Nursing Activities at Health Surveys and Health Checkups during the Early Period of Operation of the Hiroshima ABCC—Oral History Study Based on Narratives of Three Japanese Nurses

Using an oral history approach, this study analyzed the narratives obtained from semi-structured interviews administered to three Japanese women who worked as nurses for the Hiroshima Atomic Bomb Casualty Commission (ABCC). The analysis of the data in the narratives showed details of the health surveys and health checkups conducted during the early period of operation of ABCC. During the early period of operation of ABCC some survivors showed negative behaviors toward the health surveys and health checkups at the ABCC. However, it can be inferred that dedicated nursing played an important role in alleviating the stress and emotional issues of survivors at the health surveys and health checkups. The findings of the study could be beneficial to research into nursing activities for patients exposed to radiation at the present day.

Support Provided by Public Health Nurses for Fathers Who Have Abused Their Children—As Observed in Cases of Child Neglect and Physical or Psychological Abuse

This study aims to identify the support to provide to fathers who have abused children as reported by public health nurses (PHNs). In this study, a qualitative descriptive design was applied to the data analysis. Interviewees were 10 public health nurses (PHNs) in charge of child abuse services for at least 5 years at public health centers. The study analyzed 13 cases reported in the interviews. Measures to support fathers who abuse their children as suggested by PHNs were classified into direct support to the father, support to other family members, and support to be provided by others involved including related organizations. The direct support to the father includes “gaining an in-depth understanding of the abusive situation and psychological states of those involved”, “refraining from involvement in areas where it is difficult to understand the personality of the father”, and others. Support of other family members includes “understanding the marital relationship and assessing the qualities of the relationship”, “refraining from matters that will involve divorce”, and others. Support to be provided by others including related organizations includes “understanding the value of social exchange and assessment of the ability to create and maintain interpersonal relationships”, “establishing support arrangements to enable intervention when necessary”, and others. The interviews report that PHNs arrange support measures that enable intervention as it becomes required, and that this enables learning about child-abuse preventing activities.

Factors Associated with the Walking Ability of Hemiplegic Stroke Patients

Gait disturbance due to motor paralysis affects activities of daily living and quality of life in patients with stroke. Thus, commencing walking training from the acute phase of recovery is essential. This study aimed to clarify the factors affecting the walking ability of hemiplegic stroke patients. Eighty hospitalized patients with a first chemic or hemorrhagic stroke within 1 year but not less than 1 month after stroke onset were included in this study. The dependent variable was walking ability (Functional Independence Measure [FIM] locomotion score), and the independent variables were spirituality (Spirituality Rating Scale-A [SRS-A]), amount of social support (Japanese version of the Abbreviated Multidimensional Scale of Perceived Social Support, frequency of family visit), stroke severity (National Institutes of Health Stroke Scale [NIHSS]), degree of motor paralysis (lower extremity Brunnstrom stage), the lower limb loading force of the affected and unaffected side, and age. Spearman’s rank correlation coefficient and multiple regression analysis were performed. Multiple regression analysis showed that FIM locomotion score was associated with NIHSS (standard partial regression coefficient = ?0.362, P 0.001), the unaffected lower limb loading force (standard partial regression coefficient = 0.264, P 0.001), lower extremity Brunnstrom stage (standard partial regression coefficient = 0.352, P 0.001), and SRS-A (standard partial regression coefficient = 0.184, P 0.011). From our findings, walking ability was affected by stroke severity and the degree of paralysis, the unaffected lower limb loading force, and the spirituality level in patients with stroke. Promoting walking ability in patients with stroke includes training the unaffected lower limb and heightening spirituality. Training of the unaffected lower limb should be performed at the bedside or on the bed by the patient or a bedside nurse. To heighten spirituality, nurses who care for patients with stroke are encouraged to practice active listening and to show sympathy as part of emotional support and spiritual care.

Sleep and Stress of Late Middle Age Males Who Are Forced to Live in Emergency Temporary Houses and Post-Earthquake Public Houses for a Long Period Due to the Fukushima Daiichi Nuclear Power Station Accident

It has been revealed that prolonged shelter life caused by Fukushima Daiichi Nuclear Power Station accident in conjunction with the Great East Japan Earthquake influences sleep and mental health of the residents, and therefore its influence on their physical and emotional health has become a concern. Therefore, in this study, the authors aimed at clarifying actual situations of sleep and stress of middle age males living in shelters for a long period in each of emergency temporary houses and post-earthquake public houses. For 5 males who moved from emergency temporary houses to post-earthquake public houses, their objective and subjective sleep states were measured with Actigraph and PSQI, respectively. Furthermore, their objective and subjective stresses were measured with saliva stress biomarkers and GHQ28, respectively. Their data were analyzed by paired t-test. As result, in comparison between the life in the emergency temporary houses and post-earthquake public houses, significant variation was not recognized in their objective sleep states and saliva stress biomarkers though their subjective sleep and subjective stress were significantly worsened after moving to the post-earthquake public houses.

Nutritional Evaluation by Nurses and Physical Recovery of Malnourished Patients after Esophagectomy

Following an esophagectomy, nurses’ patient nutrition observations are important for physical recovery and quality of life. The study proposed to identify the factors associated with physical recovery among esophageal cancer patients after surgery based on nurses’ observations and nutritional evaluations. Data were collected from the nursing records of 21 esophagectomy patients. The data included patients’ rate of weight loss, body mass index (BMI), energy intake, and postoperative complications. Patients were divided into two groups according to their weight loss rate: <8% and ≥8%. Patient outcomes were compared between the two groups. There was no difference in average BMI before or after surgery between the two groups. There was no difference in albumin levels during hospitalization;however, after esophagectomy, energy intake at discharge was insufficient in both groups. The ≥8% weight loss may be facilitated, or at least confounded, by the presence of recurrent nerve paralysis and aspiration pneumonia. Thus, the nursing records typically identified the need to check for recurrent laryngeal nerve palsy and aspiration pneumonia in conjunction with nutritional assessment to enhance patients’ physical recovery. When weight loss was significant, nurses provided oral intake support with the NST, and patients maintained oral intake levels similar to the group with weight loss under 8%. In order to better support physical recovery among malnourished, post esophagectomy patients, nurses need to monitor for signs of recurrent nerve palsy and aspiration pneumonia in addition to nutritional intake.

Lifestyle changes in coronary heart disease—Effects of cardiac rehabilitation programs with focus on intensity, duration and content—A systematic review

Background: Although coronary heart disease (CHD) is the most common cause of death worldwide the literature shows a wide variation in the arrangement of cardiac rehabilitation and achieved lifestyle changes. Aim: The purpose of this study was to evaluate the effects of intensity (number of patient follow-ups), duration (length of intervention) and content in cardiac rehabilitation programs (CRP) regarding lifestyle changes in patients with CHD. Method: A systematic literature review of articles published in the databases PubMed and CINAHL between 1990 and 2007 was conducted. This resulted in 1120 hits of which 25 articles finally met the set criteria for inclusion. Results: The majority of significant positive results on lifestyle factors were shown among the studies describing high intensity and long duration. Included studies showed a wide variation in content, but four different interventions (informative content, educational content, practical content, behavioral and self care-oriented content) emerged. The group of studies which contained all four interventions focused on most lifestyle factors and achieved the most significant positive results. Conclusion: This systematic literature review shows that CRP should include high intensity, long duration and an intervention content covering information, knowledge, practical training, self care-activity and behavior changes in order to achieve effect on all four lifestyle factors of diet, physical activity and exercise, smoking and stress. Lifestyle changes can be reached in less lifestyle factors, with a longer duration and a variation of intensity of contacts but in combining with an informative and educational content with an additional content of a practical nature or self activity.

Study of the Conditions Surrounding Fatigue That Are Common to Medical Professionals Working in Emergency and Critical Care Centers in Japan

This study aimed to clarify the conditions surrounding fatigue that are common to medical professionals working in emergency and critical care centers in Japan. Semi-structured interviews were conducted with eight professionals ranging from doctors, nurses and pharmacists to clinical engineering technologists and radiation technologists. Their narratives were analyzed using the qualitative descriptive approach to determine fatigue common to all professionals and the reasons behind it. The five categories that emerged as the reasons for fatigue common to the subjects were [playing one’s role in treatment and procedures for emergency and critical patients], [accommodating the patient’s background and coming to terms with the outcome], [difficulties in liaising with other professionals], [feeling pressure as a responsible professional in emergency care] and [loss of sense of time caused by variable working hours]. The results revealed that fatigue common to all of the subjects was related to dealing with patients, coordinating with other professionals, having professional responsibilities and the working environment. This study suggests that arrangements to improve the working environment, ensure adequate staffing, and provide mental health support for the well-being of medical professionals working in emergency and critical care centers are necessary.

Details of Particulars of Benefit Finding through the Experiences of Breast Cancer Patients Analysis on Breast Cancer Journals Written by Patients

This study aims to analyze the descriptions in breast cancer journals written by patients and to understand the experience of benefit finding among patients with breast cancer. We selected 22 such breast cancer journals written by patients published after 2000 in Japan. The extracted statements related to benefit finding of patients experiencing breast cancer from the 22 journals were subjected to a qualitative analysis, and the following seven benefit finding elements were extracted: “Gratitude toward others”, “Benefits due to cancer”, “Happiness at living a normal life”, “Realization of and satisfaction with my growth”, “Awareness of the meaning of my existence”, “Hopes for life”, and “Willingness to contribute to others”. These benefit findings suggest that these particulars fulfill cultural, practical, spiritual, and social meanings, and lead to self-revaluation in daily life.

Effect of Foot Self-Care Behavior According to Severity of Diabetic Neuropathy in Japanese Patients with Diabetes

PURPOSE: Diabetic patients with severe diabetic neuropathy often have hypoesthesia and numbness. This study evaluated foot self-care behavior according to severity of diabetic neuropathy. METHODS: We used a hand-held nerve conduction test device DPN check (HDN-1000, Omron) to evaluate severity of diabetic neuropathy. Foot self-care was evaluated using the Japanese SDSCA (the Summary of Diabetes Self-Care Activities measure). Foot self-care comprised visual inspection, washing, wiping interdigital areas, and checking shoes, and was scored according to the number of days self-care which was performed in the previous week. RESULTS: The study evaluated 103 diabetic patients (age: 65.7 years, diabetes duration: 13.9 years, HbA1c: 7.3%). Total scores (out of 28 points) for self-care behavior according to neuropathy severity were 11.8 (Normal: n = 54), 10.6 (Mild: n = 27), 13.3 (Moderate: n = 17), and 10.8 (Severe: n = 5). Foot self-care scores were low in all groups, with particularly low scores in those with severe neuropathy. However, no statistically significant differences were observed. CONCLUSIONS: Foot self-care is essential in diabetes because lesions are more likely to occur in severe neuropathy. Living alone and the presence of recurrent foot lesions are associated with poor survival prognosis. Accordingly, foot-care intervention must take neuropathy severity and lifestyle factors into account. The severity of diabetic neuropathy must be determined and foot-care intervention should take lifestyle factors into account.

Incongruence between the Preferred Mode of Delivery and Risk of Childbirth Complications among Antepartum Women in Mulago Hospital, Uganda

Objective: Women’s preferences for the mode of delivery provide clues on their knowledge and perceptions of anticipated risk of childbirth complications.?The objective was toinvestigate?incongruence between preferred mode of delivery and risk of adverse pregnancy outcomes. Methods: Through a cross-sectional study, data were?collected from 327?women admitted to Mulago hospital. Data included socio-demographic?characteristics, past medical, gynaecological and obstetric history, pregnancy complications, knowledge of pregnancy complications and preferred mode of delivery. The preferred mode of delivery and knowledge of related risks for adverse pregnancy outcomes were compared. Results: The mean age of participants was 24.7 years (±5.9), ranging?14?-?43 years, of whom 41.4% were nulliparous. The preferred mode of delivery was vaginal (84.1%). Incongruence?(preference for a mode of delivery that did not correspond to expected or anticipated risks) occurred in 88 (26.9%) of the women, and was associated with having secondary school or higher level of education (OR 2.49, CI 1.52?-?4.08) and history of previous vaginal delivery (OR 3.82,?CI 1.94?-?7.49). Conclusion: One in four women had incongruence between preferred mode of delivery and risks of adverse pregnancy outcomes, which called?for urgent interventions to improve decision-making about intrapartum care.

Work related burnout syndrome,information satisfaction,and concern of safety among Greek nurses during the first wave of COVID-19 outbreak

Objective:To determine the levels of burnout among Greek nurses during the first wave of Coronavirus disease 2019(COVID-19)pandemic and to investigate the relationship among levels of burnout,satisfaction and concern about information,personal protection equipment(PPE),and safety for COVID-19.Methods:A cross-sectional study was conducted.Data were collected by using the Burnout subscale of the Greek version of the Professional Quality of Life Scale.Questions concerning satisfaction and concern about information,PPE,and safety for COVID-19 were added.Convenience sampling method was employed.Descriptive statistics and multiple linear regression analysis were applied,and distributions were tested for their symmetry using Bloom’s method.Results:The sample comprised of 301 nurses working in public and private hospitals in Greece.A moderate level of burnout was found among the Greek nurses(mean=29.95,±4.75).Regarding satisfaction and concern about information,PPE,and safety for COVID-19,nurses expressed overall low satisfaction with a mean score of 1.96(±0.77),and high levels of concern with a mean score of 3.19(±0.85).Increased satisfaction regarding the information provided was significantly associated with decreased levels of burnout(β=-1.32,P<0.001),and increased concern for COVID-19 was significantly associated with increased levels of burnout(β=0.83,P=0.010).Conclusions:Greek nurses expressed low satisfaction concerning information,PPE,and safety for COVID-19 and high levels of concern of possible COVID-19 transmission.Nevertheless,a moderate level of burnout was found.

Comparative efficacy and optimal duration of first-line antibiotic regimens for acute otitis media in children and adolescents:a systematic review and network meta-analysis of 89 randomized clinicaltrials

Introduction Antibiotic use for acute otitis media(AOM)is one of the major sources of antimicrobial resistance.However,the effective minimal antibiotic duration for AOM remains unclear.Moreover,guidelines often recommend broad ranges(5-10 days)of antibiotic use,yet the clinical impact of such a wide window has not been assessed.Methods We systematically searched PubMed/MEDLINE,Embase,Scopus,Web of Science,and Cochrane Library from database inception to 6 October 2021.Network meta-analysis was conducted on randomized controlled trials that assessed antibiotic treatment for AOM in children(PROSPERO CRD42020196107).Results For amoxicillin and amoxicillin-clavulanate,7-day regimens were noninferior to 10-day regimens in clinical responses[amoxicillin:risk ratio(RR)0.919(95%CI 0.820-1.031),amoxicillin-clavulanate:RR 1.108(0.957-1.282)],except for≤2 years.For the third-generation cephalosporins,7-day and 10-day regimens had similar clinical responses compared to placebo[7-day:RR 1.420(1.190-1.694),10-day:RR 1.238(1.125-1.362)compared to placebo].However,5-day regimens of amoxicillin-clavulanate and third-generation cephalosporins were inferior to 10-day regimens.Compared to amoxicillin,a shorter treatment duration was tolerable with amoxicillin-clavulanate.Conclusions Our findings indicated that 1O days of antibiotic use may be unnecessarily long,while the treatment duration should be longer than 5 days.Otherwise,5-day regimens would be sufficient for a modest treatment goal.Our findings revealed that the current wide range of recommended antibiotic durations may have influenced the clinical outcome of AOM,and a narrower antibiotic duration window should be re-established.

Pedunculated gastric tube interposition in an esophageal cancer patient with prepyloric adenocarcinoma

Gastric carcinoma is one of the malignancies that are most frequently associated with esophageal carcinoma.We describe herein our device for advanced esophageal cancer associated with early gastric cancer in the antrum.A 57-year-old man presenting with dysphagia and upper abdominal pain was admitted to our hospital.Preoperative examinations revealed locally advanced squamous cell carcinoma (SCC) of the middle thoracic esophagus (T3N0M0 Stage ⅡA) and mucosal signetring cell carcinoma of the gastric antrum (T1N0M0 Stage ⅠA).Although the gastric tumor appeared to be an intramucosal carcinoma,its margin was obscure,so endoscopic en-bloc resection was considered inadequate.We chose surgical resection of the gastric tumor as well as the esophageal SCC after neoadjuvant chemotherapy with 5-fluorouracil and cisplatin for advanced esophageal cancer.Following transthoracic esophagectomy with three-field lymph node dissection,the gastric carcinoma was removed by gastric antrectomy,which preserved the right gastroepiploic vessels,and a pedunculated short gastric tube was used as the esophageal substitute.Twenty-eight months after the surgery,the patient is well with no evidence of cancer recurrence.Because it minimizes surgical stress and organ sacrifice,gastric tube interposition is a potentially useful technique for esophageal cancer associated with localized early gastric cancer.

Gastric cancer surgery for patients with liver cirrhosis

AIM:To elucidate the influence of liver cirrhosis(LC) on the prognosis of patients with gastric cancer(GC).METHODS:Of the 1347 GC patients who underwent curative gastrectomy for GC between January 1984 and June 2007,25 patients(21 men and 4 women with a median age of 67 years;range 54-77 years) with LC were enrolled in this study.Using the Child-Pugh classification,15 patients were evaluated as grade A and 10 patients as grade B.No grade C patient underwent gastrectomy in this series.Clinical outcomes,including postoperative morbidity and survival,were retrospectively analyzed based on medical records and surgical f iles.RESULTS:There was no significant difference in operative blood loss and perioperative blood transfusion between the two groups.The most common postoperative complication was intractable ascites,which was the single postoperative morbidity noted more frequently in grade B patients(40.0%) than in grade A patients(6.7%) with statistical signif icance(P = 0.041).Operative mortality due to hepatic failure was seen in one grade A patient.Three patients had hepatocellular carcinoma(HCC) at presentation and two patients developed HCC after surgery.Overall 5-year survival rate was 58.9% in patients with early GC and 33.3% in patients with advanced GC(P = 0.230).GC-specific 5-year survival rate of early GC patients was 90.0% while that of advanced GC patients was 58.3%(P = 0.010).Four patients with early GC died of uncontrolled HCC,of which two were synchronous and two metachronous.CONCLUSION:The risk of postoperative intractable ascites is high,particularly in grade B patients.Early detection and complete control of HCC is vital to improve a patient's prognosis.

Nurses as Street Level Bureaucrats: Experiences from Diabetes Care Nurses in Kuwait

Street-level bureaucrats are described as public service workers who interact directly with citizens in the course of their work and who have substantial discretion in the execution of their work. This article is a reflection of the primary author’s doctoral research experience, which investigated the role of nurses in caring for long-term diabetes patients in two selected hospitals in Kuwait. Nurses working in diabetes care in Kuwait were reported to operate under difficult conditions and utilized the tool of discretion to provide patient care, hence were exemplary street-level bureaucrats.

Nurse odor perception in various Japanese hospital settings

Because unpleasant hospital odors affect the nursing environment,we investigated nurses'perceptions of the odors of various hospital settings:hospital rooms,nurse stations,and human waste disposal rooms to discard the urine,stools and diapers.A questionnaire based on the Japanese Ministry of the Environment's guidelines on odor index regulation was used to assess nurses'perceptions of odor intensity,comfort,tolerability,and description in the aforementioned settings.Questionnaires were distributed to nursing department directors at three Japanese hospitals,who then disseminated the questionnaires to nursing staff.Of the 1,151 questionnaires distributed,496 nurses participated.Human waste disposal rooms had greater odor intensity and were perceived as more uncomfortable than the other settings.Unpleasant odors in disposal rooms,hospital rooms,and nurse stations were rated as slightly intolerable in comparison.Hospital and disposal rooms were mainly described as having a“pungent odor such as of urine and stool.”In contrast,nurse stations were described as having other unpleasant odors,such as chemical,human-body-related,or sewage-like odors.Given that nurses spend much of their time in hospital rooms and nurse stations,odor management in these two settings would likely improve nurses'working conditions at hospitals.Improving odors at nurse stations is feasible.Such improvements could have indirect effects on nurse turnover and burnout.

Readiness for Advance Care Planning in Older Adults: A Literature Review

Introduction: In the context of end-of-life care, interest in advance care planning (ACP) has increased as an approach that allows a person to live in the manner of his or her choosing until the end. ACP is a process of discussion among the elderly persons, family members, and medical staff. However, preparations necessary for starting ACP are not clear. In this study, we aim to clarify the readiness of ACP focusing on the elderly who are the center of end-of-life care. Methods: We reviewed the literature on the subject in the CINAHL and PubMed databases. The keywords used were “advance care planning” and “readiness”. Results: Twelve articles were selected for the final analysis. ACP readiness was broadly divided into preparations on the part of the elderly themselves, family members, and medical professionals. Conclusion: The most frequently reported factor in readiness for ACP was elderly people informing their families and physicians of their intentions. In addition, the establishment of communicative relationships among elderly persons, their family members, and medical professionals was considered readiness for commencing ACP. It was suggested that enhancing these types of readiness would help reduce the barriers to ACP, thereby facilitating its practice.

Constructing family identity close to death

Daily life close to death involves physical, psychological, and social strain, exposing patients and their family members to major transitions affecting relational patterns and identity. For the individual family member, this often means sharing life with a changing person in a changing relationship, disrupting both individual identity and family identity. Our aim was to deepen the understanding of individual experiences that are important in constructing family identity close to death at home. We performed a secondary analysis of qualitative data collected through 40 interviews with persons with life-threatening illness and the family members who shared everyday life with them. The analysis resulted in interpretive descriptions which provided three patterns important for creating family identity, which we here call “we-ness” close to death. The patterns were: being an existential person, being an extension of the other, and being together in existential loneliness. Together, these three patterns seemed to play a part in the construction of family identity;we-ness, close to death. One important finding was the tension between the search for togetherness in “we-ness” while dealing with an existential loneliness, which seemed to capture an essential aspect of being a family of which one member is dying.