81 sec. The quantity of used water in NMS was 4.4±0.8l and by TS it was 18.5±2.2l.
　Our results suggested the usefulness of NMS that it was as effective as TS in detergency, as well as being faster and more water economical.

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　As a basic research to assist people who are oversensitive to cold, we investigated the relationship between peripheral and cardiac autonomic nervous response indices when hot compress was applied to healthy women. A hot compress was applied to the lower back region for 120 min, and the skin surface temperature and RR interval were then measured. The peripheral autonomic nervous response index indicated the skin surface temperature gradient, whereas the cardiac autonomic nervous response index indicated the RR interval. The sympathetic and parasympathetic nerve indices were determined using Lorenz plot analysis. Results showed that the cardiac parasympathetic nerve index was lower when hot compress was used for 120 min compared with that when hot compress was not used. The skin surface temperature gradients showed no significant difference after 120 min and were reduced more with the application of the hot compress than without it. The parasympathetic nerve index was higher after 120 min compared with that at the starting point both with and without hot compress, although no significant difference was observed between the conditions. The relationship between peripheral and cardiac sympathetic nerve indices revealed no correlation between both the conditions. Based on these results, we conclude that when a hot compress is applied, the relationship between peripheral and cardiac autonomic nervous response indices may cause regional differentiation of sympathetic efferents.

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　The purpose of this study was to evaluate the effect of a self-management program with coaching for outpatients with urge incontinence. The Subjects were twenty-one outpatients with urge urinary incontinence. We analysed the presence or absence of languages showing the coaching basic elements in the guidance on self-management by the GROW model. Participants’ voiding symptoms, implementation frequency of self-management, and Urinary Incontinence Quality of Life Scale (IQOL) scores were compared before and one month after receiving guidance on self-management. All subjects, save one, had been exposed to some of the languages showing the coaching basic elements of GROW model in the past. After the self-management program, IQOL scores (p ＜0.05), once voided volume (p ＜0.001) and the implementation frequency of self-management (p ＜0.001) all significantly increased. In addition, the frequency of urination during the day (p ＜0.05) and at night (p ＜0.01) decreased. Furthermore, a significant difference was observed in “imagination of options” (p ＜0.05) and “resource discovery” (p ＜0.001) between patients with high IQOL scores and those with low IQOL scores and those with low IQOL scores.
　We found that a self-management program offering coaching to outpatients with urge incontinence appeared to help improve patients’ self-management ability, reduce their symptoms, and enhance their quality of life.

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　The standard voiding position for individuals using a bedpan or urinal involves elevation of the head by 60 degrees from the bed because this reduces the intra-abdominal pressure and is considered comfortable. Nursing technical literatures mention a range of head-elevation angles but do not specify the optimum angle. This study focused on the relation between intra-abdominal pressure and various head-elevation angles when using a bedpan. We evaluated 14 healthy young women (average body mass index, 21±3.08) aged between 18 and 22 years. Surface electromyography was used to measure max abdominal pressure at 3-s intervals during normal respiratory movement with a range of head elevation angles (at 75, 60, 45, 30, 15 and 0 degrees). No significant difference was observed between intra-abdominal pressure and elevation angles.

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　Personal hygiene care has been neglected as part of routine nursing practice in Japan because of advancements in medical treatments and short hospital stays. As a result, bed baths given using steamed towels are becoming common, and patients are increasingly discharged from hospitals without being given an assisted shower or bath. It is debatable whether this practice satisfies the needs of patients. In the present study, we interviewed patients receiving personal hygiene care provided by nurses and examined how they perceived the care.
　We conducted semi-structured interviews with 6 inpatients who could communicate verbally and who were receiving total assistance and personal hygiene care. The patients’ responses were analyzed using a qualitative descriptive method, which revealed the following results.
　The patients were “satisfied with the detailed care” and were “satisfied with the adequate duration and methods.” However, the patients felt “dissatisfaction because of the‘brusqueness’of the care” provided by the nurses and “expected and hoped for safe and comfortable care.” These results demonstrate that although the patients felt that they were respected by the nurses, they wished to be provided with safe and comfortable care.

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　The objective of the present study was to create a provisional assessment scale for developing an assessment scale for the eating and swallowing functions of tracheostomy patients. For the provisional assessment scale, a total of 75 items having face validity were identified based on existing literature and the experiences of certified nurse specialists and certified nurses in the field of critical care. The items were then classified based on their characteristics into “items of observation by nurses” (n＝43), involving assessment by nurses, and “items on questions for patients” (n＝32), involving assessment by patients, resulting in two scales. Using these scales, the eating and swallowing functions of 14 tracheostomy patients admitted to the intensive care unit (ICU) were assessed a total of 18 times. Cronbach’s α was 0.94 for “items of observation by nurses” and 0.72 for “items on questions for patients” . In addition, a significant correlation was observed between the scores for “items of observation by nurses” and “items on questions for patients” (r ＝0.78 ; n=18, p ＜0.001). It is necessary to verify the usefulness of the present tool in the future by increasing the number of subjects for assessment and enrolling a more uniform group of subjects in order to develop a standardized assessment scale for eating and swallowing functions of tracheostomy patients.

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