Factors Related to Person-Centered Care for Older Patients With Cancer and Dementia in Designated Cancer Hospitals.

BACKGROUND: Person-centered care (PCC) should be promoted for patients with cancer and dementia who are likely to be hindered from pursuing a meaningful life owing to their will not being reflected in the cancer treatment process. OBJECTIVE: This study aimed to clarify the factors related to nurses' practice of PCC for older patients with cancer and dementia in designated cancer hospitals. METHODS: An online cross-sectional survey was administered to nurses working at designated cancer hospitals in Japan. The survey items included demographic data and factors assumed to be related to nursing practice and practice of PCC. RESULTS: A multiple regression analysis indicated that the factors related to the practice of PCC were attitude toward patients with dementia (ß = 0.264, P < .001), holding conferences (ß = 0.255, P < .001), knowledge about cancer nursing (ß = 0.168, P < .001), knowledge about dementia (ß = 0.128, P = .003), and participation in dementia care training (ß = 0.088, P = .032). CONCLUSIONS: Nurses' practice of PCC may not be sufficient to provide personalized care tailored to patients' cognitive function. The factors related to PCC are attitude toward patients with dementia, holding conferences, knowledge about cancer and dementia, and dementia care training. IMPLICATIONS FOR PRACTICE: To promote PCC for patients with cancer and dementia, nurses should learn about these conditions with an interest in patients and collaborate with other professionals. Future studies should use cluster sampling and focus on the extent of cancer or dementia symptoms.

Development and validation of the Care Transitions Scale for Patients with Heart Failure: A tool for nurses to assess patients' readiness for hospital discharge.

AIM: This study aimed to develop and assess the validity and reliability of the Care Transitions Scale for Patients with Heart Failure (CTS-HF) as a nurse-reported measure for evaluating patients' readiness for hospital discharge. METHODS: We conducted a cross-sectional study of cardiovascular ward nurses from 163 hospitals across Japan. Structural validity was assessed using exploratory factor analysis with development participants and confirmatory factor analysis with validation participants. Convergent validity was assessed by correlation with the Discharge Planning of Ward Nurses scale (DPWN). Hypotheses testing for construct validity was performed as comparisons between subgroups of transitional care practice. RESULTS: Valid responses were obtained from 704 nurses (development participants, n = 352; validation participants, n = 352). The final scale comprised 21 items divided into six factors: "Clear preparation for how to manage health at home," "Adjusting to home care/support system," "Transitions of medication management from hospital to home," "Dealing with patients' concerns and questions," "Transitions of disease management from hospital to home," and "Family support." Indices of fit supported these results (comparative fit index = 0.944, root mean square error of approximation = 0.057). The CTS-HF was significantly correlated with the DPWN. The nurses' subgroup with higher transitional care practice had higher CTS-HF scores. Cronbach's alpha was .93 for the CTS-HF. CONCLUSIONS: The CTS-HF showed sufficient reliability and validity for use in evaluating discharge care. Further studies are needed regarding the usefulness of this scale in nursing practice.

Validity and reliability of the Japanese version of the Nursing Performance Instrument.

AIM: Work performance of nurses is a critical aspect that concerns the safety of both nurses and patients, but also secondarily influences nurses' turnover due to serious fatigue and burnout. Monitoring nursing performance as well as fatigue is important for appropriate safety management of patients and nurses, and the development of a monitoring tool is essential. The Nursing Performance Instrument (NPI) can provide comprehensive and brief monitoring of nursing performance. This study aimed to verify the validity and reliability of a Japanese version of the NPI (NPI-J). METHODS: A cross-sectional study was conducted on nurses who work in inpatient care across five Japanese hospitals. We considered appropriate factor numbers with parallel analysis and the Velicer's minimum average partial test. The construct validity was evaluated using exploratory factor analysis, confirmatory factor analysis (CFA), and Pearson's correlation analysis. Cronbach's alpha was calculated for the internal consistency. RESULTS: A three-factor model eventually showed acceptable fit indices in the CFA. Moreover, the correlation results among the three factors indicated discriminant validity comparable to the original NPI. The correlation results with acute fatigue, chronic fatigue, and burnout verified convergent validity. Internal consistency was insufficient. CONCLUSION: The NPI-J demonstrated acceptable construct validity. This instrument can assess nurses' perceptions of their performance by measuring each item. Future work on the reliability of the sub-concepts will require additional items or reliability testing based on generalizability theory and item response theory.

Psychometric properties of the Japanese version of the Occupational Fatigue Exhaustion Recovery Scale among shift-work nurses.

OBJECTIVES: Shift-work nurses are at a higher risk of inadequate recovery from fatigue and developing maladaptive fatigue with significant health consequences. Therefore, it is necessary to monitor fatigue and recovery levels with a reliable scale. We investigated psychometric properties of the Japanese version of the Occupational Fatigue Exhaustion Recovery scale (OFER-J) for shift-work nurses. METHODS: Japanese shift-work nurses responded to self-administered questionnaires at baseline (n = 942) and one month later (n = 334). The confirmatory factor analysis (CFA) and exploratory factor analysis (EFA) were conducted to verify the structural validity and the correlation analysis and one-way analysis of variance were conducted to test the construct and discriminative validity. Cronbach's alpha coefficient, intra-class correlation coefficient (ICC), and smallest detectable change (SDC) were calculated to assess reliability. RESULTS: The CFA showed high correlations between the factors and whilst the goodness-of-fit of the three-factor model was suboptimal, it was in an acceptable range. Most modifications included the error covariance of the Acute Fatigue (AF) and Intershift Recovery (IR) items. The EFA showed that Chronic Fatigue (CF) and AF were not clearly separated, indicating that the two AF items dropped out. Construct and discriminative validity were also well indicated. Cronbach's alpha coefficients were 0.75-0.85. Only CF showed sufficient reproductivity (ICC = 0.74). The SDC for CF, AF, and IR was 14.0, 17.1, and 18.7, respectively. CONCLUSIONS: The validity and reliability of the OFER-J were verified as acceptable for shift-work nurses. The OFER-J could contribute to a data-based approach to fatigue management in nursing management practice.

Measurement tools that assess the quality of transitional care from patients' perspective: A literature review.

AIM: Transitional care is important for improving the quality of life of patients discharged from hospitals. Patient-reported experience measures help improve transitional care quality. Thus, this literature review aimed to identify and appraise measurement tools that assess transitional care quality from the patient's perspective and identify its components. METHODS: Development and validation studies were systematically searched in the PubMed and CINAHL databases. The review team appraised the methodological quality and statistical results of measurement properties using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology. RESULTS: A total of 30 studies and seven instruments were identified. The target population was patients discharged from hospital to a home or nursing home (mean age = 52-84 years). The measurement time was before or after the discharge. The number of items in the original versions of the measures ranged from eight to 41, with short versions ranging from three to 12. The overall methodological quality of structural validity, internal consistency, and hypotheses testing was mostly "very good or adequate," according to COSMIN criteria. However, content validity and development were mostly "inadequate or doubtful" or not reported. The main components of included measures comprised "self-care after discharge," "providing information to the patient," "patient engagement in the care plan," and "dealing with patient's concerns." CONCLUSION: The quality appraisal results and identified components are useful for choosing measurement tools in clinical practice and research. The Care Transitions Measure is the most widely validated measurement tool.

Engagement of Nepalese High-School Students in Cancer Awareness Using a Photovoice Based on the Health Belief Model.

Delivering cancer education is one of the strategies for implementing health promotion and disease prevention programs. Moreover, cancer education can help people understand the risks related to specific behaviors that can trigger cancer during later life stages. This study examines the cancer perception of high school students (median age: 14 years) using a photovoice based on the health belief model. Students were requested to take photographs to answer the framework question: "How is cancer present in your surrounding?" A theoretical thematic analysis was conducted to develop codes, and the narratives completed by the participants on the SHOWED checklist were used to create contextualization. With the use of the health belief model, the following factors were determined: risk factors and environmental pollution (perceived susceptibility), symptoms (perceived severity), prevention and screening (benefits), ignorance and poverty, and ineffective laws and regulations (perceived barriers). Linked to these themes, students' narration demonstrated the risk of developing cancer if the same environment and inadequate regulations persisted. This study highlights the need to incorporate the participation of adolescents in the design, implementation, and monitoring of several community issues to help address several unanswered questions.

Components and Related Factors of Nursing Interventions for Improving Resilience in Cancer Patients Undergoing Chemotherapy.

Resilience is considered an effective concept for cancer patients, but nursing interventions for improving resilience have not been studied adequately yet. We aimed to explore the components and related factors of nursing interventions for promoting resilience among cancer patients receiving chemotherapy (NIPRPC). This cross-sectional study included 68 facilities from 396 cancer hospitals in Japan. Participants were 377 nurses who worked at the outpatient chemotherapy center or cancer ward. They completed self-administered questionnaires including the NIPRPC items and Resilience Scale for Nurses, etc. We conducted factor, correlational, and regression analysis. Based on the exploratory factor analysis, six-dimensional factor components: "Support for patients during the present situation and increasing their self-affirmation", "Support for self-help", "Support for utilizing the cancer medical team", "Support for obtaining family cooperation", "Support for maintaining regular lifestyle during chemotherapy", and "Support for interacting with cancer patients and utilizing necessary information". The strong related factors for all six factors were the resilience of the nurses and the number of collaborations with multiple occupations. Our findings will help nurses improve the psychosocial quality of life of cancer patients and address their needs related to cancer chemotherapy treatment.

Impact of Peer-Led Cancer Education Program on Knowledge, Health Beliefs, Practice, and Self-Esteem Among Pairs of Nepalese High-School Students and Their Knowledge-Sharing Partners.

Raising cancer awareness among adolescents can increase their confidence in identifying cancer symptoms and develop healthy habits. This study tested the effectiveness of cancer education based on a new model among high schoolers. A non-randomized control group pre-post-test design study was conducted among 313 pairs of adolescent students and their knowledge-sharing partners in Lalitpur, Nepal. A baseline test was conducted before the education program, and it was followed up at two weeks and three months. Results were measured using a chi-square test, binary logistic regression, and a two-way repeated-measures ANOVA. There was a significant interaction effect of intervention and time on students' knowledge, beliefs, self-esteem, and practice, along with a change in some scores of knowledge-sharing partners. Joint assignment supported the idea of diffusion of information within the family and in the neighborhood. The peer group discussion could encourage active learning and help students to participate visibly in problem-solving and reflecting more sustainably. Time constraints, lack of human resources, and support groups, might limit this program's usage; however, preparing guidelines, and connecting communities, organizations, hospitals, volunteer health workers, and survivors can help make it more sustainable and approachable.

Cross-cultural adaptation of the Chronic Illness Resources Survey in Japanese patients with diabetes.

AIM: The Chronic Illness Resources Survey (CIRS) is a tool for assessing multiple levels of resources for self-management in people with chronic illnesses. This study aimed to examine the reliability and validity of the Japanese version of the CIRS (CIRS-J) among patients with diabetes. METHODS: This study included 102 Japanese patients with diabetes. Patients completed the CIRS-J on two occasions with additional measurements, including the multidimensional scale of perceived social support (MSPSS), the summary of diabetes self-care activities (SDSCA), and the perceived health competence scale (PHCS). The construct validity, internal consistency reliability, and test-retest reliability were evaluated. RESULTS: Factor analysis resulted in six factors. The Cronbach's α coefficient was 0.82, indicating a high internal consistency. The intraclass correlation coefficient was 0.87, indicating that the CIRS-J is stable over time. The CIRS-J showed a positive moderate association with MSPSS, SDSCA, and PHCS, with a correlation coefficient value ranging from .34 to .44. CONCLUSION: This study showed preliminary support for the reliability and validity of the CIRS-J. The availability of this instrument will help identify the spectrum of resources available for Japanese people with diabetes in both research and practical settings.

Analyzing Awareness on Risk Factors, Barriers and Prevention of Cervical Cancer among Pairs of Nepali High School Students and Their Mothers.

Providing information on increased cancer risks associated with certain behaviors might encourage adolescents to initiate protective behaviors. This study firstly determined the knowledge of risk factors and prevention of cervical cancer. Secondly, it checked an association between mothers' screening practice and student's knowledge. A descriptive, cross sectional study was conducted among 253 pairs of high school students and their mothers. Knowledge on cervical cancer was significantly lower among students and mothers. While cancer screening tests, maintenance of hygiene were considered as major preventive measures for cervical cancer, human papilloma vaccine was the least considered preventive measure. Students who were female, attended discussions on cancer and had a healthy diet had better awareness of cancer. Mothers of female students had better knowledge about cervical cancer than mothers of male students. Less perceived susceptibility and lack of knowledge were major obstacles among mothers, limiting cervical cancer screening to 15%. Although association between knowledge of students and screening practice of mothers was not clear, it was observed that cancer communication increased awareness of cervical cancer in both groups. Our findings showed a strong need for school-based cancer education program to address the issues of human papillomavirus vaccinations, cervical cancer risk and screening.

Association between sleep and fatigue in nurses who are engaged in 16 h night shifts in Japan: Assessment using actigraphy.

AIM: To determine the association between sleep and fatigue in nurses who are working in a two-shift system, including 16 h night shifts. METHODS: Sixty-one nurses were assessed on their sleeping and napping over 9 days, using actigraphy and a sleep diary. Work-related feelings of fatigue were measured by using the "Jikaku-sho shirabe" questionnaire and the Cumulative Fatigue Symptoms Index. RESULTS: The main night-time sleep started after 00:00 hours in half of the participants and the average start and end times were significantly delayed among the participants in their 20s, compared to those in their 40s . Although ~90% of the participants napped during and/or after a night shift, only 50.8% napped for >2 h during their shift and 32.8% napped in the morning after a night shift. In the high-fatigue group, significantly more nurses went to sleep after 00:25 hours than before 00:26 hours the night after a night shift. Furthermore, those nurses who napped for >2 h during their night shift exhibited a significantly lower rate of some cumulative fatigue symptoms, compared to those who did not. In addition, a combination of napping in the morning after a night shift and beginning the following night-time sleep before 00:26 hours were associated with a significant decrease in fatigue symptoms. CONCLUSIONS: Naps at an appropriate time and of an appropriate duration, along with the practice of beginning the night-time sleep early after a night shift, might relieve cumulative mental fatigue in nurses who are working 16 h night shifts.

Factors related to sense of coherence in adult patients with Type 2 diabetes.

The influence of a diabetic person's sense of burden and blood sugar control through sense of coherence (SOC) on self-management has yet to be sufficiently clarified. The purpose of this study was to examine the utility of salutogenesis, which has sense of coherence at its core, for the self-management of patients with type 2 diabetes. A total of 258 questionnaires were distributed to patients who were seen at one of three hospitals in an urban area in Japan, after obtaining consent from the patient. They were between 20 and 75 years old and regularly received care. Of the 185 responses, 177 were valid. The responses were analyzed by referring to the framework of salutogenesis, and the relationship between patient characteristics, SOC, the Problem Areas In Diabetes survey (PAID), and glycosylated hemoglobin (HbA1c) were studied with structural equation modeling (SEM). SOC had a main effect on PAID scores and an indirect effect on HbA1c. Moreover, age influenced SOC positively. The SOC of patients with type 2 diabetes in the present study was comparatively high. These observations suggest a direct effect of SOC on reducing the sense of burden from having diabetes and an indirect effect on decreasing HbA1c. This research suggested the possibility that diabetes can be controlled by improving SOC.

Validity and reliability of the Japanese version of the Care Transitions Measure.

OBJECTIVE: To evaluate the validity and reliability of the Japanese Version of the Care Transitions Measure (J-CTM-15). DESIGN: Questionnaire items were translated, and a longitudinal study was conducted. SETTING: Three urban hospitals: a special functioning hospital, a regional-designated cancer care hospital, and a private hospital in the northern part of Japan. PARTICIPANTS: Patients, aged 20 years and older, who were discharged from hospitals. MAIN OUTCOME MEASURE: Reliability was measured using Cronbach α and item-total correlations. Convergent validity was measured using a Pearson correlation with the Self-Care Agency Questionnaire. Construct validity was examined by an exploratory factor analysis. Predictive validity was examined by the ability to discriminate negative post hospital experiences, including anxiety, problems at home, readmission, emergency visit, consultation via telephone, poor health condition without consultation, and by the correlation with the 12-item Short Form Health Survey (SF-12v2). RESULTS: A total of 223 and 158 participants were selected for data analyses. The Cronbach α was 0.90. The J-CTM-15 differed from the original factor model, but significantly correlated with Self-Care Agency Questionnaire and SF-12v2 scores. The J-CTM-15 also significantly discriminated between patients who did and did not display anxiety, problems at home, and poor health condition, but did not discriminate for readmission, emergency visits, and consultation via telephone. CONCLUSION: The J-CTM-15 is a valid and reliable measure of the quality of care transitions. However, insufficient levels of predictive validity and a lack of generalizability are limitations of the current study.

Health Behavior Regarding Cardiovascular Diseases Among Nepali Adults.

The main aim was to assess Nepali adults' knowledge, health beliefs, and health promoting behaviors regarding cardiovascular diseases (CVDs). A descriptive, cross sectional study was conducted in five wards of Lalitpur Sub-Metropolitan City. A random sample of 300 Nepali individuals aged 20-65 years completed the heart disease knowledge questionnaire and health beliefs related to cardiovascular diseases. The health belief model related to CVDs was used. Sociodemographic and personal information was collected. Of the adults 45.3% were aged 20-40 years, and 50.7% were male. The male participants smoked and consumed alcohol more than the female participants (p < 0.05). The mean score on the heart disease knowledge questionnaire was 11.8 ± 4.6. Adults between 20 and 40 years age, non smokers, and daily exercisers had greater knowledge on CVDs. The mean score on the four subscales of the health beliefs related to cardiovascular disease scale were as follows: perceived susceptibility (11.5 ± 2.5), perceived severity (12.1 ± 3.5), perceived benefits (20.1 ± 2.9) and perceived barriers (19.4 ± 3.3). Adults performing health promoting activities had better knowledge and greater perceived susceptibility. A simple regression showed knowledge and education were predictors of health promoting activities. Adults who were performing more than two activities for health promotion had better knowledge of CVDs and perceived more susceptibility. Identifying the health needs, understanding cultural beliefs and misconceptions, and adopting health-promoting actions might help to improve the health behavior of Nepali adults.

Factors related to self-efficacy among men and women undergoing outpatient chemotherapy in Japan.

OBJECTIVE: This study aims to examine factors that influence self-efficacy in Japanese patients with cancer receiving outpatient chemotherapy and to identify whether there are gender-specific similarities or differences that determine self-efficacy in this setting. METHODS: A cross-sectional survey was conducted among 156 patients with cancer (86 men and 70 women) undergoing chemotherapy as outpatients across five hospitals in Japan. The patients completed the European Organization for Research and Cancer Core Quality of Life questionnaire (EORTC QLQ-C30), the Self-Efficacy for Advanced Cancer questionnaire (SEAC) which consists of three subscales (affect regulation efficacy, symptom-coping efficacy and activities of daily living efficacy), and a patient information form. Multiple regression analysis was conducted to identify factors associated with self-efficacy in men and women. RESULTS: In both men and women, insomnia was related to affect regulation efficacy, while fatigue and nausea/vomiting correlated with activities of daily living efficacy. For male patients, fatigue and nausea/vomiting also correlated with affect regulation efficacy and symptom-coping efficacy. Emotional functioning influenced self-efficacy for both genders, while physical functioning affected self-efficacy in female patients only. CONCLUSIONS: These results suggest that to enhance self-efficacy in Japanese patients with cancer undergoing outpatient chemotherapy, effective intervention is required with regard to the management of both emotional and physical functioning, specifically symptoms such as fatigue, nausea/vomiting and insomnia in both genders. Furthermore, women with a reduced level of physical function may require particular attention, as they may be at risk of lower levels of self-efficacy.