1.　Basic concept of the quality of life (QOL) coordinate theory

I abridged the four elements that define health in the World Health Organization Constitution (“complete physical, mental, spiritual and social well-being”) into two elements to create QOL coordinates. The x-axis for the QOL coordinate represents the life function axis, and the y-axis is the life happiness or spiritual axis. QOL coordinates thus express QOL for an individual. I examined and verified the validity of QOL in this article, as the basic concept for QOL coordinate theory.

2.　Development of the QOL coordinate theory

1) The characteristic feature of QOL coordinates is that, like people, they are inherently unique. Although “before” and “after” comparisons are possible for an individual using current QOL metrics, comparison between individuals is almost impossible.

The point of promoting QOL (QOL Promotion) is to improve QOL through care as an important goal in life. Through care, QOL moves toward the top right corner of the QOL coordinate axes. Care supports self-realization and self-growth of the individual and is thus accompanied by improvements in hope.

2) I showed a process of decline for elderly individuals in terms of QOL coordinates

Maintaining “high quality of life” (H-QOL) in the elderly is achieved with “activity theory” and “withdrawal theory” related to social activities. In subsequent stages, H-QOL is achieved through “gerotranscendence” theory in relation to aging. If QOL is classified as satisfactory, natural, or lonely, quality of death (QOD) will reflect this by being satisfactory, natural, or lonely, respectively.

3) In addition, satisfactory death and lonely death were not influenced by being surrounded by family at the time of death. Rather, QOD was more closely related to “independence of spirit”.

4) I incorporated the five phases from Benner’s theory of nursing skill acquisition into this theory and considered the effects of care on QOL coordinates. As a result, I considered it appropriate to call the two axes of nursing skill acquisition the “evidence axis” (scientific intellect or theoretic intellect) and “humanism axis” (caring).

5) The vertical (spiritual) axis in the QOL coordinate theory is in broad concordance with a human study clarifying human nature by Pascal. Similarly, 80 years ago, Karel strongly promoted qualitative studies over quantitative studies of human essence.

6) Mandala includes both a physical world and a spiritual world. The world after death thus resembles this world. There would be truth, beauty and fact in the next world, and those would be almost the same as in this world. The fear of death would be mitigated by belief in such a “next world”.

This study clarifies promoting factors and inhibiting factors for people to consult doctors after they were found in a health examination to be possibly diabetic. Ten patients who were found in the health examination to be possibly diabetic were interviewed in a semi-structured way and analyzed qualitatively. As a result, the following four categories of the promoting factors were identified : “Being worried about one’s own health because of age or clinical history,” “recognizing the necessity of consulting a doctor by self-assessment of the result of the health examination or by advices from others,” “being recommended by the workplace or local government,” and “few restrictions in consulting a doctor.” In addition, the following four categories of the inhibiting factors were identified : “Having no subjective symptom or recognizing no risk of disease,” “believing that I can manage the necessity of further detailed examination,” “not understanding the meaning of the result of the health examination or not knowing where to consult,” “feeling like a burden or resistance to consulting a doctor.” These results indicated that the result of the health examination on the necessity of further detailed examination could not always make the patients fully recognize the necessity and that it was important for nurses to intervene in the health examination and help the patients correctly understand the result of the health examination.

〔Purpose〕 The study aimed to examine changes in organizational commitment during the first three years after joining the organization, and to ascertain the association between organizational commitment and individual mental state, which are considered important to career development.

〔Method〕 Questionnaires were distributed, once a year, to 329 newly-graduated nurses at eight hospitals in the Kanto Koushinetsu area once a year for three years.

Organization adaptation and psychological conditions were measured by the organization commitment scale, self-efficacy scale, locus of control scale.

〔Result and Discussion〕 Scores on organizational commitment, self-efficacy, and locus of control for each year, and their changes over time. Scores decreased significantly from Year 1 to Year 3, but only in the overall organizational commitment score and that on the purpose subscale. The result showed significantly higher self-efficacy and locus of control scores in the high rather than the low organizational commitment group in Year 1 (p<.01). In Year 2, the high organizational commitment group exhibited a significantly higher score only on self-efficacy (p<.01). Furthermore, in Year 3, similar to Year 1, the high organizational commitment group exhibited significantly higher scores on self-efficacy and locus of control as compared to the low organizational commitment group (p<.01). The self-efficacy scores tended to increase from Year 1 to Year 3, and the locus of control scores decreased significantly from Year 1 to Year 3. This demonstrates a tendency in which confidence and conviction are gradually reinforced as one gains more experience as a nurse, as well as that in which the criteria of judgment rely more on external factors. Thus, while nurses gain confidence, they are not yet capable of autonomous judgment. Self-efficacy is considered beneficial for overcoming the period of suffering and difficulties during the transitional phase of one’s career. Then nurses feel confused by the various professional experiences right after joining the organization, and we must examine in detail what types of experiences are helpful to them.

Purpose : To clarify the salty taste sensitivity among community-dwelling older people and investigated how the salty taste sensitivity is related to social attributes, health consciousness, and dietary habits.

Methods : The survey was conducted in August 2018. There were 310 participants aged 65 years or above who used the welfare community center for older people. The survey conducted self-administered questionnaires (basic attributes, health consciousness, dietary habits, nutritional status), height/weight measurement, and salty taste sensitivity test.

Results : Due to the taste test, 211 people (68.1%) experienced hypogeusia, with substantial taste deterioration. When comparing younger-older people to elder-older people, 133 (73.5%) of the latter experienced a substantial reduction in the sensitivity of salty taste. By gender, 68 (76.4%) out of 89 men experienced a reduced sensitivity of taste. Men’s sensitivity of taste was poorer than women’s overall.

Discussion : There was a difference in the sensitivity of taste by gender, and hypogeusia due to aging was demonstrated. Approximately 80% of those who maintained a modest salt intake experienced a diminished sensitivity of salty taste. There were a few people who were working on reducing salt intake due to recognizing its role in the reduction taste sensitivity. Where salty taste sensitivity had diminished, even if salt intake was subjectively regarded as moderate, it was suggested that it may not be according to practical, objective standards.

Purpose : This study aims to identify relationships between role performance and burnout among nurses engaged in support of novice nurses.

Methods : We surveyed nurses, except novice nurses, working at five hospitals with 200 to 400 beds, which were related to the A medical university in the Kanto region. Among these we selected nurses engaged in support of novice nurses for a cross-sectional study using a self-rated anonymous questionnaire. Question items included personal factors, environmental factors, organization, education, coping behaviors, burnout (Japanese version of the Maslach Burnout Inventory-Human Services Survey), and performance in the role of supporting novice nurses (Self-evaluation Scale of Preceptor Role Performance for New Graduate Nurses).

Results : Of the 745 (73.9%) responses 511 (50.7%) were valid. The result of a multiple regression analysis showed that factors related to burnout were : among personal factors, work and life balance, presence of children, placement wishes, workplace, and self-assertion ; among environmental factors, workload and salary satisfaction ; among coping behaviors, persons to consult with ; among organization and education, finding meaning in novice nurse education, self-confidence in novice nurse education, and rapport with novice nurses ; and among role performance in supporting novices, providing psychological support that encourages novice nurses to continue work.

Conclusion : The findings suggested that it may be possible to prevent burnout by developing support measures that enable nurses engaged in the support of novice nurses to maintain work and life balance, as well as training and education programs to provide psychological support that encourages novice nurses to continue their work.

There has been an increase in the number of people surviving while receiving cancer treatment. Although several studies suggest that many cancer patients have financial problems since medical costs of cancer treatment are expensive, no studies have been conducted on the details of these problems or support required by cancer patients. The present study aimed to examine cancer patients’ financial problems related to their lives while receiving cancer treatment and assistance required to help with family finances. A group interview with the theme of “Knowledge of expenses for cancer treatment, living expenses, and the social security system and its utilization as necessary livelihood support required to help cancer patients continue to live at ease while receiving treatment” was conducted involving 21 patients who attended two salons for cancer patients in Shiga Prefecture, and the results were analyzed qualitatively and descriptively. The mean age of the subjects, including five males and 16 females, was 65 years old. The interview results were documented verbatim, from which 229 codes were extracted, and these codes were classified into 46 sub-categories, 19 categories, and five core categories (expressed using [　]). Since the patients had [little knowledge of systems for the promotion of subsidies including medical expenditure], they [felt burdened with the payment of medical expenses when they incurred large bills, and health care professionals also had little knowledge of the sharing of medical expenses]. Furthermore, [the patients had difficulty working/raising children while continuing to receive treatment and felt anxious about being unable to develop future plans]. The patients hoped that [health care professionals would inform them of subsidy systems] and that [consultation/support centers would provide lifestyle consultation for individual patients (recognition of consultation and requests)], so that they could develop lifestyle plans. In order to help cancer patients develop domestic financial plans, it is necessary to : provide consistent information on health/welfare care systems for cancer patients, develop check lists for patients to examine and manage their own knowledge of those systems, and provide individual patients with personal consultation support.

[PURPOSE] To visualize the frequency and items of rehabilitation conducted by patients themselves at each stage of the Hoehn and Yahr Scale towards standardization of care for Parkinson’s disease. [METHOD] 252 responses to the questionnaire to members of the Hyogo Branch of the Japan Parkinson’s Disease Association were divided into two groups by the presence or absence of self-rehabilitation, and attributes and frequencies of self-rehabilitation were compared. Open-ended notes about the content of self-rehabilitation were analyzed by the text mining method, and the strength of the relationship between the twelve rehabilitation items and the Yahr stage of the patient doing the self-rehabilitation was visualized by figures. [RESULTS] 78.8% of the patients were performing self-rehabilitation. The Yahr stage of the self-rehabilitation performer was lower (p<0.01). The average frequency of rehabilitation was 4.5 days/week. At Yahr stage 1, the average frequency of rehabilitation was 5.3 days/week, which was the most frequent of all Yahr stages, while at Yahr stage 4 the average was 3.9 days/week, which was the least frequent of all Yahr stages. It was visualized that out of the rehabilitation items, [gymnastic exercises/radio gymnastic exercises], [calisthenics/bending and stretching], and [strolling/walking] are basic items that patients at all Yahr stages perform, and that in addition to these, [dance], [yoga], and [squatting] are performed by patients at Yahr stages 1-2, [Balancing exercises] and [taijiquan] are performed by patients at Yahr stages 2-3, while [Massage] is additionally performed by patients at Yahr stages 4. [DISCUSSION] As items of rehabilitation performed by patients have been visualized, it is considered necessary to verify the safety and effectiveness of these items and standardize them as care shared by patients and caregivers in the future.

Health Literacy (HL) is an individual’s skill in findings and applying health information. Little is known about HL among elderly and Japanese-Brazilian. The purpose of this study was to examine HL, lifestyle, and health status among elderly Japanese-Brazilian in south Brazil. HL was assessed by using the14─item health literacy scale for Japanese adults. As a result, the functional HL score and the total HL score of subjects who had exercise habits were significantly higher than those of subject who had no exercise habits (p<0.05). Among female subjects, the critical HL score who had irregular dietary habits was higher than that of who had regular dietary habits (p<0.05). To maintain health status, it is necessary to give appropriate information according to the characteristics of HL in elderly Japanese-Brazilian.