Efficacies of Different Methods of Teaching Transcultural Nursing Practice in China

Purpose： This study assessed the effectiveness of three teaching methods for developing cultural competency based upon Leininger＇s theoretical framework with nursing students in China： case studies, traditional didactic learning, and self-directed learning. These methods were used in tran- scultural nursing teaching practices to identify the method that resulted in the greatest improve- ments in the nursing student＇s understanding and clinical application of transcultural nursing. Methods： The Transcultural Nursing Questionnaire（TNQ） was used for pre-and post-test comparisons of all participants in four areas of cultural knowledge and the Evaluation of Transcultural Nursing Competency（ETNC） was applied via role-play to evaluate the cultural competency of 120 of the 305 participants from three general hospitals in the PuDong New District, Shanghai, China. Individual transcultural nursing courses that focused on case study, traditional didactic or self-di- rected methods persisted for four months in three hospitals. Results： Statistical analyses of the cognitive scores of the participants in the transcultural nursing courses revealed a significant difference（P〈0.01） between scores collected before and after the teaching with the three methods. Comparisons of the three hospitals revealed that the scores for transcultural nursing cognition and simulating service assessment were significantly different（P〈0.01） for the case study nursing students. The scores of the students who were taught with the traditional didactic and self-directed methods were not significantly different across the three hospitals（P〉0.05）. Conclusion： The results revealed that the case study, traditional didactic and self-directed method effectively improved the transcultural nursing cognitive levels of the nursing students. The case study method appeared to be the most effective approach based upon the TNQ pre-and post-tests and the ETNC cultural competency scores.

Relationship between Lifestyle, Quality of Sleep, and Daytime Drowsiness of Nursing Students of University A

The harmful effects of technological devices, including smart phones have been increasingly suspected among university students;bedtimes have become increasingly later at night, and leisure activities often extend through the night. Likewise, availability and need of increasing part-time job hours have been considered. The purpose of this research was to determine the relationship among lifestyles, quality of sleep, and daytime drowsiness of nursing students of University A. The research was conducted in June 2015, when student life rhythms were considered stable after two months of lectures. Responses with missing values or with inappropriate answers were excluded. Of the data collected from 96 respondents, only 71 were acceptable. The survey focused on lifestyle, daytime sleepiness (using ESS: Epworth Sleepiness Scale) and quality of subjective sleep (using the PSQI: Pittsburgh Sleep Quality Index). Approval was obtained from the Research Ethics Committee of Shikoku University. While in this study, more than half (63.4%) of the students had poor quality of sleep, however, there was no relationship between their quality of sleep and daytime drowsiness, or between their lifestyles and the quality of sleep. These findings suggest that while university students’ use of technological devices is suspected to influence on sleep deprivation and consequent daytime drowsiness, the findings did not provide the evidence.

Development of Algorithm and System for Automatic Generation of Nursing Summaries from Nursing Care Plans

A nursing care planning system that automatically generated nursing summaries from information entered into the Psychiatric Outcome Management System (PSYCHOMS?, Tanioka et al.), was developed to enrich the content of nursing summaries at psychiatric hospitals, thereby reducing the workload of nurses. Preparing nursing summaries entails finding the required information in nursing records that span a long period of time and then concisely summarizing this information. This time consuming process depends on the clinical experience and writing ability of the nurse. The system described here automatically generates the text data needed for nursing summaries using an algorithm that synthesizes patient information recorded in electronic charts, the Nursing Care Plan information or the data entered for North American Nursing Diagnosis Association (NANDA) 13 domains with predetermined fixed phrases. Advantages of this system are that it enables nursing summaries to be generated automatically in real time, simplifies the process, and permits the standardization of useful nursing summaries that reflect the course of the nursing care provided and its evaluation. Use of this system to automatically generate nursing summaries will allow more nursing time to be devoted to patient care. The system is also useful because it enables nursing summaries that contain the required information to be generated regardless of who prepares them.

The Development of the Japanese Psychiatric Nursing Assessment Classification System (PsyNACS©)

The purpose of this study was to develop the Japanese Psychiatric Nursing Assessment Classification System (PsyNACS)©. This study used the on-line survey method from February to April 2015. There were 644 respondents comprised of professional nurses with minimum qualification of 3 years’ experience being in a psychiatric unit of a stand-alone 200-bed or more Psychiatric Hospital in Japan. Assessment items were derived from 211 specific items selected from nursing textbooks, excluding the North-American-Nursing-Diagnosis-Association (NANDA). The questionnaire contained Cover Letter, Demographic Data Sheet, and the PsyNACS© questionnaire. There were 644 questionnaires accessed but only 435 were completed and valid. Item levels of importance were evaluated: 1) Unnecessary, 2) Not very important, 3) Important and 4) Very important. Data analysis used descriptive and multivariate statistics. Factor analysis (principal factor analysis, varimax rotation), the Kaiser-Meyer-Olkin (KMO) and the Bartlett’s test of Sphericity assessed the adaptive validity of the factor analysis. Factor loadings were set at 0.4 or more for the configuration of items. Internal consistency and reliability were established using Cronbach’s alpha coefficient. Mean factor points were calculated, including standard deviation, range, and confidence interval at 95%. Statistical significance was at 0.05 level. Nine Patient Assessment Data (PAD) with 2 to 5 Cluster Assessment Data (CAD) each were categorized. Thirty one CADs comprised the Patient Assessment Data: (PAD1) Psychological symptom and stress, (PAD2) Information about treatment, (PAD3) Function of eating and balance of water, (PAD4) Life and value, (PAD5) Vital signs and health assessment, (PAD6) Self-care, (PAD7) Social support, (PAD8) Activity, sleeping and mobility capability, and (PAD9) Sexual function and sexual behavior. The PsyNACS© is a classification of items assessing health care needs within the Japanese psychiatric nursing care environment, and also can be used in various psychiatric patient care situations in all psychiatric units.

The relationship between body mass index, thickness of subcutaneous fat, and the gluteus muscle as the intramuscular injection site

An intramuscular injection (IMI) is an injection given directly into the central area of a specific muscle. Certain medicines need to be administered by the gluteal route for these to be effective. The aim of this study was to determine the influence of body mass index (BMI), subcutaneous fat, and muscular thickness of the dorsogluteal IMI site among healthy Japanese women. There were 39 healthy female subjects who volunteered and met the criteria. Their ages ranged from 40s to 60s (50.82 ± 6.04). With the data collected using the B-mode ultrasound images of the dorsogluteal site, it was found that the distance from the epidermis to the under-fascia (DEUF) of the gluteus maximus was dissimilar between the subject’s right and left buttocks. It was found that the distance from the epidermis to the iliac bone (DEI) was significantly more on the right than on the left buttocks. In the case of an adult Japanese woman with a BMI of 21 or more, the DEUF of the gluteus medius was found to be about 30 mm, and the DEI was approximately 50 mm or more. Based on these findings, it is recommended that a needle length of 38 mm (1.5 inches) can be safely used to administer IMIs to the gluteus medius muscle to effectively and efficiently deliver medications through the IMI route.

Sleep conditions and quality of life among patients with ischemic heart disease after elective percutaneous coronary intervention

In Japan, percutaneous coronary intervention (PCI) is a major therapeutic intervention for ischemic heart disease (IHD). Previous studies suggested that an association of the risk of IHD caused by sleep duration was related to factors closely associated with daily activities. However, in Japan, there is no study about this relationship objectively measured using the actigraphy in patients with IHD. Moreover, there is little reported data about sleep condition and early outcomes of patient’s Health-Related Quality of Life (QOL) after PCI. This study determines the correlations between sleep conditions and QOL (measured by SF36 version 2) of 25 patients with IHD who underwent elective PCI. Data were collected seven days after PCI using night-sleep condition. Using Spearman’s rank test, the results revealed positive correlation between vitality score and longest sleep duration (ρ = 0.43, p = 0.031): social functioning (SF) score and duration of night-time sleep (ρ = 0.42, p = 0.037);total sleep duration (ρ = 0.45, p = 0.026), and longest sleep duration (ρ = 0.44, p = 0.024);mental health score and longest sleep duration (ρ = 0.54, p = 0.006). However, negative correlation was found between physical functioning score and arousal during sleep (ρ = -0.44, p = 0.027). Sleep condition was significantly correlated with QOL. In particular, SF score was positively related to night-time sleep. This seems to indicate that SF score might be related to night-time sleep condition. Moreover, the longest sleep durations were correlated with the mental component summary. The results of the study suggest that not only the length of whole sleep durations leads to better QOL, but also the increase the amount of uninterrupted sleep.

Daily Activities and Sleep Durations of Patients with Ischemic Heart Disease Who Were Discharged to Their Homes after Elective Percutaneous Coronary Intervention

The purpose of this study was to examine the relationship between daily activities and sleep durations for patients following elective percutaneous coronary intervention (ePCI) and diagnosed with ischemic heart disease (IHD) after discharge to their homes. The actigraph data were used to collect data from twenty five patients. The duration of night-time sleep (minutes from the start to end of night-time) and actual night-time sleep duration (total sleep duration excluding wake-up durations of night-time) on the seventh day after discharge were divided into three groups;less than 360, 360 to 480, and more than 480 minutes (short, optimal and long respectively). Subsequently, among the three groups of patients, the data were analyzed by Kruskal Wallis H-test with multiple comparison procedures using the Scheffé-test in order to compare differences in daytime activity items at seven days after discharge from the hospital. Total daytime nap duration (p p p p < 0.05). However, the duration of night-time sleep and daytime activity did not significantly differ. If actual night-time sleep duration is improved from 360 to 480 minutes, daytime nap could potentially be decreased. Determining objective sleep conditions for patients and treating sleep disorders may improve overall patient health, facilitating appropriate sleep and wake rhythms.

Optimal needle insertion length for intramuscular injection of risperidone long-acting injectable (RLAI)

Risperidone long-acting injectable (RLAI) is approved for the treatment of schizophrenia in many countries. The suggested site is the gluteal muscle with a needle length of two inches (50 mm) in Japan, which is longer than the ordinarily used needle for intramuscular injections. The aim of this study was to determine the optimal needle insertion length for accurate delivery of RLAI procedure among subjects who have normal body mass index (BMI: 18 to 25) and high BMI (>25). Thirty-seven patients with schizophrenia were administered RLAI intramuscularly into the dorsogluteal muscle. The standard procedure required inserting 80% of the two inch needle. By using data collected by ultrasonography, the findings confirmed that the median needle insertion lengths for subjects with normal and high BMI were 39.0 and 45.5 mm, respectively. To deliver RLAI effectively and safely, the authors strongly recommend that a specialized needle be used that is “marked” at the 40 mm point from the tip of the needle to the base. In this way regardless of subcutaneous fat content, the RLAI can be safely delivered into the muscle without causing untoward or side effects.

Changes before and after improvement of subjective sleep state of a man diagnosed with pre-diabetes and sleep disorder

The purpose of this case study was to examine the changes before and after improvements of the subjective sleep status of Mr A, a 40-year-old man diagnosed with pre-diabetes and a sleep disorder. Data were collected using a Holter monitor for 24 hours a day for 3 days to assess autonomic nervous activity by recording bed-time and waking time activity (activity counts: ACs). Mr. A kept a diary of activities and completed the Pittsburgh Sleep Quality Index (PSQI) questionnaire. The study revealed that subjective sleeping hours correlated almost precisely with those measured by the actigraph and as described in the diary. Both the parasympathetic and sympathetic nervous system activities were imbalanced. However, no correlation was observed between the ACs and autonomic nervous activity. Subjective sleep state according to the PSQI score improved remarkably by dietary and exercise therapy from 13 to 3 points, after six months, with corresponding high level sleep satisfaction level. Significant correlations were observed between ACs and high-frequency spectral power of R-R intervals, and between ACs and the low-frequency/high frequency ratio of spectral power of R-R intervals. Although Mr. A’s sleep satisfaction level has improved, the autonomic nervous system activity remained different from that of healthy people.

Characteristic Autonomic Nervous Activity of Institutionalized Elders with Dementia

This study clarified the characteristic autonomic nervous activity of institutionalized elders diagnosed with dementia using Hasegawa’s Dementia Scale-Revised. Twenty-six healthy adult persons (HPs) in their 20 s - 40 s met the inclusion criteria, and 16 persons (27.6 ± 8.2 years old) completed the research procedure. Of 70 persons with dementia (PDs) residing at the one geriatric health services facilities, only 24 persons met the inclusion criteria, and only nine (N = 9, 83.44 ± 9.45 years old) completed the procedure. Actigraph and ambulatory electrocardiographic instruments measuring autonomic nervous activity were attached to the subjects for 24 hours. Activities and behaviors of PDs and HPs were observed by clinically experienced staff nurses and care workers. High frequency (HF) power indicating parasympathetic activity and LF/HF ratio indicating sympathetic activity were calculated. When awake, PDs’ LF/HF ratio was significantly lower than HP’s (Z = -2.60, p < 0.01), showing significant differences in the LF/HF ratios between waking and sleeping, more than those of the PDs (p < 0.001). Similarly, when awake, significant positive correlations were observed in the LF/HF ratio and actigraph activity count (AC) in 11 HPs and 3 PDs (range r = 0.17 to 0.49, p < 0.05);however, significant negative correlation was found in HF and AC of 12 HPs and 3 PDs (range r = -0.55 to -0.18, p < 0.05). While sleeping, significant positive correlations were observed in LF/HF and AC of 3 HPs and 1 PD (range r = 0.35 to 0.42, p < 0.05) and significant negative correlation was found in the HF and AC of 1 HP (r= -0.32, p < 0.001) and 1 PD (r = -0.32, p < 0.05). The mean value of LF/HF in a wakeful state was significantly lower for PDs than HPs. Combined results of behavioral observation, actigrapy and heart rate variability (HRV) analyses suggested that PDs showed positive correlations between LF/HF and AC in a wakeful state. Compared to those who showed no positive correlation, they did not require much nursing care.

Prioritizing Patient Assessment Data (PAD) Using the Japanese Psychiatric Nursing Assessment Classification System (PsyNACS)©

The study identified priorities of the Patient Assessment Data (PAD) using the Japanese Psychiatric Nursing Assessment Classification System (PsyNACS&copy;) derived from 644 psychiatric nurses’ responses who were practicing in specific units: Acute Care Units (ACU), General Care Units (GCU), Long-term Care Units (LCU), physically Complicated Disease Care Units (CDCU), and Dementia Care Units (DCU). Secondary analysis of the PsyNACS&copy;on-line survey data using four levels of “importance” was used to determine the priorities: 1) unnecessary;2) quite important;3) important and 4) very important. The Mean Factor Points (MFP) and the Welch’s ANOVA were calculated. PsyNACS&copy;score of 3 or higher indicates the PAD as priority. The results showed that in the ACU PAD1, “Psychological symptom”, “Stress coping”, and “Mood disorder and aggression”, and PAD2 “Information of adherence”, and “Information of the psychiatry rehabilitation”, and PAD7 “Situation of the family and social life”, “Relationship to the health care providers”, and “Relationships with others” are high priority (high importance). Other PADs showed results below PsyNACS&copy;score of 3. The GCU had PAD 3 “Balance of water”, the LCU had PAD 4 “Intention/Point of view”, and “Thoughts of the patient” and PAD 7 “Disease and family”. The CDCU showed PAD 2 “Blood test”, PAD 3 “Excretion situation”, and PAD 5 “General health condition”, “Respiratory and chest symptom”, and “Vital signs”, and the DCU had PAD 1 “Cognition function”, and “Delirium and derangement capacity to register failure”, PAD 3 “Function of eating”, PAD 6 “Egestion and cleanliness” and PAD 8 “Activity and sleeping”, and “Mobility capability”. These classifications indicated levels of importance in the CAD comprising the PAD below the score of “2”. Japanese psychiatric hospitals specify assessments according to functional areas. By prioritizing the CAD for each PAD, more effective and efficient assessments can be performed according to practice unit.

Methodology for Developing a Nursing Administration Analysis System

Nursing administration requires a large volume of wide-ranging information, and nurse administrators are limited in their ability to compile and analyze information for nursing administration. The purpose of this study is to create methodology for developing a nursing administration analysis system to aid nurse administrators in performing outcome analysis. In this methodology, information required for nursing administration in the PSYCHOMS? (Psychiatric Outcome Management System, registered trademark) database is analyzed according to the individual needs of nurse administrators. It features a combination of a classification method and an extraction method for obtaining quantitative and qualitative data as information required for nursing administration, and enables nurse administrators to easily obtain analysis results that they directly need. This methodology converts the time required nurse administrators to collect and organize information into time for making considerations in order to devise strategies for improving the quality of nursing care services, and can improve the quality and efficiency of nursing administration. This may lead to an increase of the quality of nursing care services at psychiatric hospitals. This methodology is highly versatile as it can be applied in information management, not only for nursing, but for the entire psychiatric hospital.

护理专业课人文关怀教学现状调查问卷的编制

目的编制护理专业课人文关怀教学现状调查问卷并检验其信效度,为评估关怀教学实施情况提供工具。方法依据Noddings关怀教育理论,结合文献分析、半结构式深入访谈结果,初步拟定问卷条目池并形成框架,再经过2轮专家咨询确定问卷初稿,对315名护理专业学生进行问卷调查,测定问卷的信效度。结果护理专业课人文关怀教学现状调查问卷包括5个维度39个条目。探索性因子分析提取5个公因子,累积方差贡献率为66.276%,问卷内容效度指数为0.939,总问卷Cronbach′sα系数为0.972,折半信度为0.894,重测信度为0.950。结论护理专业课人文关怀教学现状调查问卷具有良好的信效度,可用于调查我国护理专业课人文关怀教学现状。

Can nurses remain relevant in a technologically advanced future?

Technological breakthroughs occur at an ever-increasing rate thereby revolutionizing human health and wellness care.Technological advancements have drastically changed the structure and organization of the healthcare industry.McKinsey Global Institute estimates that 800 million workers worldwide could be replaced by robots by the year 2030.There is already a robotic revolution happening in healthcare wherein robots have made tasks and procedures more efficient and safer.Locsin and Ito has addressed the threat to nursing practice with human nurses being replaced by humanoid robots.Routine nursing care dictated solely by prescribed procedures and accomplishment of nursing tasks would be best performed by machines.With the future practice of nursing in a technologically advanced future transcending the implementation of nursing actions to achieve predictable outcomes,how can human nurses remain relevant as practitioners of nursing?Nurses should be involved in deciding which aspects of their practice can be delegated to technology.Nurses should oversee the introduction of automated technology and artificial intelligence ensuring their practice to be more about the universal aspects of human care continuing under a novel system.Nursing education and nursing research will change to encompass a differentiated demand for professional nursing practice with,and not for,robots in healthcare.

Artificial Intelligence and Autonomous Machines: Influences, Consequences, and Dilemmas in Human Care

In the field of robotics and in the health sciences, transitions have been occurring in the control of robots operating with predetermined logic and rules. Robotics in health care are influencing human caring dynamics in many ways such as enhancing dependency and surrender to machine technologies. Situations such as these are charged with possibilities of legal liabilities triggered by influences and consequences of advancing robotic technology dependency. The purpose of this paper is to identify, describe, and explain legal issues and/or dilemmas centered on robotics in healthcare while providing engaging opportunities to limit consequent legalities thus forming beneficial human health care outcomes. Laying bare these liabilities will provide critically informative data that can foster proactive encounters which can or may deter health care liabilities while ensuring quality healthcare outcomes. An attempt is made to re-conceptualize how to view agency, causality, liability responsibility, culpability, and autonomy for the new age of autonomous robots. While it is still not clear how this would turn out, a clear framing of the problem is the first step in the project.

The relationship between sleep condition and autonomic nervous function in women in their 70s with type 2 diabetes mellitus

The aim of this study was to determine the relationship between sleep condition and autonomic nervous function of women in their 70s with type 2 diabetes mellitus by analyzing the activity counts (AC) on actigraphs and heart rate variability (HRV). Ten healthy women in their 30s to 40s as control and four women patients with type 2 diabetes in their 70s wore the electrocardiograph and an actigraph for 24 hours while keeping a diary of activities, including their sleep and food intake. The Pittsburgh Sleep Quality Index was used to assess subjective sleep conditions. The subjective sleeping results were significantly correlated with those measured by the AC and HRV. However, AC and HRV correlation pattern showed different activity in the patients with type 2 diabetes mellitus. The quality of sleep of those with chronic diabetes was not good even if their HbA1c was well controlled. Furthermore, their automatic nervous function was different from the control group. The sleeping hours of patients with type 2 diabetes were shorter or longer than those of healthy women. Ultimately, this study maintains that it is important to examine automatic nervous functions using objective examination index during the early stage of diabetes mellitus.

Japanese University Teachers’ Depression Status and Its Influence Factors

Risk factors of the depression are the occupational stress. The mental health condition of university teachers who participate in the socialization of diverse students is an important issue;however, there are few studies on depression among university teachers. The purpose of this study is to clarify Japanese university teachers’ depression status assessed by the Patient Health Questionnaire-9 and its influence factors: Japanese university teachers’ depression status depression status, personal background, job situation, social support, and stress coping behavior. The self-administered questionnaire survey was mailed to 924 university teachers in Japan, with a survey return rate of 43.8% (N = 405). A total of 342 surveys were completed and valid. The Patient Health Questionnaire 9 (PHQ-9), Multidimensional Scale of Perceived Social Support (MSPSS), the Japanese version of the Brief Coping Orientation to Problems Experienced (COPE) and the Work Situation Questionnaire (WSQ) were analyzed to clarify the depression status and its influence factors. Multivariate logistic regression analysis was used to examine factors related to the major depression. The subjects included 274 men (80.1%) and 68 women (19.9%), 105 professors (30.7%), 52 associate professors (15.2%), 53 lecturers (15.5%) and 132 assistants (38.6%). The subjects’ mean of age and teaching experiences were 44.1 ± 9.7 years, 15.6 ± 10.1 years. The mean PHQ score was 3.9 ± 4.1, and 307 subjects (89.8%) were 0 - 9 points and 35 subjects (10.2%) were over 10 points (10 points or over). For women [OR = 7.009, 95% CI 2.387 - 20.584;p < 0.001], religion [OR = 1.813, 95% CI 1.175 - 2.798;p = 0.007], self-blame [OR = 1.808, 95% CI 1.280 - 2.556;p = 0.001], substance use [OR = 1.453, 95% CI 1.103 - 1.913;p = 0.008] were risk factors of depression status. On the other hand, high job satisfaction level [OR = 0.945, 95% CI 0.921 - 0.969;p < 0.001], higher age [OR = 0.927, 95% CI 0.873 - 0.984;p =0.014], use of instrumental support [OR = 0.622, 95% CI 0.399 - 0.969;p = 0.036], and use of social support [OR = 0.588, 95% CI 0.376 - 0.921;p = 0.020] were factors that reduced the risk of depression. These findings suggested that in order to improve the depression status of university teachers, and to develop mental health measures for university faculty members based on such risk factors are necessary in the future.

Occupational stress and its related factors among university teachers in Japan

The purpose of this research was to investigate occupational stress and its related factors among university teachers in Japan. Questionnaire surveys were mailed to 924 university teachers in Japan with a response rate of 43.8%, N = 405. The General Health Questionnaire 28 (GHQ-28), Multidimensional Scale of Perceived Social Support (MSPSS), short Japanese version of brief Coping Orientation to Problems Experienced (COPE) and the Work Situation Questionnaires (WSQ) developed by the authors were administered to participants. Results indicated that university teachers had some mental health problems in relation to gender, professional position, conditions of taking paid leave, job satisfaction, job control, social support, and coping skills. These findings provide evidence that in order to improve the mental health of university, teachers need to take their paid leave freely. It is important to keep high their job satisfaction levels, job control levels, and social support. The results also indicated that the ineffective coping styles lead to poor mental health. In addition, the findings identified the necessity for support of female teachers and younger lecturers, who had a greater tendency toward poor mental health.

Advances in healthcare wearable devices

Wearable devices have found numerous applications in healthcare ranging from physiological diseases,such as cardiovascular diseases,hypertension and muscle disorders to neurocognitive disorders,such as Parkinson’s disease,Alzheimer’s disease and other psychological diseases.Different types of wearables are used for this purpose,for example,skin-based wearables including tattoobased wearables,textile-based wearables,and biofluidic-based wearables.Recently,wearables have also shown encouraging improvements as a drug delivery system;therefore,enhancing its utility towards personalized healthcare.These wearables contain inherent challenges,which need to be addressed before their commercialization as a fully personalized healthcare system.This paper reviews different types of wearable devices currently being used in the healthcare field.It also highlights their efficacy in monitoring different diseases and applications of healthcare wearable devices(HWDs)for diagnostic and treatment purposes.Additionally,current challenges and limitations of these wearables in the field of healthcare along with their future perspectives are also reviewed.