研究者詳細 - 深堀　浩樹

論文 - 深堀　浩樹

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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年04月

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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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年

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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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年

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年

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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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年08月

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年05月

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年03月

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年01月

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年

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年12月

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年11月

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年09月

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年09月

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年06月

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年04月

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年04月

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年

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年09月

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年07月

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年04月

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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Rebuilding and guiding a care community: A grounded theory of end-of-life nursing care practice in long-term care settings

Nasu K., Sato K., Fukahori H.

Journal of Advanced Nursing （Journal of Advanced Nursing） 76 （ 4 ） 1009 - 1018 2020年04月

ISSN 03092402

Aims: To investigate the end-of-life (EOL) nursing care practice process in long-term care (LTC) settings for older adults in Japan. Design: A qualitative study based on grounded theory developed by Corbin and Strauss. Methods: Sampling, interviewing, and analysis were performed cyclically, with results for each stage used as the basis for data collection and next-stage analysis decisions. Semi-structured interviews were conducted from March 2015-March 2019 with 22 nurses from eight LTC settings. Analysis was performed using coding, constant comparison, and emerging categories. Results: The core category, “guiding the rebuilt care community to assist the dying resident” comprised five categories: “assessing the resident's stage,” “harmonizing care with the dying process,” “rebuilding a care community,“ “helping community members care for the resident,” and “encouraging community members to give meaning.” The participants were described as “traditional village elders“ who were the integral members of the care community, as well as guides who helped and encouraged the community. Conclusion: Results revealed the holistic process of EOL nursing-care practice in Japan. Nurses aimed to allow LTC residents to die as social human beings, surrounded by people, and not just responding physical and psychological distress. Such practice requires nursing expertise, healthcare skills, and leadership qualities to build and serve care communities. Nurses must also consider residents’ uncertainties and vulnerabilities as well as their cultural backgrounds. Impact: This study showed that the nurses hold unique roles in providing dying people with care from a community. These findings can potentially be applied for developing a universal model for LTC nurses in many aging populations, to modify their EOL care practice, educate new LTC nurses, and collaborate with other healthcare professionals.

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Impact of dementia on quality of death among cancer patients: An observational study of home palliative care users

Hirooka K., Nakanishi M., Fukahori H., Nishida A.

Geriatrics and Gerontology International （Geriatrics and Gerontology International） 20 （ 4 ） 354 - 359 2020年04月

ISSN 14441586

Aim: The number of cancer patients with dementia has increased markedly in accordance with aging societies. Cancer patients might receive palliative and end-of-life care to maintain their quality of life; however, the impact of dementia on the quality of death is unexamined in this population. Consequently, we explored the impact of dementia on the quality of death among cancer patients. Methods: Home palliative care staff members completed questionnaires regarding cancer patients’ (n = 508) cognitive status, cancer-related symptoms and quality of death using the good death inventory. Hierarchical regression analyses were carried out for the entire sample and for stratified groups based on the presence of dementia. Results: Of the 508 patients, 156 (30.7%) had dementia. Hierarchical regression analyses revealed that greater quality of death was associated with not having dementia (P < 0.001). Stratified analyses showed that dying at home was related to greater quality of death both in patients with and without dementia. The presence of a primary family caregiver was associated with greater quality of death only in patients with dementia (P < 0.001). Conclusions: Cancer patients with dementia were less likely to achieve a good death than those without. Our results suggest the importance of enhancing end-of-life care discussions with patients and their families, along with developing specific support strategies to enhance the decision-making of cancer patients with dementia and their family members. Geriatr Gerontol Int 2020; 20: 354–359.

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Advance care planning for adults with heart failure

Nishikawa Y., Hiroyama N., Fukahori H., Ota E., Mizuno A., Miyashita M., Yoneoka D., Kwong J.S.W.

Cochrane Database of Systematic Reviews （Cochrane Database of Systematic Reviews） 2020 （ 2 ） 2020年02月

Background: People with heart failure report various symptoms and show a trajectory of periodic exacerbations and recoveries, where each exacerbation event may lead to death. Current clinical practice guidelines indicate the importance of discussing future care strategies with people with heart failure. Advance care planning (ACP) is the process of discussing an individual's future care plan according to their values and preferences, and involves the person with heart failure, their family members or surrogate decision-makers, and healthcare providers. Although it is shown that ACP may improve discussion about end-of-life care and documentation of an individual's preferences, the effects of ACP for people with heart failure are uncertain. Objectives: To assess the effects of advance care planning (ACP) in people with heart failure compared to usual care strategies that do not have any components promoting ACP. Search methods: We searched CENTRAL, MEDLINE, Embase, CINAHL, Social Work Abstracts, and two clinical trials registers in October 2019. We checked the reference lists of included studies. There were no restrictions on language or publication status. Selection criteria: We included randomised controlled trials (RCTs) that compared ACP with usual care in people with heart failure. Trials could have parallel group, cluster-randomised, or cross-over designs. We included interventions that implemented ACP, such as discussing and considering values, wishes, life goals, and preferences for future medical care. The study participants comprised adults (18 years of age or older) with heart failure. Data collection and analysis: Two review authors independently extracted outcome data from the included studies, and assessed their risk of bias. We contacted trial authors when we needed to obtain missing information. Main results: We included nine RCTs (1242 participants and 426 surrogate decision-makers) in this review. The meta-analysis included seven studies (876 participants). Participants' mean ages ranged from 62 to 82 years, and 53% to 100% of the studies' participants were men. All included studies took place in the US or the UK. Only one study reported concordance between participants' preferences and end-of-life care, and it enrolled people with heart failure or renal disease. Owing to one study with small sample size, the effects of ACP on concordance between participants' preferences and end-of-life care were uncertain (risk ratio (RR) 1.19, 95% confidence interval (CI) 0.91 to 1.55; participants = 110; studies = 1; very low-quality evidence). It corresponded to an assumed risk of 625 per 1000 participants receiving usual care and a corresponding risk of 744 per 1000 (95% CI 569 to 969) for ACP. There was no evidence of a difference in quality of life between groups (standardised mean difference (SMD) 0.06, 95% CI –0.26 to 0.38; participants = 156; studies = 3; low-quality evidence). However, one study, which was not included in the meta-analysis, showed that the quality of life score improved by 14.86 points in the ACP group compared with 11.80 points in the usual care group. Completion of documentation by medical staff regarding discussions with participants about ACP processes may have increased (RR 1.68. 95% CI 1.23 to 2.29; participants = 92; studies = 2; low-quality evidence). This corresponded to an assumed risk of 489 per 1000 participants with usual care and a corresponding risk of 822 per 1000 (95% CI 602 to 1000) for ACP. One study, which was not included in the meta-analysis, also showed that ACP helped to improve documentation of the ACP process (hazard ratio (HR) 2.87, 95% CI 1.09 to 7.59; participants = 232). Three studies reported that implementation of ACP led to an improvement of participants' depression (SMD –0.58, 95% CI –0.82 to –0.34; participants = 278; studies = 3; low-quality evidence). We were uncertain about the effects of ACP on the quality of communication when compared to the usual care group (MD –0.40, 95% CI –1.61 to 0.81; participants = 9; studies = 1; very low-quality evidence). We also noted an increase in all-cause mortality in the ACP group (RR 1.32, 95% CI 1.04 to 1.67; participants = 795; studies = 5). The studies did not report participants' satisfaction with care/treatment and caregivers' satisfaction with care/treatment. Authors' conclusions: ACP may help to increase documentation by medical staff regarding discussions with participants about ACP processes, and may improve an individual's depression. However, the quality of the evidence about these outcomes was low. The quality of the evidence for each outcome was low to very low due to the small number of studies and participants included in this review. Additionally, the follow-up periods and types of ACP intervention were varied. Therefore, further studies are needed to explore the effects of ACP that consider these differences carefully.

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Exploring sociodemographic factors related to practice, attitude, knowledge, and skills concerning evidence-based practice in clinical nursing

Tomotaki A., Fukahori H., Sakai I.

Japan Journal of Nursing Science （Japan Journal of Nursing Science） 17 （ 1 ） 2020年01月

ISSN 17427932

Aim: This study aimed to explore sociodemographic factors related to evidence-based practice (EBP) competency in Japanese nurses in university hospitals. Methods: In March 2016, a survey was distributed to 843 clinical nurses who directly provide nursing care at two university hospitals in Japan. Multiple regression analyses were conducted on data received from 472 nurses using the Evidence-Based Practice Questionnaire (Japanese version). Results: Sociodemographic factors related to EBP competency were experience with conducting nursing research as a part of continuing education, education about EBP, advanced practice certification (certified nurse specialists/certified nurses), and years of experience in clinical nursing. These factors differed across the four subscales of the questionnaire: Practice, Attitude, Knowledge of Research and Practice, and Skills of Research and Practice. Specifically, experience with two or more nursing research activities was significantly positively associated with Attitude and Knowledge/Skills Concerning Research and Practice of EBP, but not related to the implementation of EBP itself. Advanced practice certification was significantly positively associated with Practice and Attitude of EBP. Conclusions: Our study quantitatively identified sociodemographic factors including experience with conducting nursing research and advanced practice certification status that were found to be related to EBP competency and these factors were differently associated with the four subscales of the Evidence-Based Practice Questionnaire (Japanese version). EBP education should depend on nurses' levels of EBP competency, and nursing educators and managers need to be cognizant of their nurses' sociodemographic factors when providing EBP education.

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Absence of relatives impairs the approach of nurses to cardiopulmonary resuscitation in non-cancer elderly patients without a do-not-attempt-resuscitation order: A vignette-based questionnaire study

Higuchi A., Takita M., Yoshii A., Akiyama T., Nemoto T., Nakahira R., Nakajima T., Fukahori H., Tsubokura M., Igarashi R.

Tohoku Journal of Experimental Medicine （Tohoku Journal of Experimental Medicine） 250 （ 1 ） 71 - 78 2020年

ISSN 00408727

A Do-Not-Attempt-Resuscitation (DNAR) order solely precludes performing cardiopulmonary resuscitation (CPR) following cardiopulmonary arrest. A patient’s personal status is known to influence a range of clinical practices, not only CPR, when a DNAR order is given. We assessed whether the absence of supporting relatives or a diagnosis of dementia can influence nurses’ perceptions of clinical practices for elderly patients with non-malignant and chronic diseases. A vignette-based questionnaire was used to evaluate nurses’ beliefs both before and after issuance of a DNAR order. Three vignettes were developed: the control vignette described an 85-year-old woman with repeated heart failure, the second and third incorporated a lack of relatives and a dementia diagnosis, respectively. The survey assessed the approach of nurses to 10 routine medical procedures, including CPR, clinical laboratory testing and nursing care, using a 5-base Likert-scale, for six vignette scenarios. A questionnaire was completed by 186 nurses (64% response). The pre-DNAR non-relative vignette showed significantly lower scores for CPR, indicating a deterioration in willingness to perform CPR, compared to the pre-DNAR control (median [interquartile]; 3 [2-4] and 4 [3-4] in the non-relative and control vignettes, respectively, p < 0.001). No significant differences were observed between the dementia and control vignettes. Absence of contactable relatives and resultant lack of communication can diminish the perception of nurses regarding the provision of CPR, even when a DNAR does not exist. This result suggests a necessity for comprehensive training all medical staff about issuance of DNAR orders and what care should be provided thereafter.

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Developing a Measure of End-of-Life Care Nursing Knowledge for Japanese Geriatric Nurses

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

Journal of Hospice and Palliative Nursing （Journal of Hospice and Palliative Nursing） 21 （ 4 ） E1 - E9 2019年08月

ISSN 15222179

This study developed an end-of-life (EOL) care nursing knowledge scale for Japanese geriatric nurses (ELNKS-JG) to measure nurse knowledge of EOL care for older adults. It also was used to evaluate the quality of The End-of-Life Nursing Education Consortium-Japan Geriatric. Participants were 1168 nurses employed in 32 institutions across Japan. The items of our measure were developed to cover 8 important topics: principles of EOL care for older adults; pain management; symptom management; ethics of care; cultural and spiritual considerations; communication; loss, grief, and bereavement; and caring for final days. The measure included 51 items with an overall Cronbach coefficient of 0.87 and an intraclass correlation coefficient of 0.81. Our measure, the ELNKS-JG, was confirmed to have good internal consistency, test-retest reliability, content validity, and known-groups validity. This scale's items included knowledge about noncancerous diseases, physical changes due to aging, family care, and multidisciplinary collaboration. The ELNKS-JG comprehensively measures a nurse's knowledge of EOL care for older adults in any EOL setting. Furthermore, this scale can evaluate educational programs aimed at improving care quality and encouraging related activities in facilities that provide EOL care.

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Posttraumatic growth in bereaved family members of patients with cancer: a qualitative analysis

Hirooka K., Fukahori H., Taku K., Izawa S., Ogawa A.

Supportive Care in Cancer （Supportive Care in Cancer） 27 （ 4 ） 1417 - 1424 2019年04月

ISSN 09414355

Background: The death of a loved one has great impact on family members even when the death was expected. While negative changes are reported, some individuals also report personal growth, known as posttraumatic growth (PTG). Many studies on PTG have been performed using quantitative methods and suggest that PTG may differ according to the traumatic event and cultural background. Purpose: This study aimed to explore how Japanese bereaved family members of patients with cancer express their experience of PTG after the patient’s death by analyzing open-ended answers provided in a cross-sectional survey. Methods: Qualitative data were collected through a survey, and thematic analysis was used to analyze the data. The present study was part of a larger cross-sectional survey of bereaved families of patients with cancer. Data analyzed in the current study were obtained from 162 bereaved family members of patients with cancer. Results: We identified 18 sub-themes within five predefined major domains of PTG. Moreover, we also identified two additional themes: changed view of life and death, and awareness of health management. Conclusions: The experience of PTG of bereaved family members varied considerably. Future research on PTG experiences among groups from diverse cultural backgrounds would be beneficial for understanding the concept and its clinical implications.

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Factors associated with depressive symptoms in patients with acute coronary syndrome undergoing percutaneous coronary intervention: A prospective cohort study

Doi M., Fukahori H., Oyama Y., Morita K.

Nursing Open （Nursing Open） 5 （ 4 ） 583 - 592 2018年10月

Aim: To identify the association between possible factors and depression among post-percutaneous coronary intervention patients with acute coronary syndrome. Design: Prospective cohort study. Methods: Sixty-eight post-percutaneous coronary intervention patients with acute coronary syndrome were enrolled between January 2016 - June 2017. The Hospital Anxiety and Depression Scale scores at 1–3 months after discharge were regressed onto uncertainty in illness and other clinical factors based on the Roy Adaptation Model. Results: Thirty-six patients were included in the final analysis. Higher baseline depression scores, higher changes in uncertainty in illness and feeling annoyed by troublesome tasks after discharge were associated with higher depressive scores at 1 month after discharge. Careful observation and support of patients’ ineffective responses in self-concept mode may be effective in preventing depression.

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調査報告分娩後出血のリスク因子のエビデンスの提示に対する臨床看護職の評価　Evidence Based Practiceの促進を目指した調査

比佐, 加奈子, 角川, 綾菜, 中西, 愛海, 廣山, 奈津子, 岩崎, 弓子, 山縣, 千尋, 小笹, 由香 and 深堀, 浩樹

看護管理 28 （ 8 ） 694 - 701 2018年08月

ISSN 0917-1355

＜文献概要＞はじめに　Evidence-Based Practice(EBP)とは,「研究によるエビデンスと,臨床現場の専門能力,患者や家族の価値観を統合させ,協働で意思決定を行う過程」と定義され,看護領域での促進が望まれる。米国では臨床の実践者が主体のEBP促進のモデルとしてIOWAモデルがあり,活用例として開腹手術後の腸蠕動音聴取の取りやめや,手術時の手袋の二重装着の促進がある。しかし,日本の看護領域ではEBPは十分には普及していない。EBPの個人的バリアには,研究に価値を感じないなどの「価値観」,文献検索能力の不足などの「スキル」の側面がある。また,組織的バリアとして時間不足,情報検索ツールへのアクセスや,英文献の読解という言語的な壁も指摘されている。本調査ではこれらの阻害要因への対応となりうる活動として,学生のEBPプロジェクトが職員・学生の学習や大学と臨床現場の協働を促進する可能性に着目し,看護系大学の学部学生・教員・大学院生らが,文献の系統的検索,質の評価,結果の統合を行い,まとめたエビデンスを臨床看護職に提示する活動(便宜的にこの一連の活動をEBP活動と呼称する。この活動はEBPの促進を目的としたもので看護実践は含まない)を行い,その活動への看護職の評価を明らかにすることを目的とした。本調査から日本におけるEBP促進の示唆が得られることが期待される。

山縣, 千尋, 西川, 裕理, 奥村, 朱美, 那須, 佳津美 and 深堀, 浩樹

日本臨床 76 （増刊7 老年医学(下) ） 711 - 716 2018年08月

ISSN 0047-1852

意外に知られていない高齢者の事故　本当は怖い○○の話(第8回)　本当は怖い"ベッド柵"の話

深堀, 浩樹

看護技術 64 （ 9 ） 897 - 901 2018年08月

ISSN 0449-752X

Development of the End-of-Life Care Nursing Attitude Scale for Japanese Geriatrics

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

Journal of Hospice and Palliative Nursing （Journal of Hospice and Palliative Nursing） 20 （ 3 ） 272 - 278 2018年06月

ISSN 1522-2179

This study aimed to develop an end-of-life (EOL) care nursing attitude scale for Japanese geriatric nurses (ELNAS-JG). The items of the ELNAS-JG were developed to cover important topics related to EOL care (eg, motivation for providing EOL care, pain and symptom management, and decision-making support care for older adults). Participants were 1663 nurses employed in 32 institutions across Japan. Of these, 1298 participants were analyzed. An exploratory factor analysis of the 26 scale items revealed a 3-factor solution describing the concepts of responsibility, willingness, and confidence: responsibility and willingness were captured in factor 1 (16 items), and confidence was split into factor 2 (6 items) and factor 3 (4 items) to capture individual and collaborative behaviors. The overall Cronbach α coefficient for the 26 items was 0.95, and the intraclass correlation coefficient was 0.83. Overall, the ELNAS-JG was confirmed to have good internal consistency, test-retest reliability, content validity, known-groups validity, and construct validity. It can comprehensively measure nurses' attitudes toward EOL care for older adults in any EOL setting. Furthermore, this scale can be used to evaluate educational programs aimed at improving care quality and encouraging related activities in facilities that provide EOL care.

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Advance care planning for heart failure

Nishikawa Y., Fukahori H., Ota E., Mizuno A., Hiroyama N., Miyashita M., Yoneoka D., Kwong J.S.W.

Cochrane Database of Systematic Reviews （Cochrane Database of Systematic Reviews） 2018 （ 5 ） 2018年05月

ISSN 1361-6137

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Evidence Based Practiceのための入院患者へのせん妄ケアに関する文献検討

瀬戸, 菜月, 川崎, 翔太, 前田, 夏咲, 西川, 裕理, 山縣, 千尋, 戸田, あゆみ, 廣山, 奈津子, 長尾, 祥子, 田村, 貴子 and 深堀, 浩樹

看護技術 64 （ 6 ） 81 - 87 2018年05月

ISSN 0449-752X

入院患者への看護師によるせん妄ケアのエビデンスをシステマティックレビュー、ランダム化比較試験(RCT)、ガイドライン、書籍・雑誌記事、質的研究の文献検討により収集し、統合することを目的に、Cochrane Library、医学中央雑誌Web版、PubMedなどを用い検索を行い、得られたわが国の看護師に適用可能と判断したシステマティックレビュー1件、RCT6件、ガイドライン10件、書籍・雑誌記事3冊、質的研究4件を分析した。その結果、システマティックレビューでは多職種による多面的介入がせん妄の発症を減少させる中程度のエビデンスが示され、個々のRCTでは、多職種による介入の具体的な内容がまとめられていたが、わが国で行われたRCTが存在しないことから、これらの多面的介入に含まれる内容から、各々の実践現場で適用可能な内容を選択し、多職種と連携しながら行っていくことが望ましいと考えられた。

The development and validation of the Evidence-Based Practice Questionnaire

Tomotaki Ai, Fukahori Hiroki, Sakai Ikuko, Kurokohchi Kana

International Journal of Nursing Practice 24 （ 2 ） 2018年04月

ISSN 1322-7114

Aim: To develop and test the validity and reliability of a Japanese version of the Evidence-Based Practice Questionnaire. Methods: The Evidence-Based Practice Questionnaire was translated into Japanese, and a back-translation was performed. In March 2016, the survey was conducted among 843 nurses in 2 university hospitals in Japan. After 2 weeks, the same questionnaire for test-retest reliability was distributed to 197 nurses. We evaluated construct validity by factor analysis: convergent, discriminant, criterion-based and known-group validity, and reliability (internal consistency via Cronbach' alpha and test-retest reliability). Results: A total of 533 (66%) of nurses who agreed to our study returned the completed questionnaire, and 108 nurses (55%) agreed to the test-retest. Factor analysis confirmed that the original model of the Evidence-Based Practices Questionnaire was not statistically appropriate for Japanese nurses. Therefore, the final version of the Japanese version adopted 18 items and 4 subscales including practice, attitudes, and knowledge/skills related to research and practice. In the final version, the validity and reliability were moderate (Cronbach alpha =.90). Conclusion: The Japanese version of the Evidence-Based Practices Questionnaire is a reliable and valid tool and can be used to assess evidence-based practice, attitudes, and research knowledge/skills in Japan.

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The development and validation of the Evidence-Based Practice Questionnaire: Japanese version

Tomotaki A., Fukahori H., Sakai I., Kurokohchi K.

International Journal of Nursing Practice （International Journal of Nursing Practice） 24 （ 2 ） 2018年04月

ISSN 13227114

Aim: To develop and test the validity and reliability of a Japanese version of the Evidence-Based Practice Questionnaire. Methods: The Evidence-Based Practice Questionnaire was translated into Japanese, and a back-translation was performed. In March 2016, the survey was conducted among 843 nurses in 2 university hospitals in Japan. After 2 weeks, the same questionnaire for test-retest reliability was distributed to 197 nurses. We evaluated construct validity by factor analysis: convergent, discriminant, criterion-based and known-group validity, and reliability (internal consistency via Cronbach' alpha and test-retest reliability). Results: A total of 533 (66%) of nurses who agreed to our study returned the completed questionnaire, and 108 nurses (55%) agreed to the test-retest. Factor analysis confirmed that the original model of the Evidence-Based Practices Questionnaire was not statistically appropriate for Japanese nurses. Therefore, the final version of the Japanese version adopted 18 items and 4 subscales including practice, attitudes, and knowledge/skills related to research and practice. In the final version, the validity and reliability were moderate (Cronbach alpha =.90). Conclusion: The Japanese version of the Evidence-Based Practices Questionnaire is a reliable and valid tool and can be used to assess evidence-based practice, attitudes, and research knowledge/skills in Japan.

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米国在住の日本人看護職者の留学の理由と準備　インターネットによる横断的調査

小林, 桃子, 佐藤, 可奈, 原田, 奈穂子, 足立, 彩花 and 深堀, 浩樹

お茶の水看護学雑誌 12 （ 1-2 ） 16 - 24 2018年03月

ISSN 1881-2112

Examining Posttraumatic Growth Among Bereaved Family Members of Patients With Cancer Who Received Palliative Care at Home

Hirooka K., Fukahori H., Taku K., Togari T., Ogawa A.

American Journal of Hospice and Palliative Medicine （American Journal of Hospice and Palliative Medicine） 35 （ 2 ） 211 - 217 2018年02月

ISSN 1049-9091

Objective: The present study examines the factor structure of the Japanese version of the Posttraumatic Growth Inventory (PTGI-J) among bereaved family members who lost loved ones to cancer after home-based palliative care in Japan. It evaluates the relationships between total score, each PTGI-J domain, and participants’ having a religious belief, gender, age, relationship to the patient, and time since patient death. Procedure: Bereaved family members (n = 849) completed the PTGI-J and a demographic questionnaire. The factor structure was tested using confirmatory factor analysis (CFA), and univariate analysis was used to test hypotheses. Results: Confirmatory factor analysis showed that the current sample moderately fitted to both 4-factor and 5-factor models. Univariate analysis revealed that having a religious belief and gender were associated with all domains and total PTGI-J score. Age, time since patient death, and relationship to the patient showed significant differences with the domains of PTGI-J. Conclusion: Clinicians may be able to adjust the support they provide based on patients’ personal characteristics. Future research should look at the mechanisms of PTG by examining the role of rumination, social support, and emotional distress among bereaved family members of patients with cancer.

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【認知症ケアプロセスの可視化　「認知症ケア加算」がもたらした成果と展望】認知症ケア加算の影響と今後の展望　認定看護師,専門看護師を対象としたWeb調査と結果から

深堀, 浩樹, 森山, 祐美, 石川, 容子, 酒井, 郁子 and 日本老年看護学会老年看護政策検討委員会

看護管理 28 （ 2 ） 109 - 113 2018年02月

ISSN 0917-1355

End-of-life experiences of family caregivers of deceased patients with cancer

Hirooka Kayo, Otani Hiroyuki, Morita Tatsuya, Miura Tomofumi, Fukahori Hiroki, Aoyama Maho, Kizawa Yoshiyuki, Shima Yasuo, Tsuneto Satoru, Miyashita Mitsunori

Psycho-Oncology 27 （ 1 ） 272 - 278 2018年01月

ISSN 1057-9249

Objectives: The purpose of this study was (a) to describe the end-of-life experience of family caregivers of cancer patients, (b) to describe talking about death and dying of the patient to minor children, and (c) to examine the association of family caregivers' experiences by their characteristics and talking about death and dying of the patient. Methods: A cross-sectional nationwide survey of bereaved family caregivers was conducted. In total, 968 questionnaires were sent to bereaved family caregivers, and 711 were completed and returned. Fifty-three responses indicating patients had minor children were analyzed. Univariate analysis and principal component analysis were performed. Results: Family caregivers' experiences were divided into 3 domains by principal component analysis: protect children from the patient's imminent death, little regard for the children, and worry and concern about the children's emotional reaction. Family caregivers' common experiences were as follows: “I wanted to know how the children felt,” “I wanted to avoid making the children confused,” and “I did not have much time to talk with and/or play with the children.” About 30% of family caregivers reported that they “did not talk” about death and dying of patients to minor children. Spouses of patients and family caregivers who did not talk about death tended to experience distress and worry. Conclusions: Most family caregivers experienced worry and fear regarding minor children's emotional reaction; therefore, clinicians need to explain children's emotional and psychological reactions to family caregivers when a patient is at the end-of-life.

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老年看護政策検討委員会活動報告　認知症ケア加算2算定申請をした病院の看護管理者からみた認知症看護研修の効果

北川, 公子, 酒井, 郁子, 深堀, 浩樹, 森山, 祐美, 石川, 容子, 亀井, 智子, 山川, みやえ, 金盛, 琢也, 正木, 治恵, 堀内, ふき and 老年看護精索検討委員会

老年看護学 22 （ 2 ） 97 - 102 2018年01月

ISSN 1346-9665

老年看護政策検討委員会活動報告　認知症ケア加算1・2算定した病院における老人専門看護師・認知症看護認定看護師が認識している認知症ケアの実態と変化

深堀, 浩樹, 酒井, 郁子, 森山, 祐美, 石川, 容子, 北川, 公子, 亀井, 智子, 山川, みやえ, 金盛, 琢也, 正木, 治恵, 堀内, ふき and 老年看護精索検討委員会

老年看護学 22 （ 2 ） 103 - 107 2018年01月

ISSN 1346-9665

End-of-life experiences of family caregivers of deceased patients with cancer: A nation-wide survey

Hirooka K., Otani H., Morita T., Miura T., Fukahori H., Aoyama M., Kizawa Y., Shima Y., Tsuneto S., Miyashita M.

Psycho-Oncology （Psycho-Oncology） 27 （ 1 ） 272 - 278 2018年01月

ISSN 10579249

Objectives: The purpose of this study was (a) to describe the end-of-life experience of family caregivers of cancer patients, (b) to describe talking about death and dying of the patient to minor children, and (c) to examine the association of family caregivers' experiences by their characteristics and talking about death and dying of the patient. Methods: A cross-sectional nationwide survey of bereaved family caregivers was conducted. In total, 968 questionnaires were sent to bereaved family caregivers, and 711 were completed and returned. Fifty-three responses indicating patients had minor children were analyzed. Univariate analysis and principal component analysis were performed. Results: Family caregivers' experiences were divided into 3 domains by principal component analysis: protect children from the patient's imminent death, little regard for the children, and worry and concern about the children's emotional reaction. Family caregivers' common experiences were as follows: “I wanted to know how the children felt,” “I wanted to avoid making the children confused,” and “I did not have much time to talk with and/or play with the children.” About 30% of family caregivers reported that they “did not talk” about death and dying of patients to minor children. Spouses of patients and family caregivers who did not talk about death tended to experience distress and worry. Conclusions: Most family caregivers experienced worry and fear regarding minor children's emotional reaction; therefore, clinicians need to explain children's emotional and psychological reactions to family caregivers when a patient is at the end-of-life.

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Quality of death, rumination, and posttraumatic growth among bereaved family members of cancer patients in home palliative care

Hirooka Kayo, Fukahori Hiroki, Taku Kanako, Togari Taisuke, Ogawa Asao

Psycho-Oncology 26 （ 12 ） 2168 - 2174 2017年12月

ISSN 1057-9249

Objective: The current study was designed to test the hypothesis that quality of death (QOD) and intrusive and deliberate rumination are associated with posttraumatic growth (PTG) among bereaved family members of cancer patients in home palliative care. Methods: Data were collected from 805 bereaved family members of cancer patients who died at home in Japan. We used a cross-sectional design and participants completed Good Death Inventory, Event-Related Rumination Inventory, and PTG Inventory. Structural equation modeling was used to test the hypothesized relationships. Results: A direct pathway from QOD to PTG was significant. We also found significant indirect pathways between QOD and PTG via deliberate rumination soon after the death and recent deliberate rumination. Conclusions: Clinicians should provide high-quality end-of-life care with the goals of achieving a good death for terminally ill cancer patients and supporting the experience of PTG in bereaved family members after their loss.

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ケアの根拠を、ことばにしよう!かたちにしよう!リハビリ病棟におけるEBPの進め方　EBPを促進するためには?(2)

深堀, 浩樹 and 友滝, 愛

リハビリナース 10 （ 5 ） 505 - 511 2017年09月

ISSN 1882-3335

ケアの根拠を、ことばにしよう!かたちにしよう!　リハビリ病棟におけるEBPの進め方　EBPを促進するためには?

友滝, 愛 and 深堀, 浩樹

リハビリナース 10 （ 4 ） 400 - 404 2017年07月

ISSN 1882-3335

文京区の診療所における災害対策状況と医療者が災害対策のために希望する外部からの支援に関する実態調査

田中, 由香利, 丸, 光惠, 佐々木, 吉子, 深堀, 浩樹, 川本, 祐子, 前田, 留美 and 大友, 康裕

Japanese Journal of Disaster Medicine 22 （ 1 ） 30 - 37 2017年07月

ISSN 2189-4035

大都市東京における災害時の医療対応には、災害拠点病院と中・小規模医療機関の連携が不可欠であるが、中・小規模医療機関側の災害対策状況を明らかにした調査は少ない。そこで文京区内診療所の災害対策状況と、診療所の医療者が災害対策をするために希望する外部からの支援を調査した。232施設に調査用紙を郵送し19施設より回答を得た。備蓄に関しては平時から頻繁に使用する薬剤や創傷処置用資材を3日分以上備蓄していると回答した施設が多かったものの、緊急時資材が不足した際の確保方法は全施設が想定していないと回答した。また災害関連マニュアルを有している施設は26.3%のみであり、防災訓練の実施は31.6%であった。医療者が希望する支援では「マニュアル作成のための手引き」が52.6%ともっとも多く、次いで「災害研修・勉強会の開催」が47.4%であった。本調査に回答した文京区内診療所の災害対策は十分とはいえず、今後診療所の災害対策を推進するためには外部の支援が必要であると考えられた。(著者抄録)

千代田区内の中小規模医療機関における災害対策状況とニーズの実態

今津, 陽子, 佐々木, 吉子, 三浦, 英恵, 深堀, 浩樹, 前田, 留美, 川本, 祐子, 田中, 加苗, 濱舘, 陽子, 宮前, 繁 and 菅原, 千賀子

日本災害看護学会誌 18 （ 3 ） 13 - 23 2017年05月

ISSN 1345-0204

【目的】千代田区内の中小規模医療機関の災害対策の実態とニーズを明らかにする.【方法】千代田区内の全474施設を対象とし,病床や職員数等の病院基本情報,備蓄状況,災害関連マニュアルの整備状況,防災訓練・職員への教育に関する質問紙調査を行った.【結果】65施設より回答が得られ(回収率13.7%),30施設(46%)が個人経営であった.備蓄状況では,食料・飲料水の平均備蓄量は,職員用がそれぞれ13.6食,1.6日分と患者用に比べ最も多かった.また,18施設(27.6%)が災害関連マニュアルを有し,防災訓練の実施は27施設(44.2%)が行っていなかった.【結論】多くの施設で備蓄,訓練を含めた災害対策が十分に行われていなかった.中小規模医療機関各施設で災害対策に関するコスト,時間,人材の確保が難しいことが示唆された.職員全体の防災意識を高めると同時に,災害対策の外部支援が必要である.(著者抄録)

Differences in posttraumatic growth and grief reactions among adolescents by relationship with the deceased

Hirooka Kayo, Fukahori Hiroki, Ozawa Miwa, Akita Yumi

Journal of Advanced Nursing 73 （ 4 ） 955 - 965 2017年04月

ISSN 0309-2402

Aim. The aim of this study was to examine three hypotheses: (1) adolescents who had experienced the death of a parent would report higher grief reactions than those who had lost a grandparent; (2) adolescents who experienced the death of a parent would report higher posttraumatic growth than those who had lost a grandparent; and (3) posttraumatic growth and grief reactions are positively associated. Background. To date, no study has investigated adolescents’ posttraumatic growth by their relationship with the deceased. Design. Cross-sectional web-based survey. Methods. Participants were adolescents who had experienced the death of a parent or grandparent in the last 5 years. Participants completed the Japanese version of the Posttraumatic Growth Inventory and grief reaction items. We conducted a web-based survey during January 2014. We used Pearson product-moment correlations to examine the association between each Posttraumatic Growth Inventory domain and each grief reaction item. Differences in the relationship with the deceased for each Posttraumatic Growth Inventory and grief reaction item were compared with an independent-sample t-test. Results. Participants (n = 124) reported grief reactions including ‘I began to get frustrated at the little things’ (43 5%), ‘It was difficult to go to school’ (41 1%) and ‘I was not able to sleep at night’ (33 9%). The independent t-test indicated that parentally bereaved adolescents reported higher posttraumatic growth and grief reactions than those who had lost a grandparent. Pearson’s bivariate analysis showed an association between grief reactions and posttraumatic growth. Conclusion. Parentally bereaved adolescents reported higher posttraumatic growth and grief reactions. Nurses should ensure bereaved adolescents receive appropriate support.

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Posttraumatic Growth Among Japanese Parentally Bereaved Adolescents

Hirooka Kayo, Fukahori Hiroki, Akita Yumi, Ozawa Miwa

American Journal of Hospice and Palliative Medicine 34 （ 5 ） 442 - 448 2017年01月

ISSN 1049-9091

Objective: The aim of this study was to explore the factors associated with posttraumatic growth (PTG) among adolescents bereaved owing to parental cancer in Japan. Methods: An anonymous cross-sectional Web-based survey was conducted, enrolling adolescents bereaved because of parental cancer in the previous 5 years. Posttraumatic growth, number of social support members, support from medical staff, and behaviors after bereavement were measured. Multiple linear regression was performed to explore the association between total PTG score and possible related factors. Results: We assessed 57 participants in this study. Mean age was 19.3 (standard deviation [SD] = 2.0) years, and most participants were female (75.4%). Mean total score of the Japanese version of the PTG inventory was 43.0 (SD = 25.6). Participants’ mean number of social support members was 2.1 (SD = 1.3), and these support members were the surviving parent (66.7%), friends (38.6%), and siblings (36.8%). The multiple linear regression model explained 45% of the variance in PTG. In this model, the following 3 behaviors after bereavement were associated with PTG: “putting palms together in front of a parent’s picture or an altar” (β =.36, P =.006), “visiting a parent’s grave” (β =.29, P =.03), and “having fun with friends” (β =.25, P =.04). Conclusion: Parentally bereaved adolescents in Japan experience PTG. Specific behaviors after bereavements might be recommended for PTG among Japanese adolescents bereaved because of parental cancer.

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新たに訪問看護分野に就労した看護師が訪問看護への移行期に経験した困難とその関連要因

森, 陽子, 大山, 裕美子, 廣岡, 佳代 and 深堀, 浩樹

日本看護管理学会誌 20 （ 2 ） 104 - 114 2016年12月

ISSN 1347-0140

目的:新たに訪問看護分野に就労した看護師が、訪問看護事業所への入職直後から6ヵ月までの訪問看護への移行期に経験した困難と、その関連要因を明らかにすることである。方法:東京23区内の435事業所に勤務する経験年数6ヵ月以上3年以内の訪問看護師を対象として、自記式質問紙を用いた横断研究を実施した。訪問看護への移行期に経験しうる困難、訪問看護開始前の看護実践能力の自己評価、訪問看護師の個人特性、所属する事業所の特性を調査票で尋ねた。探索的因子分析により移行期に経験しうる困難を構成する3つの因子を特定し、それらを従属変数とした重回帰分析を行った。結果:移行期に経験した困難の割合は、医療保険(86.7%)や介護保険(85.5%)の制度に関する知識が不足していることへの困難が高かった。看護実践能力の自己評価が低いことは、「在宅と病院の看護実践環境の違いへの困難」(β=-0.205、p<0.01)。「訪問看護の知識・技術不足」(β=-0.250、p<0.001)に影響していた。考察:移行期に経験した困難に看護実践能力の自己評価が関連していたことから、訪問看護の開始時に看護師個々の看護実践能力を見極め、個々に応じた教育を行うことが、訪問看護への移行期の困難を緩和させるために重要であると考えられた。結論:訪問看護への移行期に、看護師個々の実践能力に応じて訪問看護特有の専門性や知識を教育していくことが、新たに訪問看護を開始する看護師の訪問看護への適応に有用と考えられた。(著者抄録)

Is nurse managers' leadership style related to Japanese staff nurses' affective commitment to their hospital?

Kodama Yoshimi, Fukahori Hiroki, Sato Kana, Nishida Tomoko

Journal of Nursing Management 24 （ 7 ） 884 - 892 2016年10月

ISSN 0966-0429

AIM: To determine if nurse managers' leadership style is related to Japanese staff nurses' affective commitment to their hospital.BACKGROUND: In Western countries, nurse managers' transformational leadership style has been found to increase staff nurses' affective commitment to their hospital. However, there are few studies examining this relationship in the context of acute care hospitals in Japan.METHODS: Staff nurses completed measures of their nurse managers' perceived leadership style and factors related to their own affective commitment. The association between affective commitment and perception of leadership style was assessed with multiple logistic regression.RESULTS: Of 736 questionnaires distributed, 579 (78.9%) were returned, and data from 396 (53.8%) fully completed questionnaires were analysed. The intellectual stimulation aspect of transformational leadership positively increased staff nurses' affective commitment (odds ratio: 2.23). Nurse managers' transactional and laissez-faire leadership styles were not related to affective commitment among staff nurses.CONCLUSIONS: The intellectual stimulation aspect of transformational leadership may increase the retention of staff nurses through enhanced affective commitment.IMPLICATIONS FOR NURSING MANAGEMENT: To increase staff nurses' affective commitment to their hospital, we suggest that hospital administrators equip nurse managers with intellectual stimulation skills.

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経験を重ねた手術室看護師の手術看護の継続と他領域への異動の意志決定のプロセス

井尻, 弓子 and 深堀, 浩樹

日本手術看護学会誌 12 （ 1 ） 3 - 13 2016年06月

ISSN 1880-4780

3年以上10年未満の手術室経験を有する看護師12名(男性4名、女性8名)を対象に、手術看護の継続と他領域への異動の意志決定のプロセスを明らかにするために、半構造化面接を実施した。面接データをStraussとCorbinによる継続比較分析を用いて質的記述的に分析した。経験を重ねた手術室看護師の継続と、他領域への異動の意志決定のプロセスに関わるテーマとして、「手術室の特殊性」「手術室で自分の存在価値を見つける」「手術看護に満足できない」「手術看護を離れるか迷う」「手術看護を離れようという意志を固める」「手術看護を継続しようという意志を固める」の六つが抽出された。経験を重ねた看護師は、主に「手術看護に満足できない」ことにより他領域への異動を考えていることが示されたが、「手術室で自分の存在価値を見つける」ことができないことにより、他領域への異動を考えている者もいることが明らかになった。

How nurse managers in Japanese hospital wards manage patient violence toward their staff

Sato Kana, Yumoto Yoshie, Fukahori Hiroki

Journal of Nursing Management 24 （ 2 ） 164 - 173 2016年03月

ISSN 0966-0429

Aim: This study explores nurse managers' experiences in dealing with patient/family violence toward their staff. Background: Studies and guidelines have emphasised the responsibility of nurse managers to manage violence directed at their staff. Although studies on nursing staff have highlighted the ineffectiveness of strategies used by nurse managers, few have explored their perspectives on dealing with violence. Methods: This qualitative study adopted a grounded theory approach to explore the experiences of 26 Japanese nurse managers. Results: The nurse managers made decisions using internalised ethical values, which included maintaining organisational functioning, keeping staff safe, advocating for the patient/family and avoiding moral transgressions. They resolved internal conflicts among their ethical values by repeating a holistic assessment and simultaneous approach consisting of damage control and dialogue. They facilitated the involved persons' understanding, acceptance and sensemaking of the incident, which contributed to a resolution of the internal conflicts among their ethical values. Conclusions: Nurse managers adhere to their ethical values when dealing with patient violence toward nurses. Their ethical decision-making process should be acknowledged as an effective strategy to manage violence. Implications for nursing management: Organisational strategies that support and incorporate managers' ethical decision-making are needed to prevent and manage violence toward nurses.

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Predictors of depression in patients diagnosed with myocardial infarction after undergoing percutaneous coronary intervention

Doi-Kanno Mana, Fukahori Hiroki

Journal of Medical and Dental Sciences 63 （ 2-3 ） 37 - 43 2016年01月

ISSN 1342-8810

Aim: This study identified the factors associated with depression in patients diagnosed with myocardial infarction (MI) who underwent percutaneous coronary intervention (PCI). Methods: We searched the literature using PubMed and CINAHL from their inception in 1946 to December 2014. The search terms were "myocardial infarction," "depression," and "percutaneous coronary intervention." Studies which investigated factors associated with depression in patients diagnosed with MI who underwent typical medical procedures were searched. Results: Eleven studies met our inclusion criteria. None of these limited their samples to patients with MI who underwent PCI. Twenty-one factors were identified as possible risk factors for depression in patients who were diagnosed with MI and underwent PCI: gender; negative illness beliefs; neuroticism; autonomy; baseline depression scores; previous diagnosis of depression, anxiety, or stress; smoking; marital status; Type D personality; procedure; length of hospital stay; fat intake; functional disability; time engaged in physical activity; social support; and a history of angina, MI, coronary artery bypass graft surgery, PCI, diabetes mellitus, and stroke. Conclusions: This review suggests that these 21 factors should be considered in future studies as possible independent variables or covariates of depression among MI patients who have undergone PCI.

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Developing an instrument to self-evaluate the discharge planning of ward nurses

Sakai Shima, Yamamoto-Mitani Noriko, Takai Yukari, Fukahori Hiroki, Ogata Yasuko

Nursing Open 3 （ 1 ） 30 - 40 2016年01月

Aims To develop the Discharge Planning of Ward Nurses (DPWN), a Japanese self-evaluation instrument for ward nurses’ discharge planning practices. Design Cross-sectional survey. Methods Participants were 624 ward nurses from six hospitals in Japan with a discharge planning department. Items about discharge planning practices were collected from literature and interviews with nurses and researchers. Construct validity, concurrent validity, internal consistency and test-retest reliability were tested. Results Initially, 55 items were collected. Examination of the floor effect, item-total, good-poor analyses and exploratory factor analysis yielded a four-factor model with 24 items (‘teaching home-care skills with community/hospital professionals,’ ‘identifying clients’ potential needs early in the discharge process,’ ‘introducing social resources’ and ‘identifying client/family wishes and building consensus for discharge’). The four-factor structure was supported by confirmatory factor analysis. The DPWN correlated with scales ascertaining similar concepts, supporting concurrent validity. Internal consistency and test-retest reliability were generally satisfactory.

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日本の高齢者ケア施設における看取りの質の評価・改善に関する研究の動向

大河原, 啓文, 深堀, 浩樹, 廣岡, 佳代 and 宮下, 光令

Palliative Care Research 11 （ 1 ） 401 - 412 2016年01月

わが国で高齢者ケア施設は新たな看取りの場として期待されている.本研究の目的は,文献検討により日本の高齢者ケア施設における看取りの質の評価・改善に関する研究の動向を明らかにすることである.文献検索の結果抽出された23文献を介入研究4件,介入のための教育・質改善ツール開発3件,調査研究13件,質的研究3件に分類した.高齢者ケア施設でのケアの質に関する研究は微増傾向にあるが介入研究は少なかった.看取りの実施要因として施設長・看護管理者の方針や,医療機関との連携,家族の明確な意思決定などがあった.職員の抱える課題や教育ニーズ,介護職へのサポートの必要性が示されていた.以上より高齢者ケア施設での看取りに関する介入研究,施設長・看護管理者への支援,入居者・家族の意思決定支援や,職員対象の教育プログラムの開発などが高齢者ケア施設における看取りの質改善に有用と考えられた.(著者抄録)

若手看護学研究者の研究活動の阻害要因と日本看護科学学会に求める支援の関連要因

深堀, 浩樹, 宮下, 光令, 大山, 裕美子, 跡上, 富美, 岡谷, 恵子, 柏木, 聖代, 河野, あゆみ, 高見沢, 恵美子, 奈良間, 美保 and 吉沢, 豊予子

日本看護科学会誌 35 203 - 214 2015年12月

ISSN 0287-5330

目的:本研究の目的は若手看護学研究者の研究活動の阻害要因と日本看護科学学会に求める支援の関連要因を明らかにすることである.方法:日本看護科学学会の39歳以下の会員にウェブ調査を行った.研究の阻害要因と日本看護科学学会に求める支援の下位因子を従属変数とした重回帰分析を行った.結果:648名を分析対象とした.研究の阻害要因の中で,育児中の人(β=0.36)は「ワーク・ライフ・バランスの難しさ」を,助教・助手(β=0.31)は「教育や大学運営等の業務の負担」を感じていた.また「研究能力の不足」,「研究のリソース不足」,「研究者としてのアイデンティティの未確立」,「教育や大学運営等の業務の負担」を阻害要因と感じる人ほどJANSに「研究を促進する環境・システムの整備」を求めていた(β=0.15-0.20).結論:若手看護学研究者は個々の属性に応じ様々な研究の阻害要因を感じ,支援を求めていた.日本看護科学学会には若手研究者への支援として,(1)研究者間のネットワーク構築,(2)研究者としての能力の向上,(3)研究環境の整備を促進していくことが望まれる.(著者抄録)

Cross-sectional online survey of research productivity in young Japanese nursing faculty

Oyama Yumiko, Fukahori Hiroki, Miyashita Mitsunori, Narama Miho, Kono Ayumi, Atogami Fumi, Kashiwagi Masayo, Okaya Keiko, Takamizawa Emiko, Yoshizawa Toyoko

Japan Journal of Nursing Science 12 （ 3 ） 198 - 207 2015年07月

ISSN 1742-7932

Aim: To investigate the factors affecting the research productivity of young nursing faculty in Japan. Methods: An online survey targeting young nursing scholars (aged ≤39years) who were members of the Japan Academy of Nursing Science was conducted from October to November 2012. Of 1634 potential respondents, 648 completed the survey (39.7%), and 400 full-time faculty of a baccalaureate degree program were selected for the analysis. The numbers of English-language and Japanese publications in the past 3years were regressed onto personal characteristics, such as academic degree and type of university. Results: The mean numbers of publications in English and Japanese in the past 3years were 0.41 and 1.63, respectively. Holding a doctoral degree was significantly related to a higher number of publications in English and Japanese (e^β=5.78 and e^β=1.89, respectively). Working at a national university (e^β=2.15), having a research assistant (e^β=2.05), and the ability to read research articles in English (e^β=2.27) were significantly related to more English-language publications. Having the confidence to conduct quantitative research (e^β=1.67) was related to a larger number of Japanese publications. The lack of mentoring (e^β=0.97) and university workload (e^β=0.96) were associated with a lesser number of Japanese publications. Conclusion: The research productivity of young nursing faculty appeared to be quite low. Strategies to enhance research productivity in young nursing faculty, such as encouraging the achievement of a doctoral degree or enrichment of research resources, should be undertaken.

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研究報告病院スタッフが認識している多職種連携・協働の現状と課題に関する国内文献レビュー

佐藤, 夏美, 菅野, 眞奈 and 深堀, 浩樹

看護管理 25 （ 6 ） 504 - 509 2015年06月

ISSN 0917-1355

病院スタッフが認識する病院での多職種連携と、協働の実際や課題を調査した国内の最新の文献から、多職種連携・協働を促進する取り組みの現状や、促進していく上での課題を明らかにした。医学中央雑誌Web版Ver.5を用い、病院スタッフにアンケートもしくはインタビューを行い、多職種連携と行動の実際、課題を明らかにしている文献を集めた。「専門職間人間関係」「病院」「インタビュー」「半構造的面接」「質問紙法」などをキーワードとして、原著論文を検索した。キーワード検索の結果、959件がヒットした。除外目的のキーワード検索を行い、さらに研究目的に沿ったものを検討し、最終的に24件を分析対象とした。分析の結果、多職種連携や協働の取り組みの現状を調査していた文献が9件、多職種連携や協働の取り組みとしてカンファレンスが報告されていたのが5件、勉強会、応援体制とミーティング、シミュレーション、看護体制の見直しがそれぞれ1件実践されていた。

内視鏡室でのタイムアウト導入についての患者の意識調査

浅原, 惠子, 小沼, 千恵美, 大洞, すみ子 and 深堀, 浩樹

日本消化器内視鏡技師会会報（ 54 ） 117 - 119 2015年03月

【看護研究から政策をうみだすために】 NINRとは何か?　その歴史と看護研究における役割

前田, 留美, 深堀, 浩樹 and 丸, 光惠

看護研究 48 （ 1 ） 23 - 31 2015年02月

ISSN 0022-8370

Nurse health-related quality of life

Oyama Yumiko, Yonekura Yuki, Fukahori Hiroki

Journal of Nursing Management 23 （ 6 ） 775 - 783 2015年01月

ISSN 0966-0429

Aim: To investigate the factors affecting nurse health-related quality of life (HRQOL) by considering the patient characteristics and ward characteristics. Background: Nurse health-related quality of life is an important health outcome, and should be promoted for quality nursing care. Method: This cross-sectional study was conducted on nurses who work in general acute care wards in three university hospitals in metropolitan Japan. Multilevel analysis was conducted to investigate possible factors related to nurse health-related quality of life. Result: Nurses who worked at a ward had a significantly lower physical health score (β = -0.13, P < 0.01). These nurses had a higher ratio of patients who could not understand medical instructions, had cognitive disabilities, or required assistance with activities of daily living (ADL). The number of beds was the only factor significantly related to mental health status of nurses (β = 0.19, P < 0.05). Conclusion: Work conditions that sustain nurse health should take into account not only the number of nurses, but also patient characteristics. Further large-scale studies are needed in order to investigate the effect of hospital characteristics on nurse health-related quality of life. Implications for nursing management: Increasing the number of nurses' aides and delegating assistance with ADL to them could support nurse health-related quality of life in the acute care setting. Copyright

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A literature review of factors related to hospital nurses' health-related quality of life

Oyama Yumiko, Fukahori Hiroki

Journal of Nursing Management 23 （ 5 ） 661 - 673 2015年01月

ISSN 0966-0429

Aim: To conduct a literature review in order to determine the predictors of nurses' health-related quality of life and to clarify the implications for nursing management and future study in this area. Background: Good health is essential to the performance of health care workers. Evaluation: Relevant studies were retrieved from PubMed, Medline, CINAHL, the Japan Medical Abstract Society, and the Technology Information Aggregator, Electronic. The studies selected for this review were published in English or Japanese between 1995 and 2012, investigated nurses' health-related quality of life. The identified predictive factors of each study were categorised according to type. Key issues: Based on the criteria, 22 studies were reviewed. The predictive factors of nurses' health-related quality of life were classified into eight categories. Conclusions: Age and occupational stress should be considered when examining unknown predictive factors of nurses' health-related quality of life. In addition, it may be useful to adopt a conceptual framework and consider patient and organisational factors in future research. Implications for nursing management: It is necessary to identify nurses' occupational stressors and consider age during job placement in order to support their health.

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潜在看護師が復職後に復職をした自分になじむまでの過程

榊, 茜 and 深堀, 浩樹

日本看護管理学会誌 18 （ 2 ） 114 - 124 2014年12月

ISSN 1347-0140

看護職員確保対策のひとつに潜在看護師の就労促進があるが、復職後の支援に関する報告は少ない。本研究はグラウンデッド・セオリー・アプローチを用いて潜在看護師の復職後の経験を概念化し、復職後の定着を促進するための支援検討を目的とした。結婚・出産を機に前職を退職し、ブランクを経て病院に復職した女性看護師11名に半構成的面接を行い分析した結果、次のような復職後の過程が明らかになった。復職した看護師は、環境の変化の実感や家庭と仕事の間での葛藤などブランクを経た復職に伴う動揺に直面し、その動揺を軽減し日々の仕事を行うために、個人的な取り組みと周囲を巻き込む努力を含むブランクを補う取り組みを行っていた。この時に取り組みを後押しする心境に至ること、職場からの支援を受けることで取り組みが促進され、状況改善の感触を得ることができていた。その結果、今の自分ができる仕事を割り切ることができるなど復職をした自分になじむことができていた。復職した潜在看護師の定着支援のために受け入れる職場に求められることとして、当人と相談しながら役割を定め段階を踏んで発展させるなど適切な役割期待や、人生経験を重ねた強みを認め本人に伝えることなどが示唆された。また、復職する看護師自身にできる工夫として、環境の変化に圧倒されず前向きに捉える、積極的に周囲を巻き込み疑問を解決する、などが考えられた。(著者抄録)

特別養護老人ホームで入居者を看取った家族介護者の経験

那須, 佳津美 and 深堀, 浩樹

老年看護学 19 （ 1 ） 34 - 42 2014年11月

ISSN 1346-9665

本研究の目的は、特別養護老人ホーム(以下、特養)で入居者を看取る家族介護者の経験を明らかにすることである。地方都市にある特養3施設で、調査時点からさかのぼり2ヵ月以上1年以内に死亡した入居者の主な面会者であった家族介護者15人に、入居者を看取った経験について半構成的面接法を用いてデータ収集した。分析は、Colaizziの現象学的分析方法を用いて、質的帰納的に行った。分析の結果、特養で入居者を看取る家族介護者の経験として、【入居者との絆の実感】【入居者のために自分にできるケアの模索】【職員や同室者との折り合い】【医療処置と看取りの場の選択における葛藤】【大切な人を失っていくことへの対処】【入居者の人生と看取りの意味づけ】の6つのテーマが導かれた。看護職は、家族介護者が入居者との絆を感じて行う模索や葛藤を理解し、入居者の死後、家族介護者が入居者の人生や看取りをより満足感をもって振り返ることができるよう支援することが重要である。(著者抄録)

【看護学において若手研究者をどう育てるか?(II)】若手看護学研究者としてどう育っていくか?　日本看護科学学会研究・学術情報委員会の若手調査に携わった立場から

深堀, 浩樹

看護研究 47 （ 2 ） 97 - 110 2014年04月

ISSN 0022-8370

Family caregiver strategies to encourage older relatives with dementia to use social services

Takai Yukari, Yamamoto-Mitani Noriko, Okamoto Yuko, Fukahori Hiroki, Ko Ayako, Tanaka Makoto

Journal of Advanced Nursing 69 （ 12 ） 2675 - 2685 2013年12月

ISSN 0309-2402

Aim: To elicit the strategies used by Japanese family caregivers in the community to encourage older relatives with dementia to use adult daycare and respite stays. Background: Older adults with dementia often require adult daycare and respite stays for their family caregivers to gain respite from care-giving. However, persons with dementia often face difficulty in new environments and timely access to sufficient services may be difficult to achieve. Few studies have examined how family caregivers encourage their service use. Design: A qualitative method. Methods: Semi-structured interviews were conducted with 16 family caregivers who were caring for relatives with dementia at home between 2005-2007. Data were analysed qualitatively. Results: Family caregivers used various strategies to encourage older relatives to use services, allowing the older adult to decide whether to use the service, yearning and searching for the least harmful service, tailoring the service to the older adult, persuading the older adult to use the service, conforming the older adult to the service and coercing the older adult to use the service. Different strategies were used depending on factors such as desperation in needing respite, willingness to do what is best for the older adult, confidence in taking care of the older adult and the anticipated response of the older adult to services. Conclusion: Nurses should carefully assess caregivers' strategies in their attempts to encourage service use and should provide adequate assistance in accordance with those strategies.

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Factors associated with nurses' reporting of patients' aggressive behavior

Sato Kana, Wakabayashi Takeko, Kiyoshi-Teo Hiroko, Fukahori Hiroki

International Journal of Nursing Studies 50 （ 10 ） 1368 - 1376 2013年10月

ISSN 0020-7489

Background: Aggressive behavior and violence directed by patients at nurses are increasing worldwide. Aggressive behavior against nurses in their workplace can result in personal problems, such as impairment of physical and mental well-being, and, consequently, in organizational problems. Underreporting of patients' aggressive behavior is prevalent among nurses. Although underreporting might lead to inefficient attention to strategies for preventing aggressive behavior, the reasons for such behavior not being reported frequently have not been well examined. Objectives: To explore the frequency of nurses' reporting to their managers of patients' aggressive behavior by type and degree of impact suffered by the nurses, to examine the association between reporting of aggressive behavior and demographic factors, and to determine the reasons for underreporting. Design: A questionnaire-based cross-sectional survey. Setting: Six acute care hospitals in two regions in Japan. Participants: A total of 1953 nurses working at general acute care hospitals participated. Methods: Data were collected through a questionnaire seeking sociodemographic information, information on experience of aggressive behavior from patients, and the frequency with which they had reported such behavior in the previous month. The questionnaire also contained items assessing barriers to reporting of patients' aggressive behavior. The association between the possible influencing factors and reporting behavior was assessed using multiple logistic regression analyses. Results: Of the 1953 questionnaires distributed, 1498 (76.7%) were returned, and 1385 (70.9%) fully completed questionnaires were analyzed. More than one-third of the respondents had experienced the mildest assessed level of impact from patients' aggressive behavior, and 70% of those hardly reported any incidents. The milder the impact was, the less the nurse victims tended to report the incident. Nurse's tendency to feel that aggressive behavior was mitigated by the situation, less work experience, and lack of confidence that management would defend staff nurses from patients' aggressive behavior were found to be negatively associated with reporting behavior. Conclusions: This study identified factors associated with nurses' reporting of patients' aggressive behavior. Underreporting was found to be associated with the level of impact, managerial attitudes, nurses' work experience, and nurses' perception that the behavior was mitigated by the situation. Improving education among nurses to promote reporting incidents and establishing an organized system is needed.

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The process of Japanese nurses' emotional experience in their first international disaster relief activity

尾立, 篤子, 佐藤, 可奈 and 深堀, 浩樹

お茶の水看護学雑誌 8 （ 1 ） 1 - 15 2013年10月

ISSN 1881-2112

日本の災害支援チーム(JDRT)のメンバーとして途上国に派遣され、国際的災害支援活動(IDRA)に初めて従事した自衛隊看護師11名の体験を面接調査した。IDRAに対する情動反応の主な基盤はJDRTのメンバーとしての使命感であった。看護師は派遣前はIDRAがはっきりしないことに不安を感じ、周囲の人々の期待を強く感じていた。感情は高ぶっており、これを抑えて平静を保とうとしていた。到着後支援活動に初めて取り組んだが、過酷な状況下での絶え間ない支援活動によりストレスが蓄積し、疲労困憊した。この状況下で、自身の健康を優先したいという望みと、優先することへのためらいとの間で内なる葛藤を感じていた。派遣が長引く可能性があれば、健康を維持するための対策を講じざるを得ないと思うようになった。各種対策によりプラスの結果が得られたことにより、自身の健康が活動の持続性に影響を及ぼすことを徐々に認識し、維持するようになった。

Nursing ward managers' perceptions of pain prevalence at the aged-care facilities in Japan

Takai Yukari, Yamamoto-Mitani Noriko, Fukahori Hiroki, Kobayashi Sayuri, Chiba Yumi

Pain Management Nursing 14 （ 3 ） 2013年09月

ISSN 1524-9042

This study aimed to examine nursing ward managers' perceptions of pain prevalence among older residents and the strategies of pain management at the Health Service Facilities for the Elderly Requiring Care (HSFERC) in Japan and to investigate the factors related to the prevalence. Nursing ward managers in 3,644 HSFERC were asked to participate in this study. Questionnaires were sent to them regarding pain prevalence among the older residents in their wards, their provisions for pain care, and other pain management strategies. The perceived pain prevalence factors were examined statistically. The final sample comprised 439 participants (12.0%). A total of 5,219 residents (22.3%) were recognized as suffering from pain on the investigation day. Only 8 wards (1.8%) used pain management guidelines or care manuals, and 14 (3.2%) used a standardized pain scale. The ward managers' age (p = .008) and nursing experience (p = .006) showed a significant negative association with pain prevalence estimation. Moreover, there was a significant association between the groups' pain prevalence estimation and the nursing managers' beliefs that older adults were less sensitive to pain (p= .01), that pain was common among older people (p = .007), and that the time to treat residents' pain was insufficient (p = .001). The ward managers' perceptions regarding pain prevalence varied; the perceived pain rates were possibly lower than the actual percentages. Insufficient pain management strategies at the HSFERC were also suggested. An appropriate pain management strategy for Japanese aged care and its dissemination are urgently required.

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患者やその家族による看護師への暴力に看護師長が対応する際の困難とその要因

佐藤, 可奈, 深堀, 浩樹 and 湯本, 淑江

日本医療・病院管理学会誌 50 （ Suppl. ） 197 2013年08月

ISSN 1882-594X

高齢者訪問看護質指標(転倒予防)を用いたインターネットによる訪問看護支援システムの有効性　訪問看護師の自己評価からの分析

鈴木, みずえ, 上野, 桂子, 中間, 浩一, 深堀, 浩樹 and 山本, 則子

コミュニティケア 15 （ 8 ） 60 - 64 2013年07月

看護政策に携わる看護職が現在の職業・立場につくまでの経験

田川, 晴菜, 窪田, 和巳, 山口, さおり and 深堀, 浩樹

日本看護管理学会誌 17 （ 1 ） 48 - 56 2013年06月

ISSN 1347-0140

本研究は、看護政策に携わる看護職の現在の職業・立場につくまでの経験を明らかにし、彼らの意見から看護職の看護政策に関する興味・関心を高める方略についての示唆を得ることを目的とした。看護政策へ携わる看護職6名を対象に半構造的インタビューを実施し、質的に分析した。分析の結果、看護政策に携わる看護職の現在の職業・立場につくまでの経験として「看護政策に関心を持ったきっかけとなった経験」、「看護政策への理解を深めた体験」、「周囲の人々から対象者への反応」の3カテゴリーが、看護政策に関する興味・関心を高める方略についての意見や考えとして「看護政策への関心を高める上での障害」、「看護政策への関心を高めるために考えられる取り組み」の2カテゴリーが得られた。将来看護政策に携わりたいと考える看護職にとって、看護政策に直接携わる人との関わりが重要であるとともに、基礎教育の段階で医療・看護政策に関する内容を学び、看護以外の分野の知識や海外の医療制度・看護実践について知ることが有益であることが示唆された。また、今後より多くの看護職が看護政策に関心を持つようになるための体制を考える上で、多忙な臨床現場でも効率的に看護政策に関する情報が得られる環境整備や看護職の情報リテラシーを高める取り組み、若年層に対するアプローチが重要であることが示唆された。(著者抄録)

【ELNEC-J研修を振り返る】 ELNEC-J高齢者プログラムの試験的運用から得られた今後の課題

深堀, 浩樹, 得居, みのり, 吉岡, 佐知子, 西山, みどり, 松本, 佐知子, 塩塚, 優子, 高梨, 早苗, 高道, 香織, 齊田, 綾子, 田中, 和子 and 桑田, 美代子

看護管理 23 （ 4 ） 278 - 284 2013年04月

ISSN 0917-1355

Stressor Scale for Clinical Research Coordinators

Matsumoto Kazufumi, Sumino Kumiko, Fukahori Hiroki, Kitaoka Kazuyo, Kamibeppu Kiyoko, Nagamura Fumitaka

Journal of Advanced Nursing 68 （ 7 ） 1636 - 1645 2012年07月

ISSN 0309-2402

Aim. This article is a report of the development and psychometric testing of the Stressor Scale for Clinical Research Coordinators. Background. Job stress is viewed as a situation where working conditions interact with individual worker characteristics and result in disruption of psychological or physiological homeostasis. Clinical research coordinators, also known as research nurses, are professionals who play a central role in clinical trials. They face various problems associated with their responsibilities; however, few studies have reported on their stress. To manage their stress, it is necessary to identify the sources of stress (i.e. stressors). Method. The 56-item preliminary instrument was developed based on literature review and expert discussions. A total of 589 clinical research coordinators in 186 hospitals in Japan were surveyed in 2011. Statistical analyses on construct and concurrent validity, internal consistency, and test-retest reliability were performed. Results. A six-factor solution with 23 items was selected using exploratory factor analysis: 'quantitative workload', 'conflict with investigators', 'ambiguity of work', 'conflict with other clinical research coordinators and with supervisors', 'demands from an affiliate other than the hospital', and 'difficulty in caring for trial participants'. Confirmatory factor analysis affirmed construct validity, with a demonstrated acceptable fit between the factor structure and the observed data. All factors had significant correlations with burnout and psychological distress, which indicated acceptable concurrent validity. Cronbach's alpha coefficients ranged from 0·73-0·82. Intra-class correlation coefficients indicated almost satisfactory test-retest reliability. Conclusion. Our new instrument has acceptable validity and reliability for evaluating job stressors for clinical research coordinators.

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Aggression Exhibited by Older Dementia Clients Toward Staff in Japanese Long-Term Care

Ko Ayako, Takasaki Kinuko, Chiba Yumi, Fukahori Hiroki, Igarashi Ayumi, Takai Yukari, Yamamoto-Mitani Noriko

Journal of Elder Abuse and Neglect 24 （ 1 ） 1 - 16 2012年01月

ISSN 0894-6566

This study examined the experiences of staff members from seven Japanese hospitals who had been treated aggressively by older dementia clients. Altogether, 170 questionnaires were analyzed. In the past year, 75.3% and 63.5% of staff members had experienced physical and verbal aggression, respectively. Working numerous night shifts, working shifts other than 3-shifts, and being allotted assignments with clients who had a lower average level of physical capacity were the factors associated with recurrent client aggression. Those staff members who spent adequate time caring for their clients, who gained client consent before providing care, and who tried to build a trusting relationship with their clients were found to have experienced less aggression. Burnout, which is likely to enhance the risk of the staff mistreatment and neglect of older clients, was found to be higher among those who experienced aggression.

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Healthcare services for Japanese elderly long-staying in Thailand from the perspective of the patient and healthcare providers

Fukahori Hiroki, Baba Yuji, Hioki Fumika, Monkong Supreeda, Intarasombat Prakong, Malathum Porntip

Archives of Gerontology and Geriatrics 53 （ 2 ） 2011年09月

ISSN 0167-4943

Long-stay refers to a long visit abroad by retired middle-aged and older people. This study describes the attitudes/opinions of elderly Japanese long-staying subjects and healthcare providers in Thailand. Two cross-sectional questionnaire surveys were conducted in Chiang Mai Province, Thailand. Questionnaires were sent to a sample recruited from a self-help group of Japanese elders in Thailand (n= 68) and to Thai healthcare providers (n= 101). About half of the Japanese subjects routinely used a Thai medical service, although only 15% had been admitted to the hospital. Half of the Japanese subjects thought the quality of Thai medical services was high. Many elderly Japanese subjects were unable to speak either English or Thai, leading to communication difficulties. About 80% of healthcare professionals found no difference between caring for elderly Japanese subjects and people from Thailand. Most healthcare providers agreed that Japanese language training should be available to medical staff as translators were not always available. Healthcare providers agreed with the Thai government policy promoting long-stays. The most recognized obstacle in caring for Japanese long-stay elderly was the language barrier. More research on Japanese elders staying abroad is needed to promote effective communication between Japanese elderly and other ethnic healthcare professionals.

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【ソーシャルメディアと研究】　ソーシャルメディアが看護学の研究にもたらすもの--変わらないものと新たな可能性

深堀, 浩樹

看護研究 44 （ 4 ） 458 - 466 2011年07月

ISSN 0022-8370

精神科の男性看護師が患者を「押さえる役割」を引き受けるまでのプロセス

宮武, 郁夫 and 深堀, 浩樹

精神看護 14 （ 4 ） 69 - 75 2011年07月

ISSN 1343-2761

終末期の訪問看護における時期別の期間と訪問頻度の違い　がんとがん以外の事例の比較

佐藤, 泉, 山本, 則子, 竹森, 志穂, 平野, 優子, 宮田, 乃有, 深堀, 浩樹, 上野, まり, 柏木, 聖代, 木全, 真理 and 山田, 雅子

日本看護科学会誌 31 （ 1 ） 68 - 76 2011年03月

ISSN 0287-5330

目的:在宅高齢者終末期の時期別期間とこの間に実施された訪問看護の頻度と体制について,がんとがん以外の事例を比較しつつ明らかにする.方法:「良い」看護を提供していると判断される訪問看護ステーションの看護師31名から65歳以上のがん・がん以外の事例1件ずつ聴取し,終末期期間を分け「開始期」「維持期」「悪化期」「臨死期」について分析した.各期の期間・訪問頻度等を集計しがんとがん以外の事例を統計的に比較検討した.結果:がん以外の事例はがん事例に比べ開始期と悪化期が有意に長く,長さは多様だった.訪問頻度はがん事例では臨死期から高く,がん以外の事例は悪化期から高くなった.緊急訪問はがん以外の事例の臨死期に約半数で実施されていた.結論:がんとがん以外の事例で異なる経過と訪問看護の提供状況が見られ,事例毎に適切な看護が提供できるような制度上の工夫が看護師の技術向上とともに求められる.(著者抄録)

三重県保健師の在日外国人への保健活動

橋本, 秀実, 深堀, 浩樹, 伊藤, 薫, 馬場, 雄司, 山路, 由実子, 佐々木, 由香 and 村嶋, 正幸

三重県立看護大学紀要 14 19 - 26 2011年03月

ISSN 1343-8905

看護の統合と実践実習のあり方の検討　東京医科歯科大学の学生による実習評価から

佐藤, 可奈, 深堀, 浩樹, 佐々木, 吉子, 柏倉, 淑子, 小牟田, 智子 and 井上, 智子

看護教育 52 （ 3 ） 208 - 213 2011年03月

ISSN 0047-1895

本学では、臨床実践に近い形での看護の知識・技術の統合を目指し、夜勤実習、看護管理実習、外来看護実習、中央診療部門見学実習の4つの実習から構成される看護の統合と実践実習を行っており、今回、その効果を、実習に参加した看護学専攻4年生41名への自由記述を含むアンケート調査から検討した。その結果、学生の7割が実習に「とても満足している」「満足している」と回答し、自由記述からその理由として、他部門の業務内容や管理職の役割など未知の事柄を学べたという【新たな学習内容】、患者対看護師以外の【異なる視点からの看護】、【既習内容の統合】【就職後の具体的イメージの獲得】といった内容が挙げられた。

Home care nurses' provision of support to families of the elderly at the end of life

Hirano Yuko, Yamamoto-Mitani Noriko, Ueno Mari, Takemori Shiho, Kashiwagi Masayo, Sato Izumi, Miyata Noa, Kimata Mari, Fukahori Hiroki, Yamada Masako

Qualitative Health Research 21 （ 2 ） 199 - 213 2011年02月

ISSN 1049-7323

In this article we describe our study of assistance for family decisions and caregiving by Japanese home care nurses to families of elderly relatives at the end of life. The participants were 31 nurses who had been evaluated as providing good end-of-life care. We carried out semistructured interviews concerning the practice of family support in two cases (cancer and noncancer). We conducted a qualitative analysis using the constant comparative approach and derived several categories inductively. Home care nurses are responsible for (a) estimating the possibility of dying at home, (b) visualizing what is coming and what can be done, (c) proposing where and how the family can say goodbye, (d) building family consensus, (e) coordinating resources, and (f) offering psychological support for end-of-life care. End-of-life family care by home care nurses is a process in which multiple components of care are provided with changing content as death approaches.

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訪問看護における認知症ケアの構造化

奥村, 朱美, 山本, 則子, 小林, 小百合, 岡本, 有子 and 深堀, 浩樹

日本在宅ケア学会誌 14 （ 2 ） 26 - 33 2011年02月

ISSN 1346-9649

本研究は、訪問看護の認知症ケア構造の概念化を目的に、訪問看護師12人に半構成的面接を行い、グラウンデッド・セオリー・アプローチを参考とし分析した。協力者のうち女性は11人、看護師経験年数は平均17.2年、訪問看護師経験年数は平均8.8年であった。事例13人のうち、女性9人、年齢は60〜80代、要介護度は2〜5であった。訪問看護師の認知症ケアには、1)家に入れてもらう、2)継続して家に入れてもらえる状況をつくる、3)生活上の問題を解決する、4)療養者に楽しみをつくる、5)サービスを利用しながら療養体制を整える、6)家族が介護しながらも生活できるよう支援する、7)サービスを再調整し訪問看護を徐々に縮小する、という実践プロセスが抽出された。また、プロセスの基礎となる8)療養者・家族の経過を展望しそれを踏まえて実践する、というカテゴリーが抽出された。認知症療養者への訪問看護では経過を展望し段階を踏んで援助する必要性が示唆された。(著者抄録)

高齢者ケア施設の看護職による医療処置を安全・確実に行うための工夫と経験した危険な場面の特徴

深堀, 浩樹, 石垣, 和子, 伊藤, 隆子, 池崎, 澄江, 臼井, キミカ, 奥野, 茂代, 小野, 幸子, 日吉, 和子, 松村, 菜穂美, 百瀬, 由美子, 山本, 則子, 渡辺, みどり and 山口, 絹世

老年看護学 15 （ 1 ） 44 - 53 2011年01月

ISSN 1346-9665

高齢者ケア施設において医療処置を含むケアを安全に提供するために看護職に求められる役割は大きい。本研究は、全国の高齢者ケア施設の看護職61名を対象に、(1)医療処置を安全・確実に行うための工夫、(2)医療処置を介護職と連携して安全・確実に行うための工夫、(3)経験した危険な場面・失敗した場面、それぞれの特徴を明らかにすることを目的とした。吸引・排痰ケアなどの6つの医療処置について上記3つの質問を行い、自由記述にて得た回答に基づきカテゴリーを作成した。安全・確実に行うための工夫として"予防的なケアを実施する"などの5つ、介護職と連携して安全・確実に行うための工夫として"介護職から看護職へ報告すべき内容や基準を定める"などの7つ、危険な場面・失敗した場面として"対象者に有害事象・症状が実際に生じた場面"などの5つのカテゴリーを得た。看護職が、限られた物的・人的資源の中で可能な限り入居者個々の状態に応じ予防的な視点からケアを行い、介護職との連携においては個々の施設の状況に合わせてケア提供の分担の条件等を設定していたことが示された。(著者抄録)

Psychometric properties of the caregiving burden scale for family caregivers with relatives in nursing homes

Fukahori Hiroki, Yamamoto-Mitani Noriko, Sugiyama Tomoko, Sugai Yuichi, Kai Ichiro

Japan Journal of Nursing Science 7 （ 2 ） 136 - 147 2010年12月

ISSN 1742-7932

Aim: Most family caregivers continue their caregiving for frail relatives after admitting them to long-term care facilities. The characteristics of this caregiving differ from those related to caregiving in home-care settings. Thus, a new tool to evaluate the burden of family caregivers in institutional settings is needed. The aim of this study was to develop a new scale, the Caregiving Burden Scale for Family Caregivers with Relatives in Nursing Homes, and to confirm its validity and reliability. Methods: We conducted two cross-sectional questionnaire surveys. The participants were a convenience sample of family members of residents in seven nursing homes for the validation study and in three nursing homes for the test-retest study in Japan. Statistical analyses examined exploratory/confirmatory factor analyses, internal consistency, concurrent/discriminate validity, and test-retest reliability. Results: A four-factor solution with 16 items was selected as the most interpretable questionnaire. In the confirmatory factor analysis, the indices of fitness highly supported these results. The Cronbach's alpha coefficient for the total score was 0.86 and varied between 0.77 and 0.87 in the four domains. The scale showed moderate correlation with the Nursing Home Hassles Scale, suggesting its concurrent validity. The four domains had only a medium correlation with each other, indicating discriminate validity. Conclusions: The developed scale has acceptable validity and reliability for measuring the caregiving burden of family members with relatives in Japanese nursing homes. Future studies using the scale might lead to the improvement of care for family members with relatives in a long-term care setting.

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家族看護(学)のあり方と今後の学会活動の課題に関する見解のまとめ

山本, 則子, 荒木, 暁子, 前原, 邦江, 荻野, 雅, 森山, 美和子, 中村, 由美子 and 深堀, 浩樹

家族看護学研究 16 （ 1 ） 33 - 36 2010年08月

ISSN 1341-8351

経口水分摂取量の目測誤差に容器の性質が及ぼす影響

岡村, 竜, 深堀, 浩樹 and 山口, 和世

三重県立看護大学紀要 13 19 - 27 2010年03月

ISSN 1343-8905

経口水分摂取量の目測の実態を把握し、その誤差に容器の性質や目測の状況がおよぼす影響を検討することを目的に、患者の水分摂取量を目測した経験をもつ同一病院に勤務中の看護職者11名を被験者に、実際に目測に使用されている5種類の容器を用いて、容器からの水分の減少量を目測させる実験と、8分目まで入った容器の水分量を目測させる実験を行った。目測する容器の順番についてはランダムに決定した。その結果、容器内の水分に関する目測の誤差に関連する容器の性質として、形状・透過性・簡単な目盛りの有無、が明らかになった。この結果から、誤差を少なくするためには、容器の外形を筒状に近づけること、透明な容器であれば50mlごと程度の簡易な目盛りをつけることが有効であると考えた。

人工股関節置換術時の固定器の接触部位における皮膚保護の検討

岡林, 紀恵, 波田野, 江里子, 白木, 由花, 山崎, 睦子, 小田島, 絵美, 深堀, 浩樹 and 平野, 博美

お茶の水看護学雑誌 4 （ 2 ） 1 - 7 2009年11月

ISSN 1881-2112

手術室における褥瘡予防対策は看護師の重要な役割であるが、固定器を用いる人工股関節置換術では褥瘡発生が多くみられ、褥瘡予防の取り組みが必要である。本研究では、人工股関節置換術後の褥瘡発生を予防する目的で、保護面積を広くするなど、固定器の接触部位の皮膚保護方法を変更し、その効果を検証した。保護方法変更前後で属性を比較し、方法変更後(方法B)では有意に糖尿病患者が多かった(p=0.02)。保護方法を変更した結果、有意ではなかったものの(p=0.23)、褥瘡発生率は変更前(方法A)の27.8%から変更後(方法B)には12.9%に減少した。糖尿病患者が多い中でも褥瘡発生率が減少したことより、新たな皮膚保護方法が褥瘡予防に有効であった可能性が示唆された。(著者抄録)

Administrators' perspectives on end-of-life care for cancer patients in Japanese long-term care facilities

Fukahori Hiroki, Miyashita Mitsunori, Morita Tatsuya, Ichikawa Takayuki, Akizuki Nobuya, Akiyama Miki, Shirahige Yutaka, Eguchi Kenji

Supportive Care in Cancer 17 （ 10 ） 1247 - 1254 2009年10月

ISSN 0941-4355

The purpose of this study was to clarify administrators' perspectives on availability of recommended strategies for end-of-life (EOL) care for cancer patients at long-term care (LTC) facilities in Japan. A cross-sectional survey was conducted with administrators at Japanese LTC facilities. Participants were surveyed about their facilities, reasons for hospitalization of cancer patients, and their perspectives on availability of and strategies for EOL care. The 97 responses were divided into medical facility (n∈=∈24) and non-medical facility (n∈=∈73) groups according to physician availability. The most frequent reasons for hospitalization were a sudden change in patient's condition (49.4%), lack of around-the-clock care (43.0%), and inability to palliate symptoms (41.0%). About 50% of administrators believed their facilities could provide EOL care if supported by palliative care experts. There was no significant difference between facility types (P∈=∈0.635). Most administrators (81.2%) regarded unstable cancer patients as difficult to care for. However, many (68.4%) regarded opioids given orally as easy to administer, but regarded continuous subcutaneous infusion/central venous nutrition as difficult. Almost all administrators believed the most useful strategy was transferring patients to hospitals at the request of patients or family members (96.9%), followed by consultation with palliative care experts (88.5%). Although LTC facilities in Japan currently do not provide adequate EOL care for cancer patients, improvement might be possible with support by palliative care teams. Appropriate models are necessary for achieving a good death for cancer patients. Interventions based on these models are necessary for EOL care for cancer patients in LTC facilities.

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看護基礎教育における家族看護学教育の実態に関する調査報告

山本, 則子, 荒木, 暁子, 前原, 邦江, 荻野, 雅, 中村, 由美子, 深堀, 浩樹 and 森山, 美知子

家族看護学研究 14 （ 3 ） 66 - 74 2009年02月

ISSN 1341-8351

看護基礎教育における家族看護学教育の実態を明らかにすることを目的に、全国の看護基礎教育機関(4年制大学、短期大学、専門学校)のカリキュラム担当者を対象にアンケート調査を行い、174校(4年制大学49校、短期大学6校、専門学校119校)より有効回答を得た。その結果、全体の7割以上の学校で家族看護学を教育していたが、その教授方法と内容、教育時間数は学校により大きな差があり、その内容は患者の背景としての家族の状況理解を目指す学校から、家族システム看護の実践を教授・実習する学校まで幅広いことが分かった。また、実習到達目標や到達度チェックリストに家族看護に関する項目のある学校は約4分の1と少なく、家族看護を学ぶ必要性への認識が漠然としていることが窺えた。

特別養護老人ホームの入居者に面会する家族が行う"施設家族介護"

深堀, 浩樹, 山本, 則子, 杉山, 智子, 甲斐, 一郎 and 杉下, 知子

家族看護学研究 14 （ 1 ） 10 - 20 2008年07月

ISSN 1341-8351

東京都内の特別養護老人ホーム3施設の入居者に面会した家族21名にフォーカス・グループ・インタビューを行い、面会の際に経験した特徴的な出来事やその経験のなかで感じたことなどについて尋ね、語られた内容を質的帰納的に分析し、カテゴリー化を図った。その結果、【施設家族介護】【否定的認識】【肯定的認識】【施設家族介護に影響しうる要因】というカテゴリーが抽出された。このことから、面会した家族は【施設家族介護】を行い、そのなかで【否定的認識】と【肯定的認識】を感じていることが示唆された。【施設家族介護に影響しうる要因】のサブカテゴリーには[施設との距離][経済的状況][介護に関する規範意識][入居前の介護状況][施設職員との関係][他の家族員との関係][家族・入居者の施設生活への適応]があった。

訪問看護師による家族介護者の介護肯定感への援助と職務ストレスとの関連

深堀, 浩樹, 久保, 直子 and 河田, みどり

家族看護学研究 14 （ 1 ） 68 - 76 2008年07月

ISSN 1341-8351

三重県A市・B市の訪問看護ステーション10ヶ所に勤務する訪問看護師51名にアンケートを行い、家族介護者の介護肯定感に関する「知識」「認知経験」「援助経験」について調査するとともに、家族介護者の介護肯定感への援助と訪問看護師自身の職務ストレスとの関連について検討した。その結果、介護肯定感に関する知識を持っていたのは15名(29%)、介護肯定感の認知経験があるのは35名(69%)、介護肯定感への援助経験があるのは27名(53%)であった。職務ストレスの評価にはGray-Toft&Andersonらが開発したNursing Stress Scaleを松山らが本邦の訪問看護師用に修正した尺度を用いた。本尺度は[対応の不備][上司・同僚との連携][医師との葛藤][負担感][達成感][効率感]という6つの要素で構成されている。介護肯定感への援助との関連をみると、[上司・同僚との連携]のストレス得点が高いほど援助の実施率が低く、[負担感]のストレス得点が高いほど援助の実施率が高かった。

質的データ分析支援用ソフトウェアATLAS.tiを使ってみよう　グラウンデッドセオリーアプローチに焦点を当てて

深堀, 浩樹

看護教育 49 （ 5 ） 414 - 420 2008年05月

ISSN 0047-1895

質的データ分析支援用ソフトウェアATLAS.tiを使ってみよう　グラウンデッドセオリーアプローチに焦点を当てて(その2)

深堀, 浩樹

看護教育 49 （ 4 ） 325 - 331 2008年04月

ISSN 0047-1895

アルツハイマー型中期認知症患者へのADLケアに対する抵抗時におけるケアスタッフのかかわりの特性

杉山, 智子, 松井, 典子, 深堀, 浩樹 and 須貝, 佑一

医療看護研究 4 （ 1 ） 1 - 9 2008年03月

ISSN 1349-8630

アルツハイマー型中期認知症患者へのADLケアを行う時に生じる抵抗に際し、ケアスタッフの望ましい関わりのあり方を検討することを目的に、老人病院認知症病棟に入院中の自立歩行可能な当該患者7名とケアスタッフ20名を対象に、患者1人当たり各40時間の参加観察を行った。ケア開始時に抵抗がみられた場面のうち、ケアの完了時に患者の笑顔が伴った場面のケアを「満足できたケア」、伴わなかった場面のケアを「満足できなかったケア」、ケアが完了できなかった場面のケアを「中断したケア」とし、声かけ、ケア所要人数並びに時間について、統計学的分析を行い、それぞれのケアの特徴を検討した。その結果、各ケアとケア所要時間との関連では、排泄、身支度、食事で「満足できたケア」は、「満足できなかったケア」よりもケア達成までの時間が有意に長かった。また、声かけとの関連では、「満足できたケア」の方が「満足できなかったケア」よりもケア中の日常会話が有意に多く観察された。ケア抵抗時における関わりにおいては、時間をかけ、日常会話を取り入れてケアを行うことが、患者が満足する望ましいケアにつながることが示唆された。

質的データ分析支援用ソフトウェアATLAS.tiを使ってみよう　グラウンデッドセオリーアプローチに焦点を当てて(その1)

深堀, 浩樹

看護教育 49 （ 3 ） 247 - 252 2008年03月

ISSN 0047-1895

Factors related to family visits to nursing home residents in Japan

Fukahori Hiroki, Matsui Noriko, Mizuno Yoko, Yamamoto-Mitani Noriko, Sugai Yuichi, Sugishita Chieko

Archives of Gerontology and Geriatrics 45 （ 1 ） 73 - 86 2007年07月

ISSN 0167-4943

This study examined factors related to the frequency and duration of family visits to elderly residents of nursing homes in Japan. Data were collected using a self-administered questionnaire from 299 family members of residents of three nursing homes in Tokyo. Almost all family members visited residents more than once a month, and more than three quarters stayed for more than 1 h during each visit. These findings confirm that family involvement with the elderly is maintained even after admission to a nursing home. Multiple regression analysis revealed the variables related to a higher frequency and duration of visits. Some factors related to frequent or long visits such as the requirement of higher care or the ability to remember family visits were similar to the findings of other studies conducted in western countries, yet the results need to be understood in a Japanese cultural context. Other factors such as the gender of the visitors, distance to the nursing home, and sentiment about placement were thought to be related to the unique cultural norms of family caregiving in Japan. These findings will be useful for developing effective methods to assist nursing home residents and their families in Japan.

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質的データ分析支援用ソフトウェアATLAS.tiの紹介(後編)

安保, 寛明 and 深堀, 浩樹

看護研究 39 （ 4 ） 319 - 326 2006年08月

ISSN 0022-8370

質的データ分析支援用ソフトウェアATLAS.tiの紹介(前編)

深堀, 浩樹 and 安保, 寛明

看護研究 39 （ 3 ） 227 - 234 2006年06月

ISSN 0022-8370

看護専門学校の看護学実習における教授活動の教員自己評価と学生の授業過程評価　教員の臨床/教員経験年数との関連の検討

深堀, 浩樹, 今鷹, 瑞, 長島, 貴久代, 大久保, 結花, 大木, 千春 and 杉下, 知子

三重県立看護大学紀要 9 11 - 20 2006年03月

ISSN 1343-8905

【虐待に向き合う人々と家族看護】　健健課題を持つ人々の「沈黙を破る」ための様々な取り組み　第24回日本看護科学学会市民フォーラム「『ライフサイクルにおける健康課題』　子ども虐待,DV,高齢者虐待の現状を通して」報告

深堀, 浩樹

家族看護学研究 11 （ 1 ） 51 - 57 2005年06月

ISSN 1341-8351

特別養護老人ホーム入所者の家族介護者における精神的健康とその関連要因

深堀, 浩樹, 須貝, 佑一, 水野, 陽子, 松井, 典子 and 杉下, 知子

日本公衆衛生雑誌 52 （ 5 ） 399 - 410 2005年05月

ISSN 0546-1766

東京都内の特別養護老人ホーム3施設の入所者の在宅生活時における家族介護者189例を対象に無記名自記式調査票による質問紙調査を行った.分析対象となった家族介護者145例中,精神的健康が低かった人は59例であった.ロジスティック回帰分析で,精神的健康と関連がみられたのはソーシャルサポート,入所者に対する面会時間であり,精神的健康はソーシャルサポートを受けている人ほど高く,面会時間が長い人ほど低い傾向を認めた.施設高齢者の家族介護者に精神的健康を害している人が存在することが示された.家族介護者の精神的健康の向上には,家族会などのサポートグループの紹介や,家族の面会に着目し入所者と家族介護者のコミュニケーションを促進する援助を行うことが,有効であると考えられた

Mental health and related factors with family caregivers for elderly in special-care nursing homes for the aged

Fukahori Hiroki, Sugai Yuichi, Mizuno Yoko, Matsui Noriko, Sugishita Chieko

[Nippon kōshū eisei zasshi] Japanese journal of public health 52 （ 5 ） 399 - 410 2005年01月

ISSN 0546-1766

PURPOSE: The purpose of this study was to examine the mental health and related factors with family caregivers for the elderly in special-care nursing homes for the aged. METHODS: We conducted a questionnaire survey among family caregivers for elderly living in three special-care nursing homes in Tokyo. The questionnaire included factors from the General Health Questionnaire-28 (GHQ-28) pertaining to family caregivers, the elderly, and the relationships between them. The GHQ-28 was used to measure the mental health of the caregivers and a logistic regression model was applied for the analysis. RESULTS: Of the 145 family caregivers surveyed, 59 (40.7%) exhibited low mental health (GHQ-28> or = 7). The logistic regression analysis revealed that family caregivers with low mental health had lower social support (OR: 0.10 (0.03-0.29)) and had longer visiting times (OR: 5.80 (1.79-18.82)). DISCUSSION: The results suggested that many family caregivers for elderly persons in institutions may have poor mental health and that it is necessary to provide them with support. It is concluded that self-help groups for families and the promotion of communication between the elderly and their family caregivers might be effective for this purpose.

小児がん治療中の子どもの家族ケア実践をめぐる検討

上別府, 圭子, 亀口, 憲治, 深堀, 浩樹, 星, 順隆, 尾関, 志保, 杉浦, 仁美 and 戸邊, さえ子

家族看護 2 （ 1 ） 140 - 146 2004年02月

医療チームが良い関係を築けずにいた小児癌治療中の女児(初回面接時10歳)と40代の母親を中心とするその家族に,コンサルテーション・リエゾンとして介入し,修復に結びつけた事例を紹介した.当事例における一番の問題は,医療チームの側に「困った子」「愛情の薄い母親」といった見方が固定しかけており,治療環境が破壊の危機に瀕していたことであった.患者や家族が示した行動や態度の背後にある心理の理解を医療チームに促すことによって医療チームの共感性を機能させ,治療環境を回復することがコンサルテーション・リエゾンの最重要課題であると考える

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