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


Motivation for physical activity before and after allogeneic hematopoietic stem cell transplantation.

This study aimed to identify patient motivation for physical activity before and after allogeneic hematopoietic stem cell transplantation (HSCT). We conducted 14 semi-structured interviews of seven patients (two of each patient): one before starting a conditioning regimen and one after leaving the protected environment. All interviews were recorded and analyzed using the inductive content analysis method. The data collection period was May to December 2018. The participants comprised three men and four women aged 40-70 years. The patients underwent bone marrow, umbilical cord blood, or peripheral HSCT. The patients' motivation for physical activity before and after HSCT was classified into six categories and categorized into five themes including "to overcome HSCT," "to look after myself," "to respond to the donor," "the existence of supporters," and "encouragement from supporters." The categories and themes developed here based on patient responses provide an important perspective that should be promoted among healthcare providers who care for patients undergoing HSCT.


地域包括ケアシステムの中で急性期医療を受ける患者の願い : 希望がなきゃ生きていけない``Nursing Care for Patient Goals''(NCPG)への示唆


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.


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.


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.


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．


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


Relationship between uncertainty and emotions in advanced lung cancer patients after initial therapy

We investigated the relationship between uncertainty and emotions in advanced lung cancer patients after initial therapy. Fourteen advanced lung cancer patients participated in this study. A survey was conducted using the Universal Uncertainty in Illness Scale (UUIS) and the Profile of Mood States-Brief Form (POMS-Brief Form), Japanese Version. The total UUIS score of each participant ranged from 42 to 109, with a mean±SD of 70.7±20.9. The T-scores for the 6 factors of the POMS-Brief Form were 50.2±11.9 (mean±SD) for tension-anxiety (T-A); 49.6±12.2 for depression-dejection (D); 40.4±4.9 for anger-hostility (A-H); 41.8±9.3 for vigor (V); 44.2±5.8 for fatigue (F); and 52.7±15.2 for confusion (C). In terms of the correlation between the total UUIS score and the respective T-scores of the six POMS-Brief Form factors, a strong correlation was seen between total UUIS score and D (r=0.735, p=0.003). A substantial correlation was also seen between total UUIS score and T-A (r=0.694, p=0.006). In advanced lung cancer patients after initial therapy, uncertainty had an effect on emotions. J. Med. Invest. 64: 96-100, February, 2017.


Management of Uncertainty by Patients with Lung Cancer between Diagnosis and Treatment

診断から初回治療導入期における肺がん患者の不確かさの管理


がんサバイバーの心理的適応尺度の開発ー信頼性・妥当性の検討ー

Journal of Japanese Society of Nursing Research


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


診断から初期治療導入期における肺がん患者の不確かさの管理

診断から初期治療導入期における肺がん患者の不確かさの管理


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．

JNI : The Journal of Nursing Investigation


Experiences of advanced and recurrent colorectal cancer patients with oxaliplatin-induced peripheral neuropathy

オキサリプラチンによる抹消神経障害をもつ進行再発大腸がん患者の体験

Abstract

In the present study, we sought to clarify the experience of advanced and recurrent colorectal cancer patients with oxaliplatin-induced peripheral neuropathy. Eight advanced and recurrent colorectal cancer patients who experienced peripheral neuropathy presumably caused by oxaliplatin were enrolled in this study. We conducted a semi-structured interview based on our interview guideline. The interviews were transcribed, coded and categorized;the smallest unit comprised a separate part on symptoms and experiences of specific peripheral neuropathy, classified by focusing on similarities and differences in semantic content.

As a result, hypersensitive symptoms peculiar to oxaliplatin were determined and also five categories were identified in the patients' experiences of peripheral neuropathy:``Sense of numbness understood only after it has been experienced'', ``The will to live patiently with numbness'', ``Menace of hindrances in daily life'', ``Desiring to do things on one's own to the extent permitted by numbness'', and ``Efforts to ensure a safe life with numbness''.

These findings demonstrated the fact that the patients recognized peripheral neuropathy as a new menace to threaten life, and they received the treatment desperately with a strong will to live, and they decided to secure safety and autonomy within the limitations imposed by the numbness. These experiences can be regarded as characteristic of colorectal cancer patients in the primary treatment stage who can expect prolonged survival even with advanced and recurrent cancer, and the importance of our support for the patients to proactively manage peripheral neuropathy in life was suggested.

要 旨

本研究の目的は，オキサリプラチンによる末梢神経障害をもつ進行再発大腸がん患者の体験を明らかにすることである．対象者は進行再発大腸がんでオキサリプラチンによる外来化学療法を受け，末梢神経障害が出現している患者8名であり，インタビューガイドを用いた半構成的面接法を行った．データを逐語録にし，対象者の末梢神経障害の体験に関する部分を最小単位に抽出してコード化し，意味内容の類似性と差異に着目して分類しカテゴリー化した．その結果，治療前には想像できないオキサリプラチン特有の過剰な知覚の具体的症状が明らかになり，また，【自ら体験して初めてわかったしびれの感覚】【しびれを我慢してでも生きたい】【当たり前だった自分の生活ができなくなる脅威】【ぎりぎりまで「自分で自分のことができること」を死守】【しびれを抱えつつ安全な生活を確保するための努力】の5つのカテゴリーが抽出された．

末梢神経障害を通常の生活ができなくなる新たな脅威として認識しながらも，「生きたい」という強い意志を持ち，自ら安全性や自律性の確保を末梢神経障害の許容の限界と決め，懸命に治療を継続している患者の体験が明らかとなった．また，これらの体験は，進行再発大腸がんでも延命が期待できる一次治療段階にいる患者の特徴として捉えることができ，患者が主体的に生活の中で末梢神経障害を調整できるよう援助することの重要性が示唆された．


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．


Factors associated with discharge of long-term inpatients with schizophrenia in Japan: a retrospective study

Deinstitutionalization for people with mental disorders has only begun to be implemented in Japan. The purpose of this retrospective study was to examine factors associated with discharge for long-term patients with schizophrenia. Seventy patients were judged capable of discharge with psychiatric rehabilitation (special staff service). As a result of rehabilitation efforts, 37 patients were discharged and 33 patients remained in the hospital. Significant differences were found in age, level of family agreement about patient's disability, and length of the special staff service. These factors might be important to predict patients' potential for discharge.


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．


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


Coping strategies and psychological adjustment among breast cancer patients with recurrence/metastasis

再発・転移のある乳がん患者のコーピング方略と心理的適応

Journal of Japan Academy of Nursing Science


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

Journal of Japanese Society of Cancer Nursing


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


Weight and height growth velocities of Japanese boys and girls between age 7 and 14 years: a critical window for early adolescent overweight risk

Childhood overweight is an important worldwide problem of public health concern, with metabolic, physical and psychosocial complications. More and more evidence is accumulating that children who gain weight rapidly earlier in life are at higher risk of becoming overweight later in adulthood life. Therefore, in a seven-year longitudinal study, we studied mid-childhood and early adolescence weight and height growth velocities among 5,024 Japanese 2(nd) grade primary school boys and girls along with its effect on the likelihood of being overweight adolescents by the age of 14 y. Our findings showed that weight growth velocity of both sexes was associated with being overweight at the end of longitudinal study. Boys' risk of accelerated weight growth velocity and becoming overweight adolescents was almost doubled during ages 7 approximately 11 y and become reduced afterward. Otherwise, odds ratios of girls' weight growth velocity peaks were found only at ages from 9 approximately 10 and 10 approximately 11 y. Thus, we suggest a critical window of mid-childhood period associated with adolescence risk of overweight, and we recommend that studying weight growth determinants during 7 approximately 11 y of boys and 9 approximately 11 y of girls may help in developing and applying proper programs for prevention and intervention of overweight problem.

The Journal of Medical Investigation : JMI


Prediction of Japanese children at risk for complications of childhood obesity: gender differences for intervention approaches.

Childhood obesity is one of the most serious public health problems in Japan, especially in Tokushima compared with other prefectures. This study was designed to clarify the life habits which predispose to development of obesity and can be modified through an appropriate intervention program to combat childhood obesity and its lifestyle-related diseases. A total of 216 school children from Itano Town, a municipality of Tokushima Prefecture, Japan, who are attending the fourth grade (9-10 years) of elementary schools, participated in the study from 2004 to 2007. The study included child's life habits questionnaire, investigating physical activity by recording the daily steps using a pedometer, anthropometric measurements, hematological examination and hemodynamometry in a cross-sectional survey during a two-month period from June to July every year. We conclude that there are considerable gender-related differences for developing obesity and other lifestyle-related diseases; and all intervention strategies against obesity must consider such gender differences. For example, restriction of television watching hours must be intervened for controlling obesity in boys, however for girls, promotion of exercise practice or making more steps per day with adequate sleeping periods should be intervened as the proper approaches for preventing and controlling obesity and other lifestyle-related diseases.


Determinants of life satisfaction among Japanese elderly women attending health care and welfare service facilities.

Prolonged life expectancy must be recognized as an excellent achievement of modern medicine, but not all the elderly people are satisfied with their lives. Life satisfaction is a multi-dimensional issue that depends on many objective and subjective characteristics. In this study, we aimed at investigating the factors affecting life satisfaction of 314 elderly Japanese women attending in 28 elderly-care and welfare facilities at Tokushima Prefecture, Japan. Our results indicated that elderly subjects with depression tendencies always show significantly lower degrees of life satisfaction than others who are not depressed (p<0.001) regardless of their cognitive status. Furthermore, elderly women who shared decision for their living place and whose opinions were considered for daily life decisions reported significantly more life satisfaction levels than others. We conclude that elderly life satisfaction is affected by various determinants however, with different influencing weight. Life satisfaction of elderly people, with or without dementia, is greatly affected by their mood status and share in decision making. Avoiding elderly people depressive mood, sharing them in various daily decisions, considering their opinions, and allowing them to decide their elderly-care facility placement are crucial determinants for their life satisfaction and essential for their coping, adaptation, well-being and successful aging.


Tracking overweight and obesity in Japanese children; a six years longitudinal study.

Childhood overweight/obesity is growing steeply, globally. It is usually regarded as a risk factor for severe obesity over life-time course. Here, we investigated temporal course of overweight/obesity development in Japanese school children. A six-year longitudinal study was performed on 16,245 Japanese primary school children (8,427 boys and 7,818 girls) comprising three cohorts of 1(st) approximately 3(rd) grade. A baseline survey was conducted at 2001, followed by annual baseline studies from 2002 approximately 2007 to determine the prevalence and track overweight/obesity. Our results showed that the prevalence of overweight was 15 approximately 23% in boys and 15 approximately 18% in girls, however, for obesity it ranged between 4 approximately 7% in boys; and 2 approximately 4% in girls. As regards for tracking status, 60 approximately 80% of overweight and 35 approximately 70% of obese Japanese primary school boys track into overweight or obese junior high school adolescents. However, these percentages are lower among primary school girls, where only 50 approximately 70% overweight and 30 approximately 60% obese primary school girls track into overweight and obese adolescents, respectively. We conclude that Japanese boys are fatter than girls; and approximately 80% of overweight/obese Japanese primary school children track into junior high school overweight/obese adolescents.


受け持ち患者の手術見学実習をより効果的にするための学習環境調整に関する研究

受け持ち患者の手術見学実習をより効果的にするための学習環境調整に関する研究

Journal of Japan Operative Nursing Academy


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．

JNI : The Journal of Nursing Investigation


再発・転移のある乳がん患者のコーピング方略と心理的適応

再発・転移のある乳がん患者のコーピング方略と心理的適応


Effects of lifestyle habits and eating meals together with the family on the prevalence of obesity among school children in Tokushima, Japan: a cross-sectional questionnaire-based survey.

Obesity in children has become a major global public health concern. The prevention of obesity must start from early childhood in order to establish sound lifestyle habits and promote healthy adulthood. In this study, we evaluated factors associated with the prevention of obesity and the development of healthy lifestyle habits in children. A cross-sectional, questionnaire-based survey was performed in elementary and junior high school students in Tokushima Prefecture, Japan, during the summer of 2004. The questionnaire consisted of 30 items such as physique, sleep, eating habits, diet, exercise, free time, and attending after-school lessons. Our study revealed that eating meals as a family every day is associated with a lower rate of obesity as well as getting good lifestyle habits such as eating balanced meals and getting enough sleep. Of the 3,291 students who responded to the questionnaire, 2,688 (81.7%) reported that they eat meals with their family every day. The percentage of students who eat meals with their family every day decreased with increasing school grade, with the lowest percent in the junior high school students. However, the results regarding female junior high school students revealed a marked association between eating meals with the family every day and good lifestyle habits. We recommend that parents and school teaching staff encourage the establishment of sound, healthy lifestyle habits in children from early childhood as an effective measure for the prevention of obesity.


Functions required for walking supporting devices to improve the level of elderly people's quality of life in Japan

Information : an International Interdisciplinary Journal


Clarification of Caring Behaviors by the Family of Elderly Relations Living in Rural Japan


Truth Disclosure of Cancer Diagnoses and Its Influence on Bereaved Japanese Families.

肺がんで死亡した遺族の病名告知に対する考えや患者療養中の告知に関連した影響を明らかにするために，1994年から1997年までの関東にある総合病院の患者の記録物をデータソースとして調査した．その結果，対象遺族53名のうち患者にがん告知を実施していた家族は15.1%であった．患者に病名告知するかどうかの決定に最も優先した事柄は「家族の考え」であり，ついで「医師の判断」で，「患者本人の希望」を選択した遺族は18.0%であった．


A literature review on factors affecting psychological adjustment and coping among breast cancer survivors

乳がん体験者の心理的適応とコーピングに影響を与える要因の文献検討

Journal of Japanese Society of Cancer Nursing


看護臨地実習におけるゴードンの機能的健康パターンを用いた看護学生のアセスメントの特徴と看護実践への影響を明らかにすることを目的に面接調査を行った．その結果，機能的健康パターンのなかで<自己認識/自己概念>などの心理社会的側面に関するパターンは患者との関係性，定義·概念の難しさ解釈の多様性のため学生はむずかしいと認識していた．しかし，この枠組みを使うことで対象を全体的存在として理解を深めることに役立っていることが示唆された．

Tokai University, School of Health Sciences bulletin


外来通院中の術後肺がん患者のセルフケアの分析

外来通院中の術後肺がん患者のセルフケアの分析

術後肺がん患者のセルフケア状況を明らかにすることを目的に，外来通院中の術後肺がん患者を対象にインタビューを行い質的分析を行った．その結果，<結局は自分自身の問題><甘えたくない>という思いがセルフケアの動機となって<元の生活への復帰><がんと折り合った生活>に向けてセルフケアが方向付けられていた．具体的なセルフケアの実行には<活動耐性を高める><身体に負担のない生活方法に変更する><がんに勝つための体質造りをする>など様々なセルフケア行動が明らかとなった．また，セルフケアの実行には<情報>や<ソーシャルサポート>などが関与していることが示唆された．


成人看護学の学習導入期にある看護学生の対人関係形成の特徴

成人看護学の学習導入期にある看護学生の対人関係形成の特徴

授業の一環として実施しているが以来演習で，看護学生がどのように対象者と関係形成しているのか，その特徴を明らかにすることを目的とした．その結果，対象からの<受け入れ感覚>や対象への<人間的関心>は関係成立を促進する要素となっていた．一方，<自信のなさ>は関係成立を困難にしていた．


看護学生の臨床実習における戸惑いとその要因

看護学生の臨床実習における戸惑いとその要因

看護学生の臨床実習中の戸惑いについて質的に明らかにすることを目的とした．その結果，<緊張をもたらす次週環境><教員·指導者との関係形成>の戸惑いは学生の学習意欲を左右する重要な要因となっていた．また，臨床現場を体験して<予想とのギャップ>も戸惑いとなっており，授業の段階での教材の工夫などの必要性が示唆された．


終末期がん患者の痛みに対するセルフケアの様相

終末期がん患者の痛みに対するセルフケアの様相

終末期がん患者の痛みに対するセルフケアの様相を明らかにすることを目的に，終末期肺がん患者対象に質的研究を行った．その結果，自らに<セルフケアの低下を自覚>しながらも<痛みの意味づけ>に方向付けられた<痛みに対するニード>が動機となって「痛みの増強要因を取り除く」「痛みがもたらす家族への影響を調整する」「痛みに拘束されないで生活する努力をする」など様々な<痛みに対する方策>がとられていることが明らかとなった．