論文

Objectives: The purpose of this study was (a) to describe the end-of-life experience of family caregivers of cancer patients, (b) to describe talking about death and dying of the patient to minor children, and (c) to examine the association of family caregivers' experiences by their characteristics and talking about death and dying of the patient. Methods: A cross-sectional nationwide survey of bereaved family caregivers was conducted. In total, 968 questionnaires were sent to bereaved family caregivers, and 711 were completed and returned. Fifty-three responses indicating patients had minor children were analyzed. Univariate analysis and principal component analysis were performed. Results: Family caregivers' experiences were divided into 3 domains by principal component analysis: protect children from the patient's imminent death, little regard for the children, and worry and concern about the children's emotional reaction. Family caregivers' common experiences were as follows: “I wanted to know how the children felt,” “I wanted to avoid making the children confused,” and “I did not have much time to talk with and/or play with the children.” About 30% of family caregivers reported that they “did not talk” about death and dying of patients to minor children. Spouses of patients and family caregivers who did not talk about death tended to experience distress and worry. Conclusions: Most family caregivers experienced worry and fear regarding minor children's emotional reaction; therefore, clinicians need to explain children's emotional and psychological reactions to family caregivers when a patient is at the end-of-life.

Objective: The current study was designed to test the hypothesis that quality of death (QOD) and intrusive and deliberate rumination are associated with posttraumatic growth (PTG) among bereaved family members of cancer patients in home palliative care. Methods: Data were collected from 805 bereaved family members of cancer patients who died at home in Japan. We used a cross-sectional design and participants completed Good Death Inventory, Event-Related Rumination Inventory, and PTG Inventory. Structural equation modeling was used to test the hypothesized relationships. Results: A direct pathway from QOD to PTG was significant. We also found significant indirect pathways between QOD and PTG via deliberate rumination soon after the death and recent deliberate rumination. Conclusions: Clinicians should provide high-quality end-of-life care with the goals of achieving a good death for terminally ill cancer patients and supporting the experience of PTG in bereaved family members after their loss.

大都市東京における災害時の医療対応には、災害拠点病院と中・小規模医療機関の連携が不可欠であるが、中・小規模医療機関側の災害対策状況を明らかにした調査は少ない。そこで文京区内診療所の災害対策状況と、診療所の医療者が災害対策をするために希望する外部からの支援を調査した。232施設に調査用紙を郵送し19施設より回答を得た。備蓄に関しては平時から頻繁に使用する薬剤や創傷処置用資材を3日分以上備蓄していると回答した施設が多かったものの、緊急時資材が不足した際の確保方法は全施設が想定していないと回答した。また災害関連マニュアルを有している施設は26.3%のみであり、防災訓練の実施は31.6%であった。医療者が希望する支援では「マニュアル作成のための手引き」が52.6%ともっとも多く、次いで「災害研修・勉強会の開催」が47.4%であった。本調査に回答した文京区内診療所の災害対策は十分とはいえず、今後診療所の災害対策を推進するためには外部の支援が必要であると考えられた。(著者抄録)

【目的】千代田区内の中小規模医療機関の災害対策の実態とニーズを明らかにする.【方法】千代田区内の全474施設を対象とし,病床や職員数等の病院基本情報,備蓄状況,災害関連マニュアルの整備状況,防災訓練・職員への教育に関する質問紙調査を行った.【結果】65施設より回答が得られ(回収率13.7%),30施設(46%)が個人経営であった.備蓄状況では,食料・飲料水の平均備蓄量は,職員用がそれぞれ13.6食,1.6日分と患者用に比べ最も多かった.また,18施設(27.6%)が災害関連マニュアルを有し,防災訓練の実施は27施設(44.2%)が行っていなかった.【結論】多くの施設で備蓄,訓練を含めた災害対策が十分に行われていなかった.中小規模医療機関各施設で災害対策に関するコスト,時間,人材の確保が難しいことが示唆された.職員全体の防災意識を高めると同時に,災害対策の外部支援が必要である.(著者抄録)

Aim. The aim of this study was to examine three hypotheses: (1) adolescents who had experienced the death of a parent would report higher grief reactions than those who had lost a grandparent; (2) adolescents who experienced the death of a parent would report higher posttraumatic growth than those who had lost a grandparent; and (3) posttraumatic growth and grief reactions are positively associated. Background. To date, no study has investigated adolescents’ posttraumatic growth by their relationship with the deceased. Design. Cross-sectional web-based survey. Methods. Participants were adolescents who had experienced the death of a parent or grandparent in the last 5 years. Participants completed the Japanese version of the Posttraumatic Growth Inventory and grief reaction items. We conducted a web-based survey during January 2014. We used Pearson product-moment correlations to examine the association between each Posttraumatic Growth Inventory domain and each grief reaction item. Differences in the relationship with the deceased for each Posttraumatic Growth Inventory and grief reaction item were compared with an independent-sample t-test. Results. Participants (n = 124) reported grief reactions including ‘I began to get frustrated at the little things’ (43 5%), ‘It was difficult to go to school’ (41 1%) and ‘I was not able to sleep at night’ (33 9%). The independent t-test indicated that parentally bereaved adolescents reported higher posttraumatic growth and grief reactions than those who had lost a grandparent. Pearson’s bivariate analysis showed an association between grief reactions and posttraumatic growth. Conclusion. Parentally bereaved adolescents reported higher posttraumatic growth and grief reactions. Nurses should ensure bereaved adolescents receive appropriate support.

Objective: The aim of this study was to explore the factors associated with posttraumatic growth (PTG) among adolescents bereaved owing to parental cancer in Japan. Methods: An anonymous cross-sectional Web-based survey was conducted, enrolling adolescents bereaved because of parental cancer in the previous 5 years. Posttraumatic growth, number of social support members, support from medical staff, and behaviors after bereavement were measured. Multiple linear regression was performed to explore the association between total PTG score and possible related factors. Results: We assessed 57 participants in this study. Mean age was 19.3 (standard deviation [SD] = 2.0) years, and most participants were female (75.4%). Mean total score of the Japanese version of the PTG inventory was 43.0 (SD = 25.6). Participants’ mean number of social support members was 2.1 (SD = 1.3), and these support members were the surviving parent (66.7%), friends (38.6%), and siblings (36.8%). The multiple linear regression model explained 45% of the variance in PTG. In this model, the following 3 behaviors after bereavement were associated with PTG: “putting palms together in front of a parent’s picture or an altar” (β =.36, P =.006), “visiting a parent’s grave” (β =.29, P =.03), and “having fun with friends” (β =.25, P =.04). Conclusion: Parentally bereaved adolescents in Japan experience PTG. Specific behaviors after bereavements might be recommended for PTG among Japanese adolescents bereaved because of parental cancer.

目的:新たに訪問看護分野に就労した看護師が、訪問看護事業所への入職直後から6ヵ月までの訪問看護への移行期に経験した困難と、その関連要因を明らかにすることである。方法:東京23区内の435事業所に勤務する経験年数6ヵ月以上3年以内の訪問看護師を対象として、自記式質問紙を用いた横断研究を実施した。訪問看護への移行期に経験しうる困難、訪問看護開始前の看護実践能力の自己評価、訪問看護師の個人特性、所属する事業所の特性を調査票で尋ねた。探索的因子分析により移行期に経験しうる困難を構成する3つの因子を特定し、それらを従属変数とした重回帰分析を行った。結果:移行期に経験した困難の割合は、医療保険(86.7%)や介護保険(85.5%)の制度に関する知識が不足していることへの困難が高かった。看護実践能力の自己評価が低いことは、「在宅と病院の看護実践環境の違いへの困難」(β=-0.205、p<0.01)。「訪問看護の知識・技術不足」(β=-0.250、p<0.001)に影響していた。考察:移行期に経験した困難に看護実践能力の自己評価が関連していたことから、訪問看護の開始時に看護師個々の看護実践能力を見極め、個々に応じた教育を行うことが、訪問看護への移行期の困難を緩和させるために重要であると考えられた。結論:訪問看護への移行期に、看護師個々の実践能力に応じて訪問看護特有の専門性や知識を教育していくことが、新たに訪問看護を開始する看護師の訪問看護への適応に有用と考えられた。(著者抄録)

AIM: To determine if nurse managers' leadership style is related to Japanese staff nurses' affective commitment to their hospital.BACKGROUND: In Western countries, nurse managers' transformational leadership style has been found to increase staff nurses' affective commitment to their hospital. However, there are few studies examining this relationship in the context of acute care hospitals in Japan.METHODS: Staff nurses completed measures of their nurse managers' perceived leadership style and factors related to their own affective commitment. The association between affective commitment and perception of leadership style was assessed with multiple logistic regression.RESULTS: Of 736 questionnaires distributed, 579 (78.9%) were returned, and data from 396 (53.8%) fully completed questionnaires were analysed. The intellectual stimulation aspect of transformational leadership positively increased staff nurses' affective commitment (odds ratio: 2.23). Nurse managers' transactional and laissez-faire leadership styles were not related to affective commitment among staff nurses.CONCLUSIONS: The intellectual stimulation aspect of transformational leadership may increase the retention of staff nurses through enhanced affective commitment.IMPLICATIONS FOR NURSING MANAGEMENT: To increase staff nurses' affective commitment to their hospital, we suggest that hospital administrators equip nurse managers with intellectual stimulation skills.

3年以上10年未満の手術室経験を有する看護師12名(男性4名、女性8名)を対象に、手術看護の継続と他領域への異動の意志決定のプロセスを明らかにするために、半構造化面接を実施した。面接データをStraussとCorbinによる継続比較分析を用いて質的記述的に分析した。経験を重ねた手術室看護師の継続と、他領域への異動の意志決定のプロセスに関わるテーマとして、「手術室の特殊性」「手術室で自分の存在価値を見つける」「手術看護に満足できない」「手術看護を離れるか迷う」「手術看護を離れようという意志を固める」「手術看護を継続しようという意志を固める」の六つが抽出された。経験を重ねた看護師は、主に「手術看護に満足できない」ことにより他領域への異動を考えていることが示されたが、「手術室で自分の存在価値を見つける」ことができないことにより、他領域への異動を考えている者もいることが明らかになった。

Aim: This study explores nurse managers' experiences in dealing with patient/family violence toward their staff. Background: Studies and guidelines have emphasised the responsibility of nurse managers to manage violence directed at their staff. Although studies on nursing staff have highlighted the ineffectiveness of strategies used by nurse managers, few have explored their perspectives on dealing with violence. Methods: This qualitative study adopted a grounded theory approach to explore the experiences of 26 Japanese nurse managers. Results: The nurse managers made decisions using internalised ethical values, which included maintaining organisational functioning, keeping staff safe, advocating for the patient/family and avoiding moral transgressions. They resolved internal conflicts among their ethical values by repeating a holistic assessment and simultaneous approach consisting of damage control and dialogue. They facilitated the involved persons' understanding, acceptance and sensemaking of the incident, which contributed to a resolution of the internal conflicts among their ethical values. Conclusions: Nurse managers adhere to their ethical values when dealing with patient violence toward nurses. Their ethical decision-making process should be acknowledged as an effective strategy to manage violence. Implications for nursing management: Organisational strategies that support and incorporate managers' ethical decision-making are needed to prevent and manage violence toward nurses.

わが国で高齢者ケア施設は新たな看取りの場として期待されている.本研究の目的は,文献検討により日本の高齢者ケア施設における看取りの質の評価・改善に関する研究の動向を明らかにすることである.文献検索の結果抽出された23文献を介入研究4件,介入のための教育・質改善ツール開発3件,調査研究13件,質的研究3件に分類した.高齢者ケア施設でのケアの質に関する研究は微増傾向にあるが介入研究は少なかった.看取りの実施要因として施設長・看護管理者の方針や,医療機関との連携,家族の明確な意思決定などがあった.職員の抱える課題や教育ニーズ,介護職へのサポートの必要性が示されていた.以上より高齢者ケア施設での看取りに関する介入研究,施設長・看護管理者への支援,入居者・家族の意思決定支援や,職員対象の教育プログラムの開発などが高齢者ケア施設における看取りの質改善に有用と考えられた.(著者抄録)

Aim: This study identified the factors associated with depression in patients diagnosed with myocardial infarction (MI) who underwent percutaneous coronary intervention (PCI). Methods: We searched the literature using PubMed and CINAHL from their inception in 1946 to December 2014. The search terms were "myocardial infarction," "depression," and "percutaneous coronary intervention." Studies which investigated factors associated with depression in patients diagnosed with MI who underwent typical medical procedures were searched. Results: Eleven studies met our inclusion criteria. None of these limited their samples to patients with MI who underwent PCI. Twenty-one factors were identified as possible risk factors for depression in patients who were diagnosed with MI and underwent PCI: gender; negative illness beliefs; neuroticism; autonomy; baseline depression scores; previous diagnosis of depression, anxiety, or stress; smoking; marital status; Type D personality; procedure; length of hospital stay; fat intake; functional disability; time engaged in physical activity; social support; and a history of angina, MI, coronary artery bypass graft surgery, PCI, diabetes mellitus, and stroke. Conclusions: This review suggests that these 21 factors should be considered in future studies as possible independent variables or covariates of depression among MI patients who have undergone PCI.

Aims To develop the Discharge Planning of Ward Nurses (DPWN), a Japanese self-evaluation instrument for ward nurses’ discharge planning practices. Design Cross-sectional survey. Methods Participants were 624 ward nurses from six hospitals in Japan with a discharge planning department. Items about discharge planning practices were collected from literature and interviews with nurses and researchers. Construct validity, concurrent validity, internal consistency and test-retest reliability were tested. Results Initially, 55 items were collected. Examination of the floor effect, item-total, good-poor analyses and exploratory factor analysis yielded a four-factor model with 24 items (‘teaching home-care skills with community/hospital professionals,’ ‘identifying clients’ potential needs early in the discharge process,’ ‘introducing social resources’ and ‘identifying client/family wishes and building consensus for discharge’). The four-factor structure was supported by confirmatory factor analysis. The DPWN correlated with scales ascertaining similar concepts, supporting concurrent validity. Internal consistency and test-retest reliability were generally satisfactory.

目的:本研究の目的は若手看護学研究者の研究活動の阻害要因と日本看護科学学会に求める支援の関連要因を明らかにすることである.方法:日本看護科学学会の39歳以下の会員にウェブ調査を行った.研究の阻害要因と日本看護科学学会に求める支援の下位因子を従属変数とした重回帰分析を行った.結果:648名を分析対象とした.研究の阻害要因の中で,育児中の人(β=0.36)は「ワーク・ライフ・バランスの難しさ」を,助教・助手(β=0.31)は「教育や大学運営等の業務の負担」を感じていた.また「研究能力の不足」,「研究のリソース不足」,「研究者としてのアイデンティティの未確立」,「教育や大学運営等の業務の負担」を阻害要因と感じる人ほどJANSに「研究を促進する環境・システムの整備」を求めていた(β=0.15-0.20).結論:若手看護学研究者は個々の属性に応じ様々な研究の阻害要因を感じ,支援を求めていた.日本看護科学学会には若手研究者への支援として,(1)研究者間のネットワーク構築,(2)研究者としての能力の向上,(3)研究環境の整備を促進していくことが望まれる.(著者抄録)