Investigation of a practical assessment index to capture the clinical presentation of cachexia in patients with lung cancer

Objective: Cancer cachexia constitutes a poor prognostic factor in patients with lung cancer. However, the factors associated with cancer cachexia remain unclear. This study aimed to identify factors that influence cancer cachexia in patients with lung cancer. Methods: In this retrospective observational study conducted at the Kansai Medical University, 76 patients with lung cancer were evaluated for physical function, nutritional status (Mini Nutritional Assessment-Short Form) and physical activity (International Physical Activity Questionnaire-Short Form) at the first visit to the rehabilitation outpatient clinic. The patients were divided into cachexia and noncachexia groups. The log-rank tests and Cox proportional hazards model were used to investigate the relationship between cachexia and prognosis. To examine the factors that influence cachexia, multivariate regression analysis with significant (P < 0.05) variables in the univariate logistic regression analysis was performed. Spearman's correlation analysis was performed to investigate the association between International Physical Activity Questionnaire-Short Form and performance status. Results: Overall, 42 patients (55.2%) had cachexia associated with survival time since their first visit to the outpatient rehabilitation clinic, even after confounders adjustment (hazard ratio: 3.24, 95% confidence interval: 1.12-9.45, P = 0.031). In the multivariate analysis, Mini Nutritional Assessment-Short Form (odds ratio: 20.34, 95% confidence interval: 4.18-99.02, P < 0.001) and International Physical Activity Questionnaire-Short Form (odds ratio: 4.63, 95% confidence interval: 1.20-17.89, P = 0.026) were identified as independent factors for cachexia. There was no correlation between International Physical Activity Questionnaire-Short Form and performance status (r = 0.155, P = 0.181). Conclusion: Malnutrition and low physical activity were associated with cachexia in patients with lung cancer. The International Physical Activity Questionnaire-Short Form may be a useful indicator of physical activity in cachexia. Regularly assessing these factors and identifying suitable interventions for cachexia remain challenges to be addressed in the future.


がん自壊創を有する患者に関わる看護師の困難感の要素

がん自壊創を有する患者に関わる看護師の困難感の要素

Journal of Japanese Society of Cancer Nursing


Characterization of Empathic Attitudes of Nurses from the Perspective of End-stage Cancer Patients with Fatigue

倦怠感のある終末期がん患者が認識する看護師の共感的態度

The purpose of this study was to characterize nurses' empathic attitudes that make end-stage cancer patients with fatigue feel they are understood. Data were collected from 6 end-stage cancer patients with fatigue through participant observation and semi-structured interviews, and qualitatively and descriptively analyzed. Through analysis, 144 codes and 18 subcategories were identified, which were finally classified into 6 categories: [respecting patients' will and self-esteem in a natural manner], [being considerate of patients' anxiety about the future that drains their energy], [sympathizing with patients' true feelings that are difficult to express and speaking for them], [caring about patients as much as possible at all times], [understanding changes in patients' conditions even without much complaint from them], and [providing responsible care based on one's professional knowledge and experience]. Based on these categories, nurses' empathic attitudes may be characterized by ``dedication to try to remove the pain so that it does not overlap'' and ``high nursing competence based on palliative care experience''.

本研究は，倦怠感を有する終末期がん患者が，「倦怠感のある自分を分かってもらえた」と認識する看護師の共感的態度を明らかにすることを目的としている．倦怠感を有する終末期がん患者6名に対し，参加観察法と半構造化面接法を用いてデータ収集し，質的記述的分析を行った． 分析した結果， 144のコードが得られ，最終的に18のサブカテゴリーから，【さりげなく自分の意思や自尊心を大事にしてくれる】【気力を奪う今後の成り行きへの不安に寄り添ってくれる】【言い辛い本心を汲み取って代弁してくれる】【どんな時でも一生懸命に気遣ってくれる】【多くを話さなくても倦怠感の変化を理解してくれる】【専門的な知識と経験から責任あるケアをしてくれる】 の6つのカテゴリーが抽出された． これより，看護師の共感的態度の特徴として， ``苦痛が重ならぬように取り除こうとする専心''と``緩和ケアゆえの熟練した看護実践力''が推察された．

JNI : The Journal of Nursing Investigation


Current Status of Oncology Certified Nurse Specialist Involvement in Cancer Genome Medicine

がん看護専門看護師のがんゲノム医療への関与の実態

The purpose of this study was to clarify the current status of oncology certified nurse specialist(OCNS) involvement in cancer genome medicine. A survey of 235 OCNSs who consented to participate in the study revealed that those involved in cancer genome medicine had a better understanding of hereditary tumors. Through descriptive content analysis, 8 learning needs were identified in relation to cancer genome medicine. Among these needs,[ basic nowledge of hereditary tumors and cancer genome medicine], [regular acquisition of up-to-date information on genetic medicine], and[ genetic counseling in actual clinical settings] revealed no differences between OCNSs involved and not involved in genetic medicine. On the other hand,[ role of an OCNS in genetic medicine], [nursing care for patients and families with hereditary diseases], [systems and collaboration to incorporate genetic medicine into rganizations], [information on genetic medicine for facilities other than urban/designated hospitals], and[ programmed learning as a systematic approach to genetic medicine provided by academic societies] differed between the groups in terms of descriptive contents.


Nursing practice to fulfill the information needs of parents of hospitalized children with cancer and related factors

This study aimed to clarify the current status of nursing practice to fulfill the information needs of parents of hospitalized children with cancer and to determine the associated factors. A cross-sectional survey using a questionnaire was administered to nurses working on wards admitting children with cancer in Japan. Data were analyzed using logistic regression analysis, after exploratory factor analysis. Three factors were extracted as nursing practice: "provision of information that supports the child's future and other family members' daily lives" (factor 1), "provision of information regarding care for the child in the treatment process" (factor 2), "provision of information regarding the child's disease and treatment" (factor 3). Among these three factors, factor 1 achieved the lowest score for the level of practice. Logistic regression analysis indicated that interprofessional information sharing increased the scores of factors 1 and 3 (Odds ratio: 6.150, and 4.932, respectively); assessment of parental information needs increased the scores of factors 1, 2, and 3 (Odds ratio: 3.993, 3.654, and 3.671, respectively); and participation in training increased the score of factor 2 (Odds ratio: 3.078). Nursing practice to fulfill the parents' information needs consisted of three factors. The degree of practice varied according to the information content and was primarily influenced by assessment of parental information needs, interprofessional information sharing, and participation in training. It is necessary for nurses to accurately assess parents' needs, and interprofessional sharing of information is important to fulfill the information needs of parents.


Psychological Adjustment and Related Factors in Patients with Recurrence/Metastatic Lung Cancer after Curative Surgery

Background: Retinoblastoma (RB) occurs at a very young age. Since the disease is diagnosed at an early age, the family is responsible for the care of the child's disease acceptance. Objective: This study aims to explore the parenting process of children with RB toward disease acceptance. Methods: Eleven parents living in Japan were interviewed, and the data were analyzed using the Modified Grounded Theory Approach of Kinoshita (M-GTA). Results: There were twenty-one concepts representing the process of parenting a child with RB while guiding him or her toward disease acceptance, and nineteen of them were classified into ten categories based on semantic similarities. The two other concepts showed similar interpretability to categories. These categories and concepts were summarized into two core categories: ``Helping the child develop a positive mindset to define the disease as a part of him/herself'' and ``Paving the way in advance for the child to live comfortably when his or her living space expands''. Conclusions: In a cyclical framework of parenting, consisting of two core categories described in Results, the parents coordinated these two approaches while maintaining balance by ``Avoiding saying anything that does not need to be said'' and established their process of parenting a child with RB while guiding him or her toward disease acceptance, according to their household situation. The results suggest the necessity of recognizing that in childhood-onset cancers, such as RB, and diseases involving genetic issues, problems tend to occur not only during the treatment period but also at the time of life events and providing support from a comprehensive perspective.


Self-evaluation of Nursing Practice for Elderly Cancer Patients with Dementia Receiving Treatment in Acute Care Hospitals and Factors Influencing It

急性期病院で治療を受ける認知症高齢がん患者に対する看護実践とその関連要因

The purpose of this study was to clarify the current status of nursing practice for elderly cancer patients with dementia receiving treatment in acute care hospitals and related factors An anonymous self-administered questionnaire survey was conducted from May to July 2021 involving 400 people with experience of providing nursing care for elderly cancer patients with dementia Factor analysis identified <considering situations where patients have difficulty in managing their own safety> and <making arrangements to help patients maintain ordinariness> as factors of self-evaluation of nursing practice for elderly cancer patients with dementia receiving treatment in acute care hospitals Such evaluation was influenced by <years of nursing experience> <years of providing nursing care for elderly cancer patients with dementia> <participation in study groups/training seminars on dementia> <knowledge of dementia> <status of nursing practice for dementia> and <ethical behavior>

急性期病院で治療を受ける認知症高齢がん患者に対する看護実践とその関連要因を明らかにすることを目的とした．2021年5月∼7月に認知症高齢がん患者の看護経験を有する400名に無記名自記式質問紙調査を行った．急性期病院で治療を受ける認知症高齢がん患者に対する看護実践を構成する因子は「患者が自分の状態の安全を管理できないところを配慮する」「患者の日常性を維持させていくための工夫をする」が生成された．重回帰分析の結果，急性期病院で治療を受ける認知症高齢がん患者に対する看護実践には，「看護師経験年数」「認知症高齢がん患者の看護経験年数」「認知症に関する勉強会・研修会参加」[認知症に関する知識状況]，[認知症看護実践]，[看護師としての倫理的行動力]が関連していた．


Assessment of dyspnea, ADL, and QOL in the perioperative period in lung cancer patients treated with minimally invasive surgery

Patients with lung cancer generally undergo minimally invasive surgery, such as video-assisted thoracoscopic surgery (VATS). This study examined the changes in health conditions and symptoms of patients with lung cancer using the European Organization for Research and Treatment of Cancer-Quality of Life Questionnaire (EORTC QLQ) C-30 questionnaires after surgery. This was a longitudinal descriptive study. One hundred and three patients with lung cancer who underwent lung resection at Tokushima University Hospital between 2012 and 2021 were eligible. They completed EORTC QLQ-C30, QLQ-LC13, the Cancer Dyspnea scale (CDS), and pulmonary-ADL (P-ADL) before and 1, 3, and 6 months after surgery. Regarding functional scale scores, impairments in physical and role functions persisted for 6 months after surgery. In symptom scale scores, fatigue, pain, dyspnea, and appetite loss continued for 6 months after surgery. In CDS, sense of effort, discomfort, and total dyspnea scale scores were elevated for 6 months after surgery. In P-ADL, most ADL were impaired 1 month after surgery, but recovered by 3 months. The dyspnea index of ADL was lower for 6 months after surgery. Impairments in health conditions and symptoms persisted for 6 months after surgery despite its minimally invasive nature. J. Med. Invest. 70 : 388-402, August, 2023.

The Journal of Medical Investigation : JMI


Dealing with Reality as a Cancer Patient when Continuing Current Cancer Treatment without Possibility of New Treatment as Determined by Cancer Panel Examination

がん遺伝子パネル検査で新たな治療に至らず現行のがん治療を継続していくときのがん患者の折り合い


Resillience in cancer care : What should nurses do?

Cancer is a serious threat to human health worldwide. Attention to the quality of life (QoL) of cancer patients is increasingly recognized as an important component of and a fundamental task in cancer care. Recent studies illustrate that resilience is a key biological factor affecting cancer patients' health status and QoL. However, few studies have focused on resilience during medical procedures of cancer patients from the perspective of nursing. In this study, we summarize recent literature exploring the clinical significance of resilience in oncology nursing, propose strategies for cancer care to improve the QoL of patients through interventions on resilience, and focus on emerging theories in oncology nursing. In summary, this will emphasize the importance of resilience in oncology nursing and benefit the clinical practices that improve patients' QoL and reduce the social burden caused by cancer. J. Med. Invest. 70 : 1-6, February, 2023.


The purpose of study was to clarify the psychological adjustment and related factors in lung cancer patients with recurrence/metastasis after curative surgery. Forty-one with lung cancer who were informed of a recurrence/metastasis after curative surgery completed a questionnaire comprised of the Mental Adjustment to Cancer Scale (MAC), Psychological Adjustment scale for Cancer Survivors (PACS), and information pertaining to demographic variables. When healthcare providers intervene in patients with lung cancer that has recurred/metastasized after curative surgery, it is necessary to assess patients' psychological adjustment based on demographic information, such as age, sex, marital status, and employment status, and to provide effective support promptly. Factors associated with psychological adjustment with recurrent/metastatic lung cancer after curative surgery were 1) female, 2) having a job, 3) over 65 years of age, 4) having a spouse, and 5) advanced-stage cancer. There was no difference in psychological adjustment between treatment and the period from cancer incidence to recurrence/metastatic. J. Med. Invest. 70 : 200-207, February, 2023.


Emotions of patients with hereditary breast and ovarian cancer syndrome after risk reducing salpingo-oophorectomy

遺伝性乳癌卵巣癌症候群と診断された乳癌罹患患者のリスク低減卵管卵巣摘出術後の思い


Experience of recurrent/advanced cancer patients receiving outpatient cancer rehabilitation

外来でがんリハビリテーションを受ける再発・進行がん患者の経験

he aim of this study was to clarify the experience of recurrent/advanced cancer patients receiving outpatient cancer rehabilitation and find out how cancer rehabilitation can support cancer patients. The study was conducted by semi-structured interviews of 13 recurrent/advanced patients undergoing cancer rehabilitation during cancer chemotherapy. Six categories were extracted: [Finding the physical condition suitable for me] [Being unable to find movements that I can effectively utilize myself] [Being able to continue normal everyday life] [Showing people around me that I can still move] [Having fun actively moving my body] [Gives meaning to my present ``living'']. Characteristics of the experience of patients who have undergone cancer rehabilitation are: cancer patients can get a sense of control over their own bodily functions, they can move their own bodies autonomously, and it is a new opportunity to expand their own possibilities.

本研究では外来通院でがんリハビリテーション(以下がんリハ)をうける再発・進行がん患者の経験を明らかにし，外来通院でのがんリハがもたらす効果を可視化し，がんリハの新たな支援への示唆を得ることを目的とした結果，【自分 にあった身体の状態を見つける】【うまく自分の中で活かせる運動が掴めない】【普段と変わりない日常生活を継続できる】【自分が動けていることを周りに示す】【自分で身体を動かしていく愉しみがある】【いまの自分の`生きる'ことを意味付けてくれる】の6カテゴリーが抽出された．


ICG蛍光リンパ管造影検査リンパマッピングを受けたリンパ浮腫患者の経験

ICG蛍光リンパ管造影検査リンパマッピングを受けたリンパ浮腫患者の経験

Journal of Japanese Society of Cancer Nursing


がん治療に対する納得の尺度開発

がん治療に対する納得の尺度開発

Objective: This study aims to develop a scale for measuring cancer treatment acceptance and to examine its reliability and validity, which will help patient accept and complete cancer treatment. Methods: A questionnaire survey was conducted, involving 294 cancer patients receiving treatment. The reliability and validity of the developed cancer treatment acceptance scale were confirmed by examining evidence in content, from substantive, structural, generalizability, and external aspects. Results: Responses were obtained from 235 patients (response rate: 79.9%), and 210, who returned valid responses, were analyzed. To verify the reliability and validity of the scale, item analysis was performed. Through factor analysis for 28 items finally adopted, 2 factors, [the value of treatment] and [a positive feeling about treatment], and 18 items were identified. The goodness of fit of this model was represented by GFI = 0.901, AGFI = 0.853, CFI = 0.919, and RMSE = 0.049. The correlation coefficient with Decisional Conflict Scale was r = 0.589 to 0.667. Cronbach's alpha for each factor ranged from 0.915 to 0.945. Conclusions: We developed a scale consisting of 2 factors with 18 items to measure cancer treatment acceptance and confirmed its reliability and validity.

目的:患者が納得してがん治療を受けることは，治療完遂に向けて重要な視点である．本研究ではがん治療に対する納得の尺度を開発し，信頼性と妥当性を検討した．方法:がん治療を受けているがん患者 294 名を対象に質問紙調査を実施し，内容的，本質的，構造的，一般化可能性，外的側面からの証拠を検討した．結果:235 名から回答が得られ(回収率 79.9%)，有効回答の 210 名を分析対象とした．開発した尺度の信頼性と妥当性の検証において，項目分析を行い最終的に 28 項目で因子分析を行った．その結果，【治療する価値】【治療への前向きな気持ち】の 2 因子 18 項目が抽出された．モデルの適合度は GFI = .901，AGFI = .853，CFI = .919，RMSE = .049 であり，Decisional Conflict Scale との相関は r = –.589∼–.667 であり，各因子のクロンバック α 係数は .915∼.945 であった．結論:がん治療に対する納得の尺度 18 項目 2 因子構造を開発し，信頼性と妥当性が確保できた．

Journal of Japan Academy of Nursing Science


初期治療終了後の初発乳がんサバイバーの就労継続のプロセス

初期治療終了後の初発乳がんサバイバーの就労継続のプロセス


終末期高齢がん患者の在宅移行期に関する文献レビュー

終末期高齢がん患者の在宅移行期に関する文献レビュー

The purpose of this study was to characterize periods of hospital-to-home care transition for elderly cancer patients by extracting definitions of such periods and their characteristics as situations from the literature, and to discuss effective nursing support toward hospital-to-home care transition. Relevant research papers published within the period between 2010 and 2020 were searched for using Ichushi Web and PubMed. Descriptions related to periods of transition, characteristics of situations, and hindering/promoting factors were extracted without any changes and categorized based on descriptive content similarities. In these papers, a period of hospital-to-home care transition was described as 1 week to 1 year after discharge. As a situation, it was characterized as ``a time when the patient rebuilds his/her life'', and therefore, ``a time of instability''. Factors hindering and promoting hospital-to-home care transition were represented by6categories, which suggested the following commonalities between them : [ physical management],[patients'/families' intentions],[home care systems],[other family members' commitments to home care], [collaboration systems], and[nurses' home care experience].


治療を受けている再発転移後の肺がん患者が持つ見通し

治療を受けている再発転移後の肺がん患者が持つ見通し

This study aimed at clarifying prospects that lung cancer patients undergoing treatment after recurrence and metastasis have. The study method is based on the qualitative descriptive study design. A semi-structured interview was performed for 13 lung cancer patients undergoing treatment after recurrence and metastasis. As a result, the following five categories were extracted[; Since it is recurrence and metastasis, the death is coming to me][, I am undergoing treatment so I'm alright now but I'll die someday][, Let a matter take its own course][, My life will be going as before]and[I will be living as long as I receive treatment]. Characteristics of the above are that all of the patients are ready to accept death and they had more than two prospects. They were characteristic of patients after recurrence and metastasis that symptoms that remind them of repeated treatment and death appear and there is uncertainty for their future. The above results have suggested the need to capture the state of each prospect while confirming the prospects of lung cancer patients under treatment after recurrence and metastasis.


Extreme leanness, lower skeletal muscle quality, and loss of muscle mass during treatment are predictors of poor prognosis in cervical cancer treated with concurrent chemoradiation therapy

Human papillomavirus vaccination is not widespread in Japan, and the low screening rates result in many cases of locally advanced cervical cancer. We investigated the prognostic significance of sarcopenia in patients with cervical cancer to guide healthcare policies to improve treatment outcomes. This retrospective study included 83 patients with cervical cancer without distant metastasis who underwent primary concurrent chemoradiotherapy between 2013 and 2018. We analyzed the indicators of physical condition and muscle quantity using the SYNAPSE VINCENT software. Muscle mass and the relationship between treatment toxicity and prognosis were evaluated. The patients' median age was 60 (range 33-80) years. Cancer stage distribution was as follows: cT2b or higher, 84.3%; N1, 65.1%; and MA, 27.7%. The overall sarcopenia (skeletal muscle index [SMI] < 38.5) rate was 30.1%, and the rate was 33.9 and 22.2% in patients aged < 64 and ≥ 65 years, respectively. No correlation was observed between clinical stage and musculoskeletal indices. Treatment resulted in decreased body weight and SMI; after treatment, the sarcopenia rate increased to 37.3%. A higher intramuscular adipose tissue content (IMAC) reduced the number of chemotherapy cycles needed. Treatment-associated SMI decreases of ≥ 7% indicated poor prognosis, with significant differences in progression-free survival and overall survival (p = 0.013 and p = 0.012, respectively). Patients who were very lean (body mass index < 18.5 kg/m) before treatment had a poor prognosis (p = 0.016 and p < 0.001). Our findings emphasize the importance of assessing original nutritional status and maintaining muscle mass and quality during the treatment of patients with cervical cancer.

International Journal of Clinical Oncology


The desires of the families of patients with end-stage lung cancer

急性期病棟でBest Supportive Careとなった肺がん患者の家族の願い


Effect of Observing Surgery during Clinical Adult Nursing Practicum on Postoperative Nursing from the Perspective of Students

成人看護学実習において学生が捉えた手術見学実習体験の術後看護への影響

Aim:To clarify the effects of observing surgery during clinical adult nursing practicum on postoperative nursing from the perspective of students. Methods:Semi-structured interviews were conducted with10students in their third year at a nursing college. The obtained data were qualitatively and inductively analyzed. Results:When observing surgery for the patients they were caring for, the students were aware of[the importance of observing and assessment with the influence of surgery and anesthesia taken into account]. Subsequently, they performed[postoperative pain management based on findings from the observation of actual surgical settings], while providing various approaches, including[Approaches to the promotion of patients' awareness of the current situation in order to prevent postoperative confusion and to protect safety]. Through this process, they developed[a sense of responsibility for nursing care inspired by patients・families' coping behaviors]． Discussion:The experience of observing surgery during clinical training was suggested to help students develop practical insights for care to promote postoperative recovery and a sense of responsibility for nursing care inspired by patients・families' coping behaviors.


Impact of a web-based educational program on Japanese nurses tobacco cessation practice and attitudes in oncology settings

To evaluate the effects of a short web-based educational program on Japanese nurses' self-reported attitudes toward tobacco cessation and their use of interventions to help smokers to quit. Prospective, single-group design with a pre-educational survey, a short web-based educational program, and a follow-up survey at 3 months. Clinical nurses were asked to view two prerecorded webcasts about helping smokers quit. They completed two online surveys, one at baseline and one at a 3-month follow-up. Generalized linear models were used to determine changes in nurses' self-reported routine practice after the study intervention. A total of 1401 nurses responded to the baseline survey, 678 of whom completed the follow-up survey. Compared with baseline, nurses at follow-up were more likely to advise smokers to quit (odds ratio [OR] = 1.45, 95% confidence interval [CI: 1.15, 1.82]), assess patients' interest in quitting (OR = 1.46, 95% CI [1.01, 1.04]), and assist patients with smoking cessation (OR = 1.34, 95% CI [1.04, 1.72]). However, the proportion of nurses who consistently recommended resources for tobacco cessation did not significantly improve at follow-up. This study provides preliminary evidence that a web-based educational program can increase nurses' implementation of tobacco dependence interventions in cancer care practice. Sustaining these educational efforts could increase nurses' involvement in providing these interventions, encourage nurses to refer patients to cessation resources, and support nurses' attitudes towards their role in smoking cessation. Our short web-based educational program can increase nurses' use of tobacco-dependence interventions in cancer care practice. This role can be enhanced with additional information about existing cessation resources that nurses could use to refer patients for support post-discharge. Japanese nurses, when properly educated, are willing and significant contributors to promote tobacco use cessation for cancer patients. The contribution can be facilitated through nursing care protocol that integrate tobacco use cessation interventions within evidence-based cancer care approaches.


The Lived Experience of Nurses Who Cared for Patients with Cancer during the Terminal Phase

終末期肺がん患者・家族の看護に対する看護師の心情

This study aimed to describe the lived experiences of nurses who cared for patients with cancer and their families during the terminal phase. A semi-structured interview was conducted with twenty-two nurses who cared for patients with cancer at their terminal stage. These interviews were transcribed and analyzed by identifying words, phrases and statements that describe the experiences of the nurses. As a result, the findings of the study discovered the following six thematic categories : Regret for failing to rid of distress peculiar to lung cancer ; Cowardliness for lack of competency in their nursing skills ; Disheartening feeling during the last moments of the patient's life ; Expressing EOLC process for the family ; Worthiness to be involved during the last moments of the patient's life ; and Earnest desire to understand the patient's death. While nurses may have emotional distress and personal conflicts while taking care of patients, particularly those with lung cancer, this study revealed that The nurses' experiences of caring for patients with lung cancer during the terminal stage is critical to understanding the humanness during the EOLC. As a recommendation from this study, it is important to include the patients' families in their care. Family participation may lead them to have an easier acceptance of the patients' death, by focusing on the situation as a natural occurrence, and for the patients to have a good death. Moreover, the experience of the nurses have deepened their views of life and death situations impacting their practice, and enhancing their growth as nurses during EOL.

本研究の目的は終末期肺がん患者・家族への看護に対する看護師のネガティブおよびポジティブな感情を含めた心情を明らかにし，肺がん患者・家族の終末期における看護を検討することである．終末期肺がん患者を担当した経験がある看護師22名に半構造的面接を行い，内容を質的帰納的に分析した．結果，看護師の心情として【肺がん特有の苦悩を取り除けない心苦しさ】【終末期看護に対する自分の技量の不足への不甲斐なさ】【その人の人生最期を支える重圧感】【家族の看取りのプロセスとして心する】【人の最期に関わることへのやりがい】【患者の死を大切に理解したいという切実な思い】の6つのカテゴリーが抽出された．看護師は終末期肺がん患者のケアを行う中で多様な苦悩や治療に対する葛藤を抱えていることが分かった．また患者のみならず，家族をも看護の対象として捉え，その関わりへの困難を抱えていた．看護師は家族が患者の死を自然なものとして捉えることが出来るように関わり，患者が精神的に充実した最期を迎えることが出来るように介入していた．また患者の死の体験は死生観，看護観を深め，看護師の成長につながっていることが分かった．

JNI : The Journal of Nursing Investigation


Experience of a nurse with a dilemma of hope to recover of cancer patients who have stopped treatment

治療を中止したがん患者がもつ回復への希望に対してジレンマを抱えた看護師の体験

In this study, the authors clarified experience of nurses with the dilemma toward the wish for recovery of cancer patients who discontinued treatment. An interview survey was performed for 14 nurses who had ever care cancer patients who discontinued their treatment. Experience of nurses with the dilemma toward the wish for recovery of cancer patients who discontinued treatment consisted of the following categories ;[ I am not able to respond to the patient's wish though I want to],[There is difference how to spend the time remained between the patient and me],[I do not have a sufficient power to support the end of the patient's life],[I feel disconsolate being unable to realize the patient's wish for recover]and[I'm a nurse. I never run from my patients]. The nurses with dilemma had experience in facing nursing cares driven by the sense of responsibility as a nurse while holding pain in their heart. Ethical problems may be underlying in this experience, and the need of team work, not individual responses, has been suggested. Therefore, support to reveal experience of nurses in daily nursing care is needed.


The Development of the Arm Fixation Method to Prevent Ipsilateral Shoulder Pain in Patients Undergoing Lung Resection

The aim of the present study was to investigate the efficacy of a new upper limb fixation method-body pillow position for preventing postoperative ipsilateral shoulder pain (ISP) in patients undergoing lung resection. An experimental study design was used. We conducted two comparisons (group A: the previous position using the arm fixation device; group B: the body pillow position) at random and examined an arm fixation method that is effective for ISP prophylaxis in patients undergoing surgery in the lateral decubitus position. We approached 87 patients, two were excluded, and, thus, 85 were randomly assigned to group A (n = 43) or group B (n = 42). No significant differences were observed in the frequency of ISP between groups A and B (25.6% vs 26.2%). The intensity of ISP between both groups was analyzed by a repeated-measures analysis of variance and was shown to decrease over time in 22 patients (P = .010). The intensity of ISP on postoperative days 0 to 3 was slightly lower in group B than in group A (P = .158). Risk factors for ISP were the duration of surgery (odds ratio, 1.01; 95% confidence interval, 1.00 to 1.01) and pre-existing shoulder stiffness (odds ratio, 5.15; 95% confidence interval, 1.07 to 24.83). There was no significance in the frequency of ISP between group A and group B. The intensity of ISP on postoperative days 0 to 3 was lower in group B than in group A, although there was no significant difference. It is important perspective for perioperative care providers to prevent ISP for early postoperative recovery and improvement of postoperative quality of life. These results suggested that we must consider a better position for preventing postoperative ISP in patients undergoing lung resection.


Practical Approaches of Nurses Certified for Cancer Chemotherapy

がん化学療法看護のエキスパートナースが大切にしている実践

To clarify the practical approaches of nurses in cancer chemotherapy, semi-structured interviews were conducted with 10 nurses certified for cancer chemotherapy in Tokushima Prefecture. The interview data were classified into the following categories : [not neglecting any step, as failure is unacceptable], [accurately predicting the symptoms of chemotherapy, rather than simply waiting for patients to report them], [making efforts to fulfill patients' desire to live], [bearing a heavy responsibility for handling toxic drugs], and [playing a role in generalizing chemotherapy]. The results suggest that the practical approaches of nurses in cancer chemotherapy three features place importance on "achieving positive effects while minimizing risks", "not narrowing down the scope of life", and "reducing resistance to chemotherapy".


Nursing Students' Understanding of Orem's Power Components in Gerontological Nursing Clinical Practice

看護学生が理解する高齢者看護学実習におけるオレムのパワー構成要素

The purpose of this study was to analyze trends in nursing students' assessments of the 10 powers of self-care agency in Gerontological Nursing and to identify educational support for students. The subjects were the practice records of 66 third-year nursing students who completed Gerontological Nursing from September 2019 to February 2020. The results showed that they had a perspective of directing their attention to the patient's interest, will, motivation, and reasoning among 10 power items that all students were able to assess, and that they approached their care with a respectful attitude toward the patient's perceptions and intentions for self-care. In addition, it could be inferred that they understood self-care in terms of patients' behaviors and activities by appearance. Conversely, from the items that more than half of the students were unable to assess, it could be inferred that they were unable to assess how to apply self-care agency to the patient's prospect and lives in future.


A survey on the perceptions of "narratives of end-of-life care" among healthcare professionals and the general public

医療福祉専門職と一般市民の「看取りの語り」に対する捉え方の実態調査

The purpose of this study is to examine how to support healthcare professionals and the general public in a situation where home care is increasing by clarifying the actual situation of how to perceive the end-of-life-care of healthcare professionals and the general public who heard the "narratives of attendance to someone's death". A questionnaire survey was conducted targeting palliative care certified nurses and the general public and healthcare professionals in local city A who participated in the lecture on "Narratives of attendance to some one's death" by the bereaved family.Healthcare professionals perception of "narratives of attendance to someone's death" were in the following four categories : "Cooperation based on the roles of other professions is essential," "The way one lives one's life has an impact," "It is important to acquire a wealth of knowledge as a practitioner," and "It is based on the thoughts of the family." On the other hand, the general public's perception of "narratives of attendance to someone's death" was in the four categories of "understanding through experience and information," "continuing to seek care for the person," "making people think about the meaning of life," and "confronting one's own and one's family's view of life and death."In order to make end-of-life care satisfactory for patients and their families, it is necessary to provide information that can predict the future and adjust the environment to support them together.


Stress Coping in Families Caring for End-stage Cancer Patients with Difficulty Controlling Pain at Home

疼痛コントロールに難渋している終末期がん患者を在宅で介護する家族のストレス・コーピング

To clarify stress coping in families caring for end-stage cancer patients with difficulty controlling pain at home, semi-structured interviews were conducted with family caregivers using home-visit nursing services, and the obtained data were qualitatively, inductively analyzed. Stress responses in these family caregivers were summarized into5categories, including :[ having no idea what to do with the patient suffering from pain]and[being unsure on how to consult with medical professionals about pain]. In addition,6categories, representing the characteristics of their stress coping, such as[discharging negative emotions through recreational activities and catharsis]and [managing pain based on experience], were created. Families caring for end-stage cancer patients with difficulty controlling pain at home experienced several types of stress, but it was suggested that they personally grew through the process by adopting various coping strategies.


急性期病院に勤務する看護師のアピアランスに関する認識

急性期病院に勤務する看護師のアピアランスに関する認識


Hope-related experiences of lung cancer patients during postoperative recovery

術後回復過程にある肺がん患者のHopeの体験

Journal of Japanese Society of Cancer Nursing


Exploring the Psychological Adjustment of Female Cancer Survivors in Terms of Femininity

女性性からみた女性がんサバイバーの心理的適応の探求

The purpose of this study is to explore the psychological adjustments female cancer survivors undergo with respect to their femininity. Semi-structured interviews were performed with 29 female cancer(breast or gynecologic cancer)survivors in their20s to50s. Qualitative descriptive study data was interpreted according to Krippendorff's content analysis method.As a result, six categories were generated as psychological adjustments utilized by female cancer survivors from the viewpoint of femininity : "I like the way I am" ; "I am charming as a woman" ; "I live independently as a woman" ; "I am expanding my life as a woman" ; "I can feel connected with someone" ; and "I have graduated from pessimism." These could be interpreted as psychological adaptations that reflect feminine emotions and reflect the strength and resilience of female cancer survivors. In order for female cancer survivors to adjust to living with cancer in a psychologically healthy way, it was suggested that nursing support was important to restore the feelings of the survivors from the perspective of these feminine characteristics.


海外文献における遺伝性腫瘍に関する遺伝カウンセリングの動向

海外文献における遺伝性腫瘍に関する遺伝カウンセリングの動向


在宅で緩和ケアが必要ながん患者を支援する訪問看護師の困難感

在宅で緩和ケアが必要ながん患者を支援する訪問看護師の困難感

This study aimed to identify difficulties of visiting nurses who provide assistance to home-based cancer patients requiring palliative care. In survey1, a questionnaire survey was conducted involving30visiting nurses working for visiting nursing stations(valid response rate :90%), and the data were analyzed using descriptive statistics. In survey 2, a semi-structured interview based on an interview guide was conducted involving4visiting nurses working for visiting nursing stations, and the data were analyzed using a qualitative and inductive approach. The results of survey1showed that the visiting nurses were more likely to experience difficulties with the worsening of a patient's health status and at the initiation of home-based care. They also experienced difficulties with understanding medical conditions of patients and their families, supporting decision-making, and cooperating with visiting physicians. Their level of understanding about the explanation given by physicians and the sense of value of patients and families were factors that affected such difficulties, and so, in order to resolve them, the importance of cooperating to secure medical and nursing personnel and creating a setting where they can share their knowledge of patients' conditions and treatments was indicated. In survey 2, the following 6 categories were extracted as difficulties encountered by visiting nurses providing assistance to home-based cancer patients requiring palliative care :[dealing with the worsening of the disease], [predicting the end of life], [being unable to care for patients without cooperation],[being involved with patients by understanding their life before illness],[preparing a home care environment for a patient's end-of-life], and[limits of current work situations]. The findings suggest the need not only to provide palliative care knowledge for the prediction and understanding of illness, but also to establish a system that allows multiple medical providers to assess patients' conditions, in order to deal with their difficulties.


Relationship between Older persons with cancer' Coping Attitudes and Mental Adjustment

Objective Purpose is to examine the relationship between older persons with cancer coping attitudes and patterns of mental adjustment during treatment. Methods : Coping attitudes and patterns of mental adjustment were measured using an original questionnaire and the Mental Adjustment Cancer Scale (MAC) in 193 patients with cancer aged 65 or over under treatment with surgical therapy, chemotherapy, or radiotherapy. Results : The mean scores for "Do my best to cope with cancer" ,"Make my own decisions on treatment" in coping attitudes showed a significant positive correlation with [fighting spirit] scores in MAC, and "Cancer is just a part of my life", "At my age, no complaint about cancer development", "Face cancer in an easy-going manner", "Do my best to cope with cancer" "Be anxious about my future" were significantly correlated with [fatalism] scores. Conclusions : In conclusion, [fighting spirit] [fatalism] were shown to form the basis for elderly's mental adjustment. [Fatalism] was shown to be a main component of mental adjustment for elderly to develop affirmative coping skills based on their life experiences. In addition, [fighting spirit] was also essential to fulfill their lives, and it may be necessary to support them to keep [fighting spirit] to the end of their lives. J. Med. Invest. 67 : 44-50, February, 2020.

The Journal of Medical Investigation : JMI


Experience of the Nursing Students Who Took Charge of End-of-life Cancer Patients in Clinical Practice of Gerontological Nursing

高齢者看護学実習における終末期がん患者を受け持った看護学生の体験

In this study, we clarify the experiences of students through providing nursing care for end-of-life cancer patients and examine the guidance of clinical practice necessary to link the experiences with the result of learning. We conduct interview survey of 15 nursing third graders who take care of terminal older cancer patients in clinical practice in gerontological nursing. The students' experience was classified into six categories ; "Repentance for doing nothing", "Involvement actively with patients", "Awareness of life preciousness", "Concentration on daily nursing", "Repentance for insufficient care", "Respect for patients' own lives". The student's experience focused on the terminal stage situation, and it was an experience to learn the importance of making them live with dignity, reflecting on their own care. It was suggested that widening students' view of patients' individual lives was quite useful to consider terminal care based on the characteristics of people.

本研究は，終末期がん患者を受け持った看護学生の体験を明らかにすることを目的とした．高齢者看護学実習にて終末期がん患者を受け持った看護学生3年生15名に面接調査を実施した．終末期がん患者を受け持った学生の体験は【苦しんでいる患者がいるのに何もできず情けない】【終末期と怖気づかずに非力ながらも自分から関わっていく】【日常生活のなかで生死を目の当たりにする】【患者が生きている今日1日をしっかりと支えていく】【クリティカルな状態にある患者を看るにはまだまだ不十分さが残ると自覚する】【最期まで患者らしく人生を生き切れるようにする】のカテゴリーで構成された．学生の体験は，終末期にあるがん患者の状況から，自身のケアのあり方に対峙し，患者らしさを引き出す大切さを学ぶ体験となっていた．患者の持つその人らしさの視点を広げることは，対象の持つ特性を加味した終末期ケアを促すことになることが推察された．


The actual situation on how nursing students understand older patients using Orem's nursing theory in the Geriatric Nursing Training

高齢者看護学実習におけるオレム看護理論の活用による看護学生の高齢患者の理解の実態

The purpose of this study was to clarify how the students understand the older patients based on Orem's nursing theory in Geriatric Nursing Training. The participants were17nursing students in third grade. The interview was carried out using semi-structured interview with students for how they felt older patients. As a result, two categories were extracted ; [ they need limited care for deficient parts]and[they have toughness cultivated through their long life]. The students understood the older patients as having self-caring abilities and thought that limited care should be provided only for deficient parts of patients. Also, they understood older patients as having strength cultivated through their long life. It is necessary for teachers to assess the Self-care agency more severely for students to get hold of mature elements characteristic of older patients.


Working Situations of Patients with Cancer:A Literature Review

がん患者の就労状況に関する文献検討

Abstract The purpose of this study was to clarify the characteristics of the working situation derived from the findings of research studies on cancer patients, and to explore the possibilities of support systems towards employment of patients with cancer from the viewpoint of the health care staff.

The literature review used the Ichushi-Web (Ver .5), limiting the search to only original papers using the following keywords:"cancer" and "working", "cancer" and "working support", "cancer" and "job". Moreover, the review included dissertation studies and excluded papers focused on pediatric patients with cancer, papers designed for medical staff, and case reports.

From these inclusion and exclusion criteria, only 25 research papers remained. These were all focused on the actual conditions of working situations of patients with cancer, and the factors affecting the continuation of working by the patients with cancer. An astounding finding was that actual status of employment for patients with cancer was dictated by the status of their cancer treatments. They tended to leave their employment early, often before cancer treatment began. Factors that were found crucial to the characteristics are [Physical adjustment] [Information acquisition] [Value for working] [Support system] [Consideration of workplace] [Economic situation] influencing the viewpoint for the continuation of work for patients with cancer. Health care professionals need to understand that the social trends and policies, including the activities being carried out at places of employment are important towards the coordination of treatment and further employment of the patient with cancer. It is suggested that it is necessary to construct an intervention program that supports many types of workers, but most especially those patients with cancer.

要 旨 本研究の目的は，がん患者の就労に関する研究の動向とともに就労状況における特徴を明らかにし，医療職者の立場からがん患者の就労に対する支援体制の方向性を検討していくことである．文献は，医学中央雑誌Web版(Ver．5)を用いて，「がん」and「就労」，「がん」and「就労支援」，「がん」and「仕事」をキーワードに原著論文に限定し文献検索を行った．がん患者を対象とした就労に関連する文献に限定し，小児がん患者・小児がん経験者を対象とした論文，医療職者が対象である論文，症例報告については除外し，25論文を分析対象とした．がん患者の就労状況の実態，がん患者の就労継続を左右する要因について着目し整理した．結果，がん患者の就労状況の特徴として，がんの診断から治療開始前までの早い時期に離職する傾向にあった．がん患者の就労継続を左右する要因として，【身体調整】【情報獲得】【就労への価値】【支援体制】【職場の配慮】【経済状況】が明らかになった．医療職者は，社会の動向や施策，就労の場で行われている取り組みを理解し，患者の治療と就労の調整役として，就労継続を左右する要因である【身体調整】【情報獲得】【就労への価値】【支援体制】【職場の配慮】【経済状況】の6視点を持ち，離職が多い診断時から支援する介入プログラムを構築する必要性が示唆された．

JNI : The Journal of Nursing Investigation


Treatment associated symptoms and coping of postoperative patients with lung cancer in Japan: Development of a model of factors influencing hope

Aim Postoperative patients with lung cancer have a high recurrence rate and poor prognosis; hence, it was aimed to identify the factors affecting hope to develop a care-oriented perspective that focuses on the levels of hope of postoperative patients with lung cancer. Methods In the study, postoperative patients with lung cancer were included and data were collected for treatment-related symptoms, coping, and support-related factors as the primary variables. The Herth Hope Index, Quality of Life Questionnaire Lung Cancer Module of the European Organization for Research and Treatment of Cancer, Japanese version of the Coping Inventory for Stressful Situations, and Social Support Scale for Cancer Patients were used. Results For the 82 patients that were included in this study, 55% of the variance in the level of hope was explained by using a model that included the following: (i) symptoms of dyspnea, sore mouth, and chest pain; (ii) support, including satisfaction with postoperative symptom control by healthcare providers, satisfaction with the amount of information provided by healthcare providers, and the level of trust in the nurses during treatment and recovery; and (iii) task-oriented and social diversion coping behaviors. Conclusion As a result of this study, the support-related factors had no direct influence on hope, but they did have a significantly negative influence on the treatment-related symptoms, with improved symptoms also influencing hope.


Ipsilateral shoulder pain in patients following lung resection in the decubitus position

Aims and objectives: To examine the frequency, influencing factors and clinical course of shoulder pain in patients following lung resection. Background: Thoracoscopes have been introduced in the surgical treatment of lung cancer and allow for less invasive surgery with a minimal incision. However, decubitus position-related shoulder pain on the operated side has not yet been investigated. Design: A longitudinal descriptive study. Methods: Patients who underwent lung resection in the decubitus position. Patients were interviewed 2 days before surgery and once daily for 5 days after surgery. Interview items included background data, the concomitant use of epidural anaesthesia, operative duration, the presence of preoperative shoulder stiffness (excluding shoulder pain), type of surgery and site of operation. The intensity of pain was approximately 5 on an 11-point numerical rating scale. Descriptive statistics on patient backgrounds were obtained using SPSS Statistics 22 for Windows. Results: Of the 74 patients who underwent lung resection in a decubitus position, 30 (40.5%) developed shoulder pain on the operated side. The highest rating occurred 1 day after surgery and decreased over time. The following two factors were found to influence shoulder pain on the operated side: operative duration (Z = 2.63; p = .01) and the presence of preoperative shoulder stiffness (excluding shoulder pain) (X2= 4.16; p = .04). Conclusions: This study demonstrated that approximately 40% of patients who underwent lung resection in the decubitus position developed shoulder pain. Relevance to clinical practice: The presence of postoperative shoulder pain was related to both the duration of the operation and to the presence of preoperative shoulder stiffness. Although the shoulder pain resolves within 4 days, it causes the patient additional discomfort and distress. Therefore, further research is needed on positioning for thoracotomy in order to investigate ways to reduce or eliminate this complication of lung surgery.


Students' Care-related Attitudes during Geriatric Nursing Training


Postopearative Discomfort and Its Influence on daily Life in Patients with Lung cancer: A study Concerning the Period from Hospital Discharge to 6 Months After Surgery

術後肺がん患者の退院時から術後6ヵ月までの身体的不快症状の実態

Journal of Japanese Society of Cancer Nursing


Elements of How Older Patients with Metastatic Cancer Come to "Nattoku" with Treatment

転移のある高齢がん患者の治療に対する納得の要素

The objective of this study was to identify elements of how older patients with metastatic cancer become "nattoku" with treatment. In this study, nattoku was defined as "a state of cognitive and emotional acceptance of treatment" by older cancer patients. A qualitative descriptive study was employed, and semi-structured interviews were carried out with 20 metastatic cancer patients aged 65 years or older who were currently undergoing cancer treatment on their own volition. We extracted six elements that involve becoming nattoku with treatment: a strong intention to save oneself, certainty that the treatment was required in order to live, expectations of the potential of treatment, trusting that they chose the optimum treatment, the desire to give something back to those around them, and accepting to live life to the fullest, even while undergoing treatment. Our results suggested that the values of patients themselves were affected by their treatment status. Also, patients were not solely concerned with their own interests, but sensed the feelings of those around them and took them into consideration. A third characteristic suggested by our findings was their acceptance of treatment, and their attitude towards life and the way in which they have lived. This was characteristic of older patients with advanced illness who were in the final stage of life. These elements were fostered during the lives of older patients with metastatic cancer, and our study suggested that support that encourages patients to commit to a lifestyle and their current circumstances may help them become nattoku with treatment.

本研究の目的は，転移のある高齢がん患者の治療に対する納得の要素を明らかにすることである．本研究では，納得とは「高齢がん患者が治療に対して，能動的に認知的かつ感情的に受容した状態」と定義する．研究方法は質的記述的研究デザインで，がんに対して治療を選択した現在治療過程にある65 歳以上の転移のある高齢がん患者20 名を対象に半構造化面接法を実施した．結果，転移のある高齢がん患者の治療に対する納得の要素として，【自分を救おうとする強い意志】【生きるための治療であるとの確信】【治療の可能性への期待】【信じて任せられる最善の治療であるとの判断】【周りへ報いたいとの希求】【治療を含めて生ききる人生の受け容れ】の6 つのカテゴリーが抽出された．これらの転移のある高齢がん患者の治療に対する納得の要素の特徴として，1 つは患者自身の価値が治療状況に反映していることが示唆された．2 つ目として，自己の利害にとらわれずに周りの人達の気持ちを察し，それを自分の気持ちや意志として汲み取る特徴が推察できた．3 つ目として，治療だけでなく，自分の人生に対するあり方や生き方も含めた今の状況に対する受け容れでもある特徴が示唆された．それは，病期が進んだ状況でのライフサイクル最終段階にある高齢者のもつ特徴が表れていた．また，これらの要素は転移のある高齢がん患者が生きてきた中で培われたものでもあり，その人の生き様や今の状況に患者がコミットできるように支援することも納得に導いていく看護となることが示唆された


Students' assessments of their patients' self-care agency during gerontological nursing practicum

高齢者看護学における学生のセルフケア・エージェンシーのアセスメント

本研究では，高齢者看護学実習における学生のセルフケア・エージェンシーのアセスメントの実態を明らかにすることを目的に，A看護系大学3年生の実習記録用紙を分析した．その結果，80%の学生は妥当なアセスメントであった．特に，[孤独と社会的相互作用]，[基本的条件付け要件]，[問題の明確化]のアセスメントの評価が高く，逆に[正常性]，[特定のセルフケア要件]は低かった．また，[セルフケア・エージェンシー]の分析の結果，評価的操作から【今の自分の状態の認識】【先の状態に対する理解】【特定のセルフケア要件実施において必要な知識】【特定のセルフケア要件に対する必要性の認識】【理解力や認識力】が抽出された．移行的操作から【今の自分の状況に対する判断予測】【特定のセルフケア要件実施への関心・意欲】【自己判断力に影響する要因】が抽出された． 本研究を通して，学生の[セルフケア・エージェンシー]のアセスメントの実態として，患者の内面的な状況に関するアセスメント不足が示された．これより，学生の課題として，関係性の形成や意図的な情報収集・アセスメントが考えられた．今回の課題としてあげられた意図的行為は，セルフケアや看護ケアを深める可能性がある．そのためにも，自分の得た情報やアセスメントがどのような意味を持つのか十分な推論を通して対象者理解につなげていけるような指導を検討する必要がある．


Actual condition of lymphedema prevention behavior of postoperative breast cancer patients without lymphedema

リンパ浮腫未発症の乳がん術後患者におけるリンパ浮腫予防行動の実態

本研究では，リンパ浮腫未発症の乳がん術後患者におけるリンパ浮腫予防行動の実態調査を行った．対象者は乳房部分切除および腋窩リンパ節郭清を行った乳がん術後患者で，現在外来通院中のリンパ浮腫未発症患者40名に構成的質問紙調査と，その内の21名に面接調査を実施した．結果，リンパ浮腫に関する知識の「リンパ浮腫の病因」，「リンパ浮腫の治療」，「リンパ浮腫の改善方法」，「生活上の注意」，「リンパ浮腫をみた経験」の知識に関して知っているかどうかにより「リンパ浮腫予防法実施状況」で有意差が認められ，継続できるか否かに差があることが示された．また，「リンパ浮腫予防法の数」との間でも有意差が認められ，知識に関して知っているかどうかにより予防法の数に差があることが示された．リンパ浮腫に対する認識および予防行動に対する認識において，それぞれ4つのカテゴリーが抽出された．以上の結果より，未発症患者であるからこそ，自身の体に関心を向け継続していく力をいかにつけていくことが重要となる．そのためにも，患者が体験する日常生活の中から予防法を考案していくことや，実感を伴いながら，知識を意味づけられる予防行動に関する指導を考案していくことが継続の支援に必要である．


An actual condition survey on "career development regarding cancer nursing"

「がん看護に関するキャリアディベロップメント」に関する実態調査

本研究の目的は，看護職者のキャリアディベロップメント支援のための継続教育プログラムの構築の基礎資料を得るために，A県下の看護職者のがん看護に関する学習状況やキャリア志向の実態を明らかにすることである．A県下病床数100床以上の外・内科を併設する病院17施設の看護職者1017名中686名(回収率67．5%)を分析対象とした．結果，がん看護に関する学習項目全てにおいて学習ニードが高かった．また，がん看護の学習機会を持つ者や学習の阻害要因はないと回答した者が多かった．職業的満足感では``看護の仕事にやりがいを感じている''``仕事上での目標がある''と回答した者が多く，``今の看護の仕事に満足している''とした者は約半数であった．がんに関する資格取得希望者は少なかった．がん看護に関する学習ニードと対象者の背景および学習機会，阻害要因，キャリア志向との関係については，学習機会があると回答した方が学習ニードの合計得点の平均値が高かった(P<0．05)．また，阻害要因があると回答した方が学習ニードの合計得点の平均値が高かった(P<0．05)．職業的満足感では``看護の仕事にやりがいを感じている''で〈そう思う群〉の方が学習ニードの合計得点の平均値が高かった(P<0．05)．``仕事上での目標がある''では〈そう思う群〉の方が学習ニードの合計得点の平均値が高かった(P<0．05)．``今の看護の仕事に満足している''では〈思わない群〉の方が学習ニードの合計得点の平均値が高かった(P<0．05)．資格取得希望者の方が学習ニードの合計得点の平均値が高かった(P<0．05)．以上より，がん看護に関する学習ニードの高さが示された．がん看護に関するキャリアディベロップにおいて，施設側と教育側の連携と学習ニードを充実させていくことが鍵となることが示唆された．


Effects of students introduced "Operating Room Visits Observation item List" in a Nursing Practicum

成人看護学実習における「手術室見学実習観察項目表」を導入した実習の学習効果の検討

周手術期看護を体験的に理解することを目標にした成人看護学実習に「手術室見学実習観察項目表」(以下観察項目表とする)を導入して3年になる．この観察項目表は，手術室見学実習時の見学の視点を明確にするために，実習指導に携わる看護師(以下指導者とする)と共同作成したもので，体位固定方法など手術室看護に特有な学習視点としてあげた26項目からなる見学視点ガイドである．学生から研究への使用に同意が得られた観察項目表(学生用)は，2008年は62名(回収率:91%)，2009年は52名(84%)，2010年は56名(95%)であった．指導者から研究への使用に同意が得られた観察項目表(指導者用)は2008年は43名(63%)，2009年は35名(56%)，2010年は58名(98%)であった．これらを分析した結果，26項目のうち，3年間を通して，学生は17項目を80%以上見学できたと答えた．2008年と2010年では[ドレーン挿入]と[出血量の確認]，2009年と2010年では[全身麻酔の導入]と[硬膜外カテーテルの挿入介助]を見学できたと答えた学生の割合が有意に上昇していた(P<0．05)．また，指導者が説明できたと回答した割合が有意に高くなっていた項目は，2008年と2010年では9項目，2009年と2010年では19項目であった．今回の結果から学生が見学できていた項目の割合は3年間で差がない項目がほとんどであったが，指導者が指導できたとする項目は増加していた．また2009年以降観察項目表の導入の効果について5段階評価で確認したところ，約90%の学生が役立ったと回答した．以上のことから，手術室見学実習において，見学する視点を明確にするために「手術室見学実習観察項目表」を導入することは，学生と指導者の双方にとって，手術室見学実習を行う上で見学や指導を行う視点が明確になるため，効果的なツールであるといえる．今後は手術室看護師に分析結果のフィードバックを行い，学生が学習する機会の少ない項目については，ビデオ等の教材などを臨床とともに開発する必要があると考える．

JNI : The Journal of Nursing Investigation


The effects of chemotherapy-induced alopecic experience on daily living

がん化学療法に伴う脱毛体験が患者の日常生活へ及ぼす影響

がん化学療法に伴う脱毛体験が患者の日常生活にもたらす影響について明らかにすることを目的に，15名の患者に対して自由回答法による半構造化面接を実施した．同意を得て録音した面接内容の逐語録をデータとして，Krippendorff. Kの内容分析の手法を用いて分析を行った．分析の結果，がん化学療法に伴う脱毛体験が患者の日常生活にもたらす影響として，【脱毛した自分に違和感を感じながら人目を気にして生活する】【脱毛に備えて事前に準備する】【脱毛は仕方がないと捉え治療を受けることを優先させる】【予想以上の急速大量脱毛にがんであることの事実を突きつけられる】【時間をかけて脱毛の事実を受け入れ違う捉え方を見出す努力をする】【他者と距離を取りながら生活する】【立場，性差による脱毛の捉え方の違いを実感する】【脱毛した毛髪の処理を気にかけながら生活する】【脱毛のつらい経験から検診の啓蒙活動を行う】の9つが明らかとなった．脱毛に対して事前に十分な準備が行え，自分なりの対処法についてイメージできるよう具体的な情報提供を行うとともに，性差，治療効果や患者の治療への思いなどによって脱毛に対する捉え方はさまざまであることから，看護師はその人自身の脱毛の受け止め方や，脱毛が及ぼす生活への支障について把握し，必要な情報を提供することや患者の思いが表出しやすい環境を整えることが大切である．


Leaning Experiences of Students during Operating Room Visits in a Nursing Practicum Forcusing on Adult surgical Patients

手術患者を対象とした成人看護学実習における手術室での学生の学習経験

Journal of Japan Academy of Nursing Education


治療過程にある高齢がん患者の''がんと共に生きる''ことに対する受けとめ

治療過程にある高齢がん患者の''がんと共に生きる''ことに対する受けとめ


Students' Learning and Embarrassment for the Nursing Process Based on Orem's Nursing Theory in the Gerontological Nursing Practicum

高齢者看護学実習におけるオレム看護論を基盤とした看護過程転換に対する学生の学びと戸惑い


Learning effect and problem by a base of Orem nursing theory in undergraduate students in gerontological nursing course

高齢者看護学におけるオレム看護理論を基盤にした看護過程演習の学習効果と課題

本研究は，オレム看護理論を導入したことによる学生に対する学習効果と教育上の課題を明らかにすることを目的に紙上事例を用いた看護過程演習に対する学生の自己評価を分析した．分析対象はA 看護系大学生2年生の2003∼2006年の3年間に在籍した204名のうち同意が得られた183(89．7%)名の看護過程演習に対する自己評価とした．看護過程演習に対する自己評価は11項目の演習目標の達成度を自己評価するものと「オレム看護理論を基盤にした看護過程演習において難しかったこと」について自由記述で構成されている．そのデータを単純集計及び内容分析を行った．その結果，〈よくできた〉及び〈普通〉と回答した学生が多く，〈非常によくできた〉と〈よくできた〉を合わせて60%を超えた項目は``グループ討論に積極的に参加した''や``自己学習して臨んだ''``事例の健康障害と治療の特徴を理解できた''であった．一方，〈非常によくできた〉と〈よくできた〉を合わせて40%以下であった項目は，``セルフケア行為(エージェンシー)の確定''と``高齢者の発達上の特徴を健康問題の解決過程に考慮する''であった．自由記述による「難しかったこと」は，【セルフケア理論より患者をとらえること】【看護診断の過程】【演習記録用紙の書き方】【他の講義で使用する理論との違い】【``看護上の問題/看護診断''の表現】【具体的な看護援助方法】【情報収集の限界がある紙上事例】【事例の病態生理や特徴を把握すること】【具体的な看護援助方法】【看護計画の立案】【グループワークでの意見調整】【学習テーマ】の11のカテゴリーが抽出された．学生にとって高度な思考を必要とする看護過程は難易度の高い学習である上に，オレム看護理論の理解が求められることから，さらに難しい学習となっていることがわかった．基礎教育の学生にとって看護過程に必要な統合的な思考力を促進するためにはオレム看護論の理解はもとより，事例の提示方法やアセスメント用紙の形式などの工夫，改善を通して学生の到達度や理解度を高めていく必要が示唆された．


末期がん患者の看護に対する看護師の認識

末期がん患者の看護に対する看護師の認識

The purpose of this study was to evaluate nurses' awareness of the items required for nursing in patients with terminal cancer. The subjects of analysis were 552 nurses working in the general ward of national, public, and private hospitals. A 30 item questionnaire was formed based on the concerned papers and was carried out to evaluate nurses' awareness and its association with their attributes. The following results were drawn. More than 80% of the nurses taken part in the questionnaire agreed to the necessity of their awareness of almost every item. Such items as the procedures for administration of narcotics, and talking with the patients about their needs or death, however, the person of 50% or more were not adequately understood. It will be necessary to deepen recognition and knowledge for the WHO pain treatment method, and, to make outlook on nursing and outlook on of nurse oneself verge of death clear in future.

本研究の目的は，末期がん患者の看護に対する看護師の認識を検討することにある．国公私立に勤務する看護師552人を分析対象とした．本研究では，文献から末期がん患者の看護に対する質問30項目を設定し，それらに対する看護師の認識と看護師の年代，臨床経験年数，これまで関わってきた末期がん患者数を質問した．その結果，以下のことが明らかになった． 末期がん患者の看護に対する看護師の認識は，大半の質問項目で【大変そう思う】【そう思う】と回答していた．しかし，「鎮痛剤の使用を決める為に，疼痛アセスメントスケールが使われる」と「麻薬の使用は，医師が決めた時間を厳守すべきである」，「患者の多くは死について話したい要望を持つ」，「患者の要望を全て叶えることが，ターミナルケアでは大切だ」の項目では，【全く思わない】【思わない】と50%以上の者が回答していた．今後，WHO疼痛治療方式に対して，認識や知識を深めるとともに，看護師自身の看護観や死生観を明確にしていくことが必要である．