Objective: In order to develop the basis for a community health nursing assessment for making healthcare plans for the elderly, we identified the priority items for the assessment of social and behavioral aspects of people in the community (assessment items). Methods: Based on the International Classification for Nursing Practice (ICNP^®), the NANDA nursing diagnosis, and other literature, potential items were derived from the social role theories and the behavioral components of the "Health Dimension" in Clark's Dimension Model. A three-round Delphi survey was conducted with experienced public health nurses at administrative institutions to define the most appropriate items. Theoretical integrity and validity were evaluated in two expert reviews involving experienced researchers and educators specializing in community health nursing assessment and/or nursing diagnosis. Items were selected based on these evaluation results. Results and Discussion: Nine items were selected for the social component of the assessment: communication, social participation, family relationships, familial interaction, familial care, abuse, interaction with the opposite sex, work, and economic stability. The behavioral component of the assessment also consisted of nine items: eating patterns, physical activity, alcohol consumption, smoking, sleep/rest, recreation, stress manage ment, daily activities, and health-seeking behavior. The validity of the items for both the social and behavioral components of the assessment was established using the quantitative evaluations of experienced public health nurses and the qualitative evaluations of experts in community health nursing assessment and/or nursing diagnosis.

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Purpose: In this paper, we describe the status of students' understanding using "community inspection guidelines". Then we considered merits, limits and practical application of these "community inspection guidelines". Methods: The subjects were 101 students in a public health nursing course; the term of study was one year. Ninety-six subjects who answered all questions in the "community inspection guidelines" (effective response rate 95.0%) were analyzed by factor analysis. Then we calculated the average for the factors extracted by factor analysis. Further we analyzed the relationship between the "guidelines" and existing materials by Kruskal-Wallis test. Results: We extracted 4 factors, the appearance of the street, the appearance of people, politics/religion/health and social support, by factor analysis (cumulative contribution rate 63.3%). The high scoring factors were the appearance of the street, the appearance of people and social support. The low scoring factor was politics/religion/health. The average score using the "community inspection guidelines" was significantly higher among those who considered the connection between the "community inspection guidelines" and the existing materials. Discussion: We suggested that the "community inspection guidelines" were an effective checklist for understanding the community and that "community inspection guidelines" are a necessary and useful device. Further, we suggested that we should provide concrete advice to students when they use the "community inspection guidelines".

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The purpose of this study was to develop a receiving support scale by those in bereaved family groups, and to analyze the relevant factors. A survey was conducted with a self-evaluating questionnaire, which was distributed to 160 members in eight bereaved family groups listed in the Terminal Care journal. The exploratory factor analysis, in considering the maximum likelihood and promax rotation, revealed four underlying factors, which were labeled "Emotional Support", "Cognitive Support", "Informational Support", and "Professional Support". The result of the stepwise exploratory factor analysis revealed that the scale had 16 suitable items. In addition, based on ANOVA (analysis of variance) and multiple comparison, those receiving support, in bereaved family groups, were significantly different in age, relationships, cause of death, satisfaction with the bereavement group, reduction of grief, and daily activities. Possible reasons for these findings will be discussed.

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Purpose: The purpose of this study was to categorize the relationships established between visiting nurses and home helpers for care supply and to examine the visiting nurses' awareness and attitude promoting their collaboration. Methods: The subjects were visiting nurses and home helpers who provide care to the same frail elderly. The data were collected by a semi-structured interview and analyzed. Results and Discussion: The relationships between visiting nurses and home helpers were categorized into 4 types -Collaboration, Adaptation, Discord, and Dissociation- in combination with the elements of 8 behavioral patterns; Information sharing, Unification of methods, Role sharing, Techniques to cooperate, Awareness of the relationships, Capability to understand the outcomes, Care contents, and Skills to use measures. It was suggested that visiting nurses should have the awareness of sharing tasks, mutual promotion attitude, learning attitude, responsibility for their duties, mutual equal relationships, and supporting the entire life to establish collaborative relationships and cooperate with home helpers.

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Purpose: This study aimed to investigate the changes in the placement and role of public health nurses (PHNs) following the introduction of the Long-term Care Insurance System in 2000, and its impact on health services and future national-policy regarding PHN activities. Methods: Questionnaires were sent to the directors for elderly healthcare services in 1,344 municipalities throughout Japan (all cities and 23 wards in Tokyo; a quarter of towns/villages) shortly after the enforcement of the Long-term Care Insurance System, in February and March of 2001. The survey instrument included items on population, the number of PHNs, and involvement of PHNs in elderly healthcare and preventive approach for the Long-term Care. Results: The response rate was 42.3% (569 municipalities). Eighty percent of the municipalities experienced no change in the number of PHNs in the healthcare division after the introduction the System. Transfer of PHNs to the Long-term Care Insurance division was a factor contributing to the reduction of PHNs in the healthcare division. Reevaluation of services had led to decreases in services unique to PHNs, such as home visits and community based rehabilitation. We found minimal impact on health education and consultation, the level of impact differed by type of service. Although PHNs were involved in preventive care in 70-80% of the municipalities, they had little involvement with evaluation of services when compared to planning and management. Conclusion: The epoch-making system reform triggered by the introduction of the Long-term Care Insurance System has produced rapid service changes in the welfare and outsourcing and also effected on the decrease of PHNs' home visits, which are unique to the profession.

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We noticed the Mini-Day-Service implemented at K town of I city, S Pref. as a community activity to continuously support the better life of the aged. We qualitatively analyzed the participants' psychology and behaviors described by themselves and observed by supporters to examine the promotion factors and the process of empowerment of the aged. As a result, we found 14 main items and categorized them into 5, and demonstrated as follows; The empowerment of the Mini-Day participants is characterized as a gradual process which progresses from persistence in thinking, concern to participants/other persons, self-expression, sharing/sympathy of daily happenings, mutual recognition of existence to natural behavior. Factors of the empowerment promotion of the Mini-Day participants are the promotion of participation and the promotion of their mutual dialogue/sympathy. As the extracted items are similar to the indices of QOL and empowerment of the aged, and we considered that the Mini-Day is related to QOL of the participants.

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Purpose: To clarify how the experience of health-promoting volunteers is related to health habits, family health care or community participation and to obtain basic data on how valuable their duties are. Method: Analyzing questionnaires as in the following: Contents: Ten questions about health habits, comprising five on family health care and five on community health participation. Distribution: Among one group of 132 people who had experienced two-year terms as health-promoting volunteers in small communities and among another group of 225 people not having such experience. Valid Responses: A total of 99 from the experienced and 135 from the non-experienced. Objects: 75 from each group, 150 in total, picked up using a random table of age composition. Results: 1. There is no relationship between health habits or family health care and the experience of healthpromoting volunteers. 2. The average score for community health participation from the experienced workers is much higher than that of the non-experienced people; they read articles about health in public magazines much more eagerly, get exercise with neighbors regularly and participate in local discussion meeting, lectures or events about health. Conclusion: It's apparent that the experience of health-promoting volunteers is related to community health participation so that our action aiming to raise community health-consciousness by increasing the number of people who have two years of experience as health-promoting volunteers has proved effective. At the same time, the study shows that our next task is to develop and improve the learning program, which was aimed at promoting ideal health habits and family health care.

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Purpose and Methods: The purpose of this study is to describe the actual conditions of the prevention of fetal alcohol syndrome (FAS) and to examine the means of its prevention by a questionnaire given in 68 municipalities in Shizuoka. Results: 49 (67.1%) responses were collected. There was no significant difference between the practice of preventing FAS and the influenceable factors. Although all municipalities mention the importance of practice of FAS prevention, only 40% municipalities were practicing the prevention of FAS. About 50% municipalities were educating pregnant women on the abstinence during pregnancy, the purpose not limited to the prevention of FAS. Few municipalities included the FAS prevention or maternal temperance in their health plans. The attitudes toward temperance (maternal or not) differed between municipalities. Conclusion: There was no significant difference between the practice of preventing FAS and the influenceable factors. Although all municipalities mention the importance of practice of FAS prevention, only 40% municipalities were practicing the prevention of FAS. Public health nurses could not promote the FAS prevention and abstinence, because abstinence from alcohol is not practiced as thoroughly as that from tobacco and also because the actual conditions of pregnant women has not been investigated yet.

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