看護とケアのジャーナル

Client-centred communication is an integral part of nursing and is the foundation stone for the provision of high quality nursing care. The success and effectiveness of the nurse-client relationship lies in the words and body language that nurses choose to use when providing client care. Increasingly attention is being given to the therapeutic relationship between the nurse and the client, rather than a discrete set of communication skills for given situations, it is proposed that client-centred communication is an integral part of nursing and is the foundation stone for the provision of high quality nursing care. The impetus for this paper arose due to similarities arising between four independent research studies conducted by the authors, and the resultant need to share these key themes as a basis for improving communication teaching to nursing students. The aim of this paper is to present a novel examination of a core aspect of the nursing curriculum across four strands of the profession with a view to eliciting key communication skills that underpin the profession of nursing. This combined approach to understanding communication assisted lecturers to both understand and teach communication skills to three disciplines of nursing. These four conjoint studies demonstrate how the deployment of finely honed communication skills is important in the development of the nurse client relationship and ultimately the achievement of high quality nursing care. The paper further aims are to use the combined results of these four studies to demonstrate important characteristics of nurse/client communication that is relevant and applicable to diverse areas of nursing and ought to be encouraged in teaching practice.

Background: Sleep patterns of patients who admitted the intensive care unit (ICU) after surgery have shown fragment and disturbed sleep during early postoperative days. However, there is less information about sleep status in patients after transferred to a surgical ward from the ICU. The aim of this study was to evaluate the sleep patterns in elderly patients after cardiac surgery including stay in both the ICU and surgical ward. Methods: Twelve patients aged ≥ 65 years were examined for 3 days before and 6 days after surgery. We used to examine sleep quality an actigraph and the Oguri-Shirakawa-Azumi sleep inventory (version for patients of middle age and older) for sleep. Results: Total sleep time was significantly decreased postoperative day 3 (median, 368.5 min) and 4 (median, 433.5 min) than before surgery (median 526.0 min) (p<0.05). Nocturnal sleep time showed significant decreases from preoperative values until postoperative day 1-4 (p<0.05). Duration of longest sleep was significantly decreased postoperative day 1-3 than before surgery (p<0.05). Sleep scale (sleep length and maintenance of sleep) scores indicated a decline in sleep quality on POD3 compared with preoperative values (p<0.05). The sleep disturbances did not reach preoperative levels until at least POD4. Conclusions: The sleep disturbances persisted not only throughout patients’ ICU stay but also after they had been discharged from the ICU. Therefore, close collaboration between surgical ward and ICU nurses are the key to provide more appropriate and early interventions.

It is estimated that millions of patients suffer mental and physical disabilities, injuries and death due to adverse events. The human and economic burden of these events has also been a challenge for health care institutions, especially for nurses. In this regard, efforts are impounded to form health care professionals for safety and rehabilitation, able to manage the current health needs of people, to identify the risks associated with unsafe care, and with systemic focus. This short commentary discusses the nursing challenges for the 21st century and gives the reader some suggestions of how to solve some of these challenges towards a safer self-care in rehabilitation, especially at home.

Abstract Purpose: The purpose of this study is to examine the rate of glycemic relapse in uninsured Asian-Americans and Pacific Islanders attending the diabetes clinic of a community health center in Honolulu, Hawaii.

Methods: Target study population was patients who came to the diabetes clinic between November 1, 2011 and February 29, 2012. Their medical charts between January 2009 and February 2012 were reviewed for retrieving levels of HbA1C, LDL (low-density lipid), Triglyceride, and blood pressure. Changes in these outcomes were compared with baseline. Percent of patients with glycemic relapse was calculated. Through a ‘talk story’ session, the management team members gathered their perspectives in educating Asian-Americans and Pacific Islanders with diabetes.

Findings: Medical records of 111 patients (60 females and 51 males) with diabetes were reviewed. Average age ranged from 22 year-old to 81 year-old with mean of 58.91 (SD=9.63) year-old. Levels of HbA1C and LDL were computed at 3 ± 1 months, 6 ± 1 months, 9 ± 1 months, and 12 ± 1 months. Compared with the initial visit, means in HbA1C and in LDL at 3-month and/or 6-month follow-up visits significantly decreased.

Conclusions: The diabetes management team provided group and individual diabetes education and counseling, culturally tailored diabetes education sessions, and empowerment of diabetes self management through demonstrations and explanations. There is a need to search the intervals of reinforcement program to prevent glycemic relapse. The team also provided medical care and preventative care taking into account complementary and alternative health care practices of the different ethnic groups. Health literacy was a key barrier to optimal diabetes self management in the Asian-Americans and Pacific Islanders. Community health workers played essential roles in facilitating diabetes management.

As the largest sector of the health professions in the United States with more than three million registered nurses, the world needs to hear our voices in forging a new vision in nursing education and nursing practice. Nursing education and practice is constantly evolving and Nursing 2013 is at the cutting edge of nursing. The purpose of this paper is to integrate Ethics, Legal and Sociocultural Issues (ELSI) as nursing’s obligation to society and toward understanding nursing as a Complex Synergistic System (CSS). The theories through which nurses could view ELSI are the complexity theory, synergy theory, and systems theory. Envisioning ELSI through the CSS lens engages nurses in the multifaceted nature of nursing (complexity theory), its collaborative relationship with various disciplines (synergy theory), and the permeability of nursing's boundaries (systems theory). Understanding ELSI through CSS as a theoretical framework and lens grounds nursing education and practice and agitates Nursing 2013 to withstand and transform challenges into opportunities for growth and positive outcomes. CSS is a powerful tool/lens that shapes, magnifies, clarifies, and guides thinking, feeling and behaving in nursing education and practice. Evidencebased literature and practice is used as background and foreground information.

Introduction: Research studies in the military and aviation demonstrated that teamwork is essential to safety. However, there were limited studies dealing with the practice of teamwork between nurses and physicians in the emergency departments (EDs). Aim: The aim of this cross-sectional, quasi-interventional study was to compare nurses and physicians (staff) who worked in the interventional group emergency departments and those who worked in the control group emergency departments on the effect of teamwork on staff job satisfaction. Methodology: Data were collected over a three-year span (2009-2011) for a seven-day period in each participating hospital emergency departments using Revised Nurse Work Index, a four-point (1 to 4) Likert-type scaled instrument. Primary investigator and trained research assistants distributed surveys to ED staff who agreed to participate in the study. Completed surveys were returned into a locked box. Result: Staff who worked in the interventional group emergency departments showed significantly higher levels of staff job satisfaction associated with improved practice of teamwork (p<0.0001) than their counterparts who worked in the control group emergency departments which had no practice of teamwork. Discussion: Staff who worked in the interventional group EDs worked together and participated as equal partners in patient care leading to improved interpersonal relationships and suppression of hierarchical status among the members of both professions, however, this condition was not present in the control group. Conclusion: Active teamwork practice was associated with an increased perception of higher levels of staff’s perception of job satisfaction in the staff who worked in the interventional group EDs compared with those who worked in the control group EDs.

Purpose/Objectives: With development of innovative cancer diagnosis/treatment and increased cancer survivorship, the education of Oncology Advanced Practice Nurses (OAPN) is becoming increasingly complex, from the standpoint of both medical and nursing models. The purpose of this educational article is to address this issue and to present the authors’ reflection on the educational practice with OAPN students in a unitary approach based on Margaret Newman’s theory of health as expanding consciousness.

Data sources and data synthesis: The authors’ journals and the students’ descriptions of their practice were used, and the data was synthesized through dialogue among the authors and the OAPN students.

Conclusion and implications for nursing: It is concluded that the unitary approach focuses on identifying the client’s pattern as a pathway to finding meaning in the situation. By incorporating the medical model within a unitary approach, OAPN students gain a renewed professional nursing identity. Knowledge translation: The knowledge gained in the process of pattern recognition will make a significant difference in survivorship care and will contribute to the core of OAPN education.

Metabolic Syndrome (MetS) is a significant reason of morbidity affecting gradually more people both in the world and in our country. In this growth getting towards pandemic, basic changes in nutritional habits with sedentary life style and some characteristics which come with heredity play role. Prevalence of atherosclerotic cardiovascular disease also increases day after day. Genetic endowment and environmental factors that have changed over years are holding the responsibility. Metabolic Syndrome in definition has the importance which emphasizes that certain risk factors cause development of cardiovascular disease and diabetes mellitus (DM) together, not individually. Several guidelines have been published recently in order to easily detect MetS which has been nearly an epidemic worldwide. The present review touches upon the epidemiology, etiopathogenesis and treatment approaches of MetS in Turkey and in the world so as to enlighten healthcare professionals.

This paper presents a longitudinal evaluation of Reflective Practice Groups (RPG) for nurses from Intensive Care and Oncology settings at Nambour Hospital, Queensland. The literature review examines previous evaluations of RPG, establishing the contribution of the current study as its longitudinal, quantitative comparison of RPG from two distinct nursing contexts. The two year evaluation utilised a validated tool, the Clinical Supervision Evaluation Questionnaire (CSEQ), designed specifically for facilitative group supervision. The results support the positive findings of a pilot study by the author, with a majority of nurses from both groups rating their experience of RPG as ‘definitely positive’ throughout the evaluation period. Subtle differences in data from CSEQ subscales of purpose, process and impact indicate that aspects of, and benefits from, RPG were experienced differently in each group. Whilst both groups reported positive perceptions of process, the ICU group showed a notable positive shift in fields relating to trust, respect and safety whereas data from the Oncology group indicated an upwards trend in ratings of impact fields such as self awareness, clinical insight and quality of care. These results are discussed in relation to group characteristics and workplace contexts. Despite limitations, the data is felt to reinforce the value this RPG model places on facilitation techniques and management of group process as means of enhancing critical reflection, promoting a focus on the interpersonal aspects of care giving and encouraging supportive interaction. The study establishes a sound basis for ongoing research into this RPG model.