Giving social support at work may reduce inflammation on employees themselves: a participatory workplace intervention study among Japanese hospital nurses.

Previously, we reported that the participatory workplace intervention was effective in reducing stress-related inflammatory markers among 31 Japanese female nurses. During the analysis, we recognized that our intervention might have increased prosocial behaviors like giving social support to others in some participants. Based on this assumption, we ran a secondary analysis, which examined the effect of giving social support on inflammatory markers, autonomic nervous activity (ANA), and perceived job stress (PJS) before and after the intervention. A group of participants who had increased scores on giving social support (n=13) showed significant decreases in interferon-γ, interleukin-6, and interleukin-12/23p40 after the intervention. Another group of those who had decreased/unchanged in the scores (n=17) did not show changes in these markers. Regarding ANA and PJS, no significant changes were observed in both groups. This study presented insight that giving social support at work may provide health benefits towards employees themselves, via decreasing inflammation.

[The Strength of the Sense of Shame of the Aged in Care Scenes: Comparison Between Whether or not There is Anyone Else Around Them].

Medical staff in a hospital or nursing facility should take care of aged individuals with dignity and respect. We conducted a survey on aged individuals to derive under what care circumstances they had a sense of shame, using 12 illustrations, drawn by ourselves, which were common daily care scenes where nurses and patients meet. This survey was conducted at 4 care facilities in A prefecture, Japan. The number of surveyed persons was 43, with the following exclusion criteria: over 60 years old, more than third level of care needed, and non suspected of having dementia. We got the following results from the answers of 41 persons: 1. When elder persons are surrounded by people other than the care staff, they feel more of a sense of shame than when alone; 2. They feel more sense of shame when they use a wheelchair than when they use crutches; 3. They do not feel much shame when they get a bed-bath, even if other persons are there; and 4. Male patients feel more shame than females when they meet their family. These results suggest that elderly patients feel a stronger sense of shame when they are seen by others than when they are seen by care staff. The result 2 suggests that the use of a wheelchair exposes their physical weakness to others. Males feel a stronger sense of shame when they show a weakness in their gender role. We conclude that the sense of shame of aged individuals in daily life scenes in a care facility depends on their gender and whether or not they are surrounded by other persons.

Effects of participatory workplace improvement program on stress-related biomarkers and self-reported stress among university hospital nurses: a preliminary study.

Although participatory workplace improvement programs are known to provide favorable effects on high stress occupations like nursing, no studies have confirmed its effect using biomarkers. The aim of this study was to determine whether a participatory workplace improvement program would decrease stress-related symptoms as evaluated by biomarkers and self-reported stress among hospital nurses. Three actions to alleviate job stress, which were determined through focus group interviews and voting, were undertaken for two months. A total of 31 female Japanese nurses underwent measurement of inflammatory markers, autonomic nervous activity (ANA), and perceived job stress (PJS) at three-time points; before the program (T1), within a week after the completion of the program (T2), and three months after the program (T3). A series of inflammatory markers (Interferon-γ, Interleukin (IL)-6, and IL-12/23p40) decreased significantly at T2, and IL-12/23p40 and IL-15 significantly decreased at T3 compared to T1, while ANA and PJS remained unchanged. Our participatory program exerted beneficial effects in reducing inflammatory responses, but not for ANA and PJS. Further investigations with a better study design, i.e., a randomized controlled trial, and a larger sample size are warranted to determine what exerted beneficial effects on inflammatory markers and why other outcomes remained unchanged.

[Nursing Care Students' Image of Shame -Comparison Between First and Second Year Nursing Students].

It is not easy for nurses to estimate a patient's degree of shame, as the sense of shame depends on each person's personality, but nurses are requested to evaluate it as correctly as possible and to reduce the patient's mental load. We presume that most of the sense of shame is generated by body defects or disadvantages recognized by the patient. In this study, we tried to measure the degree of shame and to improve the basic nursing curriculum, depending on students' school year, under the assumption of what cases the nurses would frequently meet in a hospital. We prepared 13 figures that show common cases in hospitals. In these figures: 1) 6 figures show cases in which a nurse touched a patient's body; 2) 3 figures show common daily life; and 3) 4 figures show cases in which there are other people around the patient. A questionnaire was given to the first and second year students in A Nursing University, and we allocated scores of 1 to 10: 1 is "no-shame", and 10 is "very much shame". The students answered that patients must feel shame when: 1) they take off their clothes, 2) they show their disability to another person even without taking their clothes off, and 3) having people other than medical staff around them. In the results, as 2) appeared more strongly in the second year students than in the first, we thought that the second year students could surmise a patient's position in a hospital through the effect of the nursing education.

[Stressors and the Sense of Coherence Related to the Mental Health of Nurses Assuming the Roles of Wives and/or Mothers - Investigation into the Effects of Leaving Jobs Because of Marriage, Childbirth, and Childrearing].

Many female nurses leave their jobs because of major life events. However, the mental health status and related factors among nurses who assume the roles of wives and/or mothers have been insufficiently examined. Therefore we examined the mental health levels and related factors among such nurse. We conducted a questionnaire survey on 763 female nurses working at general hospitals with over 200 beds in Fukuoka Prefecture. Of 402 responses, 108 were divided into two groups: nurses who had left because of marriage, childbirth, or childrearing (leaving group), and those who had not (non-leaving group). The following were assessed: work satisfaction level, the Brief Job Stress Questionnaire, The General Health Questionnaire (GHQ) 28, and the Sense of Coherence (SOC) scale. Results showed that nurses who had assumed the roles of wives and/or mothers had lower mental health status than general women, and nurses who retained their jobs had higher mental health status and sense of comprehensibility on the SOC scale than those who left. Multiple regression analyses using the total GHQ score as an objective variable showed that only the sense of comprehensibility on the SOC scale correlated with mental health status in the non-leaving group. For the leaving group, having support, high work and life satisfaction levels, and several work stressors were correlated. These findings strongly suggest that to maintain and improve the mental health of nurses who assume the role of wives and/or mothers, greater support, higher satisfaction, reduced stressors, and maintenance and improvement of the sense of comprehensibility are required.

[The Role of Mid-Career Nurses in Educating New Nurses: from the Perspective of Self-Efficacy].

This study sought to clarify the relationship between the educational role behavior of mid-career nurses toward new nurses, and their sense of self-efficacy. Educational role behaviors of mid-career nurses toward new nurses were set to 13 items related to career ladder and previous researches. To identify the relationship between the sense of self-efficacy in mid-career nurses and performing these 13 behaviors in their educational role toward new nurses, we had 310 mid-career nurses complete a questionnaire survey and analyzed the resulting data using Spearman's rank correlation coefficient, Mann-Whitney U test, and Kruskal-Wallis test. We found that mid-career nurses who had served as preceptors (senior nurses who teach practical nursing skills to new nurses on a one-on-one basis) four or more times had a significantly higher sense of self-efficacy than those who had served as preceptors three times or less for four behaviors only (1. demonstrating specific methods when instructing new nurses on various support methods, 7. being receptive to new nurses, 11. striving for professional self-improvement in practical nursing as a mid-career nurse, and 12. co-ordinating interpersonal relationships in the organization). No relationships were observed between the total number of years of nursing experience and the number of years of working at the station concerned. For all 13 educational role behaviors, Spearman's rank correlation coefficients of 0.5-0.7 indicated a significant relationship between implementation of the educational role behavior and a sense of self-efficacy. We believe that the high sense of self-efficacy that results from the performance of the 13 behaviors by mid-career nurses in their role of teaching new nurses leads them to demonstrate these behaviors in their everyday practice. It was also found that experience alone did not mean that mid-career nurses could adopt educational role behaviors with little burden, suggesting that support is universally necessary, regardless of experience.

Nursing Education Trial Using a Virtual Nightingale Ward.

Nursing department students are expected to correctly grasp the entire concept of nursing through their education. The authors created a movie of a Nightingale ward (virtual ward, hereafter) with an architectural computer design software for education. The students' reaction to the virtual ward was categorized into three viewpoints: that of nurses, of patients, and of nurses and patients in common. Most of the reactions in each viewpoint were: "easy to observe patients" in the nurses' viewpoint; "no privacy" in the patients' viewpoint; and "wide room" in the common viewpoint, respectively. These reactions show the effectiveness of using a virtual ward in nursing education. Because these reactions are characteristics of a Nightingale ward, and even students, who have generally less experiences, recognized these characteristics from the both viewpoints of nurses and patients.

Development of Teaching Materials in Basic Nursing Using Virtual Reality －Ceiling Image Teaching Materials of a Hospital Room－.

It is difficult to understand nursing practically for students who have just started studying nursing, because they cannot imagine the actual medical scene. The authors expect that they can improve nursing learning through experiences in virtual medical environments supported by ICT (information and commnication technology). We developed teaching materials in nursing education, and in a previous study we reported that the use of a virtual hospital was useful for students who had not had medical experience. The aim of the present study was to have students consider the meaning of a hospital room ceiling. First, we showed them a few ceiling patterns, and they selected the best one among the patterns. After that, we showed the same one in a virtual hospital room. They had negative opinions about what they had thought was the best one at this time. This demonstrates that the virtual hospital room is effective when students evaluate the ceiling as a part of the hospital room.

[Implementation of Objective Structured Clinical Examination I of the Department of Nursing--Introduction of Simulation-Based Education].

The Department of Nursing of the university revised its curriculum for students admitted in 2012 or later, including the introduction of integrated subjects. With the aim of improving the practical clinical skills of students and integrating knowledge, skills, and techniques, the following integrated subjects: Objective Structured Clinical Examination (OSCE) I held in the first term of the third-year (15 hours as one credit), and OSCE II held in the second term of the fourth year (30 hours as one credit), were adopted, and simulation-based education was introduced. In this report, we summarized our experience of a simulation education system for nursing students in the year 2014 aiming to improve students' skill of wheelchair transfer of a patient with left hemiplegia and patient's living environment. Many positive responses, such as usefulness in future nursing training, were obtained upon the introduction of the simulation education system. Issues to be addressed in the future, including lack of sufficient time to practice and availability of rooms, were also noticed.

Immunoreactive insulin in diabetes mellitus patient sera detected by ultrasensitive ELISA with thio-NAD cycling.

To minimize patient suffering, the smallest possible volume of blood should be collected for diagnosis and disease monitoring. When estimating insulin secretion capacity and resistance to insulin in diabetes mellitus (DM), increasing insulin assay immunosensitivity would reduce the blood sample volume required for testing. Here we present an ultrasensitive ELISA coupled with thio-NAD cycling to measure immunoreactive insulin in blood serum. Only 5 µL of serum was required for testing, with a limit of detection (LOD) for the assay of 10(-16) moles/assay. Additional recovery tests confirmed this method can detect insulin in sera. Comparisons between a commercially available immunoreactive insulin kit and our ultrasensitive ELISA using the same commercially available reference demonstrated good data correlation, providing further evidence of assay accuracy. Together, these results demonstrate our ultrasensitive ELISA could be a powerful tool in the diagnosis and treatment of not only DM but also many other diseases in the future.

[Evaluation of Educational Effect of Problem-Posing System in Nursing Processing Study].

The nursing processing study is generally difficult, because it is important for nursing college students to understand knowledge and utilize it. We have developed an integrated system to understand, utilize, and share knowledge. We added a problem-posing function to this system, and expected that students would deeply understand the nursing processing study through the new system. This system consisted of four steps: create a problem, create an answer input section, create a hint, and verification. Nursing students created problems related to nursing processing by this system. When we gave a lecture on the nursing processing for second year students of A university, we tried to use the creating problem function of this system. We evaluated the effect by the number of problems and the contents of the created problem, that is, whether the contents consisted of a lecture stage or not. We also evaluated the correlation between those and regular examination and report scores. We derived the following: 1. weak correlation between the number of created problems and report score (r=0.27), 2. significant differences between regular examination and report scores of students who created problems corresponding to the learning stage, and those of students who created problems not corresponding to it (P<0.05). From these results, problem-posing is suggested to be effective to fix and utilize knowledge in the lecture of nursing processing theory.

Detection of HIV-1 p24 at Attomole Level by Ultrasensitive ELISA with Thio-NAD Cycling.

To reduce the window period between HIV-1 infection and the ability to diagnose it, a fourth-generation immunoassay including the detection of HIV-1 p24 antigen has been developed. However, because the commercially available systems for this assay use special, high-cost instruments to measure, for example, chemiluminescence, it is performed only by diagnostics companies and hub hospitals. To overcome this limitation, we applied an ultrasensitive ELISA coupled with a thio-NAD cycling, which is based on a usual enzyme immunoassay without special instruments, to detect HIV-1 p24. The p24 detection limit by our ultrasensitive ELISA was 0.0065 IU/assay (i.e., ca. 10(-18) moles/assay). Because HIV-1 p24 antigen is thought to be present in the virion in much greater numbers than viral RNA copies, the value of 10(-18) moles of the p24/assay corresponds to ca. 10(3) copies of the HIV-1 RNA/assay. That is, our ultrasensitive ELISA is chasing the detection limit (10(2) copies/assay) obtained by PCR-based nucleic acid testing (NAT) with a margin of only one different order. Further, the detection limit by our ultrasensitive ELISA is less than that mandated for a CE-marked HIV antigen/antibody assay. An additional recovery test using blood supported the reliability of our ultrasensitive ELISA.

[Nursing Education Utilizing Experiences in a Virtual Hospital Ward].

Environmental design should be required at medical facilities for conducting medical practice safely and for making hospitalization comfortable. Many medical nursing students cannot imagine medical facilities, especially hospital wards, when they study medical environments in a basic nursing lecture. As a result, they cannot connect well with patient assistance. We employed a computer assisted designing software, "3D My Home Designer" (Mega Soft Company) that runs on Windows 8, and considered the usefulness of it for lectures on environmental design showing how to design a hospital ward for patients' optimal hospital stay. We drew a medical facility in 2-D first, transformed it into 3D images, and then created movies of a virtual hospital ward in which a patient walked around. These movies consisted of 3 kinds: a) hospital room with changeable wall color, b) different allocations of hospital room and nurse station, and c) a blurred ward which corresponded to how a patient with poor eyesight (cataract) would see a ward. We prepared as controls: a') still images of a hospital room, b') still images of ward, and c') a documentation on how a ward is seen by a patient with a cataract. We gave a questionnaire to students and nurses about these movies and still images (controls). In a) and b), there were no differences between the movies and still images in both students and nurses. In c), both students and nurses had a viewpoint from the patient with poor eyesight. From these results, we consider that the students, who have fewer experiences in a hospital, may understand the environments well by movies and the application of a virtual movie ward to nursing education may be useful in a lecture, depending on the readiness of the students.

Ultrasensitive enzyme-linked immunosorbent assay (ELISA) of proteins by combination with the thio-NAD cycling method.

An ultrasensitive method for the determination of proteins is described that combines an enzyme-linked immunosorbent assay (ELISA) and a thionicotinamide-adenine dinucleotide (thio-NAD) cycling method. A sandwich method using a primary and a secondary antibody for antigens is employed in an ELISA. An androsterone derivative, 3α-hydroxysteroid, is produced by the hydrolysis of 3α-hydroxysteroid 3-phosphate with alkaline phosphatase linked to the secondary antibody. This 3α-hydroxysteroid is oxidized to a 3-ketosteroid by 3α- hydroxysteroid dehydrogenase (3α-HSD) with a cofactor thio-NAD. By the opposite reaction, the 3-ketosteroid is reduced to a 3α-hydroxysteroid by 3α-HSD with a cofactor NADH. During this cycling reaction, thio-NADH accumulates in a quadratic function-like fashion. Accumulated thio-NADH can be measured directly at an absorbance of 400 nm without any interference from other cofactors. These features enable us to detect a target protein with ultrasensitivity (10(-19) mol/assay) by measuring the cumulative quantity of thio-NADH. Our ultrasensitive determination of proteins thus allows for the detection of small amounts of proteins only by the application of thio-NAD cycling reagents to the usual ELISA system.

Detection of H2O2 by fluorescence correlation spectroscopy.

Fluorescence correlation spectroscopy (FCS) is a technique in which measurement of fluorescence intensity fluctuations is used to clarify dynamic molecular interactions within a very small space in a solution containing a small number of fluorescent molecules. The FCS-based analysis gives the average number and average diffusion time of the fluorescent molecules during their passage through a very small space. One advantage of FCS is that physical separation between free and bound fluorescent probes is not required because the properties of fluorescence fluctuations are accounted for. Therefore, when fluorescent probes are bound with proteins by peroxidase and hydrogen peroxide (H2O2), FCS enables us to detect H2O2 with high sensitivity. In addition, because H2O2 is generated by oxidase-catalyzed reactions, a highly sensitive method for detecting H2O2 is applicable to the measurement of low levels of various oxidases and their substrates, such as glucose. We here describe the protocol of a de novo, highly sensitive method for the measurement of H2O2 and glucose using FCS.

[A new role of nursing in violence: a reconsideration of nursing of victims].

Forensic nursing is the application of forensic science to nursing. It provides direct patient care with relation to violence, abuse, crime, victimization and exploitation. Forensic nurses integrate forensic and nursing sciences in their assessment and care of victims and perpetrators. In the U.S.A., Canada and Europe, forensic nursing practice involves advocating for the collection of evidence and reporting of crimes. Additionally, forensic nurses treat victims and perpetrators for their trauma, their families, communities and the systems that respond to them. Through its practice, forensic nursing contributes to public health by preventing health hazards caused by violence and crime. This report considers the possibility of the development of forensic nursing in Japan. We propose that the development of forensic nursing is necessary.

[Possibilities and problems in the development of forensic nursing in Japan: a questionnaire survey of clinical nurses].

Forensic nursing scientifically obtains and preserves the criminal damage from victims of domestic violence, child abuse, elder abuse, sexual violence and other related forms of violence. This was developed in North America in the 1980s, and has carried out appropriate nursing care while protecting the human rights of victims. Serious crime in Japan has been increasing, and it would seem that forensic nursing opportunities should expand as well. However, in Japan, there hasn't been much discussion about forensic nursing. Theorizing that support for clinical forensic nursing should be recognized and relevant, we carried out a survey of 581 clinical nurses to investigate the development of forensic nursing in Japan. 93 clinical nurses (16.0%) had a low level of familiarity with forensic nursing; however, 324 nurses (56.3%) had encountered patients who had suffered violence. 264 nurses (45.4%) had a feeling of wanting to be involved in forensic nursing, but were not confident with the knowledge and technology, while 144 nurses (24.8%) were concerned about the larger responsibility they would have. 400 nurses (68.8%) hoped to receive specialized knowledge and technical education. It is necessary to establish an education system for forensic nursing in accordance with the educational status-quo while considering the present state of forensic nursing education.

[Achievements in the objectives of a practicum as seen through changes in awareness of nursing and care techniques in a basic nursing practice].

This study aims to elucidate the level of achievement and the challenges in a basic nursing practicum for second-year nursing students through the association method. Analysis revealed various descriptions of learning through the practicum training experiences in terms of understanding the healthcare environment, planning and implementing daily life assistance, and involvement in building a supportive relationship with a care recipient. In this sense, we can assume that the goal of the practicum was achieved. The students' attitude toward learning showed an emphasis on knowledge, basics, reasoning, and acquisition of knowledge through experience. At the same time, however, we did not observe descriptions of developing the healthcare environment, understanding the methods of developing healthcare plans, or respect for privacy, thus not indicating whether the goal was achieved. In the future, it is necessary to additionally examine specific details of students' learning through analyzing their reports.