This study analyzed 30 previously published studies by using the concept analysis approach of Rodgers (2000) to clarify the concept of “holistic care” in nursing in Japan. The following 4 categories were extracted as attributes：“ascertaining the overall situation and getting involved,” “mitigating the threat to the patient’s existence and healing,” “being with the patient and showing compassion,” and “respecting the patient’s humanity and individual essence.” Five categories related to threats, seeking, unfulfillment, qualities, and change/diversification were extracted as antecedents in 3 contexts (patients and their families, nurses, and society). Four categories related to release, recovery, and growth were extracted as consequences. Taken together, “holistic care” was defined as respecting the humanity and individual essence of patients by healing them and mitigating the threat to their existence and showing compassion based on the attitude that nurses should try to fully understand and be involved with patients when patients feel that their existence is threatened and desire respect for their own humanity and individual essence. Following this approach will recover the patient’s humanity and their individual essence while facilitating the growth of those involved.

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 Purpose : The purpose of this crossover study was to investigate the degree of skin extension around virtual surgical wounds produced by different bed-bathing techniques.
 Methods : The participants were 15 healthy adult men. We conducted three types of partial bed-baths on different days on the following three groups : a low-extension group, in which the side of the palm was placed near the virtual surgical wound and the skin was wiped toward the wound ; a middle-extension group, in which the side of the palm was not placed near the virtual surgical wound and the skin was wiped toward the wound ; and a high-extension group, in which the skin was wiped parallel to the virtual surgical wound. We used a cotton towel to wipe the upper-left abdomen nine times (for 30 seconds) with constant pressure, according to the bed-bath method. The evaluation criteria were the degree of extension of the virtual surgical wound, level of pain, extension length of the wound, blood pressure, heart rate, and autonomic nerve activity. The degree of extension of the virtual surgical wound and level of pain were evaluated by visual analogue scale (VAS).
 Results : The VAS of the low-extension group was the lowest, and the degree of extension in the high-extension group increased significantly after the bed baths (P＜.05). The extension length significantly extended in the direction of the wound in the middle-extension group and away from the wound in the high-extension group (P＜.01). Furthermore, sympathetic nerve activity increased in both groups.
 Conclusion : These results suggest that placing the side of the palm near the surgical wound and wiping toward the wound are effective for avoiding extending the wound and decreasing wound pain.

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 This study aims to identify the thoughts (ideas) of expert nurses of cancer palliative care about daily life assistance of terminally-ill cancer patients considering safety and comfort. The researcher observed 7 expert nurses of cancer palliative care providing daily life assistance, and conducted semi-structured interviews using the observation data. The qualitative and descriptive analysis of the interview data identified 7 categories including［Attaching importance to the comfort and distress-free life of patients］,［Thinking of the ways the patients themselves wish to spend their time］,［Thinking of how patients may wish the end of life to be］,［Thinking about the risks and benefits patients are exposed to］, and［Exploring the aspects where patients, their families, and nurses are all satisfied］. The findings suggest that expert nurses of cancer palliative care are evaluating how to maintain balance between safety and comfort by considering the risks and benefits to patients and exploring the aspects where patients, their families, and nurses are all satisfied, while thinking about the comfort of terminally-ill cancer patients.

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 The purpose of this study is to compare bath oil bed bath and hot water bed bath to clarify whether bath oil bed bath has a moisturizing effect on the skin. This study was conducted on 27 elderly people aged 65 and over who live in the community. The bath oil bed bath and hot water bed bath were performed on the left and right forearms at random, respectively, and the TEWL and Stratum Corneum hydration were measured immediately before, immediately after wiping , and after 3, 5, 10, and 20 minutes. As a result, there was no interaction between the bed bath method and the passage of time. In addition, there was no difference in the effect on the skin moisturizing function by the difference in the bed bath method. When compared with the value immediately before wiping, TEWL showed a significant increase immediately after wiping and at all measurement time point. Stratum Corneum hydration showed a significant increase immediately after bed bath and a significant decrease after 10 and 20 minutes.
 From these results, it is clear that the bath oil bed bath does not show a skin moisturizing effect as compared with the hot water bed bath.
 In addition, it became clear that the skin of elderly people was prone to dryness even with a weak stimulus of a bed bath. Therefore, it was suggested that healthcare workers should give careful consideration to the skin when doing a bed bath of the elderly.

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 The aim of study was to examine the clinical utility of the water-less scrub method under the experimental conditions. A randomized control trial with a counter-balanced design, including 19 adults (ten women), was performed using three methods, i.e., the water-less scrub method, the hand wipe method, and the control. Three indexes were used to evaluate the effects of various strategies：total colony counts on the hand, bacterial identification, and a subjective evaluation of comfort using the visual analogue scale (VAS). The total colony counts after using the water-less scrub method and the hand wipe method were significantly lower than those for the control. However, no significant difference in bacterial count was detected between the water-less scrub method and hand wipe method. Hand hygiene by the water-less scrub method was most effective with respect to bacterial elimination among the three methods. Gram-positive rods, gram-positive cocci, gram-negative rods, non-fermenting gram-negative rods, yeast-like-cells, and mold were evaluated. Bacterial species associated with food poisoning, including gram-positive rods as well as non-fermenting gram-negative rods, which are opportunistic pathogens, were significantly reduced by the water-less scrub method and the hand wipe method in comparison with the control. Moreover, the VAS scores for comfort were significantly higher for the water-less scrub method and the hand wipe method than the control, respectively. These findings suggest that hand hygiene by the water-less scrub method could be useful for bacterial elimination, particularly in emergency acute situations such as the disaster areas, and is a convenient for practical applications, similar to the hand wipe method.

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 The purpose of this study was to examine the physiological responses to the application of a hot compress to the buttocks as the first step to consider preventive intervention for induration caused by intramuscular injection. We measured the physiological response when a hot compress with a hot pack was applied to on one side of the buttocks for 15 minutes in 9 healthy women. In an artificial climate chamber, we measured the skin blood flow and skin temperature of both buttocks, the tissue blood flow and the tissue hardness of the buttocks on the intervention side, rectal temperature and tympanic temperature. We observed the skin symptoms of the buttocks and interviewed the subjects about the degree of comfort or discomfort. The results were analyzed by the Mann-Whitney U-test and Friedman’s test.
 The skin temperature, skin blood flow and tissue blood flow of the heated buttock were significantly increased by the hot pack application. These findings suggest that applying a hot compress to the buttocks may prevent induration of the injection site. The tissue hardness of the heated buttock was not changed by the hot pack significantly. Therefore, we could not verify the stretching effect of the subcutaneous and muscular tissues by heating. Changes in tissue hardness should be evaluated before and after injection in patients.

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 To examine whether hand baths promote dietary intake, this study clarifies the impact of pre-meal hand bath that is intended for use in clinical settings on biological functions using the autonomic nervous system activity, heart rate, and blood pressure as indicators. A total of 19 healthy men (mean age, 21.9±3.6 years), who were sequentially assigned to the experimental (n=11) and control (n=8) groups, were enrolled in the study. The hand bath procedure was as follows : both hands were soaked in 40℃ water, washed with soap, soaked again, and then dried with a towel. The control group followed the same steps but using an empty bowl and not using soap. The result showed that pre-meal hand bath did not activate the parasympathetic nervous system, but it may have stabilized the accelerated sympathetic nervous system activities. As such, hand baths could be used to prevent the suppression of enterokinesis and secretory function by stabilizing the accelerated sympathetic nervous system activities.

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 The present study was conducted as part of an evidence-based nursing project to investigate extravasation of administered catecholamines using a rat model. Skin lesions were induced in rats by subcutaneous injection of catecholamines into the back skin, and then observed macroscopically and histologically for 7 days.
 Histological examination revealed an acute inflammatory reaction in the subcutaneous tissue on the first day, irrespective of whether or not ulcers developed, and the damage remained until the 7th day. Rats that developed ulcers showed multiple thrombi and damage to vascular endothelial cells in the subcutaneous tissue, the former persisting up to the third day. This confirmed that ulcers resulting from extravasation of the catecholamines were related to continuous circulatory disturbance due to multiple thrombus formation.
 These findings suggest that extravasation of catecholamines is significant because it results in continuous damage to subcutaneous tissue, even if the extravasation site appears macroscopically normal.

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 This study reviewed Japanese and foreign studies up to February 2019 on the use of hand baths, investigated the study designs and hand bath methods used, and described the physical and psychological effects of hand baths. In total, 12 studies identified from literature searches in PubMed, CINAHL Plus with Full Text, Cochrane Library, CiNii, and Ichushi-Web were included in this analysis. Among these 12 studies, 3 were RCTs, 4 were non-RCTs, and 5 were before-after studies. In most studies, hand baths were taken for 10 min at a water temperature of 39℃-42℃ with the hands immersed to the level of the radial styloid process. Moreover, the skin temperature-elevation effect of the hand baths was pervasive, and skin temperature increased in some areas that were not immersed. This suggests that hand baths have the effect of warming the body. The immersed areas of the hands must be covered to prevent a skin temperature drop and maintain the increased skin temperature achieved following the hand baths. Further, receiving a hand massage during hand baths seemed to increase the perceived warmth.

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　The aim of this study is to clarify the effects of hand baths on the autonomic and nervous systems. For that, we divided subjects into two groups, a hyper-sympathetic tonus group and a hyper-parasympathetic tonus group. Two measurement paradigms were used : Subjects’ autonomic reaction to hand baths was measured using heart rate variability and the central reaction of the frontal lobe was measured using Near-Infrared Spectroscopy (NIRS). In total 20 subjects participated. The experimental conditions included both a hand bath with 38℃ water for 5 min and a naïve control. Results indicated that in the hyper-sympathetic tonus group the hand bath reduced sympathetic activity and increased both parasympathetic activity and subjective feelings of relaxation. On the other hand, in the hyper-parasympathetic tonus group the hand bath increased sympathetic activity, reduced parasympathetic activity, activated the frontal lobe and activated vitality. These findings indicate that hand baths help to balance the autonomic nervous system and induce positive subjective feelings.

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 This study investigated the effects of applying a hot towel to a patient's back for ten seconds prior to wiping the skin (AHT10s) during a bed bath. We examined whether this procedure increased the skin's barrier function, thereby improving patients' cleanliness, skin temperature, and subjective evaluation of the bed bath. We conducted a crossover study with thirteen healthy adults (mean age : 24.1±1.5 years). Each participant received a bed bath with AHT10s and also a bed bath without hot towel application. The stratum corneum water content, transepidermal water loss（TEWL）, skin temperature, participants' sebum, and adenosine triphosphate (ATP) levels were measured during the bed bathing sessions, and the experience was subjectively evaluated by participants. There were no significant differences between the two types of bed baths in terms of stratum corneum water content or TEWL, which are indicators of the skin's barrier function. Furthermore, participants' sebum and ATP levels decreased significantly for both types of bed baths. Thus, following a bed bath, skin becomes cleaner without decreasing the skin's barrier function, regardless of whether a hot towel is applied for ten seconds to the back of healthy adults. We also found that a bed bath with AHT10s raised skin surface temperature by 2.2℃. After fifteen minutes of dry wiping, a bed bath with AHT10s provides significantly more comfort to subjects than a bed bath without hot towel application.

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 This study aimed to investigate the synchronization of heart rate variability, as well as the autonomic nervous activity and subjective indicators, when two individuals engage in conversation with physical contact. A total of 49 healthy men and women older than 18 years old participated in the study. Each participant was paired with another participant of the same sex and of similar age, whom he/she had never met before. The pairs were assigned to the intervention and control groups. As an experimental task, the participants in the intervention group were asked to engage in physical contact in addition to conversation. The results showed that synchronization of heart rate variability occurred in the intervention group. However, no significant difference in heart rate variability was observed between the two groups. The indicators of sympathetic nervous activity showed significant reductions in the latter half of the conversation in the intervention group relative to the control group. Subjective indicators were significantly higher in the intervention group than in the control group with respect to pleasant feelings during conversation, impression of the conversation partner, and effectiveness of physical contact. The feeling of resistance to being touched was associated with many items. These results have implications for nursing care : the recognition of physical contact for both the patient and the nurse needs to be assessed.

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 The purpose of this study was to investigate the effect of self-exercise for pain in face-down positioning, which is the assumed posture following vitrectomy. Self-exercise included neck and shoulder stretching.
 This experiment was conducted on 23 healthy adult volunteers (22.6±2.8 years old) under two conditions. The two conditions were face-down positioning only and face-down positioning plus self-exercise. Study participants maintained a face-down positioning for 90 minutes. Self-exercise was performed beginning 45 minutes after the start of positioning for 5 minutes. Evaluation included a profile of mood states, subjective pain, heart rate, heart rate variability, blood pressure, skin temperature, skin blood flow, etc.
 In contrast to face-down positioning only, the self-exercise condition resulted in a lower fatigue score (P=0.039), a lower level of subjective pain in the shoulders (P=0.049), and no decrease in diastolic blood pressure (P=0.040). Therefore, this study exhibited that support for pain relief in the shoulder region can be expected with the implementation of self-exercise during face-down positioning after vitrectomy.

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 The objective of this study was to revise the bowel movement record form and update version 2 of the flowchart－which the authors created to evaluate the necessity of nursing intervention for bowel movements (Kira et al. 2016)－based on the evaluation of classification accuracy of bowel movement patterns.
 We asked nurses and nursing students to classify bowel movement patterns using the flowchart based on the six types of bowel movements described in a simulated 2-week bowel movement record. Based on the analysis of factors that caused errors in classification, the bowel movement record form was revised and the flowchart was updated from version 2 to version 3. As a result, the number of correct classifications of the six types of bowel movements increased significantly, and the accuracy of classification of each bowel movement pattern increased significantly. However, few bowel movement patterns were classified with an accuracy of 80% or less. Based on further analysis of these results, a new bowel movement record form and a version 4 of the flowchart were proposed.

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 This study examined where and why barriers exist in the cognitive process that inhibits nurses’ ability to recognize the immediate needs of patients. A literature review of previous studies was conducted.
 Barriers inhibiting the recognition of patient needs include : nurses are inattentive in areas they should observe if not knowing what to observe ; when being focused on their regular duties, nurses are either inattentive in areas they should observe or even if they happen to see something, they do not actually recognize it ; and, in particular, nurses with no knowledge or experience do not actually recognize something even if they happen to see it.
 Observation scenarios were divided into nurses noticing patient surroundings and risk awareness, while undertaking regular nursing duties ; however, nurses’ observation and recognition of the patient’s needs were not reported. Future research should explore in more depth nurses’ ability to recognize patient needs.

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 Novice nurses often find venipuncture more difficult to learn than other nursing skills. We developed an educational program for acquiring blood sampling skills involving expert nurses’ palpation skill for locating a venipuncture site. This pilot study aimed to conduct the educational trial to nursing students and to consider the improvements from nursing students’ self-evaluations. Fifteen nursing students were allocated to either the new program group (n＝7) or the conventional program group (n＝8). We conducted both programs and administered a nursing skills examination to the participants. Six participants (85.7%) in the new program group and two participants (25.0%) in the conventional group could select the appropriate venipuncture site, where was the same site that four expert nurses selected. The results showed a significant relationship between participation in the new program and selecting the appropriate venipuncture site during the examination (P＝.041). The participants’ achievement level in the conventional group was not regular and not completely “adequate,” as some of them could not palpate a vein. However, participants in the new program group achieved “adequate” or “excellent” results. Thus, future improvements can be made to nursing skills training based on this new program to improve knowledge of the anatomy of the cubital fossa and to provide more experience to nursing students when identifying various vein features through palpation.

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