Purpose: The structural characteristics of life adjustments among lung cancer patients with decreased Performance Status (PS) were investigated.
Subjects and methods: Text analysis and cluster analysis were performed with data obtained from interviews of six lung cancer patients with PS 3 or 4 in one university hospital in Japan. The study was conducted from February to June 2009.
Results: The mean age of subjects was 73.6 years. The text data included 623 records, and the number of keywords was 1,398. Keywords that appeared with high frequency were, in order, People (51), now (47), Disease (45), and Doctor (32). Positive type (173) and negative type (366) were extracted from a sensitivity analysis. Life adjustments of lung cancer patients were divided with a linguistic method into 20 categories: “Time period”, “Other people”, “Actions in daily life”, “Symptoms”, “Lung cancer”, “Place of treatment”, “Medical treatment”, “Adjustment”, “Death”, “Physical condition”, “Feelings of difficulty”, “Relationships with others”, “Enjoyment”, “Doing one’s best”, “Acceptance”, “Living”, “Attentiveness to others”, “Belief”, “Nursing care” and “Thankfulness.” Four clusters were formed in the cluster analysis: Thoughts on receiving care, living on terms with one’s physical condition, adjustments with awareness of death, and actions in daily life appropriate to the time.
Discussion: Life adjustments of hospitalized lung cancer patients with decreased PS are closely related to time period, treatment, symptoms and it is conjectured that patients make adjustments to their actions in daily life and thoughts with a positive attitude and feelings when they reach the state of sensing that they will not be cured.
Purpose: This study examines whether nursing care predicts the incidence of complications, mortality, ambulatory ability at discharge and 3 months after surgery or the length of stay for patients who have undergone hip fracture surgery.
Methods: This is a retrospective observational study conducted at a community general hospital in Japan. Participants were patients who were 65 years or older and who had hip fracture surgery during the study period, April 2007 to March 2011. Data on demographics, treatments, nursing care and health outcomes during the hospital stay were collected from hospital records. A questionnaire regarding the patient’s health outcomes after discharge was sent to patients and/or family members.
Results: In all, 449 patients met the inclusion criteria. The average age was 81.9 years, and 79.0% were female. In total, 94.4% of the patients were recorded as having obtained nursing care for getting out of bed, and 47.7% were recorded as having obtained nursing care for bearing weight. Nursing care associated with the topic “tell patients the necessity of getting out of bed early or encourage patients to get out of bed” were significantly related to a lower incidence of complication (OR=0.341, P=0.017). Patients with recorded nursing care for weight bearing had significantly greater ambulatory ability at discharge after adjusting for the introduction of the fixed-payment system, patient characteristics, type of surgery, hours of physical therapy and length of stay before surgery (OR=1.890, P=0.006). Patients with recorded nursing care for weight bearing had significantly greater ambulatory ability at 3 months after adjusting for the same covariates (OR=2.175, P=0.008).
Conclusion: Nursing care soon after surgery in an acute care hospital can improve the long-term outcomes of patients after they undergo hip fracture surgery. In addition to physical therapists, nurses should more willingly engage in the rehabilitation of patients in the orthopedic wards.
Background: The Magnet hospital is a recognition system in the US having a low turnover and high retention of nurses and providing a high quality of patient care. We sought to examine the effect of characteristics of the work environment of Magnet hospitals on nurses’ job satisfaction using multi-level analysis in hospitals in Japan.
Methods: We distributed anonymous self-administered questionnaires in August 2011 to all nurses via the directors of the nursing departments of four private hospitals. The response rate of nurses was 91%; 373 completed questionnaires in 21 wards were used for analysis. The questionnaire items addressed basic attributes and employment characteristics, the Japanese version of the Practice Environment Scale of the Nursing Work Index (PES-NWI) for assessing characteristics of the work environment of Magnet hospitals, and a job satisfaction scale. We conducted multi-level analysis to examine effects of the PES-NWI sub-scales at both the individual and ward levels on nurses’ job satisfaction.
Results: Results of the multi-level analysis for nurses’ job satisfaction showed that a full model which included the sub-scales of the PES-NWI at both the individual and ward levels was the most appropriate model. Additionally, coefficients of ward-level values showing significant relationships with job satisfaction were greater than those of individual-level values. At the individual level, all sub-scales of the PES-NWI except for “nurse participation in hospital affairs” showed positive relationships with nurses’ job satisfaction, while at the ward level “nurse participation in hospital affairs” showed a significant positive relationship, and “nurse manager ability, leadership, and support of nurses” showed a significant negative relationship, with nurses’ job satisfaction.
Conclusion: These findings suggest that while characteristics of the work environment of Magnet hospitals are important predictors, factors relating to cultural differences, such as decentralized department structures, might influence nurses’ job satisfaction at the ward level.
Nurse Practitioners (NPs) have proven their abilities and have been authorized to practice in many developed countries. NPs play some independent roles that previously were the roles of physicians. However, NPs have not been introduced in Japan. The main reason is that there is not enough evidence that nurses can practice independently from physicians to change the Medical Practitioners Act. The Japanese version of an NP, which is similar to a Physician Assistant, is under consideration for introduction in Japan. The Japanese version of NPs would be able to conduct specific medical treatments with a “comprehensive order” from a physician. Certified Nurse Specialists (CNSs) and
Certified Nurses (CNs) are Advanced Practice Registered Nurses in Japan. The outcome evaluations of the performance of CNSs have been limited to the descriptive data of case reports. Studies that provide a high level of evidence and evaluate the work and skills of CNSs are necessary so that their abilities can be appreciated. One of the roles of CNSs is research. However, their education emphasizes clinical practice and the time allotted to research in the curriculum is limited. Nursing faculty members at universities are usually very busy providing education and do not have sufficient time to perform research.
To obtain evidence that nurses can work independently, the educational system must allow nursing faculty members at universities to have more time for research and provide the education that would allow CNSs to collaborate with faculty members who perform research. Unfortunately, the fact that there is not enough evidence of nursing ability and this is the key reason of preventing introduction of NPs in Japan is not well known to nurses. It is necessary to tell and educate nurses the necessity of research and to encourage them doing it.
Introduction: Appropriate deployment of nursing staff to secure quality nursing care has been a challenge for nurse managers. Japan’s nursing staffing system is not as well developed as that in western countries.
Aim: To clarify topics of appropriate nursing staffing and find points of improvement for Japan’s patient classification system.
Methodology: This qualitative cross-sectional study was conducted from December 2009 to February 2010. The authors surveyed three medical institutions in Japan which have adopted nursing staff deployment systems. We conducted semi-structured interviews with nurse administrators regarding nursing staff deployment at each medical facility. Content analysis was used to analyze the interview data.
Results: We identified 4 topics of nursing staffing: (1) “Improving the accuracy of the patient classification scale”, (2) “Developing the staffing system”, (3) “Circumstances causing staffing difficulties”, and (4) “Staffing system for future needs”.
Conclusion: Improvement of the scale of nursing necessity and the audit system is urgent in Japan. Developing the staffing system is also important, and nurse managers need to improve their ability to assimilate data. It is also necessary to visualize business aspects on a computer in real time, and nurse administrators should be willing to anticipate business systems in order to fulfill the needs of appropriate staffing.
The study was an exploratory pilot study in which subjects consisted of adolescent mothers and their infants in Japan.
Background: Japanese adolescents giving birth to their babies are increasing although only at a rate of 1.4%. They chose to give birth more often instead of abortion than in past years. In Japanese society, it is not easy for an adolescent to be recognized as a mother because their knowledge is not sufficient for parenting and they are not ready to be a mother. They usually need support to be a mother.
Purpose: The study examined relationships among adolescent mother-infant interaction, maternal self-esteem, and parenting stress, which affect child development, in order to make recommendations for helping Japanese adolescent mothers in parenting.
Methods: The subjects were 10 adolescent mothers and their infants aged 3–12 months (adolescent group) and 10 mothers whose mean age was 28.9 years, the same age range when Japanese women gave birth to their first baby (comparison group). This study examined differences in mother-infant interaction, self-esteem, and parenting stress between the adolescent and comparison groups.
Results: Maternal self-esteem had a significant negative correlation with mother-infant interaction and parenting stress. Nursing Child Assessment Feeding Scale scores-especially the “Sensitivity to Cues” subscale-among the adolescent group were significantly lower than those of the comparison group. High parenting stress was influenced by difficulty in understanding about infant and a restraint coming from the parenting role.
Conclusion: Delicately reading of child cues and promptly an appropriately responds to them make more attuned mother-infant relationships. The study suggested that adolescent mother-infant relationship has positive correlation of maternal self-esteem and parenting stress, informing recommendations for nurses to replace their negative selfimage of these youth with a positive one, which may ultimately lessen parenting stress.