This literature review aims to investigate the present state of research into difficulties nurses experience in providing care for elderly patients with dementia in acute care hospitals in Japan.

We searched the Ichushi Web and CiNii databases, using the key terms : “elderly with dementia”, “nurses”, and “difficulties” published from 1982 to July 2017. Nine articles that investigated difficulties nurses had experienced in providing care for elderly patients with dementia in acute care hospitals were chosen for analysis. The articles were classified by author, purpose, subject, methods, and results, and seven of the nine were analyzed qualitatively with the remaining two quantitatively evaluated.

Reports on difficulties nurses experience in providing care for elderly patients with dementia in acute care hospitals began to report in 2002, and the number of studies on this topic has increased since 2012. In the qualitative analysis we classified the difficulties identified in this study population into three types : difficulties arising from understanding problems experienced by elderly patients with dementia, those related to the environment of the hospital, and those related to nursing with respect to elderly patients with dementia. The quantitative analysis showed that many nurses experienced difficulties in this kind of nursing. In future studies, it will be necessary to investigate factors related to the difficulties, such as how serious nurses feel that these difficulties are and what types of nurses strongly feel these difficulties.

When performing oral care in elderly persons requiring nursing care, Fowler’s position, in which the head is raised to an upright position (45-60 degrees), is said to be a safe position in which aspiration is a relatively rare occurrence and patients experience considerably less pain. However, it is not understood how much physical load is caused during oral aperture when in Fowler’s position while undergoing oral care. Therefore, the principal aim of the present study was to examine the somatic effects of Fowler’s position when the mouth was open and closed. We performed an experiment in which 11 elderly women were placed in Fowler’s position when the mouth was open and closed, and performed a comparative examination of blood pressure, pulse, and heart rate variability. When the mouth was open, systolic blood pressure was significantly higher when the patient was in Fowler’s position compared with a pre-experiment supine position (p＝0.021). When the mouth was open and closed, diastolic blood pressure was significantly higher when the patient was in Fowler’s position compared with a pre-experiment supine position (p＝0.014 ; p＝0.006). No significant differences with regard to pulse were noted. There was no significant difference in parasympathetic nervous system activity (high frequency [HF]) or sympathetic nervous system activity (low frequency [LF]/HF) with regard to heart rate variability. These findings suggest that when the mouth is open while in Fowler’s position, the spine and abdominal muscles contract to maintain posture so that the body does not slide down, and systolic blood pressure increases due to the work of the muscles involved in oral aperture.

Objective : This study aimed to use text mining to reveal how people with schizophrenia adapt their identity based on the narrative of their life history, to assist future nursing care.

Methods : A semi-structured interview was conducted with people with schizophrenia who recognized themselves to be ill, perceived their current life positively, and had lived in the same community for at least one year. The interview data were analyzed using text-mining software Trend Search 2015 (SSRI), and relationships between words were examined via a co-occurrence analysis. The analysis was based on the assumption that the characteristics of such relationships could be understood based on word frequencies.

Results : Subjects included 4 men and 5 women (mean age : 46.6 years). Seven out of the nine subjects had developed schizophrenia between the age of 10 and 19 years. The text-mining keyword with the highest appearance frequency and importance index was “think.” The term with the strongest link with “think” was “good,” followed by “able to,” and “fun.” “Medicine” had a strong connection with “taking” and “effective.”

　　Conclusion : “Thinking” and “good” showed a strong connection. This was followed by the strong connection between “able to” and “fun.” This revealed that schizophrenic people found it important to be cognizant of their “good” condition. “Able to” referred to the feelings of confidence generated by the encouragement of others in response to schizophrenic people’s words, and it was an important word with respect to “acceptance.” The subjects felt that it was important to “take” their “medicine,” feeling that it was “effective.” The results evidenced that “accepting one’s illness” and “enjoying one’s life and work” encouraged individuals with schizophrenia to live in a manner true to themselves. To achieve this, it is necessary to conduct assessments to identify support needs and provide such missing support.

The prognosis of elderly patients with hepatocellular carcinoma and concurrent diabetes mellitus (DM) who require hepatectomy is poor because of their high risk of postoperative liver failure. Although the effectiveness of perioperative administration of branched-chain amino acids (BCAA) has been previously reported, its effectiveness in elderly patients with DM remains unclear. In this study, we examined the effect of preoperative administration of BCAA in middle-aged hepactomized rats with DM. A total of 22 middle-aged male Fischer 344 rats were treated with streptozotocin to induce DM and were randomly divided into two groups : 11 rats received BCAA solution and 11 rats received water for 7 days prior to surgery. Two-thirds hepatectomy was performed in all rats. The survival rate, body weight reduction rate, blood sample data (blood sugar, aspartate aminotransferase, alanine aminotransferase, endotoxin, tumor necrosis factor-α, and interleukin-6), and the bromodeoxyuridine labeling index were evaluated 48 h post-surgery. The survival rate of the BCAA group was significantly higher than that of the control group (91 vs. 54%). The rate of body weight reduction in the BCAA group was significantly lower than that in the control group 48 h after hepatectomy (9.2±2.7 vs. 13.0±3.7%, means±SD). No significant differences in blood sample data, resected liver weight, or remnant liver weight were observed between the two groups. The bromodeoxyuridine labeling index in the BCAA group was significantly higher than that in the control group (14.5±1.7 vs. 11.7±0.8%, means±SD). The present study demonstrated that preoperative administration of BCAA improved postoperative prognosis in middle-aged hepactomized rats with DM.

The purpose of this study is to review the content and face validity of the draft to develop a nursing competency scale (hereinafter referred to as “scale plan”) at intensive care homes for the elderly (hereinafter referred to as “intensive care homes”). A self-administered questionnaire survey was carried out on two separate occasions about the scale plan which had been prepared based on concept analysis and an interview on nurses working at intensive care homes. The first round of the survey targeted 7 nurses who had reported on nursing care practice at intensive care homes in academic journals or professional magazines. They were asked if the expressions of the items were appropriate, and if there was a need for any items to be added or deleted. The second round conveniently sampled 10 persons, including nurses who had submitted reports on nursing care practice at intensive care homes in academic journals and professional magazines, and researchers of elderly-nursing science versed in developing a nursing competency scale. They were asked to evaluate the relation between the items and the constituent concepts of the scale plan using content validity index. As a result, in reference to the freely-described opinions from the first survey, expression of 32 items was revised. In the second round of the survey, all items received a content validity index of 0.8 or higher, and thus they were all adopted. Reflecting the opinions of experienced nurses and researchers of elderly-nursing science obtained from the two-tier survey, item descriptions were revised to versatile expressions which can be evaluated.