General Ward Nurses' Self-Efficacy, Ethical Behavior, and Practice of Discharge Planning for End-Stage Cancer Patients: Path Analysis.

General ward nurses play a key role in discharge planning for end-stage cancer patients. It is necessary to assess the factors regarding their practice to promote discharge planning in accordance with end-stage cancer patients' wishes. This study aimed to investigate the relationships between general ward nurses' practice of discharge planning for end-stage cancer patients, self-efficacy, ethical behavior, attitude, knowledge and experience, perceived skills, and perceived barriers. A total of 288 general ward nurses from nine hospitals in a city in Japan completed the questionnaire. Path analysis was conducted to test the hypotheses. The results showed that nurses' self-efficacy, ethical behavior (do-no-harm, do-good), knowledge (experience of attending home care seminars), and perceived skills (assertiveness) were positively and directly related to the practice of discharge planning. Nursing experience and perceived skills (assertiveness) were positively associated with discharge planning practice, while perceived barriers (death discussion) and attitude (degree of leaving it to discharge planning nurses (DPNs)) were negatively associated, with self-efficacy acting as a mediator. Thus, our findings show that it is important to enhance self-efficacy and nursing ethical behavior to improve the practice of discharge planning. Accordingly, education regarding home care, assertive communication skills, death discussion, and ethics is needed for general ward nurses.

Efficacy and Practicality of Opioid Therapy in Japanese Chronic Noncancer Pain Patients.

BACKGROUND: Many Japanese adults suffer from chronic pain. However, 50% of these individuals discontinue treatment despite the persistence of pain. Both clinicians and patients in Japan tend to be concerned about the safety and efficacy of opioid therapy, and the use of opioids in chronic non-cancer pain remains less common in Japan than elsewhere. AIMS: This study examined the effects of opioid therapy on the daily lives of patients with chronic noncancer pain in Japan, where use of opioids for this type of pain remains uncommon. DESIGN: Prospective cross-sectional questionnaire study. SETTING: Data were collected over two periods, between March and April 2014 at one hospital, and between February and April 2015 at the other hospital. Subjects were recruited at the respective clinics by the study interviewer between March 1, 2014 and April 15, 2014 and between February 1, 2015 and April 15, 2015. PARTICIPANTS/SUBJECTS: This study included 34 outpatients with chronic non-cancer pain who were being treated with opioid analgesics at pain clinics in two hospitals in Sapporo. METHODS: Thirty-four Japanese patients receiving opioid medications for chronic noncancer pain in outpatient pain clinics were enrolled. Participants underwent interviews and completed the Japanese versions of the Short Form 36 (SF-36v2) and the Coping Strategies Questionnaire (CSQ). RESULTS: Sleep disruption, claiming compensation for work-related accidents, and current pain level were negatively correlated with opioid effectiveness (p < .05). Additionally, opioid effectiveness was negatively correlated with the catastrophizing subscale of the CSQ (r = -0.50, p < .01). The effects of opioid therapy had a low positive correlation with the emotional functioning role subscale of the SF-36v2 (r = 0.38, p < .05). Daily equivalent morphine dose was positively correlated with opioid therapy duration, interference with appetite, and current pain intensity. Morphine dose was also positively correlated with scores for the catastrophizing subscale of the CSQ (r = 0.36, p < .05) and negatively correlated with scores in all subdomains of the SF-36v2. CONCLUSIONS: It is important to focus on adaptive, cognitive, and emotional factors, such as emotional role functioning, to determine the efficacy of opioid treatment for chronic noncancer pain. Moreover, patients with catastrophizing significantly increased their morphine doses, resulting in an increased risk of overdose.

Social capital in Japan: What characteristics do public health nurses see in their communities?

AIM: A concept of social capital that accounts for a community's cultural background and incorporates social capital into public health nursing practice are needed. This study aimed to describe the characteristics of social capital in the context of public health nursing in Japan. METHODS: The study interviewed 11 veteran public health nurses from five municipalities across Japan and undertook a qualitative research analysis. A digital voice recorder was used to collect qualitative data by using a background data sheet and semistructured interviews. Trustworthiness in interpreting the data was ensured by conducting 13 additional interviews with residents and collating the two sets of results. RESULTS: All the participants were female: 10 were veterans with ≥15 years' experience. Nine worked in management. The methods yielded six categories: (i) the richness of the interactions among the residents; (ii) the community residents who showed concern for those in need; (iii) community civic activities; (iv) the residents' willingness to contribute to the community; (v) the health promotion volunteers who work alongside the public health nurses; and (vi) an enriched community environment. CONCLUSION: The results contribute to an understanding of social capital in the context of public health nursing activities and further research on social capital. It also is discussed how social capital can be incorporated into public health nursing activities in the future.

Identifying the contents of a type 1 diabetes outpatient care program based on the self-adjustment of insulin using the Delphi method.

AIM: The objective of this study is to identify the items necessary for an outpatient care program based on the self-adjustment of insulin for type 1 diabetes patients. METHODS: Two surveys based on the Delphi method were conducted. The survey participants were 41 certified diabetes nurses in Japan. An outpatient care program based on the self-adjustment of insulin was developed based on pertinent published work and expert opinions. RESULTS: There were a total of 87 survey items in the questionnaire, which was developed based on the care program mentioned earlier, covering matters such as the establishment of prerequisites and a cooperative relationship, the basics of blood glucose pattern management, learning and practice sessions for the self-adjustment of insulin, the implementation of the self-adjustment of insulin, and feedback. The participants' approval on items in the questionnaires was defined at 70%. Participants agreed on all of the items in the first survey. Four new parameters were added to make a total of 91 items for the second survey and participants agreed on the inclusion of 84 of them. CONCLUSION: Items necessary for a type 1 diabetes outpatient care program based on self-adjustment of insulin were subsequently selected. It is believed that this care program received a fairly strong approval from certified diabetes nurses; however, it will be necessary to have the program further evaluated in conjunction with intervention studies in the future.