Literature Review on Support for Children and Families Experiencing Parental Bereavement

Purpose: This study aimed to understand the actual nursing support in a wide perspective by reviewing overseas literature on support for children who have experienced parental bereavement and their families. The goal was to identify future challenges in nursing support in clinical practice in Japan. Method: Literature searchable as of May 2023 was retrieved using PubMed, resulting in 11 relevant articles. Result: The results revealed the following: 1) For support provided to children, 13 codes were condensed into 5 subcategories and 4 categories. 2) For support provided to families, 36 codes were condensed into 11 subcategories and 4 categories. Conclusion: Open communication was found to be essential for supporting children and their families who have experienced parental bereavement. Moreover, involvement of multiple professions facilitated the provision of specialized support to address diverse needs of children and families, playing a crucial role in overcoming grief. Additionally, the effectiveness of support systems for bereaved families highlighted the need for nursing professionals in Japan to gain knowledge through learning opportunities and to establish a multi-disciplinary approach to support, thus indicating future challenges in nursing support.

Experiences and Countermeasures of a Perinatal Ward Nursing Manager Dealing with Family Members’ Problematic Behaviors

Background: When family members and/or patients behave in a problematic way, this hinders the provision of safe and secure medical care. During the perinatal period, a family’s relationships and functions change significantly, and each family member is prone to experiencing stress. As such, conflict arises easily between family members and medical staff. Aims: Therefore, we conducted this study to shed light on the following phenomena: 1) family members’ problematic behaviors;2) the concerns of a perinatal ward nurse manager (hereafter referred to as the manager) and ward nurses;and 3) countermeasures carried out by the manager, together with the ward nurses, based on the manager’s experiences. Methods: We conducted an 80-minute, semi-structured interview with the manager, following which we analyzed the content of her narrated accounts. Results: According to the findings, 1) family members’ problematic actions include verbal abuse;arrogance, unreasonableness, and selfish behaviors;and violent conduct;2) the manager’s and ward nurses’ fears and worries about family members’ problematic behaviors;responses to gradually becoming involved with family members;and resistance to staying involved with family members following patient discharge. In addition, we examined 3) countermeasures carried out by the manager together with the ward nurses: resolute and consistent responses to family members’ problematic behaviors;attempted enforcement measures taken to deal with family members who exhibit problematic behaviors;engagement while trying to avoid conflict with family members;preparation that anticipates the occurrence of problematic conduct;cooperation with the medical team;cooperation with the hospital organization;cooperation with social resources outside the hospital;and patient protection. Conclusions: With awareness of cooperation with the medical team toward family members who engage in problematic actions, the medical staff members try to unify their response and share their feelings of hardship with each other.

Nurses’ Perception of Privacy in the NICU and GCU: A Qualitative Descriptive Study

Purpose: The purpose of this study was to identify the perceptions that determine the nursing practices of nurses working in NICU and GCU to protect the privacy of the affected children and their families, and the perceptions that arise in relation to their practices. Further to obtain information on current issues and future suggestions for nursing practice. Method: Semi-structured interviews were conducted with six nurses of Clinical Ladder I or higher currently working in the NICU and GCU, and content analysis was conducted. Result: The study identified five categories, 16 subcategories, and 63 codes: “keeping in mind to act in accordance with the characteristics of the NICU and GCU”, “trying to secure a space only for the affected children and families depending on the situation”, “feeling the need for consideration for the affected children and families”, “feeling puzzled and frustrated through the relationship with families”, “having a dilemma between the environment they want to realize for the affected children and families and the fact that it cannot be realized”. Conclusion: In considering nursing care in NICU and GCU, including consideration for privacy, the need to reflect on daily nursing care and share it with other staff members was suggested.

Assessment of Quality of Life, Family Function and Family Empowerment for Families Who Provide Home Care for a Child with Severe Motor and Intellectual Disabilities in Japan

Background: About 70% of Japanese children with severe motor and intellectual disabilities (SMID) live at home, and the number is increasing. Family members have an enormous burden of daily physical care for these children. A top priority is to understand quality of life (QoL), family function, and family empowerment to effectively support these families. We aimed to assess current living situations of families with a SMID child, and to reveal the relationships between QoL, family function, and family empowerment. Methods: Sixty-five family members from 34 families with a SMID child participated in this study. We assessed 5 parameters using the Japanese versions of the following instruments: World Health Organization Quality of Life 26 (WHOQOL26), Kinder Lebensqualitats Fragebogen (KINDL), Family Assessment Device (FAD), Family Adaptability and Cohesion Evaluation Scale KG-4 (FACESKG-4), and Family Empowerment Scale (FES). Correlation and multiple regression analyses were conducted;QoL score was the objective variable. Results: Participants included 54 parents (34 mothers, 20 fathers) and 11 siblings. The mean age of SMID children was 10.4 ± 5.03 years. Twenty-two children needed multiple types of medical care. The mean age of parents and siblings was 41.5 ± 6.16 years and 15.5 ± 2.35 years, respectively. The mean QoL score (3.28 ± 0.5) was similar to the Japanese average. The mean KINDL score (77.2 ± 12.1) was higher than those of previous studies. The mean FAD score was 1.97 ± 0.32. For FACEKG-4, the score of adaptability was correlated with WHOQOL score (r = 0.459, p < 0.05). The mean score of FES was 113.6 ± 14. As the result of multiple regression analysis, lower family FAD scores ([sb] = ?0.61, p < 0.01) indicated higher family function and greater age of participants (sb = 0.495, p < 0.01) was correlated with higher WHOQOL scores (F = 15.208, p < 0.01). Conclusions: Our results indicated that the individual QoL depended on the age of participants (equals the years of experience caring for a SMID child) and the recognition of family function as a whole. Thus, to improve family members’ QoL, we should focus on individuals and also approach the family as a whole.

Parenting Stress of Chinese Mothers Living and Child-Rearing in Japan and Related Factors

Background: Parenting stress causes physical and psychological problems for mothers during child-rearing and negatively impacts the growth and development of their children. We assumed that Chinese mothers living in Japan would experience particularly high levels of parenting stress and difficulty because they had to leave the environment in which they were born and raised in a different language and culture. Objective: The objective is to identify the actual situation and related factors of parenting stress among Chinese mothers in Japan. Methods: From July to October 2021, an online, anonymous, self-administered questionnaire was administered to the mothers of children aged 6 months to 5 years, and the data from 93 mothers were statistically analyzed. Results: Mothers in the study had one (45.2%) or two (45.2%) children in their care, and 23.7% of the mothers’ husbands were Japanese. The average score of total PSI-SF-15 of the mothers in this study was slightly higher than that of mothers raising children in China. Additionally, “I think it is a shame not to practice Chinese customs”, “I feel that Chinese customs are not respected”, “the number of children with diagnosed diseases”, “Social Support Rating Scale (SSRS) total score” and “father’s nationality” influenced the parenting stress of the mothers in this study. Conclusion: In order to reduce parenting stress among Chinese mothers in Japan, it is necessary to respect and support the practice of Chinese customs, create an environment in which it is easy to discuss children’s illnesses, and educate mothers to promote the use of social support.

Verbal Abuse, Physical Assault, and Harassment in Pediatric Medical Settings: A Nationwide Survey in Japan

Background: Verbal abuse, physical assault, and harassment of pediatric healthcare workers by patients and their families have become increasingly serious. These incidents lead to various problems, including the deterioration of staff members’ mental health and employee turnover. Methods: This study was conducted as the first Japanese nationwide survey to assess the abuse perpetrated by patients and families and experienced by medical staff in pediatric medical settings in 2018, countermeasures employed, and staff member evaluations of the countermeasures. Results: Responses from 526 facilities were received, clinics accounted for 79.8% of these facilities;88.1% of the respondents were females. Further, 10.5% of the facility staff reported having experienced verbal abuse, violence, or harassment from patients or family members. Of 1103 cases of victimizations, there were 719, 136, and 248 cases of verbal abuse, violence, and harassment, respectively. Manuals and guidelines had been created and training and drill performances were conducted as countermeasures in 10.7% and 9.0% of facilities, respectively;7.3% of staff members felt that the countermeasures were effective, corresponding to 45.6% of the affected staff. Conclusion: The findings suggest the necessity of thoroughly familiarizing staff with existing facility countermeasures as well as introducing new countermeasures such as victimization simulations.

Roles and Hopes of Family Members Living with SMID Children in Japan

The number of children with Severe Motor and Intellectual Disabilities (SMID) receiving medical treatment/recovering at home is rising yearly. Although benefits of this care are emphasized, the stress and duties of family members in the household are extremely great, especially because Japan is becoming a society of nuclear families. In this study, we described the lifestyles of nuclear families providing in-home medical care for children with SMID, focusing on family members’ roles. Roles of mothers, fathers, and siblings of children with SMID were summarized from semi-structured inter-views. As a result, for “the roles of each family member living with a child with SMID”, mothers had five roles, fathers seven, and siblings five. For “the hopes of each family member living with a child with SMID”, parents desired the whole family collaboration in care for children with SMID, and as caregivers, parents’ common thoughts included wanting siblings in order to help care for the child with SMID and wanting siblings to treasure their own lives. Siblings wanted their mother to have some time for rest and expected their fathers to have two main roles. They also expected their grandparents and other siblings to fulfill roles.

Development of a Training Textbook for Countermeasures to “Verbal Abuse, Physical Assault, and Harassment in Pediatric Medical Settings”

Background: Recently, abuse, assault, and harassment in pediatric medical settings have become more serious. We extracted typical problems from a nationwide simultaneous survey on abuse in the pediatric medical field and developed a training textbook to simulate or discuss these issues with colleagues. This study aimed to confirm the validity and usability of the contents of this training textbook. Methods: The textbook was mailed to the heads of 51 medical institutions affiliated with the Society of Ambulatory and General Pediatrics of Japan (SAGPJ) and the participants of the SAGPJ online workshop, who were asked to evaluate the textbook using a three-point scale to answer the following questions and provide opinions and impressions about the textbook. Q1. Do you think the whole content and structure of this textbook are useful? Q2. Would you use this textbook as a training textbook for all staff at your facility? A simple tabulation was performed on the evaluation using a three-point scale, while content analysis was performed on the opinions and impressions of the participants. Results: In response to Q1 and Q2, all 63 staff members from 55 facilities answered “3: Yes.” Opinions and impressions on the training textbook included “I think it can be used for workplace training” and “it is useful for exchanging various opinions among staff members and gaining a common opinion.” Conclusion: We developed a training textbook on abuse, assault, and harassment in pediatric medical settings based on a nationwide survey and confirmed the validity and usability of its contents.

Family empowerment and quality of life of parents raising children with Developmental Disabilities in 78 Japanese families

Objectives: The families of these children experience distress both at the time of diagnosis and afterward.A top priority is to understand family empowerment,family function,and family members' quality of life (QoL) and to effectively support these families in Japan.The objective of this study was to assess the actual conditions of families living with children having DDs and to explore the factors associated with family empowerment and parents' QoL.Methods: We surveyed ninety-three parents (78 mothers,15 fathers) from 78 families which lived with children with DDs in the capital region of Japan.We assessed two main outcomes using the Japanese versions of the following instruments: Family Empowerment Scale (FES),World Health Organization Quality of Life 26 (WHOQOL26),and other six outcomes.Correlation and multiple regression analyses were conducted.Results: No medication,cooperation with child rearing,assistance from a developmental support center,solved problems related to child rearing,and higher scores in Problem Solving contributed to higher FES scores.Higher WHOQOL26 scores were related to being a full-time housewife,higher self-esteem,no developmental support,a broad emotional support network,higher scores in Problem Solving and Role Function,and lower scores in Affective Reaction and General Function.Conclusions: We revealed that family empowerment and QoL of parents rearing children with DDs in Japan were affected by various subscales of family function and other family attributes.Effective interventions for improving family empowerment and QoL should be researched in the future.

Family empowerment and associated factors in Japanese families raising a child with severe motor and intellectual disabilities

Objectives:Family caregivers raising children with severe motor and intellectual disabilities(SMID)experience the enormous burden of care.The concept of family empowerment is one of the important assessment indexes of family nursing from the perspective of providing comprehensive support for these families.The objective of this study was to identify the factors associated with the empowerment of families raising a child with SMID in Japan.Methods:We conducted a nationwide questionnaire survey involving 1659 primary caregivers raising a child with SMID through 89 special schools.We assessed the main outcomes using the Family Empowerment Scale(FES).We then conducted a multiple linear regression analysis to reveal the factors associated with family empowerment.Results:In total,1362 primary caregivers were included in our study.Our results show that factors contributing to high FES scores are higher age of the primary caregiver,higher education,greater recognition of regional support,lower childcare burden,higher utilization of home visit services,higher usage of a childcare institution,higher household income,and stronger family bonding.Conclusion:Healthcare professionals should carefully assess the state of family empowerment of the primary caregivers who are younger and those who have low education,low household income,high childcare burden,and fragile bonding with the family.Second,they should encourage such families to use regional support resources for childcare.That is,policy makers should consider ways to promote home visits and institutional services for the care of children with SMID,aiming especially for the provision of well-coordinated care and services.

Empirical Study on the Empowerment of Families Raising Children with Severe Motor and Intellectual Disabilities in Japan: The Association with Positive Feelings towards Child Rearing

Background: “Children with severe motor and intellectual disabilities” refers to children with markedly limited activity due to severe overlapping of physical and intellectual disabilities. The physical and mental burden placed on families raising severely disabled children, particularly the primary caregivers, is great in home settings. For families to effectively utilize services and over-come child rearing problems, the families themselves need the “strength” to cooperate with others for the purpose of raising a severely disabled child. The ultimate goal of family support is to enable such families to achieve satisfaction and self-growth in child rearing. Methods: We used a questionnaire to survey 75 primary caregivers to empirically elucidate the empowerment and positive feelings towards child rearing of families raising children with severe motor and intellectual disabilities and the related factors. The t-test and Spearman’s rank correlation coefficient were used to examine the association with bivariates. A multiple regression analysis was conducted for empowerment and positive feelings. Results: Results revealed that life events, livelihood, awareness of social support and the child’s sleep problems were factors related to empowerment. Of these, awareness of social support from outside of the family was found to contribute the most to empowerment. Furthermore, improvement and maintenance of positive feelings towards child rearing reaffirmed the existence of empowerment in addition to reducing negative feelings towards child rearing and ensuring social support. Conclusions: Raising children with severe motor and intellectual disabilities requires specialist knowledge and skills. Support from professionals to empower the entire family is therefore important in order to strengthen positive feelings towards child rearing.

Factors Affecting Japanese HPV-Vaccination: Findings from the Semi-Structured Interviews with Adolescent Girls and Caregivers

The objective of the present study was to qualitatively assess the obstructive and facilitative factors affecting adolescent girls and their caregivers when the adolescent had received or was considering receiving the Human Papilloma Virus (HPV) vaccination. Using these data, we propose recommendations for medical and nursing staff concerned with HPV vaccination. Participants were 20 adolescent girls (aged 10 - 19 years) and their caregivers, who had visited any of the 3 pediatric clinics in the Tokyo metropolitan area during a specified period since HPV vaccination began in Japan. The girls and their caregivers were separately interviewed by 2 child and/or family nursing care specialists with a semi-structured interview. The responses were qualitatively analyzed by 2 specialists, and the obstructive and facilitative factors affecting participants’ decision to receive HPV vaccination were extracted from the responses. Among the 20 sets of participants, 7 adolescents had completed HPV vaccination, 9 were going to receive vaccination, and 4 had not received any vaccination. The obstructive/facilitative factors related to considering or receiving HPV vaccination and actual vaccination were extracted and 4 main categories of factors were identified. Facilitators toward HPV-vaccination of daughters included clear future self-image and visions, fear Cervical Cancer (CC) and desire to escape from CC, having discussion with mothers about HPV-vaccination and CC, and to have a boyfriend. Barriers toward vaccination included the mothers’ reluctance to explain the sexual matters about HPV-vaccination to their daughters and difficulty with find the appropriate clinic or hospital to HPV-vaccination. Relevant factors about vaccination included positive family attitudes toward vaccination, having family system allowing consultation and having a public financial support for vaccination for daughters. Our conceptual model adapted from the Katz, et al. conceptual framework integrated the key barriers and facilitators as factors within each of four domains. These four domains have an important link. Especially, the environmental factors and the structural and sociocultural factors domain affect the individual adolescent and the caregiver factors domain, respectively. The results of present study suggest that medical/nursing activities centered on promoting HPV vaccination in Japan should comprehensively cover CC/vaccination/sex education in an integrated fashion, while schools and public health centers should provide opportunities for caregivers and adolescents to jointly participate in awareness education on HPV vaccination.

Work Engagement of Nursery School Nurses and Its Related Factors in Japan

Purpose: This study aimed to clarify nursery school nurses’ work engagement and their pertinent related factors. Method: We conducted a survey of 136 nursery school nurses using an anonymous, self-administered questionnaire. Questionnaires were distributed to 186 people at licensed daycare centers in Ibaraki Prefecture. The following conclusions were obtained by analyzing 136 participants, excluding deficiencies: A multiple regression analysis (forced entry method) was performed. Results: The survey results show that most of the nurses in the nursery school were female, about 90$ were married, and about 70$ had children. Work engagement was generally high compared with other occupations. Moreover, it was influenced by their work-self balance (positive), the meaning of their work, and the leadership of bosses. It was suggested that there is a need for an environment where nurses can maintain a work-life balance, a place where childcare health activities can be carried out, and opportunities to participate in training and liaison meetings for nursery nurses to further enhance work engagement. Conclusion: It was influenced by work self-balance (positive), the meaning of their work, and boss leadership. It is suggested that nursery nurses further enhance their work engagement, and they need an environment where they can maintain a work-life balance, a place where they can engage in health activities in childcare, and opportunities for training and liaison meetings.