Exploring tacit knowledge based on an expert nurse's practice for stroke patients.

This study explored tacit knowledge based on an expert nurse's practice who cares for stroke patients by using the hermeneutic phenomenological approach. The participant ('Ms. A') was a nursing researcher and college faculty member involved in the education of advanced practice nurses; her specialty was stroke rehabilitation nursing. She was asked to describe the meaning and value she gained from her memorable nursing experiences. Four interviews-approximately 1 h each-were conducted, and the associated data were interpreted together with the participant based on the method of interpretive circulation. Notably, the analysis was ended when a fusion of horizons was recognized. The participant recalled her nursing experiences based on six model cases. During the analysis, the following five elements were extracted: [belief in the ability of vulnerable people to survive]; [being together]; [respect for human dignity]; [preparedness to respond to and bear suffering together]; and [theoretical knowledge base approaches true understanding of patient experience]. Further, the nursing model-the Roy Adaptation Model-utilized by Ms. A in the process of recognizing humans as whole beings was deeply interpreted and implemented as a guideline for her implicit advanced practice. Moreover, her deep understanding and utilization of theoretical knowledge base also built the foundation for her implicit advanced practice. In conclusion, Ms. A's tacit knowledge and the elements support the process of tacit knowledge acquisition. Her narratives, hermeneutic attitude as an interpreter, and learning attitude throughout interaction with others will strongly help her knowledge development. We intend to continue the study with multiple participants and explore the structure of tacit knowledge possessed by advanced practitioners. Future endeavours will include the development of a tacit knowledge learning strategy.

Experiences of dialogue in advance care planning educational programs.

BACKGROUND: Advance care planning (ACP) is a process in which adults engage in an ongoing dialogue about future medical treatment and care. Though ACP is recommended to improve the quality of end-of-life care, the details of the dialogue experience in ACP are unknown. OBJECTIVE: To explore participants' experiences of dialogue in an ACP educational program that encouraged them to discuss the value of a way of life. RESEARCH DESIGN: This qualitative descriptive study used the focus group interview method. Data were analyzed using qualitative content analysis. PARTICIPANTS AND RESEARCH CONTEXT: A dialogue-based ACP educational program was conducted in four regions in Japan for local citizens to discuss the value of their way of life. A total of 66 individuals (mean age = 55.5 ± 17.2 years; 50 women and 16 men) participated in focus group interviews. ETHICAL CONSIDERATIONS: This study was approved by the Ethical Review Committee of Tokyo Women's Medical University (no. 4723) and Kyoto University (no. R2099). FINDINGS: Five main themes were extracted: discussing one's thoughts with others in a considerate manner, reflecting on one's way of life through others, feeling a sense of connection with others through storytelling, realizing the difficulties of talking about "what if" topics, and turning one's eyes toward the future through the dialogue. These themes were interrelated and illustrated the complexity of the experience of discussing values. CONCLUSIONS: The results suggest that dialogue in ACP is useful in clarifying values. They also indicated the need for dealing with the ethical challenges of discussing value and the importance of caring for the interlocutor to have a safe dialogue. In the ACP process, safety in dialogue may improve readiness in ACP, and health practitioners who support ACP need to address the ethical challenges entailing dialogue about values.

Trial and evaluation of assertion training involving nursing students.

BACKGROUND: The concept of assertion and conceptual/practical methods of assertion (assertiveness) training were originally developed in the United States and Europe. These principles were embraced and adapted in Japan in 1970's. However, only a few studies relating to assertion (assertiveness) have been undertaken thus far in Japan, especially so in the domain of nursing students in comparison with other countries. The purpose of this study was to design and implement assertion training with nursing students and to clarify its effects. METHODS: The participants were all volunteers, invited from a class of 3rd year nursing students. Ten students (intervention group) participated in the assertion training comprised of five sessions in February 2006. Fifty-six students (control group) were participated only in the questionnaire. Both groups were asked to complete the same questionnaire twice, before and after the assertion training. The questionnaire measured levels of assertiveness, social skills, self-esteem, social support and satisfaction with university life. The results and variances, both before and after assertion training, between the intervention group and the control group were analyzed. The effectiveness of the assertion training was determined by changes in pre and post training questionnaire scores. RESULTS: The scores for social skills in the control group had a tendency to decline while the scores for social skills in the intervention group remained constant. CONCLUSION: Although there were no statistically significant results in the intervention group, the present study highlights areas appropriate for further study.

Identifying structure and aspects that 'continuing nursing care' used in discharge support from hospital to home care in Japan.

This study investigated nursing practice in continuing nursing care with the aim of identifying the key factors in nursing practice during discharge support. A literature review of papers published in Japanese in 2000 and 2011 was conducted using 'case management', 'care management', 'continuing nursing care', 'discharge support', 'discharge planning' and 'elderly person' as key words. An analysis of 54 papers revealed the following five aspects of continuing nursing care: (i) a cyclical approach aimed at realising the lifestyle desired by the person concerned; (ii) management of medical conditions for lifestyle stability; (iii) support for the patient as someone who can live independently; (iv) support to raise the ability of families to care for themselves; and (v) team approach to achieve implementation of patient-centred care. Understanding these aspects allows nurses to recreate the lifestyle of patients and families and facilitate the implementation of a systematic team approach.

[Development of a learning outcome creation program to enhance the competence of public health nurses part of action research to contribute to the local community].

OBJECTIVES: In recent years, accompanying the increased diversification and growing seriousness of public health concerns, the duties demanded of nurses have been expanding and becoming more sophisticated. The objective of this research project was to assess a study achievement creation program to enhance the competence of public health nurses, etc., carried out in the curriculum for the first half of a graduate school doctorate course. METHODS: The program was developed undergoing a process of two test trials and corrections. The program's concept was "what I learn will contribute to tomorrow," and the program was composed of five group sessions during a four-month period and four individual interviews conducted between the group sessions. During this period, the participants clearly defined the problems seen in the field and their own themes of study to resolve them, and then worked toward attainment of achievement targets that they themselves had selected. The researchers, acting as study supporters, assisted to maximize the participants' study achievements. The targeted students were eight public health nurses who were enrolled in the program for the three semesters from October 2008 to March 2010, and included four graduate students and four others registered to complete the course. The program's outcome was assessed by measuring competence before and after program implementation, and process evaluation was conducted by ascertaining whether the participants had passed through three essential stages in their study: 1) awareness of the actual conditions and of the problems concerned; 2) implementation of an improvement plan; 3) confirmation of improvements. RESULTS: As a result of implementing the program, a certain degree of success, as indicated below, was verified. In the before-and-after outcome assessment, participant A exhibited a significant degree of advancement. Furthermore, the degree of satisfaction scores of the participants after program implementation were sufficiently high to conclude that results worthy of the costs expended were obtained. In addition, it was ascertained that the essential stages of passage, as indicated in the methodology, featured in the study process of the participants. CONCLUSION: In the future, this program may find application in graduate school education and for active service public health nurses by municipal governments or companies working in cooperation with universities and associations for public health nurses. Hereafter, areas that must be tackled in order to enrich the program include establishment of study support methods in response to diverse circumstances, development of educational materials and qualitative evaluation indicators and establishment of systems to train study supporters.

[Relationship between physical restraint in nursing homes and their institutional characteristics].

OBJECTS: To clarify relationship between physical restrain in nursing home and its institutional characteristics. METHODS: The subjects consisted of all 103 nursing homes in Okayama prefecture which were open in 2002 with a total of 6,829 residents. Data were obtained by questionnaire through the "Welfare ombudsman Okayama" in 2002 and audited by local government in the same year. We then performed multiple regression analysis. The parameter in question was the ratio of residents who were physically restrained to the residents at high risk of needing physically restraint (physically restrained ratio). Independent valuables were institutional characteristics. To increase the accuracy of estimation, we hypothesized that the residents likely to be the physically restrained were elderly with serious dementia who were defined as IV and over in the dementia elderly daily living independence rank. We also performed analysis with the definition of heavy dementia elderly graded as III and over. RESULTS: We obtained data of 72 institutes housing 1,700 elderly with serious dementia, which did not have any missing values. Of these 74% had at least one resident being physically restrained. The average physically restrained ratio was 24.2%. The institutional characteristics which correlated with use of physical restraint were intensive staffing, holding periodical care conference, and having unit care. The results were robust with regard to change in the serious dementia definition. CONCLUSION: The institutional characteristics which correlate with use of physical restraint are intensive staffing, holding periodical care conference, and having unit care.