Published papers

Context: The growing number of older people significantly affects end-of-life care. However, few studies have assessed the quality of end-of-life care among cancer patients with dementia. Objectives: To assess the quality of end-of-life care among non-small cell lung cancer patients with or without dementia using a nationwide inpatient database from Japan. Methods: This was a retrospective observational study that used a nationwide inpatient database of 366 acute care hospitals from April 2014 to November 2018. Poisson regression models were used where the quality indicator was the dependent variable, dementia status was the independent variable, and the age group and Charlson comorbidity index were covariates. Incidence proportion ratios (IPRs) and confidence intervals (CIs) were obtained from the model. Results: The study population included 16,758 patients, of whom 4507 (26.9%) had dementia. The incidence proportion of opioid use (61.8% vs. 70.8%; IPR: 0.87, 95% CI: 0.83–0.91), palliative care consultation (2.7% vs. 3.8%; IPR: 0.71, 95% CI: 0.58–0.88), mechanical ventilation (4.0% vs. 5.4%; IPR: 0.74, 95% CI: 0.62–0.87), and cardiopulmonary resuscitation (2.2% vs. 2.8%; IPR: 0.79, 95% CI: 0.63–0.99) was significantly lower in patients with dementia than in those without dementia. Conclusion: Patients with dementia are less likely to receive end-of-life care. This study demonstrates the importance of providing high-quality end-of-life care regardless the cognitive status of patients with cancer.

Aims: This review aimed to determine the characteristics of a nurse-led intervention for people with dementia including mild cognitive impairment and their family in an ambulatory care setting. Background: Enhancing the role of nurses in a multidisciplinary team of ambulatory care follow-up after a diagnosis of dementia is thought to lead to successful dementia care. Design: This is a scoping review. Data Sources: MEDLINE, CINAHL, EMBASE, Cochrane, JBI, Japan Medical Abstracts Society, PsycINFO and Web of Science were searched on 14 March 2019. Review Methods: This scoping review was conducted using the Joanna Briggs Institute methodology, followed the PRISMA-ScR checklist and considered studies that included interventions conducted by nurses and included outcomes regarding dementia symptoms or family care burden. Results: Eleven studies were included. Of these, all interventions were multifactorial and reported effective results. Educational interventions were most common, and the content of education included the characteristics of dementia and how to interact with patients with dementia. The roles of nurses included caregiver education, assessment, care plan creation for continuous monitoring and team building. Conclusion: This scoping review suggested that effective nurse-led interventions in the ambulatory care of people with dementia are continuous patient and family supports, primarily caregiver education within multidisciplinary teams.

This study investigated lifestyle changes and the self-reported mental health status of Japanese community residents during the COVID-19 pandemic. Differences in demography, daily lifestyle changes, and approaches to problem solving were analyzed in two age cohorts (<60 vs ≥60 years). The prevalence of moderate/increased psychological distress was 31.7%, with no significant difference between the cohorts. Compared with the pre-COVID-19 era, more than 80% of the participants stopped eating out and spent more time at home, and more than 70% used public transport less frequently. There were significant differences between the cohorts for the time spent at home, opportunities to eat meals outside of home, and shopping in stores. Participants aged under 60 years were less likely to use television and newspapers or to consult a family doctor. Those aged over 60 years were less likely to consult friends/ colleagues or to use the Internet/social networking services. Identifying the risk factors for psychological distress is warranted for implementing measures to maintain and improve the physical and mental health of residents.

Aim: To describe factors affecting critical appraisal of research articles in evidence-based practice by certified nurse specialists who were advanced practice nurses in Japan. Design: A descriptive qualitative study. Methods: Fourteen certified nurse specialists with master's degree were included by a snowball sampling to maximize the variety of specialty fields for advanced practice nurses in Japan. Individual semi-structured interviews were conducted between November 2016 and March 2017. Interview guides included the experience of evidence-based practice and learning about critical appraisal. Results: The following four aspects were identified as factors affecting the critical appraisal of research articles in evidence-based practices—individual beliefs and attitude, learning status, organizational readiness and availability of research evidence. Each factor included both positive and negative aspects for critical appraisal in evidence-based practice. Patient or Public Contribution: If advanced practice nurses acquire knowledge/skills of critical appraisal, they would be able to select more appropriate care. This will increase to improve the health-related outcome for patients or populations.

Aim: To derive latent topics from free-text responses on the negative impact of the pandemic on research activities and determine similarities and differences in the resulting themes between academic-based and clinical-based researchers. Methods: We performed a secondary analysis of free-text responses from a cross-sectional online survey conducted by the Japan Academy of Nursing Science of its members in early 2020. The participants were categorized into two groups by workplace (academic-based and clinical-based researchers). Latent Dirichlet allocation (LDA) topic modeling was used to extract latent topics statistically and list important keywords/text associated with the topics. After organizing similar topics by principal component analysis (PCA), we finally derived topic-associated themes by reading the keywords/texts and determining the similarity and differences of the themes between the two groups. Results: A total of 201 respondents (163 academic-based and 38 clinical-based researchers) provided free-text responses. LDA identified eight and three latent topics for the academic-based and clinical-based researchers, respectively. While PCA re-grouped the eight topics derived from the former group into four themes, no merging of the topics from the latter group was performed resulting in three themes. The only theme common to the two groups was “barriers to conducting research,” with the remaining themes differing between the groups. Conclusions: Using LDA topic modeling with PCA, we identified similarities and differences in the themes described in free-text responses about the negative impact of the pandemic between academic-based and clinical-based researchers. Measures to mitigate the negative impact of pandemics on nursing research may need to be tailored separately.

Aim: To examine the patterns of the visiting nurse services provided to older adults in a type of residential facility in Japan and to identify associated factors. Methods: This secondary analysis used past survey data from visiting nurse service agencies providing services to older adults in residential facilities with few nurses, known as non-specified facilities in Japan. Approximately 515 cases were used to determine the patterns of visiting nurse services using latent class analysis. Multinomial logistic regression analysis examined the relationships between identified classes, residents' characteristics, facilities, and services provided by visiting nurses. Results: Three service patterns were identified as follows: Class 1, observational and follow-up care (37.1%); Class 2, chronic disease care (35.7%); and Class 3, end-of-life care (27.2%). Class 1 comprised fewer nursing services than the other classes and primarily involved the observation of medical conditions, whereas Classes 2 and 3 involved higher care-need levels and provided diverse nursing care support. Specifically, Class 3 was associated with the inclusion of family (odds ratio: 2.42) and a visiting nurse at the attached facility (odds ratio: 4.88). Conclusions: The three identified classes describe the older residents' healthcare needs. Additionally, the factors associated with the end-of-life care class suggest that older residents with these factors may have difficulty accessing end-of-life care by visiting nurses. Geriatr Gerontol Int 2023; ••: ••–••.

Aim To explore the individual factors (such as gender, division of household labor, childcare and elder care) and their impact on research activities in the Japanese nursing research community during the early stage of the COVID-19 pandemic from April to June in 2020. Design Cross-sectional study. Methods An online survey with a self-reported questionnaire was conducted on Japan Academy of Nursing Science members to explore the impacts of individual factors among Japanese nursing researchers from April to June 2020. A multivariate logistic regression model was used for data analysis. Results A total of 1,273 participants (90.7% female, 85.8% university faculty) were included in the analysis. This survey showed that no evidence of a significant gender gap was found in research activities in Japanese nursing researchers during the COVID-19 pandemic. Research activities during the pandemic were associated with time and motivation.

Aim: This study aimed to explore sociodemographic factors related to evidence-based practice (EBP) competency in Japanese nurses in university hospitals. Methods: In March 2016, a survey was distributed to 843 clinical nurses who directly provide nursing care at two university hospitals in Japan. Multiple regression analyses were conducted on data received from 472 nurses using the Evidence-Based Practice Questionnaire (Japanese version). Results: Sociodemographic factors related to EBP competency were experience with conducting nursing research as a part of continuing education, education about EBP, advanced practice certification (certified nurse specialists/certified nurses), and years of experience in clinical nursing. These factors differed across the four subscales of the questionnaire: Practice, Attitude, Knowledge of Research and Practice, and Skills of Research and Practice. Specifically, experience with two or more nursing research activities was significantly positively associated with Attitude and Knowledge/Skills Concerning Research and Practice of EBP, but not related to the implementation of EBP itself. Advanced practice certification was significantly positively associated with Practice and Attitude of EBP. Conclusions: Our study quantitatively identified sociodemographic factors including experience with conducting nursing research and advanced practice certification status that were found to be related to EBP competency and these factors were differently associated with the four subscales of the Evidence-Based Practice Questionnaire (Japanese version). EBP education should depend on nurses' levels of EBP competency, and nursing educators and managers need to be cognizant of their nurses' sociodemographic factors when providing EBP education.

Aim: To identify the association between possible factors and depression among post-percutaneous coronary intervention patients with acute coronary syndrome. Design: Prospective cohort study. Methods: Sixty-eight post-percutaneous coronary intervention patients with acute coronary syndrome were enrolled between January 2016 - June 2017. The Hospital Anxiety and Depression Scale scores at 1–3 months after discharge were regressed onto uncertainty in illness and other clinical factors based on the Roy Adaptation Model. Results: Thirty-six patients were included in the final analysis. Higher baseline depression scores, higher changes in uncertainty in illness and feeling annoyed by troublesome tasks after discharge were associated with higher depressive scores at 1 month after discharge. Careful observation and support of patients’ ineffective responses in self-concept mode may be effective in preventing depression.

Aim: The number of cancer patients with dementia has increased markedly in accordance with aging societies. Cancer patients might receive palliative and end-of-life care to maintain their quality of life; however, the impact of dementia on the quality of death is unexamined in this population. Consequently, we explored the impact of dementia on the quality of death among cancer patients. Methods: Home palliative care staff members completed questionnaires regarding cancer patients’ (n = 508) cognitive status, cancer-related symptoms and quality of death using the good death inventory. Hierarchical regression analyses were carried out for the entire sample and for stratified groups based on the presence of dementia. Results: Of the 508 patients, 156 (30.7%) had dementia. Hierarchical regression analyses revealed that greater quality of death was associated with not having dementia (P < 0.001). Stratified analyses showed that dying at home was related to greater quality of death both in patients with and without dementia. The presence of a primary family caregiver was associated with greater quality of death only in patients with dementia (P < 0.001). Conclusions: Cancer patients with dementia were less likely to achieve a good death than those without. Our results suggest the importance of enhancing end-of-life care discussions with patients and their families, along with developing specific support strategies to enhance the decision-making of cancer patients with dementia and their family members. Geriatr Gerontol Int 2020; 20: 354–359.

Aim: To investigate how nursing faculties' perceived time devoted to research changed during the first wave of the pandemic in Japan (April–June 2020) compared to pre-pandemic. Methods: This cross-sectional study was conducted online from July 1 to August 10, 2020 and involved 1,023 nursing faculties in Japan. Participants were asked to respond to a questionnaire based on their experiences from April to June 2020. We calculated descriptive statistics for several measures and examined associations between professional/personal demographic factors and declines in overall research time. Results: Of the 1,023 participants, 71.1% were spending less time on overall research activity; 79.6% spent less time attending academic events/conferences, and 77.4% spent less time conducting experiments/surveys. In contrast, 81.2% spent more time teaching, a much greater proportion than the global scientific community in a previous survey. As for work time allocation during the pandemic, teaching was by far the one activity that participants spent the most time on. Logistic regression analysis revealed that declines in overall research time were associated with several professional demographic factors, such as type of university, current academic position, and acquisition status of Japan's major research grant (KAKENHI) (all p <.05). Conclusions: Nursing faculties in Japan clearly spent less time on research, and more time on teaching during the first wave of the pandemic compared to pre-pandemic. The initial impact of the pandemic on nursing faculties revealed through this study is an eye-opener and a start for addressing the long-term impact on the nursing scientific community.

Introduction: The number of people with dementia (PwD) dying in long-term care (LTC) settings is expected to increase. However, effective care strategies to promote a good death for PwD remain unclear. This study aimed to explore nurses’ perceptions of a good death for PwD in LTC settings for older adults. Methods: Interviews were conducted with 19 nurses providing end-of-life care in LTC settings for older adults in Japan. The transcribed texts were analysed using inductive content analysis. Results: We identified two themes: (1) ambiguity and (2) preparedness. Participants perceived that there was ambiguity regarding a good death for PwD and emphasised the need for preparedness of those around PwD for a good death. Five categories represented preparedness: (a) reaffirming the original personality before dementia; (b) respecting that PwD change; (c) interpreting and fulfilling obscure desires, feelings, and sensations; (d) providing care consistent with an agreed-upon natural death process; and (e) maintaining relationships. Conclusion: Long-term care nurses should encourage families and multidisciplinary team members, including the nurses themselves, to prepare for a good death of the PwD. Future research should focus on healthcare professionals’ perspectives on advance care planning in the early stages of dementia, as well as the perceptions of PwD, their family members and other healthcare professionals regarding the natural death process.

Aim: To elucidate influence of a do-not-attempt-resuscitation (DNAR) order on nurses’ perceptions of the medical procedures and nursing practices for non-cancer older patients. Design: A vignette-based questionnaire study. Methods: A questionnaire survey asking nurses their perceptions of clinical practices for the following three vignettes was performed in a community hospital in Japan (N = 120): the control vignettes with an older patient with repeated heart failure who was living alone and the other two with either an absence of relatives or a diagnosis of dementia. We also prepared additions to each vignette describing a DNAR order. Results: Nurses’ perception on cardiopulmonary resuscitation, defibrillation, blood tests and intravenous nutrition showed statistically significant and minimally important declines after the DNAR order compared with before for all three vignettes (p <.001). DNAR orders can influence nurses’ perceptions of clinical practices for non-cancer older patients with chronic heart failure.

Objectives: The quality of care for dementia in acute-care settings has been criticised. In 2016, the Japanese universal health insurance system introduced a financial incentive scheme for dementia care by dementia specialist teams in acute-care hospitals. This study aimed to investigate the effectiveness of this financial incentive scheme on short-term outcomes (in-hospital mortality and 30-day readmission). Design and Methods: Using a Japanese nationwide inpatient database, we identified older adult patients with moderate-to-severe dementia admitted for pneumonia, heart failure, cerebral infarction, urinary tract infection, intracranial injury or hip fracture from April 2014 to March 2018. We selected 180 propensity score-matched pairs of hospitals that adopted (n = 180 of 185) and that did not adopt (n = 180 of 744) the financial incentive scheme. We then conducted a patient-level difference-in-differences analysis. In a sensitivity analysis, we restricted the postintervention group to patients who actually received dementia care. Results: There was no association between a hospital's adoption of the incentive scheme and in-hospital mortality (adjusted odds ratio [aOR]: 0.97; 95% confidence interval [CI]: 0.88–1.06; p = 0.48) or 30-day readmission (aOR: 1.04; 95% CI: 0.95–1.14; p = 0.37). Only 29% of patients in hospitals adopting the scheme actually received dementia care. The sensitivity analysis showed that receiving dementia care was associated with decreased in-hospital mortality. Conclusions: The financial incentive scheme to enhance dementia care by dementia specialist teams in Japan may not be working effectively, but the results do suggest that individual dementia care was associated with decreased in-hospital mortality.

Background: Pain is a common health problem in undergraduate students. Pain prevalence, pain management strategies and knowledge among healthcare groups has not been revealed yet. Aim: This study explored pain prevalence, intensity, pain management strategies, knowledge, and education in undergraduate students specializing in healthcare science. The findings will highlight the necessity for increasing pain management education in the university setting. Design: A questionnaire-based, cross-sectional study was conducted. Settings/ Participants: Data was collected from 1,490 university students in Tokyo between December 2015 and April 2016. A χ square test was performed to examine differences in pain status and management strategies according to gender. We compared medical knowledge scores among disciplines using one-way analysis of variance. Results: In total, 511 (79.2%) students had experienced bodily pain during the preceding 6 months. Pain prevalence differed by gender. More nursing students had used both pharmacological and nonpharmacological methods for pain management than had students from other disciplines (p = .011). Pain medication knowledge of students in other disciplines was low to moderate, with greater knowledge observed in medical students (p < .05). Conclusions: Education regarding pain management should be developed that considers differences among disciplines. Additionally, poor pain management knowledge could affect the quality of care students provide to patients after graduation. Enhancing pain management knowledge by providing suitable pain management education in universities may contribute to better pain management for students, and this may translate to their work in clinical settings.

Background: The death of a loved one has great impact on family members even when the death was expected. While negative changes are reported, some individuals also report personal growth, known as posttraumatic growth (PTG). Many studies on PTG have been performed using quantitative methods and suggest that PTG may differ according to the traumatic event and cultural background. Purpose: This study aimed to explore how Japanese bereaved family members of patients with cancer express their experience of PTG after the patient’s death by analyzing open-ended answers provided in a cross-sectional survey. Methods: Qualitative data were collected through a survey, and thematic analysis was used to analyze the data. The present study was part of a larger cross-sectional survey of bereaved families of patients with cancer. Data analyzed in the current study were obtained from 162 bereaved family members of patients with cancer. Results: We identified 18 sub-themes within five predefined major domains of PTG. Moreover, we also identified two additional themes: changed view of life and death, and awareness of health management. Conclusions: The experience of PTG of bereaved family members varied considerably. Future research on PTG experiences among groups from diverse cultural backgrounds would be beneficial for understanding the concept and its clinical implications.

The number of deaths of older adults in long-term care settings will increase with the aging population. Nurses and care workers in these settings face various challenges in providing end-of-life care, and interventions for quality end-of-life care may be useful. This feasibility study aims to explore the preliminary effect and acceptability of an intervention named the EOL Care Tool to improve end-of-life care in long-term-care facilities. We conducted a single-arm quasi-experimental study using mixed methods. This tool consisted of multiple components: professionalized lectures, newly developed structured documents, regular conferences regarding end-of-life care, and educational support from administrators. Twenty-four nurses and fifty-five care workers employed in a long-term care facility participated. For nurses, improvement in attitudes toward end-of-life care (p < 0.05) and interdisciplinary collaboration (p < 0.05) were shown quantitatively. Regarding acceptability, nurses and care workers evaluated the tool positively except for the difficulty of using the new documents. However, qualitative results showed that care workers felt the reluctance to address the work regarding end-of-life care. Therefore, a good preliminary effect and acceptability for nurses were indicated, while acceptability for care workers was only moderate. Revision to address the mentioned issues and evaluation of the revised tool with a more robust research design are required.

Background: Japan has the largest population of older adults in the world; it is only growing as life expectancy increases worldwide. As such, solutions to potential obstacles must be studied to maintain healthy, productive lives for older adults. In 2011, the Japanese government has started a policy to increase “Elderly Housing with Care Services (EHCS)”, which is one of a private rental housing, as a place where safe and secure end-of-life care can be provided. The government expect for them to provide end-of-life care by collaborating with the Home-Visit Nursing Agencies (HVNA). The purpose of this study is to clarify the situation of the end-of-life care provision in EHCS in collaboration with HVNA and to examine the factors that associate with the provision of the end-of-life care in EHCS. Methods: A two-stage nationwide survey (fax and mail surveys) were conducted. Of the 5,172 HVNA of the National Association for Visiting Nurse Services members, members from 359 agencies visited EHCS. Logistic regression analysis was conducted with the provision of end-of-life care to EHCS in 2017 as the dependent variable, and the following as independent variables: characteristics of HVNA and EHCS; characteristics of residents; collaborations between HVNA and EHCS; and the reasons for starting home-visit nursing. Results: Of the 342 HVNA who responded to the collaborations with EHCS, 21.6% provided end-of-life care. The following factors were significantly associated with the provision of end-of-life care to inmates in elderly care facilities: being affiliated with a HVNA, admitting many residents using long-term care insurance, collaborating with each other for more than three years, and started visiting-nurse services after being requested by a resident’s physician. Conclusions: This study clarified the situation of the provision of end-of-life care in EHCS in collaboration with HVNA and the related factors that help in providing end-of-life care in EHCS.

Aims: To investigate the end-of-life (EOL) nursing care practice process in long-term care (LTC) settings for older adults in Japan. Design: A qualitative study based on grounded theory developed by Corbin and Strauss. Methods: Sampling, interviewing, and analysis were performed cyclically, with results for each stage used as the basis for data collection and next-stage analysis decisions. Semi-structured interviews were conducted from March 2015-March 2019 with 22 nurses from eight LTC settings. Analysis was performed using coding, constant comparison, and emerging categories. Results: The core category, “guiding the rebuilt care community to assist the dying resident” comprised five categories: “assessing the resident's stage,” “harmonizing care with the dying process,” “rebuilding a care community,“ “helping community members care for the resident,” and “encouraging community members to give meaning.” The participants were described as “traditional village elders“ who were the integral members of the care community, as well as guides who helped and encouraged the community. Conclusion: Results revealed the holistic process of EOL nursing-care practice in Japan. Nurses aimed to allow LTC residents to die as social human beings, surrounded by people, and not just responding physical and psychological distress. Such practice requires nursing expertise, healthcare skills, and leadership qualities to build and serve care communities. Nurses must also consider residents’ uncertainties and vulnerabilities as well as their cultural backgrounds. Impact: This study showed that the nurses hold unique roles in providing dying people with care from a community. These findings can potentially be applied for developing a universal model for LTC nurses in many aging populations, to modify their EOL care practice, educate new LTC nurses, and collaborate with other healthcare professionals.

Background: The COVID-19 pandemic has disrupted the lives of many. Particularly, nursing students experience greater stress as their normal curriculum is interrupted and some of them face the risk of being infected as frontline workers. Nursing faculty members may face similar struggles, in addition to developing teaching materials for online learning. Thus, it is important to examine the faculty members' and students' views on their ability to adapt during the pandemic to obtain a holistic view of how learning and training has been affected. Design: The descriptive cross-sectional quantitative design was used. Settings: Data were collected from Southeast and East Asian Nursing Education and Research Network (SEANERN) affiliated nursing institutions from January 2021 to August 2021. Participants: A total of 1897 nursing students and 395 faculty members from SEANERN-affiliated nursing institutions in Cambodia, Hong Kong, Indonesia, Japan, Laos, Malaysia, Philippines, Singapore, Thailand and Vietnam were recruited for this study. Methods: Quantitative surveys were used to explore the satisfaction levels in education modalities, confidence levels, psychosocial well-being, sense of coherence and stress levels of nursing students and faculty members during the COVID-19 pandemic. Results: Participants were mostly satisfied with the new education modalities, although most students felt that their education was compromised. Both groups showed positive levels of psychosocial well-being, despite scoring low to medium on the sense of coherence scale and experiencing great stress. The participants' sense of coherence was positively correlated with their psychosocial well-being and negatively correlated with stress levels. Conclusions: While the COVID-19 pandemic had negatively impacted the lives of nursing students and faculty members, most of them had a healthy level of psychosocial well-being. Having a strong sense of coherence was associated with better psychosocial health and lower stress levels. As such, it may be helpful to develop interventions aimed at improving the sense of coherence of nursing students and staff to help them manage stressors better.