The purpose of this study was to develop an instrument to assess and support the learning processes for self-care ability for diabetes prevention. First, the model which shows the learning processes for self-care ability and the questionnaire to assess the achievement level in these learning processes were developed based upon the works of Matsushita (1990) and Orem (1991). Then, a survey using this questionnaire was performed on 8 participants in a diabetes education course, and 52 participants in the continuous education course. These courses were part of community based health education that public health nurses of T city planned and implemented for the purpose of preventing diabetes. Moreover, I visited 8 participants who had completed the questionnaire, and interviewed them about their present condition and life style. The following results were obtained: 1) Cronbach's alpha was 0.86 to 0.91 for a sample of 52 diabetes education participants, indicating the internal consistency of this questionnaire. 2) Stages of learning process were interrelated and the results of path analysis revealed the following stages of the learning process progress:【recognition】→【judgment】→【decision-making】→【practice】→【continuation】. 3) It was suggested that learning enhanced self-care ability. In other words, to know the ideal state and the actual state of one's own condition, and to recognize the gap between them, facilitated the advancement in the learning process. More subjects are required for examination of the validity of this questionnaire.

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This study aims to clarify those needs of intractable illness that involve public health nurses and to systematically put in order the developing process of care management for those cases. We used a researching method of personal interviews with thirteen expert public health nurses involved in an inveterate case, asking questions in detail about care management processes. Care management process activity indices were used in the analysis framework in order to read situations, needs and processes by units of activities taken by the public health nurses with their own words. As a result, ten categories have been extracted as needs concerning the betterment of relevant medical care, assistance to user's home care and daily living, improvement of home care environments and overall extended care management. Public health nurse processes are featured by starting with interview on application for public aid for medical expenses, taking action on the subjects, their family members, specialist doctors, neighborhood doctors, and care-team members. Also included were individual interrelations so that services will best fit the needs, while anticipating the future situations from early phases, flexibly and timely arranging the existing services (medical care, health care, welfare etc. whether public or non-public), taking action to improve the regime of related institutions. In particular, the features include, among others, securing the breath of life and driving spirit, arrangement of an environment that utilizes remaining functions and reduces caring load, maintenance of emergency response, use of hospitals for short-stay purposes, talking to doctors for patients, working as an interpreter, effecting liaison with inveterate disease caring businesses, and assistance to care team members.

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Purpose: We focused on client outcomes in home care, and identified influential care items, achievement of care implementation and care processes in outcome improvement. Methods: (1) We aimed to refine 119 care items for 23 client outcome areas in home care. The number of visiting nursing stations were calculated by types of organizations across the country in October 2000, and based each on the proportional distribution ratio. We asked the directors of 500 stations for their participation in this survey, and received 220 replies. We refined the number of care items to 60 for statistical analysis. (2) We carried out the survey on these 60 care items for 527 clients, who were 40 or over and continued: to receive care services for two months, of 7 visiting nursing stations in November 2000. Terminal cases were excluded., Achievement of home care was weighted by : it was "always," "sometimes," and "not" implemented when necessary. (3) Client outcomes were measured at two points, September and November, 2000. We measured Changes using 41 assessment items in 23 outcome areas of health conditions including ADL, IADL and symptoms during a period of two months. (4) We classified the cases into improvement and non-improvement groups in outcomes. It was compared with the achievement degrees of each care item using t-test, and we studied the care items influencing the improvement of outcomes, and the degrees of implementation. Results: In 23 outcome areas for care effectiveness, there was a significantly higher, achievement degree of care in 13 areas in the improvement group over those in the non-improvement group. The more cases that "it was always implemented when it was necessary," the more their outcomes were improved. The areas likely to improve outcomes of clients were: (1)JABC independence and locomotion in ADL, (2)meal preparation, safety of key, fire and water, management of air conditioning and heater in IADL, and urinary incontinence. The outcome areas of caregivers were : (1)physical fatigue, (2)psychological fatigue, (3)the knowledge and technique of caregiving, (4)free time for caregivers, and (5)willingness to continue caregiving. The care items that influenced many of the outcomes were encouragement, securing water, urinary incontinence, medication and sleep. When looking at the care processes in care items, of assessment, planning, care implementation and care evaluation/record, many items in care evaluation/record were significantly higher in the improvement group than, in the non-improvement group. Evaluation and record were identified as an important factor for outcome, improvements. Conclusion: This study found that client outcomes were more improved when there were more cases that "it is always implemented if it is necessary," and care evaluation was especially effective in the reprocess.

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Child-rearing has been evaluated mainly from negative perspectives in Japan. Perspectives such as the anxiety, burden, and the stress of child-rearing. It should also be necessary and important to examine and support the positive dimensions of child-rearing. In this study, in order to evaluate child-rearing from a positive perspective, we paid special attention to parental development and reviewed the other possibilities of evaluating child-rearing. We then will attempt to construct the "Parental Development Scale" and investigate the scale's reliability and validity to 649 mothers whose first child is between one month and 3 and a half years old. They were located and recruited using both the mother's and the child's health record cards from a community health center. The parental development scale Originally consisted of 17 items. Two items were later excluded because the responses showed extremely partial tendencies. The remaining 15 items were analyzed using data collected from 368 mother's without missing values. Applying factor analysis, the parental development scale showed one factor, structure. Face, content, and criterion-related validities, plus the reliability coefficient were investigated. The parental development Scale presents the possibility, or at least one worth some consideration, to evaluate child-rearing from a positive perspective. There is still a need for further investigation.

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Purpose: We researched the lives of patients who suffered a fracture of femoral neck and had been operated in the Atumi Peninsula district to study whether a fracture of femoral neck is the main cause of being bedridden. We studied the uneasiness of the patients and their family on two occasions, the first being When they were discharged from the hospital and the second was after 1-2 years had passed since their operations. We observed and examined their actual home situations and health conditions following 1.5-2.5 years after their operations. Our purpose was to get a clear vision of how to care for and support sufferers by analyzing, these results. Objects and Method: The objects of this study were 45 patients (7 males and 38 females) who suffered a fracture of femoral neck, their entry and operation at a hospital in Atumi Peninsula, Aichi Prefecture during the year of 1998. We prepared their medical files and health records, which were written by the doctor who were in charge when they discharged. We sent questionnaires by mail to the patients 1-2 years after their operations. Moreover public health nurses visited and surveyed 26 patients at their home 1.5-2.5 years after their operations. We analyzed all of these results longitudinally. Result: We found five clear points. 1) The ADL of 33.3% of the patients who were at their homes after operation grew larger. 2) Families who take care of discharged patients have uneasiness, apprehension, and difficulties. Therefore they need to receive continuous support in their community. 3) It is the point of health education to prevent of re-fracture. 4) Bedridden patients who had a fracture of femoral neck had serious complications. We found that these complications were main causes of being bedridden. Thus we conclude that a fracture of femoral neck is not a direct cause of being bedridden. 5) Nurses should be more attentive to the patients' life after being discharged. It is indispensable for the patients and their families to receive support from health care, medical care, and welfare, which are inter connected. Support should be continued, not only by the hospital, but also by the community. It should also be given according to each patient's situation and family's living conditions.

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The purpose of the study is to explore how to give effective oral care instruction, while we observe how caregivers provide oral care to the sick elderly who stay at home, and reveal factors which influence the care. The subjects were twenty-two sick elderly people who received assistance from home-visiting nurse stations and their twenty-two caregivers. All the sick elderly people are ranked C in the ADL Standard. We gave oral assessment to the elderly while interviews were held with their caregivers. As a means of analyzing the results, we used the PRECEDE and PROCEED Model in which every stage is classified from 2 to 4. The second stage is from the epidemiological point of view. There were carious, swallowing disorders and oral insanitation among more than eighty percent of the elderly people. The third stage was viewed from a standpoint of how caregivers dispensed oral care. Forty percent of them gave oral care to their charges more than once a day while sixty percent did not do so regularly. The factors that had an effect on the behavior of these caregivers were as follows: four predisposing factors which are their knowledge, the occasion which disposes them to give oral care, their present skill; emotional factors which are their interest in dental care, relationships with other family members, burden of care and others; enabling factors which are care in a hospital and domiciliary services as well as other factors; reinforcing ones which are effectiveness of care and encouragement, etc. These factors worked either positively or negatively and influenced the behaviors of the caregivers. As a conclusion, the paper suggests how to support caregivers administering oral care to sick elderly people who stay at home.

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Purpose: This study evaluated the learning achievements of baccalaureate nursing students in clinical home health education for one week, and highlighted the items of which learning achievement levels were high and those with few opportunities to experience. Methods: The survey was conducted utilizing 48 nursing college students and 33 staff nurse preceptors from 6 different home care agencies in F Prefecture. The questionnaire with 37 items consisted of the categories that were assessment, care planning and evaluation, medical care and care for clients' daily living, disease and impairment, rehabilitation care, infection control, terminal care, mental and emotional care, family support care, coalition with other professionals, and others asked the students' learning achievements. The achievement level of each item was measured with 4 scales from very well to very little, and with the optional of "no opportunities of experience." The clinical home health education system included such programs as orientation of home nursing care, 12-16 home visits with the staff nurses, care planning for the client with more than two times of the student visits, care practice, and case conferences. Results: The nursing care items which over 40% of each student and nurses evaluated as the highest achievement level were; "value of home nursing care", "personal hygiene", "assessment of the clients' needs", and "care planning." On the other hand, the care items with low learning achievement as well as few opportunities to experience were; "financial support care", "cooperation with medical staff in other institutes", "collaboration with other concerning persons", "infection control", "emergency care", and "teaching the proper use of medical equipment to caregivers." Conclusion: It is appropriate that the highly achieved nursing care items should make the students' learning objectives in one week of clinical home health education. And it is recommended to provide students with more learning opportunities in educational settings than one week of clinical practice in order to master techniques and increase the knowledge for care items of which their learning achievement levels were low.

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The purpose of this study was to examine the effects of a community care program consisting of health guidance, reminiscence group and mild exercise to prevent the decline of functions of daily living activities in the community-dwelling frail elderly. Subjects were 18 frail elderly 65 years and older, and met to the criteria of frailty in this study (7 male; 11 female, mean age (SD): 80.7(5.8)). The community care program was provided once a week for three months by public health nurses in the community center. As a results; 1) The maximum length of step as a marker of physiological function had a tendency to improve in the female subjects, but not improved in the male subjects; 2) The TMIG Index as a marker of physical function showed little significant improvement in the female subjects and male subjects. Some of the subjects and the items of The TWIG Index showed potential improvement; 3) The subjective well-being as a marker of psycho-social functions showed significant improvement with both female and male subjects. The results of this study showed that the community care program consisting of health guidance, reminiscence group and mild exercise was effective to prevent the decline of functions of the daily living activities in the community-dwelling frail elderly, and can be applied to other frail elderly populations. It was also recommended that the identifying of the target subjects, the development of a care program and its outcomes must be included in the future studies.

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The purpose of this study is to make evident the elements affecting of the independence of elderly victims of the Great Hanshin-Awaji Earthquake after four and half years, who were living alone in eternal apartment compleyes. Semi structured interviews were conducted with ten subjects. Qualitative analysis method was employed. As a result, the elements found were the acceptance of the suffering experience, giving up, relationship and mutual support with disaster victims; utilization of social resources, relaxation behavior, and the management of living alone. Specifically, the acceptance and surrender were features for the elderly victims. Utilization of social resources was linked with keeping relationship with other victims. This result suggests that nursing staff should pay attention to the ability of self determination and make the social resources available for the elderly to have this ability.

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Objective: As the elderly population increases, the number of elderly people suffering from dementia is also showing an increase, but public sector support measures remain inadequate. Seventy % of all senjor citizens with dementia in Japan are cared for at home. The remaining 30% are cared for at care facilities or hospitals. These people cannot be managed at home for a of reasons. To help elderly people with dementia and their caretakers maintain a decent QOL, the sequence of events leading to readmission and their background circumstances were investigated for 35 of the caretakers (group A) of elderly people with dementia who had previonsly been cared for at home and were admitted to a sanatorium ward. The findings were compared with those for 30 caretakers (group B) of elderly people with dementia who continued to be cared for at home while utilizing domiciliary services, This comparison was performed to identify, factors making it difficult to continue with domiciliary care and what supportive measures for nursing and care-giving should be developed for the future. Methods: Age, gender, duration of dementia, primary diagnosis, associated diseases, treatment, ADL selfcare grade, dementia grade, and extent of dependence on the caregivers were determined from medical records. To assess the status of the caregivers and their background circumstances, the age, gender, relationship with the elderly person, duration of providing care, the number of persons in the household, the availability of an alternative care-giver, the availability of the family doctor, the utilization of services, and the burden of care-giving (CCI score and 27 items) were surveyed through interview. Results: The ADL grade of the persons requiring care was correlated with the amount of care-giving provided in both groups. There Were significant differences, in the burden of care-giving between the groups, which was especially high with respect to toileting, transfer, and bathing. The time required for care-giving became greater with decreasing ADL grade, and this was especially obvious in group A. In both groups, the burden of care-giving was lighter when alternative care-gives were available, and more alternative care-gives were available in group B, suggesting that this was a factor in the continuation of home care. There was no difference between the groups in the number of persons utilizing domiciliary care services. The percentage utilizing such services was significantly higher in group B than in group A, suggesting that this was also a factor in the continuation of home care. As for the burden of care-giving, there was no difference between the groups regarding the CCI score and the total score for the 27 items. The score for a feeling of restriction among the 27 items was significantly high in group A than in group B, suggesting this was a factor in the discontinuation of home care. There was a marked difference in the duration of care-giving, but in both groups the duration of care-giving was not correlated with the perceived burden of care. Common reasons for hospitalization in group A were deterioration of the elderly persons conditions and limitations on the ability of the care-givers to provide care. Many persons cited limitations on care-giving as a reason. They also complained of a heavier burden of these duties. Conclusion: Importance should be attached to sufficient understanding of the QOL and the circumstances of both the persons requiring care and their care-givers, so that the improvement of services, and support provided, can be based on each individual situation in the future.

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When we started health promotion,, at first we analyzed the inhabitants-initiative health planning activity for middle-age & elder people in Fuda & Nakanoshima area and the evaluation value set up along those activities. Then we evaluated the effects using this value and tried to build up the strategy of practical public health activities in these region. The process of this method was divided into four parts. It was suggested the importance that specialists in public health shared the achievable goal with inhabitants and always keep in mind that achievable goal not only at the planning & executive stage but also evaluate stage.

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This study examined, the role that home care staff played in the process of adaptation to home care for elderly disabled patients and their families following hospital discharge using qualitative analysis. The sample consisted of three home care cases involving elderly disabled patients in a city in Aichi Prefecture, Japan. The cases were particularly challenging ones for home care staff because of patients' clinical symptoms and need for special support. Data consisted of home visiting records and interviews with home care staff. Data were collected from the beginning of each case to the end of August 1998. Data analysis focused on patient and family adaptation to home care and the support given by home care staff to follow process; (1) an initial period of confusion, for patients and families during the introduction of home care services, (2) a stable period of home care and (3) a period of deterioration. During the early stages of home care support, patients and families showed signs of stress. They, were anxious about having home-care support and had unclear expectations regarding home care staff. During periods (1) and (2), home care staff had work on building supportive relationships with patients and families and provide reassurance. The home care staff who concerned then was not, specific profession, but the specific person. Next, home care staff waited to see how patients and families would utilize various support systems. The approach they used during this time was non-confrontational. Staff mainly observed and quietly supported patients and families according to their responses. Patient and family adaptation to home care is dependent upon a process in which patients, families and home, care staff recognize that a gap exists in mutual understanding. Unless all parties can agree on certain points, moving to the next goal is impossible, such as changing a lifestyle or learning to live with a handicap. Home care staff must always first consider the level of patient and family adaptation to a life requiring home care support in order to progress to the next steps of care.

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Purpose : The purpose of this study was to examine the relationship between life-style changes before and after stroke onset, and psychological conditions after discharge in cerebrovascular patients. Method : Subjects were 27 cerebrovascular patients aged 60 years old and over who could walk on foot and had discharged. They were interviewed at home two months later after discharge. Scales of "depression", "anxiety", "motivation", "satisfaction", "feeling of loneliness" as psychological conditions and changes before and after stroke onset in "role at household", "hobby", "going out", "visiting", "acquaintance" and "work" were measured. Result : 1. The life-styles were reduced 10〜50% of patients. Most reduction was shown in "going out", and it was 51.9%. 2. There were a lot of relationships between changes of life-styles and psychological conditions. Especially levels of "going out" and "acquaintance" were correlated significantly with most of psychological scores. Conclusion : These findings suggested that both services that did not reduce life-style and psychological supports were need for some part of cerebrovascular patients even if ADLs were good.

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[in Japanese]

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[in Japanese]

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[in Japanese]

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This study was made to analyze the learning of students of the guidance on public health in disaster for the subjects of students specialized in public health nursing. The educational system for the public health nursing in disaster has not been established yet and, in order to start the program, it required development of the educational objectives, teaching methods and materials for the curriculum. The teaching program conducted for this study was composed of the following contents. (1) Practice and group discussion based on the VTR titled "Activities of Public Health Nurses on the Site of Great Hanshin Earthquake" (recording of 3-month activities right after the occurrence). (2) Lecture on the basic knowledge of disaster medicine and nursing. (3) Deskwork simulation exercise for triage. (4) Deskwork simulation exercise for organizing an evacuation system and its presentation. These contents were taught in an intensive program for the total of 4 classes (360 minutes) in two days. An investigation was made in the form of questionnaires to see how much they have learnt and to get their comments, before, during and after the course, and analysis was done focusing on their understanding of the roles of public health nurses, on their knowledge of the disaster nursing, on their understanding of the triage, on changing of the measures of social attitude, on their thoughts for the teachings. Effects of the program were shown in the following points ; they got better understanding of practical activities of public health nurses at the time of disaster, they reconfirmed the way how the activities of public health nurses should be in normal condition, and they realized that they should take disaster relief and disaster preventive activities as a part of their own roles by connecting activities in disaster with those of ordinary circumstances. In the course of basic education for public health nurses, a consideration of disaster as one phenomenon resulted in indirect understanding of the principles and fundamental aspect of the roles and activities of public health nurses in ordinary times. It is effective to introduce the simulation method that assumed the disaster scene concretely, not only to teach the knowledge on disaster nursing but also to educate their ability of practical activity needed in disaster spot. And it is also essential to develop and devise audiovisual educational aids to help them visualize the circumstances in disaster and to provide other teaching materials to let them have creative thinking of countermeasures as if they themselves were experiencing the disaster.

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