Observation of Curative Effect of Surgical Nursing in Patients with Grade III Hand-Foot Syndrome

Objective: To investigate the effect of surgical nursing on grade III Hand-Foot Syndrome (HFS) induced by Doxorubicin hydrochloride liposome chemotherapy after breast cancer surgery. Method: From January 2019 to December 2019, 10 patients with HFS grade III caused by Doxorubicin hydrochloride liposome chemotherapy after breast cancer surgery in the Breast Department of Cancer Prevention and Treatment Center of Sun Yat-sen University were selected, and surgical nursing methods were used to intervene and observe the therapeutic effects of the patients. Results: One patient was cured within 7 days, the cure rate was 10% in 7 days, 8 patients were cured within 10 days, the cure rate was 80% in 10 days, 10 patients were cured within 15 days, the cure rate was 100% in 15 days. Conclusion: The surgical nursing method is effective for patients with grade III HFS caused by Doxorubicin hydrochloride liposome chemotherapy after breast cancer surgery, shortening the treatment time of HFS, and is worthy of clinical promotion.

Current Status of the Application of Surgical Specialty Nursing Quality Evaluation Indicators

This paper reviews the current status of the application of surgical specialty nursing quality evaluation indicators both domestically and internationally.It covers the related concepts,theoretical foundations,construction methods,construction fields,application research,and existing shortcomings of these indicators.It suggests that scholars and researchers in the nursing field in China should base their work on mature theories,use scientific research methods,and construct a quality indicator system that aligns with China’s surgical development,is practical,unified,suitable for the local context,and beneficial for the development of the surgical nursing discipline.

Effect of continuous nursing on rehabilitation of older patients with joint replacement after discharge

BACKGROUND Joint replacement is a common treatment for older patients with high incidences of hip joint diseases.However,postoperative recovery is slow and complications are common,which reduces surgical effectiveness.Therefore,patients require long-term,high-quality,and effective nursing interventions to promote rehabilitation.Continuity of care has been used successfully in other diseases;however,little research has been conducted on older patients who have undergone hip replacement.AIM To explore the clinical effect of continuous nursing on rehabilitation after discharge of older individuals who have undergone joint replacement.METHODS A retrospective analysis was performed on the clinical data of 113 elderly patients.Patients receiving routine nursing were included in the convention group(n=60),and those receiving continuous nursing,according to various methods,were included in the continuation group(n=53).Harris score,short form 36(SF-36)score,complication rate,and readmission rate were compared between the convention and continuation groups.RESULTS After discharge,Harris and SF-36 scores of the continuation group were higher than those of the convention group.The Harris and SF-36 scores of the two groups showed an increasing trend with time,and there was an interaction effect between group and time(Harris score:F_(intergroup effect)=376.500,F_(time effect)=20.090,Finteraction effect=4.824;SF-36 score:F_(intergroup effect)=236.200,Ftime effect=16.710,Finteraction effect=5.584;all P<0.05).Furthermore,the total complication and readmission rates in the continuation group were lower(P<0.05).CONCLUSION Continuous nursing could significantly improve hip function and quality of life in older patients after joint replacement and reduce the incidence of complications and readmission rates.

The Place of Nursing Theory in the Management of Post-Operative Infections in a Hospital Environment: Case of Cibitoke District Hospital

Introduction: Post-operative infections, such as surgical site infections (SSIs), are a significant concern in healthcare settings. Nurses play a crucial role in the prevention and management of these infections. The use of nursing theory could contribute to the prevention of SSIs. The aim of this study was to evaluate the role of nursing theory in the management of surgical site infections (SSIs) in a hospital environment. Method: A cross-sectional study was conducted using descriptive and analytical methods to assess the role of nursing theory in the management of Post-operative infections (POI) in a hospital setting in October 2023. The study population consisted of nurses working in the Surgery, Emergency, and Maternity units at Cibitoke District Hospital. A sample size of 71 nurses working full or part time in the Surgery were invited to participate in this study. A questionnaire was used to collect the data, and SPSS version 21.0 software was used for analysis. Results: The study found that nursing theory did not have any statistically significant place in the management of POI (p-value = 0.523). However, the results showed that experience was the only significant factor influencing the management of POI (p-value = 0.004). This is explained by the analysis of the net effects of the explanatory variable where we noticed that those who had more experience were more likely to manage post-operative infections. The participants’ knowledge regarding nursing theory in the management was poor as they scored less than 30% in all the variables used to measure their knowledge. Conclusion: The study revealed that nurses’ knowledge of nursing theories and their applications in the management of SSIs was poor. Continuing professional development, curriculum review, and in-service training were highly recommended.

Nursing of a patient with multiple primary cancers: A case report and review of literature

BACKGROUND Although the occurrence of multiple primary cancers(MPC)is not exceedingly common,it is not rare in clinical practice.In recent years,there has been a notable increase in its incidence.The frequent confusion between MPC and tumor metastasis or recurrence often leads to delays in diagnosis and treatment.This study aimed to enhance understanding of MPC,improve diagnostic accuracy,guide precise clinical treatment,and implement a case management nursing model(CMNM)to facilitate quick patient recovery.CASE SUMMARY A 61-year-old female patient presented with persistent upper abdominal pain lasting over 2 months.Gastroscopy revealed the presence of both gastric and duodenal cancers.Following a thorough evaluation,the patient underwent pancreaticoduodenectomy,cholecystectomy,and total gastrectomy.Post-surgery,an individualized case management nursing approach was applied,leading to a successful recovery.Three months after the surgery,follow-up examinations showed no signs of recurrence.CONCLUSION The CMNM effectively promoted rapid patient recovery,enhanced the quality of orthopedic nursing services,and accelerated postoperative recovery,ultimately leading to increased patient satisfaction with nursing care.

Impact of the Rapid Recovery Concept on Complications and Patient Quality of Life in the Perioperative Nursing of Robot-Assisted Radical Oesophageal Cancer

Aim: This study evaluates the impact of Enhanced Recovery After Surgery (ERAS) nursing on postoperative complications and quality of life in patients undergoing robot-assisted minimally invasive esophagectomy (RAMIE). Methods: A total of 150 patients who underwent RAMIE from January 2020 to January 2022 at our hospital were randomly assigned to either the observation group or the control group, with 75 patients in each. The control group received standard perioperative management and nursing care, while the observation group was treated with ERAS nursing strategies. Interventions continued until discharge, and outcomes such as postoperative complications, quality of life, and nutritional status were compared between the groups. Results: The observation group exhibited a significantly lower incidence of postoperative adverse reactions compared to the control group (P ionally, all dimension scores of the Short-Form 36 Health Survey (SF-36), including the total score, were higher in the observation group (P < 0.05). Furthermore, the Nutritional Risk Screening (NRS) scores for impaired nutritional status and disease severity, along with the total NRS score, were significantly lower in the observation group compared to the control group (P Conclusion: Implementing ERAS nursing in the perioperative care of patients undergoing RAMIE is associated with reduced postoperative complications and enhanced postoperative quality of life and nutritional status. .

Nursing Effect of Rapid Rehabilitation Surgery Concept in Laparoscopic Surgery for Extrahepatic Bile Duct Stones

Objective: To explore the application value of rapid rehabilitation concept in patients with extrahepatic bile duct stones under laparoscopy during perioperative period. Methods: 90 patients with extrahepatic bile duct stones treated in our hospital from January 2022 to February 2023 were selected as the research object and randomly divided into the study group and the control group. The control group was given routine care, and the observation group was given rapid surgical rehabilitation care. The postoperative anal exhaust time, first meal time, early activity time, pain time, abdominal drainage tube removal time, hospitalization time and complication rate were compared between the two groups. The independent sample T test was used for the measurement data, and the x2 test was used for the counting data, and the difference was statistically significant (P Results: The postoperative anal exhaust time, first meal time, early activity time, pain time, abdominal drainage tube removal time and hospitalization time in the study group were shorter than those in the control group (all P Conclusion: The concept of rapid rehabilitation can significantly improve the perioperative nursing effect of patients with extrahepatic bile duct stones and accelerate their rehabilitation, which is worth improving and popularizing.

Effectiveness of the“online+offline+practice”trinity teaching model on the learning of junior nursing students:an exploratory study

Background:Surgical Nursing is a main course of nursing specialty and a large course lasting 96 credit hours.In response to the teaching pain points such as the complicated and boring content of the surgical nursing course and the disconnection between classroom theory and clinical practice,surgical nursing is undergoing a teaching reform.Methods:The Surgical Nursing course builds trinity teaching model of“online+offline+practice”and implements teaching reforms by combining the Bridge,Objective,Pre-assessment,Participatory learning,Post-assessment,and Summary(BOPPPS)teaching concept.We constructed a trinity teaching model,and these teaching reform measures included building an online learning platform,offline case teaching and scenario simulation and hospital and community practice.The 50 students in the junior year of the undergraduate nursing program in the class of 2020 were used as the study subjects,and the students’comprehensive scores were compared.The questionnaire was also used to assess students’independent learning ability and to evaluate students’satisfaction with the teaching.Results:The students’course pass(≥60 points)rate was 100%,and the excellence(≥80 points)rate was 24.00%.Students’independent learning ability improved,and the scores and total scores of cognitive self-management ability,information ability and learning co-operation ability were significantly better than those of the national norm(P<0.01).The satisfaction of students in the BOPPPS group with classroom teaching was also significantly higher than that of the control group.Conclusion:The“online+offline+practice”trinity teaching mode can effectively integrate the“Rain Classroom”online platform with the BOPPPS teaching mode.It guides students to actively participate in classroom thinking and discussion,improves students’independent learning ability,and effectively enhances the effect of classroom teaching.

Operating Room Nurses’ Role in Multidisciplinary Surgical Coordination for a Patient with a Large Abdominal Tumor and Multiple Pelvic Fractures

In this study,we have summarized the coordination of operating room nurses participating in the multidisciplinary team in diagnosing and treating a patient with a large abdominal tumor and multiple pelvic fractures.To perform surgical treatment on patients with various conditions,it is crucial to consider the patients from a holistic perspective.Thus,the existing medical model has shifted from a“disease-centered”approach focusing on single-disciplinary diagnosis and treatment,to a“patient-centered”approach that involves multiple disciplines in diagnosis and therapy.Operating room nurses,as crucial collaborators of surgeons,should make necessary adjustments to enhance their comprehension of patients,improving the overall quality of surgical coordination.

Application Effect of Informationized Teaching Method Based on Evidence-based Nursing in Surgical Nursing Teaching

Objective:The study was to analyze the application effect of informationized teaching method based on evidence-based nursing in surgical nursing teaching.Methods:From December 2019 to December 2020,60 students were selected as the research objects and randomly divided into two groups,each with 30 students in the teaching group.The observation group applied informationized teaching based on evidence-based nursing method,and the control group used the traditional teaching model.The teaching effect was evaluated.Results:The test scores of subjective theoretical knowledge and objective theoretical knowledge of the observation group were significantly higher than those of the control group,and the comprehensive ability evaluation of the observation group was also higher(P<0.05).The majority of students accepted the informationized teaching method based on evidence-based nursing,and a few held a neutral or disapproval attitude.Conclusion:Informationized teaching method based on evidencebased nursing can improve students'theoretical and practical levels in surgical nursing teaching,and most students also accept this teaching method,which has application value.

Perioperative Nursing for Adult Congenital Heart Disease with Severe Pulmonary Arterial Hypertension

Objectives: To explore the main points of perioperative nursing for adult congenital heart disease with severe pulmonary arterial hypertension. Methods: A retrospective study of 13 patients with congenital heart disease and severe pulmonary arterial hypertension who admitted to the perioperative period of care from January 2018 to December 2019. To prevent perioperative complications of the patients, the focus is on respiratory and circulatory system care, followed by blood coagulation monitoring, digestive system protection and psychological care. Results: All 13 patients passed the perioperative period and were discharged from ICU. Conclusion: Adult congenital heart disease with severe pulmonary arterial hypertension has high perioperative risk, respiratory and circulatory system care is the key.

Art making and expressive art therapy in adult health and nursing care:A scoping review

Objectives:While receptive art engagement is known to promote health and wellbeing,active art engagement has not been fully explored in health and nursing care.This review is to describe the existing knowledge on art making and expressive art therapy in adult health and nursing care between 2010 and 2020.Methods:Relevant studies and grey literature were searched and identified between March 17 and April 10,2020 from EBSCO,CINAHL,Medline and ERIC databases and a general Internet search.Following data charting and extraction,the data(n=42 papers)were summarized and reported in accordance with PRISMA-ScR guidelines.Results:In the included papers,both art making and expressive art therapy were seen in different health care and nursing contexts:yet not the home care context.The emphasis of art activities were group activities for chronically or terminally ill residents,adults aged 65 years or older.A focus on personal narrative was often seen,which may explain why art activities appear to be linked to acknowledging and building new strengths and skills,making meaning of experiences,personal growth,symptom alleviation,and communication;all used to foster collaboration between patients,patients’near-ones and health care professionals.Conclusions:Art activities appear to be suitable for every context and can promote personcenteredness and the measurement of nursing outcomes,and they should be considered an essential part of health and nursing care,nursing education and care for health care personnel.

Emotional Support and Well-Being of Adults with Congenital Heart Disease (ACHD): Contributions of a Specialist Nursing Service

Living with a congenital heart condition can require a daunting and uncertain patient journey during which the support of a specialist nursing service is vital. A descriptive, cross-sectional evaluation completed over two years, utilised a postal questionnaire to investigate patient’s satisfaction with aspects of service. Qualitative responses to open questions on satisfaction with emotional support (n = 103) and contributions to well-being (n = 90) were analysed using a framework approach which identified eight themes. Professional knowledge and expertise, service accessibility, caring attributes, enabling patients to cope with anxiety, depression and meeting changing needs contributed positively to both patient well-being and emotional support. Family support was influential on emotional support alone, whilst mediating medical liaison exerted an impact on well-being by enhancing feelings of security. In conclusion, the specialist nursing service contributed positively to well-being and emotional support of patients and thereby to selective aspects of continuity of care.

Tracheobronchial intubation using flexible bronchoscopy in children with Pierre Robin sequence:Nursing considerations for complications

BACKGROUND It has been shown that children with Pierre Robin sequence(PRS)have a higher risk of difficult intubation before surgery.When mask ventilation or tracheobronchial intubation is expected to be challenging,flexible bronchoscopy(FB)is advantageous in airway safety when it is used to guide tracheobronchial intubation(TI).AIM To evaluate the complications of TI using FB in children with PRS and explore the effect of nursing services on postoperative complications.METHODS One hundred and five children with PRS underwent TI using FB before early mandibular distraction osteogenesis.One hundred and eight children with common pneumonia who did not have a difficult airway were set as the control group.Demographic data,success rates of TI,time required for TI,number of TI attempts,and the incidence of postoperative complications were assessed.Besides,the strategies used to attenuate complications were investigated.RESULTS The success rate of TI was 100%in children with PRS,while the success rate at the first attempt in the PRS group was significantly lower than that in the control group(88.6%vs 98.2%,P=0.005).The time required for TI in the PRS group was markedly longer than that in the control group(P<0.001).Children in the PRS group required repetitive operations to enter the glottis successfully(P=0.017).The incidence of complications was noticeably higher in the PRS group(50/105,47.6%)than in the control group(36/108,33.3%)(P=0.034).Seven of 105 PRS children experienced laryngeal edema (LE) (6.7%), compared with one (0.9%) in the control group(P = 0.034). Out of the seven patients who had LE, all were reintubated and managed withsteroids: six recovered with inhaled steroids alone before extubated, and one was given systemiccorticosteroids before recovery.CONCLUSIONFB contributes to a high success rate of TI in children with PRS. To prevent LE, operators shouldpay more attention to catheter material, catheter lubrication and intubation time.

Analysis of the evidence of related factors,associated conditions and at-risk populations of the NANDA-I nursing diagnosis insomnia

Objectives:To summarize evidence in the literature on the predictors of insomnia in adults and to determine correspondences with diagnostic indicators of the NANDA-I diagnosis Insomnia.Methods:An integrative review performed in Pubmed,Virtual Health Library and CINAHL.Forty-eight articles published in Portuguese,English or Spanish from 2011 to 2018 were included.An analysis of correspondence between the predictors and the NANDA-I related factors and associated conditions for Insomnia was performed.Results:There was a correspondence of the predictors found in this review with NANDA-I related factors and associated conditions,except for grieving and frequent naps during the day.Smoking,caffeine intake,dysfunctional sleep beliefs,obesity and caregiver role strain are possible new related factors;chronic illness is a possible new associated condition and individuals going through changes in marital status,economically disadvantaged,female gender,increasing age and night shift worker are possible new at-risk populations.Conclusion:The predictors of insomnia that had a correspondence with the NANDA-I elements can support the evidence base of the nursing diagnosis.The predictors found without a correspondence with the diagnosis can be considered for inclusion in the NANDA-I classification,thereby supporting the clinical reasoning of nurses and students.

Compliance of state registered nurses to nursing standards during practice in tertiary facilities in Malawi

The aim of this study was to describe the quality of practice offered by nurses to patients who underwent surgical incision into the abdomen (post-laparotomy) at tertiary hospitals (Kamuzu, Mzuzu, Queen Elizabeth and Zomba) in Malawi. The study design was descriptively cross sectional and utilized a quantitative data collection and analysis method. All available 48 registered nurses in the surgical ward of four central hospitals and 100 patients that were admitted in the ward during the time of study were recruited. A 3-point scale rating consisting of compliance (C = 1), partial compliance (C 1.0-0.5) and non compliance (C 0.5-0.0) was used to describe the nurse midwives compliance with the process standards of care. Results show that nurses in all the 4 central hospitals partially complied with assessment and planning standards. During assessment, the nurses assessed the physical aspects of care but did not assess the psychological, spiritual and cultural aspects of care. At planning the nurses assigned and delegated tasks based on the knowledge and skills of the provider selected but did not comply with factors related to safety, effectiveness and cost of care. All the facilities fully complied with implementation standard because they implemented care in a safe and appropriate manner and communicated with patients/ significant others and other health care providers. However, regarding systematic and ongoing evaluation of patients’ condition only Mzuzu Central hospital partially complied while the rest of the facilities were not compliant. All the facilities did not comply with documentation standard of care because the patient records were not legible and did not precisely depict comprehensiveness of care nor bore signatures of the implementers of the care. Results are discussed by relating the level of compliance to standards and the quality of patient care.

Jordanian Nurses’ Knowledge of Preventing Surgical Site Infections in Acute Care Settings

Background: Surgical Site Infection (SSI) is one of the most common healthcare-associated infections, its account for up to 16% of all healthcare-associated infections worldwide. The SSIs can contribute to post-operative morbidity, prolonged recovery, delayed discharge and increasing cost. Nurses’ knowledge of the evidence-based recommendations is necessary to provide high-quality nursing care. Aims: To assess the level of Jordanian nurses’ knowledge regarding evidence based guidelines for the prevention of SSIs, to describe the relationship between nurses’ knowledge and selected sociodemographics, to examine the differences in nurses’ knowledge with respect to selected dichotomized variables, and to identify the most significant predictors of Jordanian nurses’ knowledge regarding evidence based guidelines for the prevention of SSIs. Design: Cross-sectional design. Sample: Two hundred registered nurses at four targeted hospitals were recruited conveniently. Results: The mean of the total knowledge scores of the sample was 3.28 out of nine (SD = 1.72, range = 0 - 7), the median was 3 out of nine. There were a statistically significant correlation between all tested continuous sociodemographics variables and the total knowledge score (p > 0.05). There is a significant difference in nurses’ knowledge between those who are attending to special surgical related training course and who are not. The most significant predictors of Jordanian nurses’ knowledge were: the number of credit hours attended by nurses for surgical-related training courses and the total years of work experience in nursing. These variables explained 16.7% of variance. Conclusion: The results of this study shed light on the obstacles that hampers the Jordanian nurses’ knowledge regarding evidence based guidelines for the prevention of SSIs in acute care settings. However, the successful implementation of infection control measures, particularly SSIs prevention measures, and well-structured continuing education programs are considered as a substantial element that would improve nurses’ knowledge.

Surgical Site Infection Prevention Practices and Associated Factors among Nurses Working in Government Hospitals of Harari Regional State and Dire Dawa City Administration, Eastern Ethiopia

Background:Surgical site infections are the most frequent type of preventable hospital acquired infections with a serious and undesirable outcome of surgery associated with increase morbidity,mortality rate,hospital stay,readmission and excess cost.Surgical site infection prevention is one of the most important challenge in delivering optimal nursing care.Studies suggest that the nurses’practices of surgical site infection prevention is not well addressed.Moreover,there is clearly paucity of information,in Africa including the study area.Objective:The aim of this study was to assess surgical site infection prevention practices and associated factors among nurses working in government hospitals of Harari Regional State and Dire Dawa City Administration,Eastern Ethiopia from March 01 to 28,2019.Method and Materials:An institutional based cross-sectional study design was employed for a total of 515 nurses.Simple random sampling method was used to select study participants.Data were collected using pretested structured self-administered questionnaire supplemented by observation.Data were checked,coded,entered and cleaned using Epi-data version 3.1 and exported to SPSS version 20 for analysis.Bivariate and multivariate analysis were undertaken and P values less than 0.05 at 95%confidence interval were considered as statistically significant.Result:The overall self-reported level of SSI prevention practice was found to be 40.8%(95%CI:36.9%,45.4%).Nurses with BSc and above[Adjusted odds ratio(AOR)=2.52,95%CI(1.14,5.54)],trained on infection prevention[AOR=2.22,95%CI(1.29,3.82)],good knowledge[AOR=2.21,95%CI(1.32,3.71)],good attitude[AOR=5.11,95%CI(3.05,8.57)],got supply of personal protective equipment[AOR=2.57,95%CI(1.46,4.49)],had management support[AOR=3.41,95%CI(1.90,6.12)],experience of 5 to 10 years[AOR=5.38,95%CI(2.82,10.27)]and≥11 years[AOR=3.48,95%CI(1.47,8.25)],were found to be statistically and positively associated with nurses SSI prevention practice.Conclusion:In this study,the level of surgical site infection prevention practice was poor.Being BSc and above,being knowledgeable and good attitude,got personal protective equipment,had management support,serving for≥5 years and trained on infection prevention were found to be significantly associated with surgical site infection prevention practice.Updating knowledge and practice of nurses through in-service education and training on latest evidence-based practice,regularly supplying of personal protective equipment,developing hospital policy and procedures for surgical site infection prevention practice is recommended.

Knowledge and Tube Feeding Practices for Older Adult Patients among Japanese Registered Nurses

The aim of this study was to examine nurses’ thinking regarding the indications for tube feeding in older adults with eating difficulties and to determine whether the team approach can improve their knowledge and tube feeding practices. We sent self-administered questionnaires to 436 nurses and collected them from November to December 2010 (response rate, 70.0%). The results indicated that approximately 30% of the Japanese nurses thought that older patients with dementia should be on tube feeding and more than half of the nurses answered that tube feeding is indicated for aspiration-prone, frail, older adults. Moreover, our findings showed that nurses who organize multidisciplinary teams performed more interventions for dysphagia before introducing tube feeding than the reference group as analyzed by multivariate adjustment (odds ratio, 2.1-6.6). In conclusion, a multidisciplinary team approach is expected to make better decisions on the treatment and care of older patients with difficulty eating, including the need for tube

Characteristics of a Transactive Phenomenon in Relationships among Older Adults with Dementia, Nurses as Intermediaries, and Communication Robot

Healthcare for older adults with dementia is an important healthcare problem in Japan and in other developed countries. Importantly, healthcare workers in Japan are also getting older. In order to address solutions to this problem, using robots is being realized and is starting to assist healthcare and welfare practice needs. The aim of this study was to identify the characteristics of a transactive phenomenon in relationships among older adults with dementia, with nurses as intermediaries and with a cognitive skill-aid robot. Subjects were two institutionalized older adults who were diagnosed with dementia using Hasegawa’s Dementia Scale-Revised;a Kabochan (Nodding Kabochan) fixed with a remote-controlled speaker, Pechat (Kabochan with Pechat). Measurements of autonomic nervous activity were done using wearable electrocardiography attached to the subjects for four hours. Heart Rate Variability data were assessed at various frequency bands using a HRV software tool. In a continuously recorded data, interbeat (R-R) intervals were obtained for a 1-min segment using the maximum entropy method. In this study, the two major spectral components of HRV, the variances of the low-frequency (LF: 0.04 - 0.15 Hz) band and high-frequency (HF: 0.15 - 0.4 Hz) band, were calculated. Activities and behaviors of subjects transacting with Kabochan were observed by the expert nurses and video-recorded. Throughout the transaction period, observations were recorded of patients’ behavior, words uttered and over-all contents of the transactive conversation with the Kabochan or Kabochan with Pechat. Identified characteristics were transactive relationship phenomenon;changes in autonomic nervous system activity of persons with dementia are expressed as per one minute, linguistic response of elderly people, transactive relations among Kabochan, Kabochan with Pechat, and nurses as intermediaries. These were exhibited as Figures: Situation 1, A Sense of Fear, Situation 2, A Pleasant Sensation, and Situation 3, Misunderstanding and Confusion. It also showed that autonomic nervous system activity of persons with communication skills is actively changing in older adults with dementia. Conversation of adding Pechat to the Kabochan illustrated that nurses as intermediaries showed emotional conversations as established by effectively manipulating the Pechat. Also, it was revealed that if Kabochan with Pechat uttered words about patient’s personal information in a conversation, the patient felt a sense of fear. The researchers suggest that when developing future communication robot for elderly with dementia, it is necessary to consider, for an effective conversation, transactive relationships including nurses as intermediaries. The role functions of these intermediaries have been shown of high versatility, indicating that situations such as these can also be controlled by other healthcare providers such as by occupational therapists.