看護とケアのジャーナル

Various issues confront Japan's elderly population, particularly in rural areas. These issues need to be examined to fully understand the dynamics of the provision of health care. Only by understanding the different components and their impact on patient care can improvements be made to the delivery of services and ultimately the quality of care. In this review, a consideration of different aspects of care is undertaken, with a focus on rural areas. Potentials for improvements are also discussed. Electronic databases such as CiNii and ICHUSHI searched by Japanese and PubMed and CINAHL searched by English were searched to retrieve peer-reviewed primary research literature. A narrative synthesis of the findings sections of the papers was applied to identify key themes. These themes consider the range of issues affecting health care in rural Japan: Service delivery, distribution, resources, health care, rural and elderly. In total, eight papers with either qualitative or quantitative methodology were included in the review. The review highlights a broad range of issues being confronted, most of them likely to have a medium to long term impact on the quality of care in Japanese rural areas. Government, community and professional carers’ attention to these issues is thus critical to ensuring improved health care to reassure a high quality of life for elderly in rural areas in Japan.

Background: Violence in nursing care is a complicated and dangerous risk, especially for general nurses. The incidence of violence has been rising in the past few years. The article deals with the issue of violence during mutual contact of a patient and a nurse in the Czech Republic. Its main aim is to map violence which appears only during mutual contact between general nurses and patients. The secondary aims were to identify the most common problems in these situations and to find possibilities to solve them. The aims were tested by four goals.
Objective: To describe violence in Czech Republic in nursing and to appear conditions during mutual contact between general nurses and patients.
Methods: Data from questionnaires were available on 896 nurses from different departments of Czech Republic. Stated goals were verified by chi-squared test (p=0.001).
Results: Female and male health care workers alike experience violence in providing nursing care in the Czech Republic. General Nurses in the Czech Republic are the professional group that is most exposed to verbal violence (p>0.001). Violence in health care in the Czech Republic is thus mostly a problem of nursing care. The nurses with secondary education are exposed to violence more often than nurses with tertiary education (p>0.001). There is possible to prepare nurses for dealing with a violent patient and prevent violence by choosing the correct style of communication. Based on these results, we created a short educational programme that provides nurses with communication skills which deescalate violence. Nurses can then practise these skills independently during contact with a violent patient. The results of quantitative research showed a lack of reporting of violent situations and poor support from the health care facilities management personnel.
Conclusion: The main recommendation for the practice is to educate future health care workers efficiently and on all levels of the education system. Violence in nursing care is a complicated and dangerous risk, especially for general nurses. We found out that female nurses are not more susceptible to violence than male health workers. We proved that general nurses face violence (verbal violence) above all other healthcare professionals in the Czech Republic, so that it is possible to approve that the violence is not a problem of the health care but above all of the nursing care.

Objective: This study aimed to examine the relationship between contact styles and self-esteem of people with obesity.
Methods: This relational and descriptive study was conducted in 2015 with 322 persons with obesity that were followed in endocrinology clinics of two hospitals at Ä°zmir and agreed to participate. The Introductory Information Form, Rosenberg Self-Esteem Scale (RSES) and Revised Form of Gestalt Contact Styles Scale (GCSS-RF) were used.
Results: Mean age of the people with obesity was 46.18 ± 11.89. 84.2% were female. Their mean RSES score was 1.48 ± 0.26. Mean GCSS-RF sub-dimension scores were: confluence 2.63 ± 0.45 (min=1, max=3.92); deflection 3.13 ± 0.69 (min=1.38, max=4.69); contact 2.71 ± 0.60 (min=1, max=4.45); emotional desensitization 2.78 ± 0.62 (min=1, max=4.83); retroflection 2.96 ± 0.75 (min=1.22, max=6.67). An inverse relationship was found between the mean scores of retroflection (r=-0.52, p<0.01), contact (r=-0.12, p<0.01), deflection (r=-0.50, p<0.01), confluence (r=-0.21, p<0.01), and self-esteem. No relationship was found between these sub-dimensions and emotional desensitization (r=0.07, p>0.05).
Conclusion: Self-esteem of people with obesity is lower than the moderate level. Individuals use confluence, deflection, contact, emotional desensitization, and retroflection respectively. Participants who use these subdimensions, except for emotional desensitization, have negative self-esteem.

Clinical learning is a fundamental element in nursing curricula from the sourcing of appropriate experiences for students to national board registration requirements and workforce requirements. For nursing students, the first year of their first semester experience of being in the clinical area is daunting and the exposure to caring for life is overbearing for them. Students are very scared of making mistakes and harming the patients. Good clinical nursing environment is not only plays an important role in the development of the students’ competency but also their confidence, organizational skills, and practical preparedness. The purpose of this study was to prepare the first year nursing students the confidence level through structured clinical teaching initiatives, called CNI. This is a Quasi Experimental one group pre and post-test design. Samples had been selected from 30 students of the Diploma of Nursing program in First Year and First Semester. CNI emphasized the structured clinical teaching and supervision for three consecutive semesters from Semester 1 to Semester 3. Results revealed that, students exhibited high selfconfidence level after the implementation of CNI especially in delivery of patient care. The students’ ability to listen, to recognize, to identify health issues even from non-verbal cues on patients’ problem was one of the highest achievements after the implementation of the CNI. In conclusion, a structured program on how to guide students learning in the clinical placement will improve the confidence level especially for the beginners and no matter how weak the guideline is, it’s really worth it.

The objective was to study the indicators of the process of transition of family caregivers and the influence of this in the care for elderly with Parkinson's disease in the family context. This study is exploratory, descriptive and qualitative conducted with 20 family caregivers of older adults with Parkinson's disease. The results revealed that, at the passage of exit from transition, family caregivers show integration of the routine of care in their personal life, acceptance of the health state of their relative through positive view of the disease, as well as they use strategies to acquire skills related to care for elderly with Parkinson's and they recognize in themselves the identity of family caregivers. Interventions are needed to identify the specific concerns of family members to strengthen and facilitate the process of transition to exercise the role of caregiver, in face of the various changes in routine that Parkinson's raises.

Aim: This study aimed to determine the reliability and validity of the Self-Harm Antipathy Scale-Japanese Version (SHAS-J).
Methods: A self-administered questionnaire was distributed to 764 nurses working in 32 emergency departments across Japan and 302 (39.5%) of them responded effectively. The questionnaires collected demographic data about the nurses and the SHAS-J. Data were evaluated with Cronbach’s alpha along with exploratory factor, confirmatory factor, and correlation analyses.
Results: Factor analysis of the SHAS-J resulted in extraction of four factors. The four factors comprised “low empathic practice competence”, “care futility”, “lack of active understanding” and “ignorance about rights and responsibilities”. Cronbach’s alpha for the four factors were 0.83-0.54.
Conclusion: The reliability and validity of the SHAS-J were approximately verified.

Urinary bladder catheterization and drainage are the commonly done procedures in hospitalized patients. We are reporting a rare occurrence of spontaneous knotting of a Foley catheter in a 10 year’s old agitated boy after 12 h of successful catheterization and adequate drainage. Trans-abdominal ultrasound-guided suprapubic puncture of the none deflating Foley catheter balloon followed by gentle and sustained traction was used to remove the spontaneously knotted Foley catheter inside the urinary bladder. We recommend health care providers should consider spontaneous knotting of Foley catheter as cause of none draining Foley catheter. Securing the catheter and control of agitation can prevent this complication.

Type 2 Diabetes Mellitus (DM) has disproportionately affected Korean American immigrants (KAI) in the United States. Biomedical, more individualistic, management models have focused primarily on individual responsibility for the prevention of costly complications. Traditionally, collectivism has been an important attribute of the KAI community. We conducted a qualitative study to explore the individual and collective values within the context of family while caring for DM in middle-aged (40-64 years) KAI. The following themes emerged from individual in-depth interviews: (1) Personal accountability for family harmony: I do it on my own; (2) Preserving appearance of family harmony at all costs: personal sacrifice for the good of the whole; and (3) Family harmony through mutuality: we take care of each other. The process of reconciliation of the individual and collective ethic requires one to find coping strategies, while considering social roles, gender and intergenerational interactions, in order to maintain harmony in KAI families.

Background: Self-medication with antibiotics is a common phenomenon, especially in the developing world where infectious diseases are common causes of death and a major cause of resistance towards antibiotics. Nursing students are susceptible to self-medication on the account of handling and having access to different types of antibiotics in their future practices.
Objective: The aim of this study is to estimate the knowledge of antibiotics and prevalence of self-medication with antibiotics among third year nursing students of King Saud Bin Abdul Aziz University for health sciences, Al Ahsa, Saudi Arabia.
Methods: A questionnaire comprising of twenty five questions on the self-medication behaviors and the knowledge of antibiotics was distributed to a sample of 80 students. Data were statistically analyzed using SPSS version 21. Descriptive statistics including frequencies, percentages, means and standard deviations were computed. A P value of <0.05 was considered as statistically significant.
Results: Results indicate that among the participants 35.44% practiced self-medication using antibiotics. The most commonly used antibiotics were amoxicillin (68%), followed by erythromycin (28%). Regarding the source of antibiotics used, most students obtained their antibiotics from community pharmacies (60.7%), whereas 21.4% of them used leftover antibiotics from family and friends. Antibiotics were most commonly used for treatment of cold-flu, sore throat and fever (70.3%). The majority of students checked the instructions of use (93%).In terms of knowledge of antibiotics uses 82.3% of students were aware that antibiotics act on bacteria; however, more than 50% of them were not familiar with the term, antibiotic ‘resistance’.
Conclusion: The findings from this study highlight the prevalence of self-medication and usage of antibiotics among nursing students, the lack of some important knowledge and the risks associated with them.

The transition from hospital to home is a vulnerable period for the elderly patient with complex conditions, who are often frail, at risk for adverse events and unable to navigate a system of poorly coordinated care in the postdischarge period. This article presents the results of a randomized control trial evaluating the effectiveness of an intervention involving a care transitions nurse and a rapid response nurse at lengthening the time to first readmission, emergency department use and total hospital bed days during the 30 days, 60 days and 90 days post-discharge periods for patients at high risk of readmission. The intervening impact of social isolation and patient frailty was also evaluated. No statistically significant differences were found between the intervention and control groups on the time to first readmission or in the post-discharge emergency department or inpatient bed use. Social isolation and frailty were not shown to significantly influence these outcomes.