Effectiveness of a Diabetes Oral Nursing Program Including a Modified Diabetes Oral Health Assessment Tool for Nurses (M-DiOHAT©): A 12-Month Follow-Up Intervention Study

This study aimed to evaluate the effectiveness of a diabetes oral nursing intervention program for individuals with diabetes. Fifty-six participants with diabetes underwent a diabetes oral nursing intervention program. The program's effect was evaluated through questionnaires and small interviews. The modified diabetes oral health assessment tool (M-DiOHAT©) was used to assess and educate four factors;oral conditions, behaviors, perceptions and knowledge about diabetes and periodontal disease, and health information-sharing, among participants at baseline, 3, 6, and 12 months later. Primary outcomes included changes in the M-DiOHAT© total scores. Secondary outcomes included scores on the motivation stage of changes in oral health behaviors' scales, dental visits, number of present teeth, hemoglobin A1c (HbA1c), and participants' comments. The M-DiOHAT© total score and the motivation stage score significantly improved with the narrative comment of "being motivated to practice oral health behaviors" between the baseline and 12 months later. Eight participants visited the dentist, whereas no differences were observed in the number of present teeth or HbA1c. This program improved participants' M-DiOHAT© total score, motivation stage score, and dental visits. These results suggest the program improved oral health perceptions and behaviors among individuals with diabetes. J. Med. Invest. 69 : 86-96, February, 2022.

The Journal of Medical Investigation : JMI


糖尿病患者の口腔保健行動アセスメントツールを用いた看護支援プログラムの評価

糖尿病患者の口腔保健行動アセスメントツールを用いた看護支援プログラムの評価

Journal of the The Japan Diabetes Society


Modified diabetes oral health assessment tool (M-DiOHAT©) for nurses and their association with efficacy beliefs and outcome expectancies in patients with diabetes

JNI : The Journal of Nursing Investigation


Dietary diversity and characteristics of lifestyle and awareness of health in Japanese workers:a cross-sectional study.

The aim of this study was to clarify the characteristics of lifestyle and health awareness according to dietary diversity in a Japanese worksite population. The participants were 1,312 men and women aged 20 to 63 years who were living in Tokushima Prefecture, Japan during the period 2012-2013. We obtained anthropometric data and information on lifestyle characteristics using a self-administered questionnaire. Dietary intake was assessed using a food frequency questionnaire, and dietary diversity was determined using the Quantitative Index for Dietary Diversity (QUANTIDD). The characteristics of lifestyle and health awareness according to quartiles of the QUANTIDD score were assessed using the chi-square test and a general linear model. The higher the QUANTIDD score was, the larger were the proportions of participants who knew the appropriate amount of dietary intake and participants who referred to nutritional component information when choosing and/or buying food. Among participants with higher QUANTIDD scores, the proportion of participants who considered their current diet was good was high in women, whereas the proportion of participants who wanted to improve their diet in the future was high in men. Those results indicate that higher dietary diversity was related to better characteristics of lifestyle and awareness of health. J. Med. Invest. 67 : 255-264, August, 2020.

The aim of this study was to clarify the characteristics of lifestyle and health awareness according to dietary diversity in a Japanese worksite population. The participants were 1,312 men and women aged 20 to 63 years who were living in Tokushima Prefecture, Japan during the period 2012-2013. We obtained anthropometric data and information on lifestyle characteristics using a self-administered questionnaire. Dietary intake was assessed using a food frequency questionnaire, and dietary diversity was determined using the Quantitative Index for Dietary Diversity (QUANTIDD). The characteristics of lifestyle and health awareness according to quartiles of the QUANTIDD score were assessed using the chi-square test and a general linear model. The higher the QUANTIDD score was, the larger were the proportions of participants who knew the appropriate amount of dietary intake and participants who referred to nutritional component information when choosing and / or buying food. Among participants with higher QUANTIDD scores, the proportion of participants who considered their current diet was good was high in women, whereas the proportion of participants who wanted to improve their diet in the future was high in men. Those results indicate that higher dietary diversity was related to better characteristics of lifestyle and awareness of health. J. Med. Invest. 67 : 255-264, August, 2020.


Assessing the oral health of in-patients with diabetes using a clinical version of the diabetes oral health assessment tool© and its association with dental examinations


Associations of dietary diversity with allergic diseases in Japanese workers: a cross-sectional study.

The aim of this study was to determine the associations of dietary diversity with prevalences of allergic diseases. The participants were 1,317 men and women aged 20 to 63 years who were living in Tokushima Prefecture, Japan during the period 2012-2013. We obtained anthropometric data and information on lifestyle characteristics and current medical histories of allergic diseases using a self-administered questionnaire. Dietary intake was assessed using a food frequency questionnaire, and dietary diversity was determined using the Quantitative Index for Dietary Diversity (QUANTIDD). The ORs and 95% CIs for each of the allergic diseases with a 1 standard deviation (SD) increase in the QUANTIDD score were estimated, controlling for age, family history of allergic diseases, education, smoking, drinking, physical activity, energy intake and BMI. Higher dietary diversity showed significant inverse dose-response relationships with allergic diseases and allergic rhinitis in women. Multivariate-adjusted ORs (95% CI) for allergic diseases and allergic rhinitis with 1 SD increase in the QUANTIDD score were 0.77 (95% CI: 0.60-0.98, p=0.037) and 0.69 (95% CI: 0.53-0.90, p=0.007), respectively, in women. There were no significant associations between dietary diversity and allergic diseases in men. The results indicate that there is an inverse association between higher dietary diversity and allergic rhinitis in Japanese female workers.

Asia Pacific Journal of Clinical Nutrition


Effect of Foot Self-Care Behavior According to Severity of Diabetic Neuropathy in Japanese Patients with Diabetes


The utilization of the Diabetes Oral Health Assessment Tool© for Nurses by Diabetes Nurse Specialists


Soy product and isoflavone intake associations with allergic diseases in Japanese workers: rhinitis, dermatitis and asthma.

The aim of this study was to determine the associations of intake of soy products and isoflavones with allergic diseases. We conducted a cross-sectional study in 1437 participants (aged 20-64 years) who were living in Tokushima Prefecture, Japan during the period 2010- 2011. We obtained anthropometric data and information on life style characteristics including dietary intake and current medical histories of allergic diseases using a structural self-administered questionnaire. Multiple logistic regression models were used to assess the associations of soy products and isoflavones with allergic diseases after controlling for age, family history of allergic diseases, smoking, drinking, physical activity, energy intake, BMI and dietary factors. Intake of soy products showed significant inverse dose-response relationships with allergic rhinitis. The third quartile for soy products had an adjusted OR of 0.56 (95% CI: 0.35-0.91) compared to the reference group (first quartile), though intake of soy products showed no dose-response relationship with atopic dermatitis. Intake of soy isoflavones showed a significant inverse dose-response relationship with atopic dermatitis, though the association between intake of soy isoflavones and atopic dermatitis was U-shaped after adjustments for potential confounders. On the other hand, the associations between intake of soy isoflavones and other allergic diseases were not significant. The results indicate that higher intake of soy products is associated with reduced risk of allergic rhinitis in Japanese workers. Furthermore, moderate intake amounts of soy products and soy isoflavones are associated with inverse risk of atopic dermatitis.


Associations between intake of dietary fermented soy food and concentrations of inflammatory markers: a cross-sectional study in Japanese workers

Epidemiological investigations have shown that consumption of soybeans or soy foods reduces the risk of the development of cardiovascular disease, cancer and osteoporosis. The aim of this study was to determine the associations between different soy foods and inflammatory markers, including high-sensitivity C-reactive protein (hs-CRP), interleukin (IL)-6, and IL-18, in Japanese workers. The cross-sectional study included 1,426 Japanese workers (1,053 men and 373 women) aged 20 to 64 years. Intake of 12 soy foods was estimated by a validated food frequency questionnaire. Associations of total soy foods, fermented soy food, non-fermented soy food, soy isoflavone with hs-CRP, IL-6, and IL-18 levels were examined by general linear model regression analysis. We found that total fermented soy food intake was inversely associated with multivariable-adjusted geometric concentration of IL-6 in men (Q1:1.03 pg/mL, Q5:0.94 pg /mL;P for trend = 0.031). Furthermore, it was shown that IL-6 concentrations were inversely associated with miso intake (β = -0.068;p = 0.034) and soy sauce intake in men (β = -0.074;p = 0.018). This study suggests that intake of total fermented soy food, miso and soy sauce be associated with IL-6 concentrations in Japanese men. J. Med. Invest. 65:74-80, February, 2018.


Prioritizing Patient Assessment Data (PAD) Using the Japanese Psychiatric Nursing Assessment Classification System (PsyNACS)©


Development of the Diabetes Oral Health Assessment Tool © for Nurses


Nurse administrators and hospital directors' perspectives about nurses' abilities in performing specific medical practices in hospitals within Tokushima Prefecture

徳島県内の看護職員高度人材育成研修推進事業における特定行為に係る実態調査

The purpose of this survey was to determine nurse administrators and hospital directors' perspectives about nurses' abilities in performing specific medical practices in hospitals in Tokushima Prefecture. The nurse administrators and hospital directors of all hospitals (113 hospitals) in Tokushima Prefecture were invited to respond to a survey questionnaire by mail posted during the period between February and March of 2015. Responses were received from 46 nurse administrators (response rate, 41%) and 38 hospital directors (response rate, 34%). The obtained data were analyzed using descriptive statistics and the narrative descriptions summarized. Majority of responses from nurse administrators and hospital directors were accepting that nurses have responsibilities for administering medicines such as tranquilizers, anti-anxiety and anticonvulsant drugs. This result was not affected by the size of the hospital, in which fifty four percent (54%) of respondents were from hospitals with less than 100 beds. In Japan, only hospitals with 100 beds or more may have procedures involving highly invasive treatments. Because of this, many of the respondents answered ``not applicable'' to statements in the questionnaire which were related to invasive treatments. Recruitment of nurses, strategies to cope with accidents and education curriculum were important concerns of nurse administrators and hospital directors which remain to be answered in future investigations.


Professional Nurses'Attitudes towards the introducution of Humaniod Nursing Robots(HNRs) in Health Care Settings


Employment of Newly Graduated Nurses by Psychiatric Hospitals in Shikoku region

四国地方における精神科病院の新卒看護師採用に関する実態

It is important for psychiatric hospitals (PHs) to have experienced nurses who are interested in nursing patients with psychiatric/mental health problems. Recruitment of newly graduated nurses who share a passion for patients with these conditions is critical to both the profession and to the nurses. In doing so, it is critical that these nurses are nurtured and valued, who can show a high level of practical nursing ability. However, at present, it is difficult to employ experienced psychiatric nurses especially those newly graduated nurses. Therefore, an inquiry survey was conducted to determine the situation and condition concerning the employment of newly graduated nurses by PHs in Shikoku region. Participants were nurse administrators of PHs, institutions that are concerned with the psychiatric patient care within the Shikoku Region. There are 62 PHs that are members of the Japanese Psychiatric Hospitals Association in the Shikoku region. Administrators of 61 of these hospitals were provided with the survey forms, however, only 58 survey forms were returned. Results of the survey showed that twenty-four PHs (41．4%) have not hired any new nurses for more than several years now, and forty-six PHs (79．3%) have not hired any new nurses in 2014. The PHs that hired the most new nurses hired only one to two nurses. Regarding the employment of newly graduated nurses, findings revealed that nursing administrators wanted nurses to feel attracted to psychiatric nursing and that they wanted to nurture and retain them. However, they also believed that they were not positioned to accept newly graduated nurses and that they could only accept experienced nurses. Since it is believed that the present conditions, where hiring newly graduated nurses is difficult, will continue in the future, further efforts will be required to secure jobs for new nurses.


Cut-off value of total adiponectin for managing risk of developing metabolic syndrome in male Japanese workers.

To determine the optimal cut-off value of serum total adiponectin for managing the risk of developing metabolic syndrome (MetS) in male Japanese workers. A total of 365 subjects without MetS aged 20-60 years were followed up prospectively for a mean of 3.1 years. The accelerated failure-time model was used to estimate time ratio (TR) and cut-off value for developing MetS. During follow-up, 45 subjects developed MetS. Age-adjusted TR significantly declined with decreasing total adiponectin level (≤ 4.9, 5.0-6.6, 6.7-8.8 and ≥ 8.9 μg/ml, P for trend = 0.003). In multivariate analyses, TR of MetS was 0.12 (95% CI 0.02-0.78; P = 0.03) in subjects with total adiponectin level of 5.0-6.6 μg/ml, and 0.15 (95% CI 0.02-0.97; P = 0.047) in subjects with total adiponectin level ≤ 4.9 μg/ml compared with those with total adiponectin level ≥ 8.9 μg/ml. The accelerated failure-time model showed that the optimal cut-off value of total adiponectin for managing the risk of developing MetS was 6.2 μg/ml. In the multivariate-adjusted model, the mean time to the development of MetS was 78% shorter for total adiponectin level ≤ 6.2 μg/ml compared with > 6.2 μg/ml (TR 0.22, 95% CI: 0.08-0.64, P = 0.005). Our findings suggest that the cut-off value for managing the risk of developing MetS is 6.2 μg/ml in male Japanese workers. Subjects with total adiponectin level ≤ 6.2 μg/ml developed MetS more rapidly than did those with total adiponectin level > 6.2 μg/ml.


Oral Health Behaviors and Associated Factors in Patients with Diabetes


Epidemiology : Relationship between Physical Activity and Metabolic Syndrome in Male Workers

勤労男性の生活における身体活動とメタボリックシンドロームとの関連

Journal of the The Japan Diabetes Society


Period between Dinner and Bedtime Is Related to Hypertension

勤労者の夕食終了から就寝時間までの間隔と健康状態との関係

The aim of this study was to examine the association between the period between dinner and bedtime, and various adult lifestyle-related diseases in the workplace. We analyzed 470 men and 252 women aged 20-65 years who had been enrolled in baseline surveys conducted for the Tokushima Diabetes Cohort Study in a workplace setting in Tokushima prefecture. Multiple logistic regression models were used for analyzing the association of the time between dinner and bedtime and the prevalence rates of adult lifestyle-related diseases. The period between dinner and bedtime tended to show an inverse dose-response relationship with hypertension (p for trend = 0.04) after adjustment for age, sex and other potential confounders. The group with the longest period between dinner and bedtime had an adjusted odds ratio of 0.38 (95% confidence interval 0.17-0.82) compared to the reference group (first quartile group) . Additionally, the period between dinner and bedtime showed an inverse dose-response relationship with hypertension for subjects who ate dinner after 21:00 (p for trend = 0.02) . These results indicate that the period between dinner and bedtime is inversely associated with the prevalence of hypertension.

近年, 生活習慣病や精神疾患などを抱える勤労者が増加している．一方, 朝食欠食, 過食, 身体活動の不足, 短時間睡眠など, 生活習慣の乱れが疾病の発症に関連することが報告されている．我々は, 徳島県勤労者において, 夕食終了から就寝までの間隔と生活習慣病の有病状況との関係について横断研究を行った．20歳以上の勤労者735名を対象に, 食物摂取頻度調査, 生活に関する質問票調査, 採血, 身体計測を実施した．夕食終了から就寝までの間隔が2時間未満の対象者を対照群とし, ロジスティック回帰分析を用いて解析を行った．高血圧に関して, 対照群に比し3-4時間, 4時間以上の群で, 有意に調整オッズ比が低下した．さらに21時以降の食事摂取者で, 高血圧の調整オッズ比は3-4時間空ける群で有意に低下し, 量反応性の関係が認められた．これらのことより, 夕食終了から就寝までの間隔を空けることが, 高血圧の予防につながる可能性が示唆された．

Journal of Japanese Society of Nutrition and Food Science


Exercise intervention soon after stroke patient onset to prevent muscle atrophy


Does food intake and life style relate to the prevalence of allergic disease?

食物摂取および生活習慣とアレルギー疾患との関連について

Journal of rehabilitation and health science


片麻痺疑似体験後のレポート分析からみた看護学生の学び

片麻痺疑似体験後のレポート分析からみた看護学生の学び

日本脳神経看護研究学会誌

日本脳神経看護研究学会誌


長期臥床中に痙縮・拘縮が出現した脳腫瘍患者の関節拘縮改善のための看護方法の検討

長期臥床中に痙縮・拘縮が出現した脳腫瘍患者の関節拘縮改善のための看護方法の検討


日本国内における脳腫瘍の看護研究の動向

日本国内における脳腫瘍の看護研究の動向


Bedside assessment of leg muscle mass by nurses

看護職がベッドサイドで評価可能な下肢筋肉量測定方法の検討

日本脳神経看護研究学会会誌

日本脳神経看護研究学会会誌


Changes in student nurses' image of hemiplegic patients, based on an analysis of their reports after a simulated experience of hemiplegia

片麻痺擬似体験後のレポート分析からみた看護学生の片麻痺患者に対するイメージの変化

In order to show the changes in the image that nursing students have regarding hemiplegic patients before and after simulated experiences of hemiplegia, a content analysis of the reports made by the students was qualitatively conducted, and comparisons were performed. The subjects were65students in Junior year, all participants signed an informed consent. During the implementation of the simulated hemiplegic experiences, the students experienced becoming hemiplegic patients for approximately 20 minutes. Hemiplegia was set for the upper and lower limbs on the side of the dominant hand, and students who took the part of hemiplegic patients experienced various activities associated with daily living. As a result, the number of descriptions of their image of hemiplegic patients after the simulated experiences increased, and the descriptions of such images were also more specific. After the experience, as their response ``it is not easy to imagine what it is like for hemiplegic patients'' was no longer observed, and thus it was not included as a category. The details of the image of the categories and the subcategories showed a more positive image, such as things that they can do in spite of their paralysis, compared to negative details before the experience. In addition, the students felt the stress that hemiplegic patients have, which resulted in them having a more empathetic image regarding psychological aspects. Furthermore, the simulated experiences provided a good opportunity todevelop an image of the patients, which cannot be obtained from reading books or articles.

看護学生の片麻痺疑似体験前後の片麻痺患者に対するイメージの変化を明らかにするため，学生が記載したレポートについて質的に内容分析を行い，比較した．対象は3年次看護学生のうち研究協力が得られた65名であった．片麻痺擬似体験は，片麻痺患者を約20分間体験した．片麻痺の設定は利き手側の上下肢とし，片麻痺患者役は日常生活動作を実施した． その結果，擬似体験後の片麻痺患者に対するイメージの記述数は増加し，イメージの内容がより具体的となった．体験後は「片麻痺患者は想像しにくい」の記述がなくなり，カテゴリーとして抽出されなかった．カテゴリーやサブカテゴリーは，体験前の否定的なイメージから，麻痺があっても可能なことはあるなど肯定的なイメージが増えた．また，学生は片麻痺患者の体験するストレスを実感することで，心理面に対する共感的イメージをもつことにつながった．さらに，擬似体験は，机上の学習では気づくことができない患者を想像する貴重な機会となっていた．

JNI : The Journal of Nursing Investigation


Literature review of dietary behaviors related to mastication among adults with type 2 diabetes mellitus

2型糖尿病を有する人の食行動の中の咀嚼に焦点を当てた研究の動向


脳卒中早期に片麻痺となり機能回復訓練を受けた患者の回復感覚

脳卒中早期に片麻痺となり機能回復訓練を受けた患者の回復感覚

日本脳神経看護研究学会論文集

日本脳神経看護研究学会論文集


Study on factors related to loss of lower extremity muscle mass in elderly acute stroke patients

The present study investigated the factors contributing to the loss of upper and lower extremity muscle mass in three elderly stroke patients with right hemiplegia in whom our rehabilitation program could not be performed at 1‐2 weeks after onset. The results revealed common factors such as prolonged accurate microinjection of hypotensive agents, severe hemiplegia(Brunnstrom stage I or Ⅱ), diarrhea and delayed initiation of tube feeding at 3 to 8 days after onset. With regard to individual differences, while all patients were recovering in bed, the degree of decrease in muscle mass varied among patients because they moved their extremities differently.


Learning of the students who have undertaken the patients necessitating rehabilitation

リハビリテーションの必要な患者を受け持った学生の学び

The learning of the students who experienced rehabilitation nursing of patients having disturbance of motility and/or impairment of consciousness was analyzed from their reports after the clinical practice. As the result, 203 codes were extracted and classified into 39 sub categories and 11 categories. The categories were ``understanding of the method of the rehabilitation nursing and consciousness of its necessity'', ``importance of the grasp and difficulty of the judgment of the patient situation'', ``thought of the patients who need rehabilitation'', ``consciousness of the role as a nurse'', ``necessity of the assist to the family'', ``actual feeling of worth doing of the nursing'', ``importance of the cooperation of the medical person'', ``importance and difficulty of the communication'', ``importance and difficulty of safety ensuring'', ``importance and difficulty of explanation, guidance and education'', and ``others''. It was found that the knowledge obtained through the rehabilitation nursing was mainly characterized with ``importance of safety ensuring'', ``thought of the patients'', and ``actual feeling of worth doing of the nursing''.

運動機能障害や意識レベルの障害があり，リハビリテーション看護の必要な患者を受け持った学生の実習終了後のレポートより，学生の学びを抽出し，内容分析を行った．その結果，203コードが抽出でき，39サブカテゴリー，10カテゴリーに分類できた．その内容は『リハビリテーション看護の方法の理解と必要性の自覚』，『患者の状況・把握の重要性と判断の難しさ』，『リハビリテーションの必要な患者の思い』，『看護師としての役割の自覚』，『看護のやりがいの実感』，『医療者の連携の重要性』，『家族への援助の必要性』，『コミュニケーションの重要性と難しさ』，『安全確保の重要性と難しさ』，『説明・指導・教育の重要性と難しさ』であった．この中で『リハビリテーションの必要な患者の思い』，『看護のやりがいの実感』，『安全確保の重要性と難しさ』，の3つが，リハビリテーション看護の必要な，運動機能障害や意識レベルの障害がある患者についての特徴的な学びであることがわかった．


Literature review regarding the sense of health and values among adults with type 2 diabetes in Japan

成人2型糖尿病患者の抱く健康観・価値観―過去10年間の国内文献の検討―

Objectives : The purpose of this study was to review literature published over a 10-year period focusing on the sense of health and values among adults with type 2 diabetes in Japan. Methods : We used Ichushi-Web(Ver 4)to identify literature published from 1996 to 2006. Operationally, we defined the sense of health and values as `` the basic way of thinking and understanding one' s own life and the behaviors that adults with type 2 diabetes value highly in their individual lives'' . Results : 1 A total of 23 primary studies were selected. 2 Adults with type2diabetes thought a great deal about living their lives with minimal disorder and inconvenience. Furthermore, they consider self-control to be important for facilitating their understand of the difficulty of managing diabetes and the possible complications. 3 Other important items for adults with type 2 diabetes were diet, family members who tried to support the patients' individuality, hobbies, and their favorite food. These items had developed over a long period of time and are thought to facilitate the individuality of the patients and enrich their lives. However, these items not only helped the patients to perform self-care behaviors(SCB), but also prevented SCB. The patients considered SCB were their responsibility, but felt they were physically, mentally, and socially painful. Conclusion : Before helping with SCB through nursing interventions, nurses must recognize the sense of health and values among adults with type 2 diabetes in addition to their backgrounds and self-control processes. If changes to the patients' sense of health and values are required, nurses should take the necessary steps to ensure that the patient agrees with and accepts the changes. Further research should attempt to identify methods for facilitating SCB. In addition, nursing interventions should also attempt to identify methods of changing the factors that negatively affect SCB while maintaining respect for the patients' sense of health and values.

成人2型糖尿病患者(以下，患者)の抱く健康観・価値観の動向について，健康観・価値観を「その人らしさを大切にした日々の生活の送り方や行動に対する見方・考え方，判断の基盤となる見方・考え方」と定義して，医学中央雑誌を用いて，過去10年間の文献検索を行ったところ，患者は，できるだけ身体に不自由や障害がない状態で，生きることを大切と考え，そのために，糖尿病のもたらす怖さを認識し，自己管理行動が大切であると考えていた．また，自己管理行動以外にも，命をはぐくむ食べ物，その人らしい生き方を支える家族や仕事，趣味や嗜好品なども大切であると考えていた．これらは，長年にわたり培われてきたものであり，患者の個別的な生き方を支え，生活の質を潤すものと捉えていた．しかし，同時に，これらは，糖尿病の自己管理行動を促進する場合だけではなく，阻害する場合もあった．また，患者は自己管理行動を身体・心理・社会面での苦痛や負担をもたらすものであると捉えていた．よって，看護介入を行うにあたっては，患者の抱く健康観・価値観の背景や過程を十分に理解した上で，患者の自己管理行動の遂行を援助する必要がある．そして，健康観・価値観の転換が必要な場合には，患者が納得でき，あるいは折り合いが持てるように段階的に進めていく必要がある．今後，患者の抱く健康観・価値観を尊重しながら，いかにして，自己管理行動を促進させる要因を増強させ，阻害する要因の転換を図っていくかということについて研究する必要があると考えられた．


Effects of intervention with back-lying exercises with bent knees pointing upwards to prevent disuse muscle atrophy in patients with post-stroke hemiplegia

The present study measured lower extremity muscle mass using DXA (Dual energy X-ray Absorptiometry) in order to verify the effectiveness of intervention with a series of movements, including lying hip raise exercise with bent knees pointing upwards, among bedridden patients with post-stroke hemiplegia in the acute post-stroke period. Subjects in the intervention group were required to perform 10 repetitions of a series of back-lying exercises once a day with researchers, in addition to the exercises performed by those in a control group. The first measurement of muscle mass was conducted at three to five days after onset, and the second measurement was conducted seven days after the first. Muscle mass in the lower extremities was reduced by approximately 600g (decrease rate : 9%)on the paralyzed side and by 280g on the non-paralyzed side(decrease rate: 5%)in one week in the Brunnstrom stage ≤ II subgroup(site of measurement : lower extremities) (n＝8) of the control group (n＝23). The decrease in muscle mass in the Brunnstrom stage ≤ II subgroup (n＝4) of the intervention group (n＝15) was approximately 260g on the paralyzed side (decrease rate : 5%) and approximately 280g (decrease rate : 5%)on the non-paralyzed side. Thus, muscle mass decreased on both sides, and this occurred regardless of degree of paralysis. Comparison of the Brunnstrom stage ≥ III subgroups between the control and intervention groups also confirmed that the decease in muscle mass was smaller in the latter group. Thus, it was confirmed that back-lying exercises combining lower extremity movements, including hip raises with bent knees pointing upwards, prevented the decrease in lower extremity muscle mass on the paralyzed side in post-stroke patients. The present study also suggests that these exercise movements can be applied to preventive care for bedridden patients with other severe diseases.


Changes in lower extremity muscle mass among bedridden patients with post-stroke hemiplegia in the acute post-stroke period

The present study analyzed16patients who were bedridden for one week immediately after onset of post-stroke hemiplegia. We used DXA(dual energy X-ray absorptiometry)to determine changes in muscle mass in the lower extremities on both paralyzed and non-paralyzed sides. The first measurement was conducted 3 to 5 days after the onset, and the second measurement was conducted 7 days after the first. Muscle mass in the lower extremities was reduced by approximately 600g (9%) on the paralyzed side with and by 200g on the non-paralyzed side (3%) in the Brunnstrom stage≤II group (n＝5). Although the decrease of muscle mass in the Brunnstrom stage≥III group(n＝11, relatively slight degree of functional motion impairment)was not significant, a decrease of approximately 300g (decrease rate : 5%)was observed on the paralyzed side and approximately 100g (decrease rate : 1．5%)was seen on the non-paralyzed side. Hence, muscle mass declined on both sides, and this occurred regardless of degree of paralysis. The findings suggested that conventional range of motion exercises, functional position maintenance, and postural changes are inadequate to prevent disuse muscle atrophy in post-stroke patients ; thus, it is necessary to develop a new rehabilitation program which adopts different exercises such as trunk motion, even for patients in the acute stage after stoke onset.


発症間もない脳卒中片麻痺患者の思い

発症間もない脳卒中片麻痺患者の思い


Accuracy of tissue thickness of the rectus femoris region as measured by ultrasound

In order to verify the accuracy of the thickness of the rectus femoris muscle and overlying subcutaneous fat as assessed by ultrasound, experiments were conducted on 10 healthy subjects aged over 30 years to assess the following: 1) concordance of measurements made by two different observers; 2) concordance of repeated measurements made by the same observer ; and 3) concordance of repeated measurements made by the same observer with and without an imaging aid(ultrasound gel block). Between two observers with varying experience in ultrasound, no significant difference in measured muscle thickness was observed ; however, there was a significant difference in subcutaneous fat thickness. When measurements were made by the same observer on two separate days, a significant positive correlation was evident for muscle and subcutaneous fat thickness between the first and second tests. While use of the imaging aid was associated with higher concordance of measurements between the first and second tests, the measurements themselves were affected. Although ultrasonic measurement of tissue thickness requires further investigation to minimize intra-observer error and examine correlations with other imaging techniques, the accuracy of the measurements in the present study suggests that clinical application may be possible.


術後患者観察における看護学生が行う観察・判断状況 --- 実習前・後のモデル人形を用いた排液観察の調査から

日本看護学会論文集: 看護教育

日本看護学会論文集: 看護教育


看護学生が初回基礎看護学実習で興味·関心を抱いたこと

看護学生が初回基礎看護学実習で興味·関心を抱いたこと

第36回日本看護学会論文集看護教育

第36回日本看護学会論文集看護教育


脳神経疾患で意識障害があり拘縮など廃用症候群の出現した患者を受け持った学生の学び


Changes in the thickness of leg muscles before and after laparotomy

広島保健学学会 特別講演In order to establish an objective and convenient technique to assess postoperative recovery following laparotomy, in particular activities of daily living, we measured the thickness of muscle tissues by ultrasound sonography. In the present study, the following four muscular compartments were selected: rectus femoris, biceps femoris, extensor digitorum longus, and soleus. These account for a large portion of the systemic skeletal musculature and are important for locomotion. Subjects were 28 patients who underwent moderately invasive surgery for stomach or colon cancer. The results showed that muscle thickness decreased significantly in all four compartments. Rectus femoris exhibited the greatest reduction in thickness and was most affected by short-term or long-term recumbency. Furthermore, for soleus, the tendency was that the longer the recumbency, the greater the wasting. These findings suggest that, of the four areas of the lower limb, rectus femoris is most affected by short-term recumbency and is most suited for objectively assessing postoperative recovery. The results of the present study suggest that it would be effective to design a recovery program focused on maintaining the femoral extensor muscles, which are most affected by short-term recumbency following laparotomy.

Journal of Health Sciences, Hiroshima University


Content analysis of nursing students' learning though clinical practices with individuals with diabetes mellitus

臨地実習で糖尿病患者を受け持った学生の学びの分析

学士課程3年次での成人看護学実習で，糖尿病患者を受け持った看護学生(以下，学生)34名の学びの内容について検討することを目的に，学生の記述したレポート内容を質的帰納的に分析した．その結果，4カテゴリー(「療養行動が主体的に実践できるための具体的な支援方法」「学生が感じた困難感や達成感」「療養生活支援のために必要な看護技術」「療養生活を送る対象の理解」)と17サブカテゴリーが抽出された．学生は糖尿病患者を理解し，療養生活行動が主体的に行えるための支援方法を考えていた．そして，患者の行動変容を目指した介入の難しさを実感しながら，患者が主体的に療養行動を実践できるように支援することの大切さについて考え，学生としての立場での看護実践の喜びを感じていた．今後は，学生の学びについて，個々の事例ごとの確認を丁寧に行いながら，学びの内容を卒業時の到達目標と照らし合わせて確認する方法を考案することの必要性が示唆された．

JNI : The Journal of Nursing Investigation


Literature review of nursing interventions and evaluations for the persons with diabetes mellitus in Japan --- ―国内での文献検討から―

糖尿病を有する人に対する看護介入とその評価の現状 --- ―国内での文献検討から―

医学中央雑誌Web版(Ver．3)を用いて，1994年から2004年の過去10年間に，糖尿病を有する人を対象に，看護師が行った教育や指導などの看護介入行為のうち，その効果が患者の持つ問題の解決に有効であると報告されている研究論文の分析を行い，以下の結果が得られた． 1．対象となった論文は16編あった． 2．介入内容は食に関連するものが11編あった．看護師は，患者の持つ問題の明確化，その具体的な対応，到達目標の設定に対して，患者が主体的に取り組むことができるように，患者の情緒面も含めて援助していた． 3．介入内容の評価を看護師が行っていたものは13編あった．評価項目は糖尿病の血糖コントロール指標としてのHbA1cがすべての文献で用いられていた． 以上のことより，今後は，患者の自己管理を支援するために，患者が一貫して主体的に取り組めるような介入方法を開発することが必要である．また，介入結果の評価においては，血糖コントロール指標に加えて，患者の行動や心理の変化を適切に評価できる評価方法や評価指標を開発する必要があると考えられた．


臨地実習における摂食·嚥下障害患者の食事支援時の学生の実習記録分析

臨地実習における摂食·嚥下障害患者の食事支援時の学生の実習記録分析

日本看護学会論文集: 看護教育

日本看護学会論文集: 看護教育


臨地実習での学習内容に対する学生自己評価の変化-成人看護学臨地実習で興味·関心のあるテーマを課題学習に導入した場合と導入しなかった場合の比較から-

臨地実習での学びを効果的にするために，3年課程3年次学生を対象に臨地実習固有の学習内容を用いた学生自己評価を継続しているが，自己評価得点は，実習開始前から中期にかけて上昇しても，中期から終了時には上昇しない傾向が続いた．そのため，成人看護学臨地実習(急性期)では，2003年度後期に学生の興味・関心のあるテーマを課題学習として導入することを試みた．課題学習を導入した2003年度後期(36人)と導入しなかった2001年度後期(34人)の自己評価得点の差を統計的に検定することにより，課題学習の効果を検討した．その結果，以下の結果が得られた． ① 課題学習のテーマを決定する過程において，学生は，自己の学習状況を振り返り，整理することができた． ② 終了時の自己評価では，課題学習を導入しなかった2001年度では4．0点以上の高得点の項目が20項目であったのに対し，課題学習を導入した2003年度では40項目もあり，学生は学習内容に到達したと高く評価していた． これらのことより，興味・関心のあるテーマを課題学習として導入することは，学生の自発性を高め，学習内容に対する学生の到達度の認識を高める可能性があると考えられた．


術後安静期間が延長した2事例における下肢筋組織厚，エネルギー摂取量，行動範囲の変化


Self-evaluation Study of Nursing Students' Recognition of Their Degree of Achievement of Educational Goals in Clinical Practice --- -臨地実習開始前，中，後における自己評価の変化の分析から-

臨地実習における学習内容に対する学生の到達度の認識 --- -臨地実習開始前，中，後における自己評価の変化の分析から-

Objective: The purpose of this study was to :assess the nursing students' recognition of their achievement of their educational goals in clinical practice ;and discuss the clinical teaching interventions of nursing education by means of self-evaluation for the students at a 3-year nursing junior college. Methods: We used the self-evaluation questionnaire (62 questions). Self-evaluation was performed three times: the first was before clinical practice (hereinafter first evaluation), at the middle point of clinical practice (middle evaluation) and after the clinical practice (final evaluation). Results: 1. There ware 2patterns in self-evaluation scores. One was rise, and the other was not rise by comparison between first evaluation and final evaluation. 2. Only 7 scores were improved among 62 questions.They were classified cognitive domain, and they were recognized by the nursing students to be achieved of their educational goals. 3. In the final evaluation there were 14 items for which they had not achieved their educational goals. They were the following items: comparing their clinical practice experience with nursing theory, performing clinical practice while thinking about the nature of nursing and using communication skills, and the process of nursing diagnosis. Conclusions: Nursing students need educational intervention. That is, they need teachers to teach them, or to think with them, how to use the nursing process to overcome patients' problems in each clinical situation by means of communication skills. It is also important to make effective use of conferences at school to so that student's can shore experiences.

臨地実習指導における教育的な介入への示唆を得ることを目的に，3年課程短期大学3年次学生を対象に，臨地実習開始前·中期·終了後に，国立大学医療技術短期大学部看護学科協議会臨地実習委員会Aグループが作成した「臨地実習固有の学習内容」を用いて，学生の臨地実習固有の学習内容に対する到達度の認識について，調査を行った．その結果，以下の結果が得られた． ① 自己評価得点は，実習開始前と比べて終了時に自己評価が有意に上昇したもの(以下上昇群)と，上昇しなかったもの(非上昇群)の2群に大きく分類できた． ② 上昇群のうち，段階的に評価が上昇した項目は7項目であった． ③ 学生は，認知領域は高く自己評価し，学習内容に到達したと認識していた． ④ 学生は14項目は終了時に至っても，到達レベルに達していないと自己評価しており，それらの項目は，コミュニケーションや看護過程，理論との照合など看護を深める取り組みに関する内容であった． 以上のことから，教育的な介入として，学生がコミュニケーション技術を有効に用いながら，看護過程を展開し，看護実践を深めることができるように，カンファレンスを有効に活用し，場面を捉えて，学生の学習状況にあわせて，丁寧に指導を行うことが必要であると考えられた．学年進行に伴う到達レベルの詳細な明示など，学生の成長を長期的な視点に立って支援することの必要性が示唆された．


Analysis of cases applying shiatsu massage for nursing care

指圧を看護ケアに取り入れた事例の文献検討

Shiatsu massage is one of the common therapeutic methods in oriental medicine, and is considered to be useful for supporting conventional medicine. However, there has been little evidence for its effects. In this report, papers dealing with the application of shiatsu massage to nursing care are extracted from literature, in order to clarify the effects and problems of this method as a nursing care. Papers containing studies of shiatsu massage by nurses as a nursing care were extracted from literature by using the Japan Centra Revuo Medicina (WEB issue, version 3), and those published during 10 years from 1993 to 2003 were analyzed. It was found that the relaxation effects by shiatsu massage were reported for various symptoms. Among these, 10 papers were analyzed in detail, which described the effects on relief of the following symptoms; dysphasia (constipation) (5 papers), nausea and vomiting at cancer chemotherapy (3 papers), pain from cancer (1 paper), and edema generated after lymphadenectomy (1 paper). It was found from these papers that shiatsu massage is effective for patients who have positive thinking to this therapy. On the other hand, the necessity of further experiments was indicated because of the lack of common methods and effects in this therapy; for example, position, force, frequency, etc., should be optimized.

東洋医学の1つの手法である指圧を看護ケアに取り入れた論文の検討を行ない，その効果と問題点を明らかにすることを目的に，『医学中央雑誌』(WEB版ver.3)を使用して1993年から2003年まで10年間に，看護師による指圧の影響が明らかにできた論文を抽出した．その結果10論文が得られた．10論文の内訳は排便障害(便秘)の軽減および排ガスの促進5件，癌化学療法実施時の副作用(嘔気·嘔吐等)の軽減3件，癌性疼痛の軽減1件，リンパ節郭清後に発生した浮腫の軽減1件であった．それぞれの論文に共通して言えることは，患者が指圧について肯定的に捉える場合は，その効果が非常に大きいことであった．さらに指圧の圧迫部位，圧迫の強さ，頻度など，まだ一定の手技と効果が得られていないため，追試験を重ねる必要性が示唆された．


Study on the difference in observation points between students before and after experiencing related nursing practice --- On the observations of vital signs and oxygen inhalation by use of an acute stage dummy

看護学生の実習開始前と終了後の観察の相違に関する検討 --- 術後急性状況のモデル人形を用いたバイタルサインと酸素吸入療法の観察に注目して

The difference in observation points for postoperative patients between two groups of nursing students was analyzed in terms of the students' experience of related training for the purpose of improving the training tutorial. The object was 72 students before starting adult nursing training (nursing of the acute stage patient) and 45 students after the training termination. The students were allowed to observe an acute stage dummy for 10 minutes and to write down the observation results of the 'drains and tubes', 'fluid therapy', and 'vital signs'. The descriptions about these three items were analyzed by classifying them into 'correct', 'mistaken', and 'no description'. The main results are as follows. The percentage of nursing students who correctly reported the 'heart rate on the monitor' was lower in the group after training termination comparing to the other group. As for the 'oxygen flow rate', many mistakes were found in the both groups, indicating the technical problem on the monitoring of the oxygen flow meter. In the both groups, no student described 'core temperature on the monitor' and 'oxygen concentration'. These results suggest the necessity of developing tutorial method to improve the students' observation ability for postoperative patients. The use of an acute stage dummy would be helpful for the practice of observations. It is also necessary for the teachers to check the observation behaviors of students during the exercises and practices in order to make the observations correct.

本研究は術後急性期の状況を設定したモデル人形を用い，実習開始前と実習終了後の学生が行なった術後患者に対する観察のちがいを分析し，今後の実習指導に生かすことを目的に行った． 対象は成人看護実習(急性期患者の看護)の実習開始前の学生72名と実習終了後の学生45名であった． 方法は実習室でモデル人形を用いて，10分間学生に自由に観察させた．この時の観察用紙に記入された記入項目を分析対象とした．分析方法は「ドレーン·チューブについて」「輸液について」「バイタルサインについて」を自由に記載してもらい，筆者らが『観察できた』『誤認』『記入なし』の3つに分類した． その結果，「モニター上に表示:心拍数」は実習終了後の学生の方が観察できていなかった．「酸素流量」は，『誤認』がどちらの学生も他の項目より多く，酸素流量計の見方を正確に把握していないことがわかった．「モニター上に表示:深部体温」，「酸素濃度」に関してはどちらの学生も『記入なし』であった．今後は学生の術後患者に対する観察能力が，より向上するように指導を行なっていく必要性が示唆された．そのためには急性期モデル人形を活用することで観察の機会を多くして練習を重ねるとともに，演習時および実習時において観察が的確になされているかを教員が確認する必要が示唆された．


臥床日数が開腹術後患者の下肢筋組織厚減少に及ぼす影響

臥床日数が開腹術後患者の下肢筋組織厚減少に及ぼす影響

日本看護学会論文集: 成人看護I

日本看護学会論文集: 成人看護I


バッグマスクで人工呼吸法を用いた心肺蘇生演習での学び --- 演習記録の内容分析より

第34回日本看護学会論文集―看護教育―

第34回日本看護学会論文集―看護教育―


Evaluation of a new rehabilitation program for postoperative patients with breast cancer

The purpose of the present study was to evaluate the efficacy of a newly designed rehabilitation program for postoperative patients with breast cancer. This was achieved through examinations to clarify the range of motion (ROM) of the shoulder joint, postoperative pain and recovery of activities of daily living (ADL). The ROM of the shoulder joint was evaluated with respect to five items and determinations were carried out five times. Patients were orally questioned four times regarding their pain after surgery, movement-associated chest pain, pain at night and operative wound pain. Evaluation of the ADL after discharge was conducted using a three-level rating method at postoperative week 4 and week 12. A total of 72 patients were studied, comprising 39 who underwent pectoral muscle-conserving mastectomy and 33 who underwent breast-conserving surgery. The arm movement of forward raising showed the greatest decline, followed by lateral raising of the arm. Postoperative time-course changes in internal/external arm rotation, as well as backward arm raising were slight. Comparison of the operative procedures revealed differences only for lateral arm raising at postoperative week 4, while there were no differences in any of the shoulder joint movements. Lowering of the ROM of the shoulder joint was more marked at an earlier time (week 1 to week 2) after surgery, but it was not statistically significant. Pain at night and operative wound pain were prolonged over the period, and reported in postoperative week 1 to week 12 by 3-15% of patients. All ADL items became almost normal in approximately 90% of patients at postoperative week 4. The efficacy of the present rehabilitation program early after surgery was demonstrated in terms of recovery of ADL as well as the ROM of the arm on the affected side.


乳癌術後患者の早期機能回復訓練実施による肩関節可動域の評価

乳癌術後患者の早期機能回復訓練実施による肩関節可動域の評価

日本リハビリテーション看護学会学術大会誌第1集

日本リハビリテーション看護学会学術大会誌第1集


乳癌縮小手術を受けた患者の術後回復過程に関する研究(1) --- 肩関節可動域の回復遅延に関わる要因の分析

本研究は，乳癌で胸筋切除を伴わない縮小手術を受けた患者の肩関節の可動域の回復遅延ケースにおける，回復遅延に関わる要因を明らかにし，術後の機能回復訓練時の患者指導に活かすことを目的とした．対象は乳房温存術や胸筋温存乳房切除術を受けた乳癌術後患者39名で，機能回復訓練を術後12週間縦断的に観察しえたケースにおいて，肩関節可動域の回復状態を良好群と遅延群の2群にわけ，その2群間の比較を，肩関節可動域や疼痛・日常生活動作から観察した．その結果，遅延群ケースから肩関節可動域の回復に関わる主要因として，創部の動作時の疼痛が考えられ，2つめの要因としてこの動作時の疼痛の発生により術後必要とされる運動を行わないことで，さらに回復を遅延させていることが考えられた．よって，動作時の疼痛を訴え，肩関節可動域の回復の遅れを認める例には，機能回復訓練状態の観察と術後12週目までの継続的な運動の必要性の指導のほかに，肩関節可動域訓練を看護師が患者とともに一緒に行うという確実な実施が，肩関節の可動域の回復遅延の予防となると考えられた．

JNI : The Journal of Nursing Investigation


乳癌縮小手術(乳房温存術,胸筋温存乳房切除術)を受けた患者の術後回復過程に関する研究(2) --- 患者の術式選択時の情報提供のための術式別回復過程の比較

成人で手術後リハビリテーションの必要な患者の看護ケアの開発·改善の一助にすることを目的に，温存術と切除術を受けた乳癌患者39名の術式別回復状態の比較を行った．切除術の1週目に握力が，有意に低下し，運動プログラムに，等尺性運動を取り入れることが示唆された．

JNI : The Journal of Nursing Investigation


Temperature effect of a disinfectant in operative field during surgery under local anesthesia


乳房温存術および胸筋温存乳房切除術に対する新しい術後機能回復訓練実施プログラムの評価


老人福祉施設で働く看護·介護職員の老年観

老人福祉施設で働く看護·介護職員の老年観


静的，動的および複合での運動における血圧応答の比較

静的，動的および複合での運動における血圧応答の比較

静的運動では収縮期および拡張期血圧は急激に上昇する事が知られているが，静的運動と動的運動を組み合わせた運動では血圧どのような変化を示すかを，日常生活での荷物を持った状態で歩行を行う場合のシミレーション実験として検討した．その結果，静的運動で上昇した血圧は動的運動により抑制を受け，血圧上昇が抑えられることを報告した．


静的，動的および複合での運動における血圧応答の比較

静的，動的および複合での運動における血圧応答の比較


Effectiveness of mammographic screening for brest cancer in women aged over 50 years in Japan


脳神経病棟の急変対応 --- 再発見!バイタルサインと基準値

脳神経病棟の急変対応 --- 再発見!バイタルサインと基準値


今だから言える新人ナースに伝えておきたい看護の基本 --- 術前・術後の処理・管理


急性期のベッドサイドでよく使われるアセスメントツールの使い方

急性期のベッドサイドでよく使われるアセスメントツールの使い方


`安全な早期離床'を支える 急性期リハビリテーションのための観察とアセスメント

`安全な早期離床'を支える 急性期リハビリテーションのための観察とアセスメント


脳卒中で発症3日間のリハビリテーション看護

脳卒中で発症3日間のリハビリテーション看護


ADLや運動機能に関連する脳神経疾患患者に必要な評価

ADLや運動機能に関連する脳神経疾患患者に必要な評価


急性期におけるADL向上ケアの目的

急性期におけるADL向上ケアの目的


脳浮腫のある患者のケアに求められる看護のエビデンスは何か

脳浮腫のある患者のケアに求められる看護のエビデンスは何か


福祉施設で生活する後期高齢者の生きがいについて

福祉施設で生活する後期高齢者の生きがいについて


閉じこもり状態にある高齢者の生きがいについて --- 面接調査による考察

閉じこもり状態にある高齢者の生きがいについて --- 面接調査による考察

Bulletin of School of Medical Sciences, the University of Tokushima

徳島大学医療技術短期大学部紀要


食事療法を施行中の心疾患患者の食事に対する思いの考察

食事療法を施行中の心疾患患者の食事に対する思いの考察

徳島大学医療技術短期大学部紀要