Details of a Researcher - Fukahori, Hiroki

Papers - Fukahori, Hiroki

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Latent Dirichlet allocation topic modeling of free-text responses exploring the negative impact of the early COVID-19 pandemic on research in nursing

Inoue M., Fukahori H., Matsubara M., Yoshinaga N., Tohira H.

Japan Journal of Nursing Science (Japan Journal of Nursing Science) 20 ( 2 ) 2023.04

ISSN 17427932

Aim: To derive latent topics from free-text responses on the negative impact of the pandemic on research activities and determine similarities and differences in the resulting themes between academic-based and clinical-based researchers. Methods: We performed a secondary analysis of free-text responses from a cross-sectional online survey conducted by the Japan Academy of Nursing Science of its members in early 2020. The participants were categorized into two groups by workplace (academic-based and clinical-based researchers). Latent Dirichlet allocation (LDA) topic modeling was used to extract latent topics statistically and list important keywords/text associated with the topics. After organizing similar topics by principal component analysis (PCA), we finally derived topic-associated themes by reading the keywords/texts and determining the similarity and differences of the themes between the two groups. Results: A total of 201 respondents (163 academic-based and 38 clinical-based researchers) provided free-text responses. LDA identified eight and three latent topics for the academic-based and clinical-based researchers, respectively. While PCA re-grouped the eight topics derived from the former group into four themes, no merging of the topics from the latter group was performed resulting in three themes. The only theme common to the two groups was “barriers to conducting research,” with the remaining themes differing between the groups. Conclusions: Using LDA topic modeling with PCA, we identified similarities and differences in the themes described in free-text responses about the negative impact of the pandemic between academic-based and clinical-based researchers. Measures to mitigate the negative impact of pandemics on nursing research may need to be tailored separately.

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Patterns of visiting nurse services for older adults in Japanese residential facilities: A latent class analysis

Mashida Y., Fukahori H., Ikezaki S., Fukui S.

Geriatrics and Gerontology International (Geriatrics and Gerontology International) 2023

ISSN 14441586

Aim: To examine the patterns of the visiting nurse services provided to older adults in a type of residential facility in Japan and to identify associated factors. Methods: This secondary analysis used past survey data from visiting nurse service agencies providing services to older adults in residential facilities with few nurses, known as non-specified facilities in Japan. Approximately 515 cases were used to determine the patterns of visiting nurse services using latent class analysis. Multinomial logistic regression analysis examined the relationships between identified classes, residents' characteristics, facilities, and services provided by visiting nurses. Results: Three service patterns were identified as follows: Class 1, observational and follow-up care (37.1%); Class 2, chronic disease care (35.7%); and Class 3, end-of-life care (27.2%). Class 1 comprised fewer nursing services than the other classes and primarily involved the observation of medical conditions, whereas Classes 2 and 3 involved higher care-need levels and provided diverse nursing care support. Specifically, Class 3 was associated with the inclusion of family (odds ratio: 2.42) and a visiting nurse at the attached facility (odds ratio: 4.88). Conclusions: The three identified classes describe the older residents' healthcare needs. Additionally, the factors associated with the end-of-life care class suggest that older residents with these factors may have difficulty accessing end-of-life care by visiting nurses. Geriatr Gerontol Int 2023; ••: ••–••.

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Age Group Differences in Daily Life Changes among Community Residents during the COVID-19 Pandemic: A Pilot Study on Intergenerational Comparison

Yamamoto-Takiguchi N., Uchiyama E., Fukahori H., Taguchi A., Nagata S.

Keio Journal of Medicine (Keio Journal of Medicine) 72 ( 1 ) 11 - 20 2023

ISSN 00229717

This study investigated lifestyle changes and the self-reported mental health status of Japanese community residents during the COVID-19 pandemic. Differences in demography, daily lifestyle changes, and approaches to problem solving were analyzed in two age cohorts (<60 vs ≥60 years). The prevalence of moderate/increased psychological distress was 31.7%, with no significant difference between the cohorts. Compared with the pre-COVID-19 era, more than 80% of the participants stopped eating out and spent more time at home, and more than 70% used public transport less frequently. There were significant differences between the cohorts for the time spent at home, opportunities to eat meals outside of home, and shopping in stores. Participants aged under 60 years were less likely to use television and newspapers or to consult a family doctor. Those aged over 60 years were less likely to consult friends/ colleagues or to use the Internet/social networking services. Identifying the risk factors for psychological distress is warranted for implementing measures to maintain and improve the physical and mental health of residents.

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Factors affecting the critical appraisal of research articles in Evidence-Based practices by advanced practice nurses: A descriptive qualitative study

Tomotaki A., Sakai I., Fukahori H., Tsuda Y., Okumura-Hiroshige A.

Nursing Open (Nursing Open) 2023

Aim: To describe factors affecting critical appraisal of research articles in evidence-based practice by certified nurse specialists who were advanced practice nurses in Japan. Design: A descriptive qualitative study. Methods: Fourteen certified nurse specialists with master's degree were included by a snowball sampling to maximize the variety of specialty fields for advanced practice nurses in Japan. Individual semi-structured interviews were conducted between November 2016 and March 2017. Interview guides included the experience of evidence-based practice and learning about critical appraisal. Results: The following four aspects were identified as factors affecting the critical appraisal of research articles in evidence-based practices—individual beliefs and attitude, learning status, organizational readiness and availability of research evidence. Each factor included both positive and negative aspects for critical appraisal in evidence-based practice. Patient or Public Contribution: If advanced practice nurses acquire knowledge/skills of critical appraisal, they would be able to select more appropriate care. This will increase to improve the health-related outcome for patients or populations.

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Relationship between research activities and individual factors among Japanese nursing researchers during the COVID-19 pandemic

Takeuchi A., Yokota S., Tomotaki A., Fukahori H., Shimpuku Y., Yoshinaga N.

PLoS ONE (PLoS ONE) 17 ( 8 August ) 2022.08

Aim To explore the individual factors (such as gender, division of household labor, childcare and elder care) and their impact on research activities in the Japanese nursing research community during the early stage of the COVID-19 pandemic from April to June in 2020. Design Cross-sectional study. Methods An online survey with a self-reported questionnaire was conducted on Japan Academy of Nursing Science members to explore the impacts of individual factors among Japanese nursing researchers from April to June 2020. A multivariate logistic regression model was used for data analysis. Results A total of 1,273 participants (90.7% female, 85.8% university faculty) were included in the analysis. This survey showed that no evidence of a significant gender gap was found in research activities in Japanese nursing researchers during the COVID-19 pandemic. Research activities during the pandemic were associated with time and motivation.

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Long-term care nurses’ perceptions of a good death for people with dementia: A qualitative descriptive study

Nasu K., Fukahori H., Miyashita M.

International Journal of Older People Nursing (International Journal of Older People Nursing) 17 ( 3 ) 2022.05

ISSN 17483735

Introduction: The number of people with dementia (PwD) dying in long-term care (LTC) settings is expected to increase. However, effective care strategies to promote a good death for PwD remain unclear. This study aimed to explore nurses’ perceptions of a good death for PwD in LTC settings for older adults. Methods: Interviews were conducted with 19 nurses providing end-of-life care in LTC settings for older adults in Japan. The transcribed texts were analysed using inductive content analysis. Results: We identified two themes: (1) ambiguity and (2) preparedness. Participants perceived that there was ambiguity regarding a good death for PwD and emphasised the need for preparedness of those around PwD for a good death. Five categories represented preparedness: (a) reaffirming the original personality before dementia; (b) respecting that PwD change; (c) interpreting and fulfilling obscure desires, feelings, and sensations; (d) providing care consistent with an agreed-upon natural death process; and (e) maintaining relationships. Conclusion: Long-term care nurses should encourage families and multidisciplinary team members, including the nurses themselves, to prepare for a good death of the PwD. Future research should focus on healthcare professionals’ perspectives on advance care planning in the early stages of dementia, as well as the perceptions of PwD, their family members and other healthcare professionals regarding the natural death process.

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Salutogenesis and COVID-19 pandemic impacting nursing education across SEANERN affiliated universities: A multi-national study

Shorey S., Ang E., Baridwan N.S., Bonito S.R., Dones L.B.P., Flores J.L.A., Freedman-Doan R., Fukahori H., Hirooka K., Koy V., Lee W.L., Lin C.C., Luk T.T., Nantsupawat A., Nguyen A.T.H., Nurumal M.S., Phanpaseuth S., Setiawan A., Shibuki T., Sumaiyah Jamaluddin T.S., TQ H., Tun S., Wati N.D.N.K., Xu X., Kunaviktikul W.

Nurse Education Today (Nurse Education Today) 110 2022.03

ISSN 02606917

Background: The COVID-19 pandemic has disrupted the lives of many. Particularly, nursing students experience greater stress as their normal curriculum is interrupted and some of them face the risk of being infected as frontline workers. Nursing faculty members may face similar struggles, in addition to developing teaching materials for online learning. Thus, it is important to examine the faculty members' and students' views on their ability to adapt during the pandemic to obtain a holistic view of how learning and training has been affected. Design: The descriptive cross-sectional quantitative design was used. Settings: Data were collected from Southeast and East Asian Nursing Education and Research Network (SEANERN) affiliated nursing institutions from January 2021 to August 2021. Participants: A total of 1897 nursing students and 395 faculty members from SEANERN-affiliated nursing institutions in Cambodia, Hong Kong, Indonesia, Japan, Laos, Malaysia, Philippines, Singapore, Thailand and Vietnam were recruited for this study. Methods: Quantitative surveys were used to explore the satisfaction levels in education modalities, confidence levels, psychosocial well-being, sense of coherence and stress levels of nursing students and faculty members during the COVID-19 pandemic. Results: Participants were mostly satisfied with the new education modalities, although most students felt that their education was compromised. Both groups showed positive levels of psychosocial well-being, despite scoring low to medium on the sense of coherence scale and experiencing great stress. The participants' sense of coherence was positively correlated with their psychosocial well-being and negatively correlated with stress levels. Conclusions: While the COVID-19 pandemic had negatively impacted the lives of nursing students and faculty members, most of them had a healthy level of psychosocial well-being. Having a strong sense of coherence was associated with better psychosocial health and lower stress levels. As such, it may be helpful to develop interventions aimed at improving the sense of coherence of nursing students and staff to help them manage stressors better.

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Initial impact of the COVID-19 pandemic on time Japanese nursing faculty devote to research: Cross-sectional survey

Yoshinaga N., Nakagami G., Fukahori H., Shimpuku Y., Sanada H., Sugama J.

Japan Journal of Nursing Science (Japan Journal of Nursing Science) 19 ( 1 ) 2022.01

ISSN 17427932

Aim: To investigate how nursing faculties' perceived time devoted to research changed during the first wave of the pandemic in Japan (April–June 2020) compared to pre-pandemic. Methods: This cross-sectional study was conducted online from July 1 to August 10, 2020 and involved 1,023 nursing faculties in Japan. Participants were asked to respond to a questionnaire based on their experiences from April to June 2020. We calculated descriptive statistics for several measures and examined associations between professional/personal demographic factors and declines in overall research time. Results: Of the 1,023 participants, 71.1% were spending less time on overall research activity; 79.6% spent less time attending academic events/conferences, and 77.4% spent less time conducting experiments/surveys. In contrast, 81.2% spent more time teaching, a much greater proportion than the global scientific community in a previous survey. As for work time allocation during the pandemic, teaching was by far the one activity that participants spent the most time on. Logistic regression analysis revealed that declines in overall research time were associated with several professional demographic factors, such as type of university, current academic position, and acquisition status of Japan's major research grant (KAKENHI) (all p <.05). Conclusions: Nursing faculties in Japan clearly spent less time on research, and more time on teaching during the first wave of the pandemic compared to pre-pandemic. The initial impact of the pandemic on nursing faculties revealed through this study is an eye-opener and a start for addressing the long-term impact on the nursing scientific community.

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Quality of End-of-Life in Cancer Patients With Dementia: Using A Nationwide Inpatient Database

Hirooka K., Okumura Y., Matsumoto S., Fukahori H., Ogawa A.

Journal of Pain and Symptom Management (Journal of Pain and Symptom Management) 64 ( 1 ) 1 - 7 2022

ISSN 08853924

Context: The growing number of older people significantly affects end-of-life care. However, few studies have assessed the quality of end-of-life care among cancer patients with dementia. Objectives: To assess the quality of end-of-life care among non-small cell lung cancer patients with or without dementia using a nationwide inpatient database from Japan. Methods: This was a retrospective observational study that used a nationwide inpatient database of 366 acute care hospitals from April 2014 to November 2018. Poisson regression models were used where the quality indicator was the dependent variable, dementia status was the independent variable, and the age group and Charlson comorbidity index were covariates. Incidence proportion ratios (IPRs) and confidence intervals (CIs) were obtained from the model. Results: The study population included 16,758 patients, of whom 4507 (26.9%) had dementia. The incidence proportion of opioid use (61.8% vs. 70.8%; IPR: 0.87, 95% CI: 0.83–0.91), palliative care consultation (2.7% vs. 3.8%; IPR: 0.71, 95% CI: 0.58–0.88), mechanical ventilation (4.0% vs. 5.4%; IPR: 0.74, 95% CI: 0.62–0.87), and cardiopulmonary resuscitation (2.2% vs. 2.8%; IPR: 0.79, 95% CI: 0.63–0.99) was significantly lower in patients with dementia than in those without dementia. Conclusion: Patients with dementia are less likely to receive end-of-life care. This study demonstrates the importance of providing high-quality end-of-life care regardless the cognitive status of patients with cancer.

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Provision and related factors of end-of-life care in elderly housing with care services in collaboration with home-visiting nurse agencies: a nationwide survey

Fukui S., Otsuki N., Ikezaki S., Fukahori H., Irie S.

BMC Palliative Care (BMC Palliative Care) 20 ( 1 ) 2021.12

Background: Japan has the largest population of older adults in the world; it is only growing as life expectancy increases worldwide. As such, solutions to potential obstacles must be studied to maintain healthy, productive lives for older adults. In 2011, the Japanese government has started a policy to increase “Elderly Housing with Care Services (EHCS)”, which is one of a private rental housing, as a place where safe and secure end-of-life care can be provided. The government expect for them to provide end-of-life care by collaborating with the Home-Visit Nursing Agencies (HVNA). The purpose of this study is to clarify the situation of the end-of-life care provision in EHCS in collaboration with HVNA and to examine the factors that associate with the provision of the end-of-life care in EHCS. Methods: A two-stage nationwide survey (fax and mail surveys) were conducted. Of the 5,172 HVNA of the National Association for Visiting Nurse Services members, members from 359 agencies visited EHCS. Logistic regression analysis was conducted with the provision of end-of-life care to EHCS in 2017 as the dependent variable, and the following as independent variables: characteristics of HVNA and EHCS; characteristics of residents; collaborations between HVNA and EHCS; and the reasons for starting home-visit nursing. Results: Of the 342 HVNA who responded to the collaborations with EHCS, 21.6% provided end-of-life care. The following factors were significantly associated with the provision of end-of-life care to inmates in elderly care facilities: being affiliated with a HVNA, admitting many residents using long-term care insurance, collaborating with each other for more than three years, and started visiting-nurse services after being requested by a resident’s physician. Conclusions: This study clarified the situation of the provision of end-of-life care in EHCS in collaboration with HVNA and the related factors that help in providing end-of-life care in EHCS.

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Validity and reliability of Japanese version of the pressure ulcer knowledge assessment tool

Yamamoto-Kon A., Fukahori H., Ogata Y., Nagano M.

Journal of Tissue Viability (Journal of Tissue Viability) 30 ( 4 ) 566 - 570 2021.11

ISSN 0965206X

Aim: To develop Japanese version of the pressure ulcer knowledge assessment tool, a tool for measuring nurses’ pressure ulcer knowledge to effectively evaluate the efficacy of current educational programs, resulting in prevention and early treatment, and to verify its validity and reliability among Japanese nurses. Materials and methods: A total of 1716 nurses across three university hospitals participated in this study. All had been employed for at least one year. Managers, part-timers, and those in the operating room and the outpatient ward were excluded from the study as it is limited to bedside preventive care. The original tool was translated into Japanese using the Brislin's translation model. A cross-sectional study was used to examine the reliability and validity of the measure within a Japanese sample. Assessment of the multiple-choice test items included analysis of the validity (item difficulty and discriminating index), construct validity, internal consistency, and stability (test–retest reliability). Results: The item difficulty indices ranged from 0.17 to 0.95, whereas values for item discrimination ranged from 0.15 to 0.45. Known group validity of the scale was confirmed; therefore, the higher-expertize group consisting of wound, ostomy, and continence nurses significantly outperformed nurses certified in other fields. The overall internal consistency reliability was 0.86 with a two-week test–retest intraclass correlation of 0.60. Conclusions: The instrument may be applied as a reliable and valid measure to assess nurses’ pressure ulcer knowledge in the fields of nursing education, research, and practice in Japan.

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Outcomes of a financial incentive scheme for dementia care by dementia specialist teams in acute-care hospitals: A difference-in-differences analysis of a nationwide retrospective cohort study in Japan

Morita K., Fukahori H., Ogawara H., Iwagami M., Matsui H., Okura T., Itoh S., Fushimi K., Yasunaga H.

International Journal of Geriatric Psychiatry (International Journal of Geriatric Psychiatry) 36 ( 9 ) 1386 - 1397 2021.09

ISSN 08856230

Objectives: The quality of care for dementia in acute-care settings has been criticised. In 2016, the Japanese universal health insurance system introduced a financial incentive scheme for dementia care by dementia specialist teams in acute-care hospitals. This study aimed to investigate the effectiveness of this financial incentive scheme on short-term outcomes (in-hospital mortality and 30-day readmission). Design and Methods: Using a Japanese nationwide inpatient database, we identified older adult patients with moderate-to-severe dementia admitted for pneumonia, heart failure, cerebral infarction, urinary tract infection, intracranial injury or hip fracture from April 2014 to March 2018. We selected 180 propensity score-matched pairs of hospitals that adopted (n = 180 of 185) and that did not adopt (n = 180 of 744) the financial incentive scheme. We then conducted a patient-level difference-in-differences analysis. In a sensitivity analysis, we restricted the postintervention group to patients who actually received dementia care. Results: There was no association between a hospital's adoption of the incentive scheme and in-hospital mortality (adjusted odds ratio [aOR]: 0.97; 95% confidence interval [CI]: 0.88–1.06; p = 0.48) or 30-day readmission (aOR: 1.04; 95% CI: 0.95–1.14; p = 0.37). Only 29% of patients in hospitals adopting the scheme actually received dementia care. The sensitivity analysis showed that receiving dementia care was associated with decreased in-hospital mortality. Conclusions: The financial incentive scheme to enhance dementia care by dementia specialist teams in Japan may not be working effectively, but the results do suggest that individual dementia care was associated with decreased in-hospital mortality.

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Preliminary effect and acceptability of an intervention to improve end-of-life care in long-term-care facilities: A feasibility study

Yamagata C., Matsumoto S., Miyashita M., Kanno Y., Taguchi A., Sato K., Fukahori H.

Healthcare (Switzerland) (Healthcare (Switzerland)) 9 ( 9 ) 2021.09

The number of deaths of older adults in long-term care settings will increase with the aging population. Nurses and care workers in these settings face various challenges in providing end-of-life care, and interventions for quality end-of-life care may be useful. This feasibility study aims to explore the preliminary effect and acceptability of an intervention named the EOL Care Tool to improve end-of-life care in long-term-care facilities. We conducted a single-arm quasi-experimental study using mixed methods. This tool consisted of multiple components: professionalized lectures, newly developed structured documents, regular conferences regarding end-of-life care, and educational support from administrators. Twenty-four nurses and fifty-five care workers employed in a long-term care facility participated. For nurses, improvement in attitudes toward end-of-life care (p < 0.05) and interdisciplinary collaboration (p < 0.05) were shown quantitatively. Regarding acceptability, nurses and care workers evaluated the tool positively except for the difficulty of using the new documents. However, qualitative results showed that care workers felt the reluctance to address the work regarding end-of-life care. Therefore, a good preliminary effect and acceptability for nurses were indicated, while acceptability for care workers was only moderate. Revision to address the mentioned issues and evaluation of the revised tool with a more robust research design are required.

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Pain Prevalence, Pain Management, and the Need for Pain Education in Healthcare Undergraduates

Kodama Y., Fukahori H., Tse M., Yamamoto-Mitani N.

Pain Management Nursing (Pain Management Nursing) 22 ( 3 ) 408 - 413 2021.06

ISSN 15249042

Background: Pain is a common health problem in undergraduate students. Pain prevalence, pain management strategies and knowledge among healthcare groups has not been revealed yet. Aim: This study explored pain prevalence, intensity, pain management strategies, knowledge, and education in undergraduate students specializing in healthcare science. The findings will highlight the necessity for increasing pain management education in the university setting. Design: A questionnaire-based, cross-sectional study was conducted. Settings/ Participants: Data was collected from 1,490 university students in Tokyo between December 2015 and April 2016. A χ square test was performed to examine differences in pain status and management strategies according to gender. We compared medical knowledge scores among disciplines using one-way analysis of variance. Results: In total, 511 (79.2%) students had experienced bodily pain during the preceding 6 months. Pain prevalence differed by gender. More nursing students had used both pharmacological and nonpharmacological methods for pain management than had students from other disciplines (p = .011). Pain medication knowledge of students in other disciplines was low to moderate, with greater knowledge observed in medical students (p < .05). Conclusions: Education regarding pain management should be developed that considers differences among disciplines. Additionally, poor pain management knowledge could affect the quality of care students provide to patients after graduation. Enhancing pain management knowledge by providing suitable pain management education in universities may contribute to better pain management for students, and this may translate to their work in clinical settings.

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Cochrane corner: Advance care planning for adults with heart failure

Nishikawa Y., Fukahori H., Mizuno A., Kwong J.S.W.

Heart (Heart) 107 ( 8 ) 609 - 611 2021.04

ISSN 13556037

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Defining a good death for people with dementia: A scoping review

Takahashi Z., Yamakawa M., Nakanishi M., Fukahori H., Igarashi N., Aoyama M., Sato K., Sakai S., Nagae H., Miyashita M.

Japan Journal of Nursing Science (Japan Journal of Nursing Science) 18 ( 2 ) 2021.04

ISSN 17427932

Aim: End-of-life care for people with dementia is becoming increasingly important as the global population ages. However, there is no agreed definition of a good death for people with dementia. The current review examined previous literature to establish the current state of knowledge on this issue. Methods: We conducted a scoping review using a standard methodological framework. Relevant studies were identified from four databases. Studies were included if they were in English, discussed palliative or end-of-life care for dementia, and defined or explained a good death. The definitions or explanations of a good death were categorized into subthemes, and grouped into broader themes. Results: We identified 11 articles discussing or explaining a good death in dementia, which were published between 2009 and 2017. Most of these studies drew on the views of healthcare professionals and/or family members of people with dementia, and only one considered the views of people with dementia themselves. Ten themes were identified, including pain-free status, peaceful/comfort, dignity, family presence, surrounded by familiar things and people, person-centered communication, spirituality, life completion, treatment preferences, and other. Conclusions: The characteristics of a good death in dementia showed similarities with those identified more generally. However, there were some themes that were specific to end-of-life care in dementia, notably “surrounded by familiar things and people” and “person-centered communication”. To obtain a fuller picture of the nature of a good death in dementia, researchers need to examine the views of people living with dementia.

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Sustainable nurse-led care for people with dementia including mild cognitive impairment and their family in an ambulatory care setting: A scoping review

Yamakawa M., Kanamori T., Fukahori H., Sakai I.

International Journal of Nursing Practice (International Journal of Nursing Practice) 28 ( 3 ) 2021

ISSN 13227114

Aims: This review aimed to determine the characteristics of a nurse-led intervention for people with dementia including mild cognitive impairment and their family in an ambulatory care setting. Background: Enhancing the role of nurses in a multidisciplinary team of ambulatory care follow-up after a diagnosis of dementia is thought to lead to successful dementia care. Design: This is a scoping review. Data Sources: MEDLINE, CINAHL, EMBASE, Cochrane, JBI, Japan Medical Abstracts Society, PsycINFO and Web of Science were searched on 14 March 2019. Review Methods: This scoping review was conducted using the Joanna Briggs Institute methodology, followed the PRISMA-ScR checklist and considered studies that included interventions conducted by nurses and included outcomes regarding dementia symptoms or family care burden. Results: Eleven studies were included. Of these, all interventions were multifactorial and reported effective results. Educational interventions were most common, and the content of education included the characteristics of dementia and how to interact with patients with dementia. The roles of nurses included caregiver education, assessment, care plan creation for continuous monitoring and team building. Conclusion: This scoping review suggested that effective nurse-led interventions in the ambulatory care of people with dementia are continuous patient and family supports, primarily caregiver education within multidisciplinary teams.

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Effect of an end-of-life gerontological nursing education programme on the attitudes and knowledge of clinical nurses: A non-randomised controlled trial

Okumura-Hiroshige A., Fukahori H., Yoshioka S., Nishiyama M., Takamichi K., Kuwata M.

International Journal of Older People Nursing (International Journal of Older People Nursing) 15 ( 3 ) 2020.09

ISSN 17483735

Aims: To evaluate how a structured interactive two-day education programme for clinical nurses on end-of-life (EOL) care for older people affects nurses’ attitudes and knowledge. Design: Non-randomised controlled trial. Methods: Nurses were recruited separately for intervention and control groups. The intervention group assisted older patients with EOL care and recruited patients for the programme. To prevent sampling bias, control group nurses were recruited from a facility with numerous EOL care opportunities. The intervention was a two-day educational programme. Using valid and reliable scales, we evaluated the attitudes (total score range: 26–130) and knowledge (total score range: 0–51) of the intervention group four times (pretraining, post-training, 3 months, 6 months) and the control group three times (baseline, 3 months, 6 months) between January 2016 and April 2017. Analysis of covariance examined both groups’ score changes at 3 and 6 months while adjusting for confounding factors. Results: Participants were 338 nurses caring primarily for older people (intervention group: 164; control group: 174); 142 responded at all measurement points. The change in mean value of the attitude scale from baseline to 3 months (differences in the groups’ attitude scores = 7.33; 95% CI = 2.43–12.24; p =.004) and 6 months (differences in groups’ attitude scores = 5.77; 95% CI = 0.17–11.37; p =.044) was greater in the intervention group. Moreover, the mean knowledge scale score change from baseline to 3 months was greater in the intervention group (differences in groups’ knowledge scores = 5.74; 95% CI = 4.07 to 7.39; p <.001). There was no evidence of a change in this score between baseline and 6 months. Conclusion: The programme improved nurses’ medium- to long-term attitudes and knowledge. Thus, it may help nurses enhance the quality of care they provide. Implications for practice: A two-day educational program improves nurses’ medium- to long-term attitudes and knowledge on end-oflife care. For quality end-of-life care for older people, a structured and evidence-based educational program should be provided to nursing staff.

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Nurses’ perceptions of medical procedures and nursing practices for older patients with non-cancer long-term illness and do-not-attempt-resuscitation orders: A vignette study

Higuchi A., Yoshii A., Takita M., Tsubokura M., Fukahori H., Igarashi R.

Nursing Open (Nursing Open) 7 ( 4 ) 1179 - 1186 2020.07

Aim: To elucidate influence of a do-not-attempt-resuscitation (DNAR) order on nurses’ perceptions of the medical procedures and nursing practices for non-cancer older patients. Design: A vignette-based questionnaire study. Methods: A questionnaire survey asking nurses their perceptions of clinical practices for the following three vignettes was performed in a community hospital in Japan (N = 120): the control vignettes with an older patient with repeated heart failure who was living alone and the other two with either an absence of relatives or a diagnosis of dementia. We also prepared additions to each vignette describing a DNAR order. Results: Nurses’ perception on cardiopulmonary resuscitation, defibrillation, blood tests and intravenous nutrition showed statistically significant and minimally important declines after the DNAR order compared with before for all three vignettes (p <.001). DNAR orders can influence nurses’ perceptions of clinical practices for non-cancer older patients with chronic heart failure.

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End-of-life nursing care practice in long-term care settings for older adults: A qualitative systematic review

Nasu K., Konno R., Fukahori H.

International Journal of Nursing Practice (International Journal of Nursing Practice) 26 ( 2 ) 2020.04

ISSN 13227114

Aim: To synthesize qualitative evidence on nurses' end-of-life care practices in long-term care settings for older adults. Background: Qualitative evidence on how nurses describe their own end-of-life care practice has not been reviewed systematically. Design: Qualitative systematic review. Data Sources: Databases MEDLINE, CINAHL, PsycINFO, EMBASE, Mednar, Google Scholar, and Ichushi were searched for published and unpublished studies in English or Japanese. Methods: The review followed the Joanna Briggs Institute approach to qualitative systematic reviews. Each study was assessed by two independent reviewers for methodological quality. The qualitative findings were pooled to produce categories and synthesized through meta-aggregation. Results: Twenty studies met all inclusion criteria. Their 137 findings were grouped into 10 categories and then aggregated into three synthesized findings: playing multidimensional roles to help residents die with dignity, needing resources and support for professional commitment, and feeling mismatch between responsibilities and power, affecting multidisciplinary teamwork. Conclusion: Nurses play multidimensional roles as the health care professionals most versed in residents' complex needs. Managers and policymakers should empower nurses to resolve the mismatch and help nurses obtain needed resources for end-of-life care that ensures residents die with dignity.

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