Published papers

Aim: The increasing number of elderly people has caused increased demand for home-visiting nurses. Nursing managers should develop healthy workplaces in order to grow their workforce. This study investigated the work engagement of home-visiting nurses as an index of workplace health. The aim of the present study was to reveal factors contributing to work engagement among Japanese home-visiting nurses. Methods: An anonymous, self-administered questionnaire was sent to 208 home-visiting nurses from 28 nursing agencies in three districts; 177 (85.1%) returned the questionnaires. The Job Demands-Resources model, which explains the relationship between work environment and employee well-being, was used as a conceptual guide. The authors employed three survey instruments: (i) questions on individual variables; (ii) questions on organizational variables; and (iii) the Utrecht Work Engagement Scale (Japanese version). Multiple regression analyses were performed in order to examine the relationships between individual variables, organizational variables, and work engagement. Results: Nurse managers and nurses who felt that there was a positive relationship between work and family had significantly higher work engagement levels than others. The support of a supervisor was significantly associated with work engagement. Nurses in middle-sized but not large agencies had significantly higher work engagement than nurses in small agencies. Conclusion: Supervisor support and an appropriate number of people reporting to each supervisor are important factors in fostering work engagement among home-visiting nurses.

Our objectives were to describe the care provided during the nighttime and to discuss the characteristics of individuals who are more likely to be cared for at nighttime by visiting nurses of home visiting nurse agencies (HVNAs). Thirty-one clients participated in this study. Eight clients were physically independent and 23 clients were chair/bed bound. Among the physically independent group, the contents of the care at scheduled times were insulin injection and blood sugar measurement in four clients. Among the chair/bed-bound group, the most frequently given medical treatment was sputum suction (16 clients). The majority of clients who received HVNA services at night and early in the morning required medical treatment. The disease condition of clients was unstable and assessment of changes in disease condition was desirable.

This study develops a measure of the efficiency of visiting nurse (VN) agencies in Japan, examining the issues related to the measurement of efficiency, and identifying the characteristics that influence efficiency. We have employed a data envelopment analysis to measure the efficiency of 108 VN agencies, using the numbers of 5 types of staff as the input variables and the numbers of 3 types of visits as the output variables. The median efficiency scores of the VN agencies were found to be 0.80 and 1.00 according to the constant returns to scale (CRS) and variable returns to scale (VRS) models, respectively, and the median scale efficiency score was 0.95. This study supports using both the CRS and VRS models to measure the scale efficiency of VN service agencies. We also found that relatively efficient VN agencies filled at least 30 % of staff positions with experienced workers, and so concluded that this characteristic has a direct influence on the length of visits.

Objective: The purpose of this study was to describe the support provided by Japanese public health nurses (PHNs) to high-risk tuberculosis (TB) patients, focusing specifically on the support aimed at preventing interruptions in treatment. Design and Sample: A qualitative descriptive approach was used with a convenience sample of 11 PHNs in Japan who cared for TB patients at highest risk for medication adherence problems. Measures: Semi-structured interviews were conducted to learn the scope and practice of PHNs with high-risk TB patients. Data were analyzed using a qualitative descriptive analysis process. Results: One main theme was identified: "Supporting the patients in overcoming tuberculosis, regaining health, and living a healthier life." Three categories with five subcategories described the nurses' activities: (1) empathetic and reliable support, (2) motivational strategies for medication adherence, and (3) developing a foundation for healthier life. Conclusions: The nurses interviewed described creative and extraordinary strategies used to promote medication adherence and facilitate development of a healthy posttreatment lifestyle. Their approach was patient-centered and culturally congruent. Findings may be transferrable to PHN practice in other regions as care for this economically disadvantaged and marginalized population is a critical need.

Objectives: To determine if providing perinatal immunization education positively changes the immunization status of infants, influences the infant immunization knowledge, attitudes and beliefs of mothers and affects the intent to vaccinate children in Japan where immunization education is limited. Methods: Pregnant women were recruited from three sites in Tokyo, Japan and were assigned to two intervention (pre- or postnatal education) groups and a control group. The immunization status of infants was assessed and a written survey was performed before and after the intervention. Results: Among 119 study participants, 106 subjects replied to the post-survey. The intervention groups (34.3%) had higher immunization rates in infants at three months of age than the control group (8.3%) (P = 0.005); however, no differences were observed between the prenatal (29.4%) and postnatal groups (38.9%) (P = 0.40). The percentage of women intended to vaccinate their infants was higher in the intervention groups (61.4%) compared to the control group (33.3%) (P = 0.01). The improvement in score for basic knowledge was higher in the intervention groups, particularly in the prenatal group (mean ± S.D.: 3.4 ± 1.8) compared to the control (1.9 ± 1.9) (P = 0.003). Conclusions: Perinatal immunization education improved the immunization status of infants, increased the women's knowledge on immunization and intention to vaccinate their infants.

Aim: To identify workplace factors related to home visiting nurses' (HVNs) positive attitudes toward caring for dying patients. Methods: In this cross-sectional study, 343 HVNs working in 62 agencies across Chiba prefecture, eastern Japan, received an anonymous self-administered questionnaire from July to August 2012. Results: 304 questionnaires (88.6%) were returned, and the data of 206 HVNs (60.1%) in 54 different agencies was analysed. Multiple regression analysis showed that attendance at terminal care seminars, agency support of schedule organisation enabling attendance at terminal care seminars, and positive feedback from patients and families were significantly positively associated with HVNs' attitudes toward terminal care. Conclusion: These results may give useful interventional methods for nursing managers to enhance HVNs' terminal care practices.

To determine means of improving the efficiency of home nursing services, we conducted an experimental pretest-posttest study to compare the time spent by home visiting nurses (HVNs) on providing care with or without assistance. HVNs' job-related satisfaction levels were also compared. Forty-four clients in six visiting nursing offices in Fukuoka prefecture were selected for this study, which was conducted between July 2009 and January 2010. With assistance, HVNs' total care time and time spent performing trivial tasks decreased and time spent on communicating or teaching increased. Furthermore, HVNs were more satisfied with providing care than with their usual visits. We conclude that introduction of a skill mix might improve home visiting nursing service efficiency through shortening the HVNs' length of stay at a client's home.

Background: Strengthening interorganizational relationships in the community has become an increasingly valued strategy for improving public health in recent years. However, no intervention strategy to foster an interorganizational network in the community has yet been devised. The purpose of this study was to examine the effects on members of an organization of an intervention program designed to promote interorganizational network building between multidisciplinary agencies and community-based organizations (CBOs). Methods. The program was conducted in Setagaya and Suginami wards, Tokyo, Japan, for staff of community comprehensive support centers (CCSCs), which are multidisciplinary organizations responsible for the support of the elderly. A cluster non-randomized design with a CCSC as a cluster unit (N = 47) was used. The intervention group comprised 20 centers and the control group 27 centers. Those 27 centers declined to participate in program sessions, but did participate through completing pre- and post-intervention surveys. In total, 158 staff members were eligible to participate in this study, 73 from the intervention group and 85 from the control group. Of the 73 members in the intervention group, 19 participated in the monthly program sessions, over a period of 10 months. Attendees participated in group discussions during the sessions. The effects of the intervention were examined by comparing three groups (attendees and non-attendees of the program from the intervention group, and the control group) and between two groups (intervention group and control group). Results: We found no significant difference in any outcome between the intervention group and the control group. However, among the three groups, a significant effect was found in the recognition of knowledge and skills for building networks with CBOs. Recognition of knowledge and skills increased significantly among the attendees compared to non-attendees in the intervention group and the control group. In addition, there was a significant effect, particularly on those with relatively low baseline scores, for the recognition of knowledge and skills. Conclusions: The tested intervention proved effective for attendees regarding their recognition of knowledge and skills for promoting interorganizational network building with CBOs.

Background: In response to the rapid aging of the population in Japan, many care systems have been created in quick succession. Establishment of discharge planning departments (DPDs) in hospitals is one of them. In this study, we compared the distribution and characteristics of DPDs and the characteristics of the hospitals that have DPDs between 2001 and 2010 in Japan. Methods: We mailed a questionnaire about the characteristics of hospitals and existence and situation of DPDs to all general hospitals with 100 or more general beds in 2001 and in 2010. Results: In 2001, of the 3,268 hospitals queried, 1,568 (48.0%) responded and 1,357 (41.5%) were selected for data analysis. In 2010, among 2,600 hospitals, 940 hospitals (36.1%) responded and 913 (35.1%) met the inclusion criteria. The percentage of hospitals with DPDs increased from 30% to more than 70% between the two surveys. More departments were under the direct control of the hospital director and more physicians participated in discharge planning activities in 2010 than in 2001. In 2001, private hospitals and hospitals with an affiliated institution or agency tended to have a DPD; however, the relationship between these factors and the presence of a DPD had disappeared in 2010. Larger hospitals and hospitals with more nurses per patient tended to have a DPD both in 2001 and 2010. Conclusions: Since 2008, the establishment of a DPD has been directly connected to medical fees so hospital administrators might have recognized the DPD as a 'necessary and paid for' department. Having a DPD was the majority's policy in Japan, and we must recognize the importance of quality assurance through DPDs from now on, especially in small hospitals.

The rapid increase in the population of the elderly has raised several social issues. The current study focused on sleep dissatisfaction in family caregivers to identify family caregivers with a heavy care burden. This study aimed to detect the characteristics of caregivers who are most likely to have sleep dissatisfaction. A chi-squared automatic interaction detection technique was used to analyze data collected from 92 research care managers who collected demographic and sleep dissatisfaction information from 280 caregivers and their care recipients. Caregivers whose care recipients were unstable and bedridden were most likely to have sleep dissatisfaction. When care recipients were not stable or non-bedridden, had severe dementia symptoms, and were physically independent, their caregivers were the second most likely to have sleep dissatisfaction. When care recipients were not stable or non-bedridden, had moderate dementia symptoms, and did not need help in transferring, their caregivers had the lowest risk of sleep dissatisfaction. Although many recent studies have found a high prevalence of insomnia among the elderly, describing the characteristics of caregivers who are most likely to have sleep dissatisfaction is a significant challenge. When care recipients are physically independent, the severity of the recipient's dementia symptoms relates to the caregiver's dissatisfaction with his/her sleep. In physically dependent care recipients, the severity of the recipient's dementia did not contribute to the caregiver's dissatisfaction with his/her sleep.

Aim: The rapidly rising number of older people has inevitably caused an increasing demand for home visiting nurses. Nursing managers must develop a healthy workplace to recruit and retain a workforce of nurses. This study focused on home visiting nurses' perceptions of time pressure as a changeable work demand. The aim was to investigate perceptions of time pressure and reveal the relationship between perceived time pressure and burnout among home visiting nurses. Methods: From 32 agencies in three districts, 28 home visiting nurses agreed to participate in this study. Two hundred and eight home visiting nurses received an anonymous self-administered questionnaire by mail, and 177 (85.1%) filled out and returned the questionnaire to the researchers. The Job Demands-Resources model for burnout, which explains the relationship between a work environment and employee well-being, was used as a conceptual guide. Three survey instruments were employed: questions on sociodemographic variables and worksite environments, including time pressure; the Japanese burnout inventory; and a Japanese version of the job content questionnaire. Multiple regression analyses were performed to examine the relationships between time pressure and burnout inventory scores. Results: About 30% of home visiting nurses perceived time pressure frequently. When home visiting nurses perceived time pressure more frequently, they experienced higher emotional exhaustion and depersonalization. Conclusion: Time pressure was often perceived as another job demand and had a significant relationship with burnout. This indicates the importance of lessening time pressure to develop healthy work places for community health nurses.

Aim: The purpose of this study was to examine the current state and issues of doctoral nursing programs from the perspective of recipients of the educational process. Methods: All 46 doctoral nursing programs in Japan in 2008 were asked to participate in this study and 28 programs agreed to participate. The questionnaire had 3 sections that evaluated the quality of doctoral education, which are 17 items on the program features, 12 items on the quality of faculty, and 9 items on resources. Results: The questionnaire was distributed to 304 graduate students and 127 students returned by mail. Most of the students agreed that the program goal and curriculum were consistent with the philosophy and mission of the university. The quality of the faculty and of the resources, such as library and computing facilities, were highly rated, while faculty mentorship and support staff for student research were viewed as areas for improvement. Only 30% of the students reported that a periodic assessment of the doctoral program was available in the university, and even when such an assessment did exist, students and graduates were not often involved in the program evaluation. Conclusions: To improve the quality of doctoral nursing education in Japan, there is an urgent need for faculty development and the provision of research support services for faculty and students including more technical and support staff. Furthermore, it is imperative to conduct periodic evaluation of doctoral nursing programs in Japan.

Aim: To evaluate the effects of an educational program on discharge planning for staff nurses that was developed to improve their knowledge, attitudes, and practice as well as the organizational climate regarding discharge planning. Methods: Quasi-experimental design was used. Participants were 256 staff nurses on general internal medicine units in a 1210-bed national university hospital in the Tokyo area. Two groups were studied: an education group consisting of 102 nurses from 4 units and a control group consisting of 154 nurses from 6 units. The 3-month education program included study meetings, periodic conferences, and home visits following discharge. The control group received no education. Both groups answered an anonymous self-administered questionnaire before and after the intervention period. For post-intervention group comparisons, analysis of covariance was used. Results: We analyzed the data obtained from 87 education group nurses (response rate: 85.3%) and 104 control group nurses (response rate: 67.5%). In the education group, knowledge increased post intervention regarding home visiting nursing services, the hospital discharge planning department, and two relevant Japanese laws related to discharge planning. In addition, the education group showed improvement in attitudes towards discharge planning. Likewise, co-workers' recognition of discharge planning needs and their support for discharge planning were significantly improved in education-group units compared with control-group units. Conclusion: This education program was successful in strengthening knowledge of various systems related to discharge planning, improving the nurses' attitudes towards discharge planning, and impacting the climate of entire units; therefore, it was found to be effective.

Japanese social security systems and institutions for the elderly, as well as the general attitude toward elderly care services among the Japanese population, have been undergoing a dramatic change. By examining the association between institutional trust, which is a representative element of social capital, and anxiety regarding receiving elderly care, we can uncover clues toward building a more robust social security system for the elderly. This study examines the relationship between institutional trust, in the national social security and municipal healthcare systems for the elderly, and anxiety with respect to receiving elderly care among the general Japanese population. A cross-sectional survey was conducted using a self-administered questionnaire that was returned by mail in January and February 2005. The target population was 4735 community residents aged 2075 years, who lived in the city of Koka, Shiga, Japan. A total of 2264 questionnaires were included in the analysis. A binominal logistic regression analysis showed that responses of 'trust' [odds ratio (OR): 2.09, 95 confidence interval (95 CI): 1.014.30] and 'strongly trust' (OR: 3.80, 95 CI: 1.559.31) for the national system were associated with not having anxiety regarding elderly care, compared with the reference category of feeling strongly distrust. However, trust in the municipal system showed no association with this anxiety. These results indicate the importance of developing strategies to increase a common trust in the national care services for the elderly to reduce the anxiety people feel regarding whether they will be able to receive elderly care when required.

Evaluation of doctoral programs in nursing is becoming more important with the rapid increase in the programs in Japan. This study aimed to evaluate doctoral nursing programs by faculty members and to analyze the relationship of the evaluation with educational and research activities of faculty members in Japan. Target settings were all 46 doctoral nursing programs. Eighty-five faculty members from 28 programs answered the questionnaire, which included 17 items for program evaluation, 12 items for faculty evaluation, 9 items for resource evaluation, 3 items for overall evaluations, and educational and research activities. A majority gave low evaluations for sources of funding, the number of faculty members and support staff, and administrative systems. Faculty members who financially supported a greater number of students gave a higher evaluation for extramural funding support, publication, provision of diverse learning experiences, time of supervision, and research infrastructure. The more time a faculty member spent on advising doctoral students, the higher were their evaluations on the supportive learning environment, administrative systems, time of supervision, and timely feedback on students' research. The findings of this study indicate a need for improvement in research infrastructure, funding sources, and human resources to achieve quality nursing doctoral education in Japan.

Evaluation of doctoral education in nursing is needed with the rapid increase in doctoral nursing programs in Japan. This study aimed to compare the evaluations of doctoral nursing education by students, graduates, and faculty. All 46 doctoral nursing programs in Japan were target settings. 127 students who had been in the doctoral program, 24 graduates and 87 faculty members had responded to the survey. A questionnaire with 17 items for program evaluation, 12 items for faculty evaluation, 9 items for resource evaluation, and 3 for overall evaluations was distributed in November and December 2008. Responses to 1 program evaluation item, 2 faculty evaluation items and 4 resource evaluation items indicated significant differences among evaluators. While 79.2% of graduates responded positively that the number of faculty members was sufficient to facilitate learning, only 36.1% of faculty members and 49.6% of students responded affirmatively. Graduates' ratings were the most positive and faculty members were the least positive, especially for infrastructure or equipment such as libraries, computers, and the number of technical and support staff. The significant differences among the evaluators suggested that having evaluators in various roles is important to evaluate the quality of doctoral nursing education.

To determine the prevalence of knee pain, and implementation status of health behavior for knee pain among young-old persons living in a rural area in Japan by sex, and to study related factors. An anonymous self-administered questionnaire covering demographic variables, lifestyle such as smoking, drinking, farm work, snow removal, 'ochanomi' (tea break with friends), hospital visits, knee pain, JKOM (Japanese knee osteoarthritis measure) and health behavior was distributed to 2,758 persons aged 65 to 74 years living in Minamiaizu town, a rural and snowy town of Fukushima Prefecture in November, 2008. Valid responses were obtained from 1,415 (response rate: 51.3%). The prevalence of knee pain was 35.1%, and twice as many women as men had pain in their knees. People with knee pain had a higher body mass index, higher risk of motor deterioration, lower frequency of going out, and more hospital visits than people without knee pain. Health behavior was emphasized by 657 persons (46.3%), and the rate was higher in people with knee pain. As to companions and information source for health behaviors, 'ochanomi' friends were popular for women and family members for men. Walking was more common and exercise and diet were less common in men than in women. Among the women with knee pain, the implementation rate of health behavior was higher in non-smokers, farm workers, and 'ochanomi' participants than in others. Among men without knee pain, the implementation rate was higher in non-smokers and in people with high scores on the JKOM subscale of "pain or stiffness" and "health status". Among women without knee pain, more people living alone and going out once or more a week focused on health behavior more than the other people. The prevalence of knee pain in this study was similar to that in a previous study on elderly living in a mountain area. Type, information source, companion and related factors of health behavior differed by sex and presence of knee pain; therefore, approaches for encouraging health behavior should be suited to the target population's characteristics. Many people obtain information from non-professionals, so health care workers should provide details about adequate methods for health behavior in a careful manner.