Development and Psychometric Evaluation of a Japanese Version of Newly Graduated Nurses' Difficulties with End-of-Life Care for Cancer Patients (NDEC Scale).

(1) Background: End-of-life care (EoL care) for cancer patients is stressful for nurses and can easily lead to burnout. Newly graduated nurses (NGNs) have a particularly difficult time, but no scale or inventory has been designed to evaluate their difficulties. This study developed and tested the reliability and validity of a scale to measure NGNs' difficulties with EoL care for cancer patients (NDEC scale). (2) Methods: This study population consisted of 1000 NGNs and 1000 nurses with at least five years of clinical experience (GNs) that were working in hospitals in Japan. The initial scale consisted of six factors and 28 items. The reliability and validity of the scale were tested. (3) Results: A total of 171 NGNs and 194 GNs responded to the survey. The scale consisted of five factors and 25 items with the factors including "Feeling painful", "Can't deal with patients and their families", "Don't know the answer", "Cannot afford", and "Being afraid of death". The criteria validity, known population validity, and internal consistency were confirmed. (4) Conclusions: The scale was validated to have a certain level of reliability and validity. The NDEC scale is expected to be used for self-care for NGNs and as an effectiveness indicator for educational programs.

Compliance of Static Stretching and the Effect on Blood Pressure and Arteriosclerosis Index in Hypertensive Patients.

Background: Treatment of high blood pressure is a combination of lifestyle changes and medications, and appropriateexercise therapy is recommended as one of the lifestyle-related changes. Recently, stretching, a low-intensity exercise, was reported to be antihypertensive and effective for improving arteriosclerosis, in addition to aerobic exercise. The present study investigated the short-term effects of continuous stretching and rest-induced rebound on vascular endothelial function in hypertensive patients. Methods: This study was conducted as a single-arm prospective interventional study including patients between 30 and 70 years of age undergoing treatment for hypertension from October 2019 until May 2021. The intervention consisted of six months of daily stretching, one month of rest, and another three months of stretching. We measured arteriosclerosis indices such as cardio ankle vascular index (CAVI), ankle brachial pressure index (ABI) and reactive hyperemia index (RHI), and flexibility at the baseline and one, three, six, seven, and ten months from the baseline. Results: We included a total of ten patients (three males and seven females) with an average age of 60.10 ± 6.05 years. The exercise rate for the entire period was 90% or more, and the anteflexion measurement value improved significantly before and after the intervention (p < 0.001). Blood pressure and CAVI/ABI were well controlled throughout the study period. RHI did not show any significant improvement during the initial six months, and only slightly improved by the third month (p = 0.063). Even after the rest phase and resumption of stretching, RHI remained stable. Conclusions: The compliance of the stretching program we used, evaluated by the exercise implementation rate for the entire period, was 90% or more; therefore, easy to perform and continue by hypertensive patients. However, we did not observe a significant positive effect on arteriosclerosis index or blood pressure in this study.

Skeletal Muscle Index at Intensive Care Unit Admission Is a Predictor of Intensive Care Unit-Acquired Weakness in Patients With Sepsis.

BACKGROUND: Intensive care unit-acquired weakness (ICU-AW) can be diagnosed using the Medical Research Council (MRC) score. However, such scoring may not be possible in ICU patients who may be sedated or delirious or have encephalopathy. Currently, a quantitative assessment of the cross-sectional area of the muscle is available to assess changes in skeletal muscle mass using computed tomography (CT) images. This assessment calculates the skeletal muscle index (SMI) (cm2/m2) by dividing the cross-sectional area (cm2) of the skeletal muscle at the level of the third lumbar vertebra by the square of the patient's height (m2) on CT. This study assessed the effectiveness of SMI, as measured by abdominal CT scans, in predicting the onset of ICU-AW in patients with sepsis admitted to the ICU. METHODS: We examined septic ICU patients admitted to the Niigata University Hospital ICU during 2012 - 2017 under mechanical ventilation. Patients were retrospectively divided into two groups by MRC score at ICU discharge: group AW comprised patients with an MRC score < 48, and group non-AW (NAW) comprised the remaining patients. Clinicopathological factors at ICU admission such as age, gender, underlying disease, body mass index, and SMI were compared between the two groups. Statistical analyses were performed using the Mann-Whitney U test, Fisher's exact test, receiver operator characteristic (ROC) analysis and multivariate analysis. RESULTS: A total of 31 septic patients were examined, and 23 patients met the criteria for ICU-AW. The prevalence of women was significantly higher in group AW (P < 0.05). All clinical factors, except for gender, were not significantly different between the two groups. SMI was significantly lower in group AW than in group NAW (P < 0.05). ROC analysis revealed that the cut-off value of SMI for predicting ICU-AW was 44.1, and the multivariate analysis revealed that only low SMI was a significant factor in predicting ICU-AW (P < 0.05). CONCLUSIONS: Our results show that SMI measurement at ICU admission is a valid predictive factor for ICU-AW progression in septic patients.

Consensus development of quality indicators for end-of-life care for elders in Japan.

AIMS AND OBJECTIVES: Quality indicators for end-of-life care have been published; however, none have been developed specifically for nursing in the cultural and traditional context of Japan. This study aimed to develop and build a consensus of quality indicators for end-of-life care for elders in Japan from the perspective of nursing science. METHODS: To develop the quality indicators, we used a literature review, expert panel process, and the Delphi technique among clinical nurse specialists in geriatrics. RESULTS: Quality indicators were identified in 7 major areas: advance directives and surrogate continuity, ethical daily care, care preferences and decisions about life-sustaining treatment, assessment and management of pain and other symptoms, daily care for the dying, family care, and institutional systems for end-of-life care. CONCLUSIONS: These quality indicators represent the first attempt to develop a best practices approach toward improving the quality of elderly end-of-life care in nursing.

Nurse education program on meaninglessness in terminally ill cancer patients: a randomized controlled study of a novel two-day workshop.

BACKGROUND: Fostering patients' sense of meaning is an essential task for palliative care clinicians. Few studies have reported the effects on nurses of a short-term training program aimed at improving skills to relieve feelings of meaninglessness in terminally ill cancer patients. OBJECTIVE: The primary aim of this study was to determine the impact on nurses of a novel two-day education program focusing on care that addresses patients' feelings of meaninglessness. Measured were impacts on nurses' confidence, self-reported practice, attitudes toward caring for such patients, burnout, meaning of life, and knowledge. METHODS: This study was a randomized controlled trial using the waiting list control. Intervention consisted of a two-day interactive education program. A total of 76 nurses randomly allocated to two groups completed the study. Outcome measures included confidence scale; self-reported practice scale; scales of nursing attitudes toward caring for patients who experience feelings of meaningless (willingness to help, positive appraisal, helplessness, nurse-perceived value of being, and nurse-perceived value of patients' inner power); Maslach burnout scale, Functional Assessment of Chronic Illness Therapy-Spiritual, and knowledge scale. RESULTS: There were significant intervention effects in nurse-reported confidence and nurse-perceived value of patients' inner power. Nurse-reported helplessness showed marginally significant improvement after intervention (p=0.067). No significant intervention effects were observed in the self-reported practice scale; attitudes toward caring for patients (willingness to help, positive appraisal, and nurse-perceived value of being); burnout scale, meaning of life; and knowledge score. The percentages of nurses who evaluated this program as useful or very useful were 95% (understanding the conceptual framework) and 85% (helping to learn how to provide care for patients feeling meaninglessness in clinical practice). CONCLUSION: This short-term educational intervention had a significant beneficial effect on nurses' confidence and modest effects on attitudes.