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.

Factors Influencing Parenting Stress in the Mothers of Infants and the Effects of Artwork Production.

Background: The importance of support for the mothers of infants to cope with parenting stress due to isolated parenting environments is being emphasized. In order to reduce the parenting stress in parenting mothers while improving the quality of parenting support for them, it is important to identify factors influencing such stress. We investigated the effects of artwork production in different styles, conducted self-evaluation of such production, and identified factors influencing parenting stress in mothers, involving those who participated in a handprint artwork production workshop. Methods: We included 140 mothers who participated in a handprint artwork production workshop, dividing them into 2 groups: A: 70 with children younger than 3 years of age who engaged in artwork production alone; and B: 70 who engaged in it through collaboration with their children aged 3 years or older. The instructor distributed an anonymous, self-administered questionnaire to all the mothers, and collected their responses. The questionnaire examined the following items: attributes, the number of participations in the workshop, artwork production self-evaluation, and parenting stress. Results: There were 140 (100%) responses, and the number of valid responses was 65 from Group A and 54 from Group B, a total of 119 (85%). The mean [parenting strain] score was significantly higher in Group B. Multiple regression analysis identified the child's age and presence/absence of his/her siblings overall and in Group A, and , an item for artwork production self-evaluation, in Group B as factors influencing the total [parenting strain] score. Conclusion: The present results suggest that the child's age and presence/absence of his/her siblings could influence parenting stress in the mothers. Additionally, there was a correlation between the level of parenting stress and score for among the mothers who engaged in artwork production through collaboration with their children.

Subjective recovery accounts of Japanese female patients suffering from alcohol use disorder. A phenomenological study.

PURPOSE: This study aimed to examine the subjective recovery accounts of Japanese female patients with alcohol use disorder (AUD) and the factors that affect their recovery. DESIGN AND METHODS: This qualitative study used a phenomenological design. A focus group with 10 Japanese participants was conducted. FINDINGS: Five theme clusters emerged: drinking to forget unpleasant feelings, fighting compulsive cravings with craving, unhealed wounds from past traumatic experiences, encounters with role models in self-help groups, and changing one's mindset to a proactive pursuit of happiness. PRACTICE IMPLICATIONS: To support the recovery of women with AUD, psychiatric nurses should help them improve their family relationships, find recovery models, and proactively provide them with trauma-informed care.

Resilience and related factors as predictors of relapse risk in patients with substance use disorder: a cross-sectional study.

BACKGROUND: Resilience, referring to the inherent ability to naturally recover in the face of adverse conditions, is an essential concept in discussions of substance use disorder (SUD) recovery. This study's objective was to shed light on resilience and related factors that affect relapse risk in patients with SUDs. METHOD: Fifty-two patients with SUDs were given a self-administrated questionnaire from February to April 2015 consisting of question items for sociodemographic characteristics, relapse risk (Stimulant Relapse Risk Scale), and resilience (Bidimensional Resilience Scale). Scale scores were tested for associations with subject attributes, after which resilience's effects on relapse risk were analyzed using correlation and multiple regression (forced-entry) analyses. RESULTS: Stimulants were the most common substance related to SUD (n = 26, 21.7%; multiple answers). Bivariate correlation showed that higher acquired resilience was significantly associated with a lower relapse risk (r = - 0.314, P < 0.01). Reduced relapse risk was significantly associated with current employment (Std. ß = - 0.446, P < 0.05). CONCLUSION: Our findings demonstrate the necessity of recovery support to enhance acquired resistance in patients with SUDs to prevent relapses. Reinforcing employment support services and encouraging patients to continue treatment were suggested as potentially effective measures to enhance resilience in individuals with SUDs on their road to recovery.

Factors Influencing Psychological Independence in Adolescents and Their Relationship to Coaching-based Support from Significant Others.

BACKGROUND: An increasing number of adolescents are experiencing social maladjustment. This development may be due to serious conflicts regarding psychological independence. This study aimed to elucidate factors that influence psychological independence in adolescents and to clarify the relationship among coaching-based support from significant others, adolescent self-esteem, and adolescent psychological independence, in order to help prevent and treat social maladjustment in adolescents. METHODS: A total of 1814 students in all years at 2 universities and 1 junior college in A Prefecture, Japan, completed an anonymous self-administered questionnaire. The questionnaire asked about the participants' attributes, support relationships, psychological independence, and self-esteem. Coaching-based support was assessed by the Accelerate your Coaching Effectiveness scale; psychological independence by the Psychological Jiritsu Scale; and self-esteem by the Rosenberg Self-Esteem Scale. RESULTS: Gender, grade, major, current living situation were found to influence psychological independence of adolescents. The most significant others who had the most influence on psychological independence were mothers, fathers, and friends for male adolescents, and mothers, friends, and fathers for female adolescents, in that order. In female, coaching-based support from significant others increased their self-esteem and promoted all the sub-scales of psychological independence. In male, coaching-based support boosted their self-esteem and promoted the following sub-scales; "future orientation", "appropriate human relations", "value judgment and execution", "responsibility", and "social perspective", except for "self-control". CONCLUSION: We believe that coaching-based support from significant others can effectively help adolescents build their self-esteem and can promote their psychological independence.

Emotional Intelligence and Work Perceptions Among Nurse Managers.

BACKGROUND: Emotional intelligence (EI) refers to a person's ability to acknowledge the feelings of oneself and others, and to control those feelings so as to behave in a socially acceptable manner. We investigated the relationships between the characteristics of EI among nurse managers, and their perceptions of how much their position's roles and responsibilities can be delegated to other staff members. METHODS: We surveyed 150 nurse managers working at 30 hospitals by using an anonymous questionnaire. The questionnaire consists of basic attributes, EI and work perception. The emotional intelligence scale (EQS) domain scores were analyzed by means of one-way repeated-measures analysis of variance. EQS scores were compared with corresponding averages for working adults in the instructions. The perceived importance of duties of nurse managers was compared between the resulting EQS scores 'High' and 'Low' groups. RESULTS: The analysis population consisted of 105 nurse managers. Their EQS scored higher in all three domains, and with the exception of Altruism for all factor scores than the average for working adults. The perceived importance of the typical duties of nurse managers were compared between the High and Low groups for each EQS domain. Significant differences were observed between nurse managers with High and Low Intrapersonal emotional quotient (EQ) on four tasks. No significant differences were found for any of the responsibilities when nurse managers with High and Low Interpersonal EQ or Situational EQ were compared. CONCLUSION: The nurse managers' average EQS scores were higher in all areas. The high scores that were exhibited by could be considered desirable qualities for nurse managers. It seemed nurse managers with high scores in intrapersonal EQ struck a good balance between placing importance on EI considerations like managing relationships and creating a comfortable workplace, and management and leadership behaviors like department management and operations and data management.

Relationship Between Difficulties Encountered in School Life or Daily Life by Professional Training College Students and Their Sources of Advice.

BACKGROUND: This study attempted to clarify issues regarding difficulties in school life perceived by professional training college students and educational support systems for students including possible developmental disabilities. METHODS: We surveyed 953 students enrolled at 9 professional training colleges in Japan by using an anonymous self-administered questionnaire to investigate difficulties during school life, help-seeking preferences, and self-esteem. Difficulties were investigated by using the Self-Cognitive Difficulties Scale, help-seeking preferences were assessed with the Help-Seeking Preferences Scale, and self-esteem was assessed by the Rosenberg Self-Esteem Scale. We also investigated the relationship between the Self-Cognitive Difficulties Scale and the sources of advice used by students. RESULTS: Responses were obtained from 863 students, and those of 775 students were considered to be valid. In terms of learning scenarios, 271 students (35.0%) responded that written examinations caused the most difficulties. The Rosenberg Self-Esteem Scale and Help-Seeking Preferences Scale were negatively correlated with the Self-Cognitive Difficulties Scale. With respect to the relationship between sub-factors of the Self-Cognitive Difficulties Scale and sources of advice, the students who asked specialists for advice had significantly higher scores for the factors of interpersonal relationships and reading/writing, as well as significantly higher scores for impulsivity and learning-related difficulties. The students who asked their previous high school teachers for advice had significantly higher scores for inattention and reading/writing. Furthermore, the students who asked senior students in the same department for advice had a significantly higher score for learning-related difficulties. CONCLUSION: Our results suggested that professional training college students with a high Self-Cognitive Difficulties Scale score are more likely to choose a specialist as the source of advice. When providing educational support to professional training college students, it is important to consider the possibility that their sources of advice might differ depending on their individual self-perceived difficulty characteristics.

Health Related Quality of Life in Japanese Patients with Localized Prostate Cancer: Comparative Retrospective Study of Robot-Assisted Laparoscopic Radical Prostatectomy Versus Radiation Therapy.

BACKGROUND: Radical prostatectomy and radiotherapy are standard treatments for localized prostate cancer. When making decisions about treatment, it is important to not only consider medical information such as the patient's age, performance status, and complications, but also the impact on quality of life (QOL) after treatment.Our purpose was to compare health related quality of life (HRQOL) after robot-assisted laparoscopic radical prostatectomy (RARP) versus radiation therapy in Japanese patients with localized prostate cancer retrospectively. METHODS: Patients with localized prostate cancer receiving RARP or radiotherapy at Tottori University Hospital between October 2010 and December 2014 were enrolled in a retrospective observational study with follow-up for 24 months to December 2016. The Medical Outcome Study 8-Item Short-Form Health Survey was performed before treatment and 1, 3, 6, 12, and 24 months post-treatment. RESULTS: Complete responses to the questionnaire were obtained from 154/227 patients receiving RARP, 41/67 patients receiving intensity-modulated radiation therapy, 35/82 patients receiving low dose rate brachytherapy, and 18/28 patients given low dose rate brachytherapy plus external beam radiation therapy. The median physical component summary score of the Medical Outcome Study 8-Item Short-Form Health Survey was significantly lower at 1 month after prostatectomy than radiotherapy, but was similar for both treatments at 3 months, and was significantly higher at 6, 12 and 24 months after prostatectomy. The median mental component summary score was also significantly lower in the prostatectomy group at 1 month, but not from 3 months onwards. CONCLUSION: Our study suggested that HRQOL was inferior at 1 month after RARP, however, recovered at 3 months after RARP and was better than after radiotherapy at 6, 12, and 24 months.

Factors Influencing Psychiatric Nurses' Job Satisfaction Levels: Focusing on Their Frequency of Experiencing Negative Emotions Toward Patients and Support at Their Workplaces.

BACKGROUND: We examined factors influencing psychiatric nurses' job satisfaction levels focusing on their frequency of experiencing negative emotions toward patients and support at their workplaces. METHODS: An anonymous, self-administered questionnaire survey was conducted involving 1,097 psychiatric nurses working at 13 psychiatric hospitals in the Chugoku area to investigate their basic attributes, work-related factors, and scores from 3 scales: the Negative Feeling toward Patient Frequency scale, an original support-in-workplace scale, and the new Brief Job Stress Questionnaire (job stress and satisfaction). Correlations between basic attributes/work-related factors and scores from each scale, and the relationships among the study items were analyzed. Furthermore, logistic regression analysis was performed using the job satisfaction level. RESULTS: The subjects were the 577 psychiatric nurses who returned valid responses without missing data (response rate: 60.4%, valid responses: 87.0%). The subjects were the 577 psychiatric nurses who returned valid responses without missing data (response rate: 60.4%, valid responses: 87.0%). To clarify the level of influence on the job satisfaction level of each variable, logistic regression analysis was performed adopting the stepwise method for all of the items that were correlated with the job satisfaction level as a dependent variable. Support (from supervisors) at the workplace (OR: 1.069), job stress (OR: 0.751), Negative Feeling toward Patient Frequency-Total scale scores (OR: 0.980) were found to influence the job satisfaction level. CONCLUSION: Support from supervisors may be indispensable, and working environments that reduce job stress and negative emotions toward patients may be required to increase the job satisfaction levels of psychiatric nurses. This survey suggested that the establishment and maintenance of favorable working environments and interpersonal relationships increase job satisfaction levels while reducing stress, thereby improving job retention among psychiatric nurses.

Erratum for Matsumoto and Yoshioka, "Factors Influencing Psychiatric Nurses' Job Satisfaction Levels: Focusing on Their Frequency of Experiencing Negative Emotions Toward Patients and Support at Their Workplaces".

[This corrects the article DOI: 10.33160/yam.2019.11.006.].

A Survey of Epilepsy-related Knowledge, Attitudes and Practices of Home Healthcare Nurses in the San-in Region of Japan.

BACKGROUND: Comprehensive care is necessary for people with epilepsy (PWE) to lead a fulfilling life at home and in the community. The purpose of this study was to determine the epilepsy-related knowledge, attitudes and practices of home healthcare nurses (HHNs) in the San-in region of Japan. METHODS: A questionnaire survey was conducted by mail of 546 HHNs working in Tottori and Shimane Prefectures. The questionnaire assessed the epilepsy-related knowledge, attitudes and practices of HHNs. For the analysis, simple and cross tabulation of questionnaire responses were conducted, and the chi-squared test was used for statistical testing. RESULTS: A total of 285 HHNs participated in the study. Of the respondents, 43.9% had experience taking care of PWE in a home healthcare nursing setting. Regarding the cause of epilepsy, in descending order the percentage of correct responses were 86.7% for stroke, 85.3% for head injury, and only 13.3% for dementia. Concerning how to respond to an epileptic seizure, almost all respondents answered correctly, but 29.8% gave the incorrect answer of "place something inside the mouth." Regarding the practices of HHNs in relation to caring for PWE, nurses scored 52.0% for collaborating with the attending physician, indicating the need for improvement. The score for "provide information about social resources" was low at 18.4%. Of the respondents, 95.8% answered that epilepsy-related knowledge and technical skills were necessary for home healthcare nursing practice, and 87.7% were interested in participating in a workshop on epilepsy. CONCLUSION: The study revealed an inadequate level of knowledge of epilepsy with dementia and corresponding epileptic seizures, a low awareness of nursing care in collaboration with physicians, and the importance of providing information about social resources. There is a need to offer information and education on the latest knowledge about epilepsy to HHNs.

Realities and Challenges of Support for Children with Special Needs in Nursery Schools.

BACKGROUND: Nursery schools and kindergartens have been struggling to cope with increasing numbers of children with special needs. Hence, we conducted a study on what nursery school teachers (NSTs) will require regarding learning and societal resources for supporting such children in the future. METHODS: A questionnaire survey was conducted for 2,476 NSTs employed in 154 nursery schools in Shimane and Kochi Prefectures. The questionnaires were sent by post to officials at each nursery school. The completed questionnaires were collected by the school officials and returned by post. In addition to statistical processing of the survey results, the content of the free description responses was analyzed using the KJ method. RESULTS: Responses were obtained from 1,509 NSTs at 118 nursery schools. Of the respondents, 90.7% had experienced difficulties coping with children with special needs, and 83.9% were in charge of caring for such children. Such children were enrolled in every childcare facility participating in the survey. The NSTs primarily needed to learn about specific coping methods, the illness, and skills for supporting parents; concerning the societal resources, they needed the addition of assistant NSTs, the implementation of age-five check-up, and the recruitment of mentors. The free description responses were categorized into the following five categories: demand for child care administration, cooperation with professional staff, support for parents, developmental health checkups, and on-site needs for nursery childcare. One of the specific demands was to develop human resources capable of providing parents with appropriate advice. CONCLUSION: The results have shown that all NSTs are required to deal with children with special needs. Future challenges for providing support for such children are: ⅰ) to raise awareness of such children; ⅱ) to eliminate regional disparities; ⅲ) to provide professional training for NSTs specializing in developmental disorders; ⅳ) to train and re-educate assistant NSTs and ⅴ) to enhance infant screening.

Resilience Associated with Self-Disclosure and Relapse Risks in Patients with Alcohol Use Disorders.

BACKGROUND: The aim of this study was to clarify the self-disclosure and risks of relapse associated with promoting resilience of patients with alcohol use disorders (AUD) and participating in self-help groups. METHODS: An anonymous, self-administered questionnaire survey was administered to 48 patients with AUD and participating in self-help groups; this questionnaire consisted of basic attributes, a bidimensional resilience scale to assess both innate and acquired resilience factors, a scale to assess depth of self-disclosure, and a scale assessing relapse risks. We conducted an evaluation by dividing the respondents into a high group and low group based on their median values for both innate and acquired resilience. RESULTS: Innate/acquired resilience had a mutually reinforcing relationship, and, compared with the low resilience group, the high resilience group had significantly reduced risks for relapses and resulted in deeper self-disclosure. CONCLUSION: Patients with high resilience had lower risk of alcohol relapse and deeper self-disclosure. The results suggest that one way of supporting patients with AUD in recovery is assisting them in building personal relationships with others and in deepening self-disclosure in a setting where they can relax, thus promoting their natural ability to recover.

Physical and mental factors associated with obesity in individuals with mental disorders attending psychiatric day-care facilities.

BACKGROUND: Individuals with mental disorders have increased rates of obesity and metabolic syndrome. Here we evaluated factors influencing obesity in individuals with mental disorders who were attending psychiatric day-care facilities on an outpatient basis. METHODS: The subjects (n = 108) were outpatients attending hospital-based rehabilitation programs. We assessed body fat, weight, height, waist circumference, body mass index (BMI), blood pressure, Geriatric Depression Scale-15 (GDS) scores, frequency of day-care visits, satisfaction with body shape, physical comorbidity and lifestyle habits. Lifestyle habits were evaluated using Breslow's health index based on health-related choices. RESULTS: The subjects were divided into 2 groups: obese group (BMI ≥ 25 kg/m(2)) and non-obese group (BMI < 25 kg/m(2)). The physical parameters and attributes of both groups were compared, and factors related to BMI were statistically analyzed. The prevalence of obesity was 47.2% in all patients, 42.4% in males and 54.8% in females. Weight, waist circumference, body fat and systolic and diastolic blood pressure were significantly higher in the obese group than in the non-obese group. Body fat, waist circumference, systolic blood pressure and diastolic blood pressure exhibited significant positive correlations with BMI, whereas the frequency of day-care visits, satisfaction with body shape, GDS score and Breslow's health index exhibited significant negative correlations with BMI. CONCLUSION: The present results showed that the prevalence of obesity was high in outpatients with mental disorders. Improvement in lifestyle choices is necessary to prevent obesity and the onset of metabolic syndrome in such patients.

Pharmacokinetics and tissue distribution of tacrolimus (FK506) after a single or repeated ocular instillation in rabbits.

PURPOSE: The aim of this study was to investigate the ocular distribution of tacrolimus (FK506) and absorption into the systemic circulation after a single or repeated topical instillation of FK506 ophthalmic suspension in male New Zealand white rabbits. METHODS: In the single instillation study (group 1), 29.1-34.8 microL of a 0.1, 0.3, and 1% suspension was administered to each of the 15 rabbits. In the repeated instillation study (group 2), 27.1-39.5 microL of a 0.3% suspension was administered to 27 rabbits q.i.d. (i.e., at 3-h intervals) for 14 days. In the intravenous (i.v.) dose study (group 3), 1 mg/kg of FK506 was administered to 3 rabbits. The amount of FK506 was measured by using a competitive enzyme immunoassay. RESULTS: The results for single and repeated instillation studies were similar. In the single instillation study, blood T(max) after an instillation of the 0.1, 0.3, and 1% suspensions (at 0.8, 1.0, and 1.0 hours) did not differ significantly among these doses. One (1) h after an instillation of the 1% suspension, ocular tissue concentrations, except the retina/choroid, vitreous body, and lens, were higher than the blood concentration (C(max): 2.7 ng/mL). In particular, concentrations in the conjunctiva, cornea, iris, and anterior sclera were much higher than the blood concentration (148, 900, 120, and 145 ng/g tissue). In the repeated instillation study, concentrations in the blood and ocular tissues (except the lens) reached a steady state by the 7th day. In the i.v. dose study, AUC(0-24h) and T(1/2) were 1643 ng h/mL and 18.5 h, respectively. CONCLUSIONS: The high-level distribution of FK506 was observed in the conjunctiva, which is desirable because the conjunctiva is the target tissue for pharmacologic effect (i.e., efficacy).

[A case of Addison's disease presented with depression as a first symptom].

This report describes a 52-year-old male patient with idiopathic Addison's disease presenting depression as a first symptom. His psychomotor inhibition, depressive mood, sleep disturbances, general fatigue, muscular pain, and arthralgia were considered to be due to intense work in a stressful environment. Neither his physician nor his orthopedist found any physical disease. Therefore, he was diagnosed with endogenous depression by a psychiatric clinic, and antidepressants were prescribed. Antidepressants were not sufficient for improving his symptoms, and he was admitted to our hospital. Endocrine blood examination revealed primary adrenocortical insufficiency. Treatment with glucocorticoid induced rapid improvement in both the psychiatric and physical symptoms. It is well known that psychiatric symptoms occur in the progressive stage of Addison's disease. At present, however, the occurrence of psychiatric symptoms is very rare, mainly because of a decrease in the incidence of this disease or an increase in mild cases. In addition, Addison's disease presenting with psychiatric features in the early stage has the tendency to be overlooked and misdiagnosed. Thus, we suggest the necessity of blood work for ACTH and cortisol in the field of psychiatry.

[Efficacy of intervention with externalization therapy for eating disorders].

Externalization has been one of the effective methods in the fields of brief therapy, family therapy, and psycho-education in recent years. In this study, we investigated the efficacy of intervention with externalization at the first stage of therapy in 25 patients with eating disorders. The subjects consisted of 11 patients with anorexia nervosa (AN) and 14 with bulimia nervosa (BN). The Eating Disorder Inventory (EDI) was evaluated at the first session, the 10th session, and six months later. The obtained results showed intervention with externalization resulted in significant decreases in not only total EDI score but also all the EDI subscale scores. We also found that there were great differences between the EDI subscale scores of anorexia nervosa and bulimia nervosa patients. Therapy was significantly less effective for patients with anorexia nervosa than for those with bulimia nervosa, and much less effective for the restricting type of anorexia nervosa. In addition, all the EDI subscale scores were significantly decreased, irrespective of the complication of personality disorder. The efficacy of intervention with externalization continued for six months. Especially in patients with anorexia nervosa, there were significant decreases in the EDI subscale scores when compared with the scores in the 10th session. The present findings indicates that initial intervention with externalization is effective for treating eating disorders, regardless of the severity of illness.