A Concept Analysis of Self-Management of Physical Frailty.

This review aimed to clarify the concept of self-management in the context of physical frailty and to provide insights that support the development of interventions to prevent physical frailty. A concept analysis using thirty-three studies was performed, six attributes of the concept "self-management of physical frailty" were identified: {Cooperating with healthcare professionals or familiar persons}, {Investing and managing in resources}, {Acquisition and maintenance of individualized self-management strategies}, {Self-directed process}, {Goal setting and personalized action planning} and {Living with one's own health condition with a positive attitude}. Self-management of physical frailty can be defined as a process in which an individual independently sets goals and action plans, engages in strategies such as exercise and nutritional management, and lives with one's own health condition with a positive attitude by collaborating with healthcare professionals and others, in addition to utilizing resources. To support the process in which an individual independently sets goals and action plans, engages in strategies, self-management support based on learning theories that lead to cognitive, emotional, and behavioral changes is necessary.

Perspectives of nursing students on end-of-life nurse education: A qualitative study of the guided death experience.

BACKGROUND: Although various studies reported on educational methods for end-of-life care, there is lack of evidence on how nursing students experience simulated death. OBJECTIVES: This study explored the experiences of undergraduate nursing students who participated in a guided death experience. DESIGN: The research utilized a qualitative descriptive design. SETTINGS: The research was conducted at a Japanese university nursing school. PARTICIPANTS: A total of 82 nursing students were recruited to complete an end-of-life course in which they participated in a guided death experience as part of their third-year curriculum. METHODS: Descriptions of the guided death experience were analyzed using content analysis. RESULTS: Nursing students' experiences in the guided death experience fell into two main categories: "subjective experience of immersing oneself in the world of the patient who is dying" and "formation of nursing perspectives of end-of-life care." The former focused on subjective experiences of nursing students vividly expressing their own emotions such as grief, anger, fear, and depression during the guided death experience process. The latter expressed recognition of the essence of end-of-life-care through the guided death experience, such as thinking about needs of the person who is dying, being present, and listening to the individual. CONCLUSIONS: In end-of-life nurse education, the guided death experience allows students to face first-person death. This fosters a core view of nursing in palliative and end-of-life care. Overall, the guided death experience is an important means of preparatory education for relevant clinical practice.

Usefulness of HbA1c Measurements by HPLC- and Immuno-Assay for Screening Unstable Hemoglobinopathy.

OBJECTIVE: Unstable hemoglobinopathy (UH), red blood cell membrane disease (MD), and red blood cell enzymopathy are known as major congenital hemolytic anemias. Specialized examinations are needed for their differential diagnosis. We hypothesized that simultaneous measurements of HbA1c levels using high-performance liquid chromatography (HPLC) by fast mode (FM) and immunoassay [HPLC (FM)-HbA1c and IA-HbA1c, respectively] are useful for the differential diagnosis of UH from other congenital hemolytic anemias and verified this hypothesis in this study. METHODS: HPLC (FM)-HbA1c and IA-HbA1c levels were simultaneously measured in 5 variant hemoglobinopathy (VH) patients with ß-chain heterozygous mutation, 8 MD patients, 6 UH patients, and 10 healthy controls. None of the patients had diabetes mellitus. RESULTS: In VH patients, HPLC-HbA1c levels were low, whereas IA-HbA1c levels were within the reference range. In MD patients, HPLC-HbA1c and IA-HbA1c levels were similarly low. In UH patients, both HPLC-HbA1c and IA-HbA1c levels were low, but HPLC-HbA1c levels were significantly lower than IA-HbA1c levels. The HPLC-HbA1c/IA-HbA1c ratio was 90% or more in all MD patients and control subjects. This ratio was, however, less than 90% in all VH patients and UH patients. CONCLUSION: The HPLC (FM)-HbA1c/IA-HbA1c ratio calculated using simultaneous measurements of HPLC (FM)-HbA1c and IA-HbA1c levels is useful for the differential diagnosis of VH, MD, and UH.

Generational differences in factors influencing job turnover among Japanese nurses: an exploratory comparative design.

BACKGROUND: Although nurse turnover is a serious problem, the fact that each nurse has different work-related needs/values, and leaves their job for different reasons makes it difficult for organisations to develop effective countermeasures against it. Understanding nurses' needs and the reasons for job turnover by the generation in which they were born may provide some feasible solutions. OBJECTIVES: The purpose of the study was to identify specific work-related needs and values of nurses in three generations (born in 1946-1959, 1960-1974, 1975-present). The study also aimed to explore generation-specific reasons that might make nurses consider leaving the jobs. SETTINGS: The study was conducted in three public hospitals in Japan. PARTICIPANTS: A convenience sample of 315 registered nurses participated in the study. METHODS: A survey method was used to collect quantitative and qualitative data. Quantitative data were analysed by ANOVA, and qualitative data were analysed by content analysis. RESULTS: Nurses born between 1960 and 1974 embraced high needs and values in professional privileges such as autonomy and recognition, while those born after 1975 expressed low needs and values in the opportunities for clinical challenge. For nurses born between 1960 and 1974, the imbalance between their jobs and personal life made them consider leaving their jobs. For those born after 1975, losing the confidence to care made them consider turning over. Nurses born after 1960 tended to value economic return and job security more highly compared to those born between 1946 and 1959. CONCLUSIONS: Nurses in different generations have different sets of needs/values and reasons for job turnover. Understanding generation-specific needs and values of nurses may enable organisations and Nurse Managers to develop feasible and effective countermeasures to reduce nurse turnover.

Nurses' leaving intentions: antecedents and mediating factors.

AIM: This paper is a report of a study to investigate how nurses' work values, perceptions of environmental characteristics, and organizational commitment are related to their leaving intentions. BACKGROUND: Nurse leaving is a serious international problem as it contributes to the nursing shortage that threatens the welfare of society. The characteristics of nurses, the work environment and nurses' feelings towards their jobs (or organizations) have an impact on their leaving intentions. METHOD: A convenience sample of 849 Registered Nurses was recruited from three public hospitals in the central-west region of Japan during 2006 and 319 completed questionnaires were returned (response rate 39%). Data were analysed using regression analysis. FINDINGS: Nurses' work values and their perceptions of their workplace environment interacted to influence leaving intentions. When there was a match between the importance nurses placed on being able to challenge current clinical practices and the number of the actual opportunities to do so, leaving intentions were low. When there was a mismatch, intention to quit the job became stronger. In addition, organizational commitment intervened between nurses' perceptions of the match in clinical challenges and leaving intention. CONCLUSION: Nurses' leaving intentions, deserve extensive exploration of their causes. Such exploration should include attending to both nurses' needs and organizational characteristics, investigating how the match between them could affect nurses' leaving intention, and exploring factors that intervene between nurses' perceptions of the match and leaving intention.

Expression of hard alpha-keratins in pilomatrixoma, craniopharyngioma, and calcifying odontogenic cyst.

To examine the properties of shadow and ghost cells, 3 kinds of antibodies were raised against human hair proteins and their immunoreactivity was examined in tumors expressing those cells: pilomatrixoma, 14 cases; craniopharyngioma, 17 cases; and calcifying odontogenic cyst (COC), 14 cases. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis and Western blot analyses demonstrated that 2 polyclonal antibodies, PA-HP1 and PA-HP 2, reacted strongly with type I acidic and type II neutral/basic hard alpha-keratins. The other monoclonal antibody, MA-HP1, reacted with type II neutral/basic hard alpha-keratins. Immunohistochemical examination revealed that all 3 antibodies reacted only with the hair shaft in sections of normal skin and dermoid cyst. In all pilomatrixoma cases, 3 antibodies reacted with the cytoplasm of transitional and shadow cells but not with that of basophilic cells. Positive reactions were found only in shadow cells of all 13 adamantinomatous craniopharyngiomas. In all COCs, the antibodies reacted only with ghost cells, not with other epithelial components. Immunoreactivity for phosphothreonine, detected in hard alpha-keratins, also was found in transitional, shadow, and ghost cells. The appearance of shadow or ghost cells might represent differentiation into hair in these 3 kinds of tumors.