Characteristics of Patients with Decreased Cognitive Function Undergoing Treatment for Acute Exacerbation of Chronic Heart Failure—Basic Survey for Standardization of Nursing to Prevent Discontinuation of Treatment

The purpose of this study is to clarify the characteristics of patients with decreased cognitive function undergoing treatment for acute exacerbation phase of chronic heart failure as a basic survey with a view to the standardization of nursing to prevent discontinuation of treatment of patients with declining cognitive function in the acute exacerbation phase of chronic heart failure. As the first stage of the research, using the interview guide created based on the background of discontinuation of treatment and symptomatic monitoring from 33 target literature sources, seven certified chronic heart failure nurses and 15 certified dementia nurses were given semi-structured interviews. Data obtained from the interviews was analyzed by qualitative induction. As a result, we obtained opinions/views on 8 situations namely, “cognitive function at hospitalization”, “characteristics at hospitalization, “characteristics when receiving examinations, procedures or treatment”, “characteristics of course of treatment”, “characteristics related to difficulties in grasping the symptoms of chronic heart failure and indices of deterioration”, “characteristics when using diuretics”, “characteristics concerning compliance with dietary restrictions” and “support required for discharge from hospital” concerning patients with declining cognitive function. In the future, it is necessary to prepare nursing protocols incorporating these contents for standardization of nursing.

Development of the Irrational Belief Test for Nurses (IBTN): Examination of Reliability and Validity

[Purpose]: The purpose of this study is to develop irrational belief test for nurses, and to examine reliability and validity. [Method]: In study 1, The Irrational belief test for nurses was developed based JIBT-20 (mori et al., 1994) of previous studies. And for the nurse (N = 96, 5 male, 91 female), carried out preliminary investigation, created the provisional version of the Irrational belief test for nurses, and examined factor structure and internal consistency. In study 2, for the nurse (N = 541, 21 male, 520 female) examined validity based on JIBT-20 (Japanese Irrational Belief Test), MBI (Maslach Burnout Inventory), ATQ-R Japanese version (Automatic Thoughts Questionnare-Revised), and for the nurse (N = 91, 3 male, 88 female) examined a test-retest reliability four weeks afterward before long. [Result]: As a result of the explanatory factor analysis by a maximum likelihood estimation and promax rotation, 28-item 7 factors were extracted and was named a “patient belief”, “self-expectation”, “avoidance”, “self-inhibition”, “Ethical blame”, “helplessness”, and “dependence”. Moreover, as a result of conducting confirmation factor analysis, the hypothetical model obtained by explanatory factor analysis fitted (GFI = 0.89, AGFI = 0.86). About the reliability of the measure, a Cronbach’s alpha coefficient is 0.68 - 0.82, and a test-retest reliability is 0.64 and reliability is affirmed. About construct validity was checked correlation with JIBT-20, and about criterion validity was checked the correlation with MBI and ATQ-R Japanese-translation version. [Conclusion]: It is suggested that reliability and validity are verified and the irrational belief test for nurses is a useful measure. The developed test can be used to measure the irrational belief in the context of burnout in nurses.

36-Month Follow-Up Study of Post-Intervention Chronic Heart Failure Patients

Aim: Although numerous studies of disease management and case management of chronic heart failure (CHF) have been carried out, length of effectiveness after program commencement has not been examined, so we examined a follow-up study at 36 months after program commencement. Methods: Participants went for follow-up visits to one Japanese clinic which specializes in internal cardiovascular medicine and they were given diagnoses of CHF. 104 outpatients participated in this study and randomized control trial was implemented. An educational program was implemented for 6 months. The data were collected at baseline, 3, 6, 9, 12 months from both intervention and control groups and at 24 and 36 months from the intervention group. Results: There was significant improvement in New York Heart Association (NYHA) in the intervention group between baseline and 36 months. Improvement in weight monitoring and activities or exercise in the intervention group continued up to 36 months. Meanwhile, sodium restricted diets and quitting smoking and/or drinking depended on individual preference and it was difficult to make improvements in these areas. Conclusions: The educational program showed promise in preventing CHF outpatients from deteriorating significantly on a long-term basis as self-monitoring of activity and weight continued significantly and there were no participants with CHF who deteriorated in the intervention group at 36 months after program commencement, although the program aimed only to provide illness and self-management knowledge. On the other hand, future work will need to compare participants in this program to a control group over an extended period of time with consideration for relieving the burden of the control group.

The Effect of the Group Cognitive Behavior Therapy in a Nurse’s Burnout and Intention to Resign

Purpose: The purpose of the present study was to decrease burnout and intention to resign by practicing cognitive behavioral approach to nurses of the 3 years nursing clinical experience. Methods: Nurses (N = 180) who worked at acute-care hospitals and whose clinical experience was 3 years were requested. Nurses (n = 95, male 5, female 90) who were able to do participation at all the sessions were objects. The program was created and carried out for a nurse’s burnout with reference to cognitive behavior therapy. Evaluation of intervention was asked to complete a questionnaire that measured burnout (MBI), job stressors (NJSS), automatic thoughts (the shorter version of Japanese version ATQ-R), Irrational Belief Test for Nurses (IBTN), coping measure and whether or not they had an intention to resign. Measurement was performed 3 times of a baseline, after the end of session and follow-up. Analysis of covariance which adjusted the baseline level was performed. Result: According to the results, “helplessness”, “positive thinking” and “personal accomplishment” were significant (p < 0.01). According to the results of Friedman test, significant difference was observed in “emotional exhaustion” in the group with low degree of irrational belief (p < 0.10 ) and in the group with high degree (p < 0.05). With regard to the intention to leave the job, “wants to continue working as a nurse” was significant in the group in 3 months after intervention (p < 0.05). Conclusion: It is suggested that cognitive behavioral approach appears to be effective for reducing nurse’s burnout or intention to resign in nurses of the 3 years nursing clinical experience.

A Scale of Parental Anxiety about Pediatric Emergency Medical Care Services of Japan: Development, Reliability, Validity, Generalizability and Usefulness

Aim: The purpose of this study was to develop a scale, “parental anxiety about pediatric emergency medical care services” (PAPEMCS), and to evaluate its psychometric properties. Methods: Participants were 14,510 parents with children 6 years old or younger in Kagawa Prefecture. Using each half of the participants, exploratory factor analysis was performed to generate items and factors for the PAPEMCS, and confirmatory factor analysis (CFA) was used to establish the construct validity. The generalizability of the PAPEMCS was evaluated by congruence tests and multigroup CFA. The usefulness of the PAPEMCS was established by the relationship between the PAPEMCS and non-urgent usage of pediatric emergency medical care services (PEMCS). Results: The PAPEMCS compromised 4 factors: “anxiety about quality of PEMCS”, “anxiety about PEMCS system”, “anxiety about public support”, and “anxiety about private support”. All reliability estimates (polychoric ordinal alpha coefficients, item-rest correlations), the item discrimination, 5 fit indices for CFA, the convergent validity (indicator reliabilities, composite reliabilities, average variance extracteds), and the discriminant validity fulfilled the acceptability thresholds. All generalizability estimates fulfilled the predetermined levels of acceptability (Tucker’s congruence coefficients, congruence tests, strict factorial invariance). The usefulness of the PAPEMCS was established by the higher scores of the PAPEMCS being related to non-urgent usage of PEMCS. Conclusions: The PAPEMCS demonstrated satisfactory reliability, validity, generalizability and usefulness. The PAPEMCS is useful to quantify the contents and extent of parental anxiety about PEMCS, and to clarify the mechanisms of non-urgent PEMCS usage.

Structure of Professional Identity of Public Health Nurses Working for Governmental Agencies

Background: Public health nurses in Japan are nationally licensed professionals who act as members of local governments and provide services to local community residents. Public health nurses must establish their professional identity early on in order to deliver high quality public health services. However, the structure of their professional identity is not fully understood. Objectives: Our purpose was to investigate structures of professional identity of public health nurses working for governmental agencies, and to clarify characteristics of their professional identity. Methods: Questionnaire surveys were conducted on 670 PHNs working for local governmental agencies. The investigation items included measurement indices for professional identity of PHNs, basic attributes, and scales which reflect aspects of self-respect. After analyzing the investigated items, we conducted exploratory factor analysis. Also we named extracted factors, and investigated reliability and appropriateness. Relationships with the attributes or self-respect aspects were also analyzed. Results: Of 350 respondents (52.2%), 309 effective answers (effective answer ratio: 88.2%) were analyzed. Item and factor analyses identified 12 items, which were categorized into 3 factors: “intention to develop professionally”, “confidence in own abilities”, and “occupational affinity”. Scales of self-respect aspects and the index for professional identity showed positive correlation. The coefficient for all 12 items was 0.89. Significant difference with the attributes were noted for “age”, “years of experience as PHNs”, and “number of PHN in the workplace”. Conclusion: Professional identify of PHNs is found to be consisted of 3 factors.

Health Promotion and Life Course Dynamics: Transitions of Brazilian Elderly

Background: Understanding life transitions is important to help people to achieve their developmental needs. No studies have examined the patterns of responses to life transitions, eliciting the experiences of growing old of retired Brazilian older adults. Aim: To identify and describe the patterns of responses to life transitions of retired Brazilian older adults. Design: Using a theoretical perspective of transition as a guide, a qualitative, secondary narrative research design was incorporated to obtain data from 11 interviews. Method: Initial data collection took place during a broader study on the influence of people’s working life history. Eleven autonomous and independent persons, 64 - 82 years old, were interviewed at a geriatric outpatient unit in Rio de Janeiro to obtain their perceptions of old age. The secondary, narrative holistic-content analysis focused on the patterns of responses to life transitions. Results: The first turning point was a childhood event and the next was their first job. The third turning point was moving to another place/house or another city, the fourth starting a family, and retirement was the last turning point. Conclusions: While older people may feel environmentally disconnected throughout life, their patterns of response, together with the available resources and prevention/interventions influence the transition process. Health Promotion actions are needed at vulnerable points during the transition process, thereby facilitating the health outcomes.

Assessment of a portfolio as an effective tool to promote self-management among patients with ischemic heart diseases: A preliminary trial

Portfolio has been used as an approach to promoting self-learning in the field of education and its effectiveness was reported in school education. The purpose of this study was to assess effectiveness of portfolio as a tool for educating patients with ischemic heart diseases as self-management behavior in terms of applicability and efficacy. Subjects of this study were seventeen patients who had myocardial infarction or angina. They were assigned to collect information about their themes chosen from diet, exercise, alcohol intake, smoking cessation, and stress management and gathered in files. Thirty minutes face-to-face educational interviews were conducted by a nurse for once per month over three months. Self-management, self-efficacy, and physiological data were evaluated for baseline and 3 months. Two participants dropped within two months (completion rate is 88.2%). The results showed that portfolio was effective as a self-management education tool on patients who were willing to participate, but did not improve physiological data if they did not continuously implement lifestyle change. Moreover it was dangerous when the patients acquired incorrect information on diseases. For these patients, health education by health professionals is required prior to conducting portfolio. Attributes fit for portfolio were assessed. Effectiveness of portfolio related to high self-efficacy and high self-management, but did not relate to living status, having job, educational background, and health locus of control.

Development and Evaluation of Disease Management Program and Service Framework for Patients with Chronic Disease

We developed a disease management program and service framework to enhance the self-management skills of patients with chronic diseases for the first time in Japan. In this study, we analyzed the efficacy of this program. A single-group pre-test and post-test design was used. In the program, disease management nurses provided self-management education to patients that were specific for their disease and risk factors in cooperation with their primary physicians. The duration of the program was 6 or 12 months. A total of 1258 patients were enrolled. After excluding discontinued subjects, 987 patients in the diabetes program and 11 patients (except those with diabetic nephropathy) in the chronic kidney disease (CKD) program were analyzed. The diabetic patients showed improvement of HbA1c and blood pressure after intervention, as well as maintaining renal function. CKD patients showed no change of renal function after intervention, but there was improvement of non high density lipoprotein-cholesterol (HDL-c). The patients acquired the ability to detect at an early stage and respond to abnormal symptoms and data, which enabled them to avoid progression of their diseases and emergency hospitalization. The program was effective at preventing disease progression in patients with chronic illnesses and may contribute to the containment of medical costs.

Pain-Relieving Effect of Music on Preschoolers during Immunization: A Randomized Controlled Trial

Background: Immunization is a medical procedure many children frequently undergo. As it involves pain, it is important to develop effective pain relief methods that are applicable from infancy. Objective: To clarify the pain-relieving effect of music from speakers on preschoolers during immunization. Methods: A randomized controlled trial using sex-based stratified randomization was conducted at a Japanese pediatric clinic between October and December 2016, involving 48 preschoolers aged 5 - 6. Among these, 25 listened to music (“Twinkle Twinkle Little Star” played by a music box) from speakers before, during, and after influenza immunization (Music group), while the other 23 were not treated with musical intervention (Control group), with the following outcomes: primary: the Face Scale score;and secondary: the heart rate (HR) and oxygen saturation (SpO2) and salivary alpha amylase (sAA) levels. Results: The Face Scale score and HR of the Control group immediately after influenza immunization were significantly higher than their baseline values (P < 0.0001, P < 0.05). There were no significant differences between the Music and Control groups in the Face Scale score, HR, or SpO2 level immediately after influenza immunization or in the sAA level 10 minutes after it. Conclusion: Influenza immunization was painful for preschoolers. When based on the Face Scale score, HR, SpO2 and sAA levels as indices to measure immunization-related pain, music did not show pain-relieving effects.

Efficacy and Usability of an E-Learning Program for Fostering Qualified Disease Management Nurses

In order to train nurses to perform disease management and telenursing, we developed an e-learning education program, and assessed the efficacy. A single-group pre-test and post-test design was used. Nurses who worked at a medical institution or a disease management company were included, and the duration of the program was set 2 months. We developed the program so that it could grow attitude and improve knowledge and skills in disease management and patient education. Of 55 subjects, 48 who completed the program were analyzed. After the program, subjects increased knowledge and interests in disease management and patient education. Almost of the subjects answered that e-learning was a good learning method. Our program was effective at enhancing subject’s interests in disease management and patient education, and considered to improve their skills in the future.

Benefit of Using Sick Child Care Facilities to the Children and Their Parents

Introduction: Sick child care is a form of nursing care provided temporarily for sick children when they cannot be cared for by their parents at home. To clarify the benefits of using sick child care facilities for children and their parents, we surveyed these parents about the benefits of such care and their needs. Method: Study design: Descriptive research. We studied parents whose children had used one of the 11 sick child care facilities for sick children in Hiroshima City in 2014. A total of 156 parents consented to participate in the study. We investigated their usage situation of sick child care, perceived benefits of such care, and care-related requests in a quantitative and qualitative manner. Results: Both nuclear families consisting of the dual income parents and their children and single-mother households reported that their children (mean age: 2.46 years [SD: 1.77 years]) had used sick child care because of infectious diseases. Approximately 10% of the parents were using the fee reduction systems of sick child care intended for people with a low income. Parents viewed sick child care as beneficial both in early the health recovery of children, and as support for child raising and working. On the other hand, some parents left their children at home alone when sick child care was not available due to the limited number of sick child care facilities and an insufficient capacity to accept children. Some parents desired an increased number of care facilities, as well as a reduction in or subsidies for care fees. Conclusion: The results of this study suggest that, to ensure children’s health and safety, and support their parents for working and child raising, there is a need to increase the number of sick child care facilities along with expanding care services.

Prioritizing Strategies for Building the Resilience of Public Health Systems to Disasters Across Multiple Communities and Countries

The COVID-19 pandemic highlighted the urgent need to strengthen public health systems.In response,the United Nations Disaster Risk Reduction(UNDRR) Public Health System Resilience Scorecard(Scorecard) was applied in workshops across multiple countries.The aim of our research was to explore the workshop findings to develop priority strategies for strengthening public health system resilience.We conducted a workshop from 14 to 16 March 2023,at the UNDRR Global Education and Training Institute in Incheon,Republic of Korea.A sequential modified Delphi method was utilized to develop a set of prioritized resilience strategies.These were drawn from 70 strategies identified from 13 distinct workshops in eight countries.After two surveys,23 strategies were finalized.Ten received ratings of "High" or Very High" from89% of participants.These related to the inclusion of public health risks in emergency plans,integrating multidisciplinary teams into public health,enabling local transport mechanisms,and improving the ability to manage an influx of patients.The Scorecard provides an adaptable framework to identify and prioritize strategies for strengthening public health system resilience.By leveraging this methodology,our study demonstrated how resilience strategies could inform disaster risk reduction funding,policies,and actions.

Undiagnosed obstructive sleep apnea in hypertensive outpatients in primary care—Associations with sleep complaints, depressive symptoms and global perceived health

Objective: 1) To describe the prevalence of undiagnosed obstructive sleep apnea (OSA) and depressive symptoms in hypertensive men and women below 65 years of age, and 2) to describe the association of OSA to subjective sleep complaints, depressive symptoms and global perceived health. Design: Cross-sectional design focusing on nursing care outcomes of obstructive sleep apnea. Setting: Four primary care health centres in Sweden. PATIENTS: 411 consecutive patients (52% women), mean age 57.9 years (SD 5.9 years), with diagnosed hypertension (BP > 140/90). Main Outcome Measures: Prevalence of OSA and depressive symptoms, and association of OSA to sleep complaints, depressive symptoms and global perceived health. RESULTS: Mild, moderate and severe OSA was seen among 29%, 16% and 14% of patients, respectively. Depressive symptoms were seen in 16% of the total group, with a higher prevalence among men, compared to women, 21% vs. 12%. No differences were found regarding blood pressure, estimated sleep need, sleep sufficiency index, insomnia symptoms, daytime sleepiness or depressive symptoms with respect to different degrees of OSA. Apnea-hypopnea index was significantly associated to perceived health after adjustment for gender and comorbidities, but when depressive symptoms and non-restorative sleep were added to the model, 33% of the variance in global perceived health was explained. Conclusion: OSA is highly prevalent among patients with hypertension in primary care and does together with sleep complaints and depressive symptoms have a negative impact on global perceived health. Hypertensive patients without subjective sleep complaints or depressive symptoms may still have OSA.