HIROSHI ONO

This study aimed to identify the current state of nursing theory development among Japanese scholars by analyzing the syllabi of doctoral nursing programs in Japan to examine the educational content relating to nursing philosophy and theory and by reviewing the related literature. Only 17.2% of the doctoral-level nursing programs in Japan offer courses in philosophy or theory. Florence Nightingale was the most frequently discussed figure in the literature. Middle-range and situation-specific theories originating in Japan have emerged relatively later than those introduced by Western theorists. Recently, the development of nursing theories, particularly situation-specific theories, has begun in Japan, showing promising prospects for advancement in the field.

Introduction: The purpose of this study was to clarify the relationship between the available service information on small-scale multifunctional in-home nursing care (KANTAKI) and its operational status via text mining. Methods: We obtained nationwide textual information on KANTAKI from the Nursing Care Service Information Disclosure System and the Ministry of Health, Labour, and Welfare, and analyzed the characteristics of the word usage using KH Coder. The number of users and employees and the implementation of services were compared among the facilities that used terms relating to medical dependency and end-of-life care, which are KANTAKI characteristics, and with other facilities. Results: The facilities that used terms relating to medical dependency and end-of-life care showed significantly more users requiring nursing care level 5 and more full-time nursing staff than those not using such terms. Moreover, regarding service provision, the rate of procedures was significantly higher in 11 of 12 items, except for stoma. Conclusion: The facilities that use terms relating to medical dependency and end-of-life care in their information have more users and provide a greater variety of services. In the future, educational support is required to enable facility managers to understand the services and translate them into their work.

Introduction Various stressors have been identified in patients in the intensive care unit (ICU), including postoperative pain, ventilatory management, and nursing care. However, sedated patients are less responsive, and nurses have difficulty capturing their stressors. Objective To investigate patient stress caused by nursing care performed in the ICU on sedated patients based on changes in physiological indices. Methods We observed nursing care performed on patients with postoperative esophageal cancer under sedation in the ICU. This included endotracheal suctioning and turning, the time required for the care, and the patients’ behavioral responses. Information on arousal levels, autonomic nervous system indices, and vital signs were also obtained. The changes in indicators before and after care were then compared and analyzed. Results There were 14 patients in the study. The mean age of the patients was 68 years. Ninety-nine scenes of nursing care were observed, and in six of these, additional bolus sedation was administered because of the patient's significant body movements. In endotracheal suctioning, no significant changes were observed in all indicators. In turning, vital signs changed significantly, and when both were continued, all indicators changed significantly. Conclusion Our study found that different types and combinations of nursing care may cause different stresses to the patients. Moreover, the autonomic nervous system indices may be more likely to react to stresses in a variety of nursing care, while arousal levels may be more likely to react to burdensome stresses. If the characteristics of these physiological indicators can be understood and effectively utilized during care, it may be possible to better identify and reduce patient stress during sedation management.

Background Japan is a superaging society unparalleled in the world. Elderly people who need medical care do not receive adequate support in the community. As a new service to address this issue, a small-scale multifunctional in-home care nursing service called Kantaki was created in 2012. Kantaki, in collaboration with a primary physician, operates 24 hours a day and provides various nursing services (home visits, home care, day care, and overnight stays) to older people living in the community. The Japanese Nursing Association is working hard to promote this system; however, its low utilization rate is an issue. Objective This study aimed to determine factors influencing the utilization rate of Kantaki facilities. Methods This was a cross-sectional study. A questionnaire on the operation of Kantaki was sent to all administrators of Kantaki facilities operating in Japan from October 1 to December 31, 2020. A multiple regression analysis was used to determine factors associated with a high utilization rate. Results Responses from 154 of the 593 facilities were analyzed. The average utilization rate for all valid responding facilities was 79.4%. The average number of actual users and the break-even point were almost equal, resulting in little surplus profit from facility operations. A multiple regression analysis showed that factors that had a significant impact on the utilization rate included the break-even point, a surplus of users relative to the break-even point (ie, the margin of revenues), the number of months in office of the administrator, the type of corporation (ie, nonprofit), and Kantaki’s profit from operating home-visit nursing offices. The break-even point, a surplus of users relative to the break-even point, and the number of months in office of the administrator were robust. In addition, support for reducing the burden on family helpers, a service sought by the system, significantly and negatively affected the utilization rate. In the analysis that removed the most influential factors, the cooperation of the home-visit nursing office, Kantaki’s profit from operating the home-visit nursing office, and the number of full-time care workers were significantly related. Conclusions To improve the utilization rate, managers need to stabilize their organization and increase profitability. However, a positive relationship was found between the break-even point and utilization rate, suggesting that simply increasing users did not contribute to cost reduction. Moreover, providing services that meet the needs of individual clients may result in lower utilization rates. These results, which are inconsistent with common sense, reflect the divergence between the assumptions underlying the system’s design and actual conditions. To solve these issues, institutional reforms, such as an increase in nursing care fee points, may be necessary.

This study evaluated the effectiveness of a life-enhancement program designed to focus on dining conditions in welfare facilities for seniors living in Japan. Effectiveness was specifically evaluated based on whether improvements were achieved in (1) nutritional status, (2) oral health, (3) frequency of fever, and (4) vitality of appetite across three sites. As part of a comprehensive-care initiative that began with dining support, the program consisted of two main components: (1) a 3-month intensive program comprised of (a) collective experiential learning for residents and staff (including nutritionists, nurses, and physiotherapists) and (b) a tailor-made individual program for residents followed by (2) a 3-month continuation program. Participants included 168 individuals (31 males and 137 females) from a total of three facilities (average age was 85.9 [60-104] years). Results showed that the intensive program significantly improved nutritional status (e.g., BMI, caloric intake, and water intake; P < 0.000-0.005) and tongue movement (P < 0.000) while significantly reducing dental-plaque and tongue-coating indices (P < 0.000). Significant improvements were also achieved for degree of appetite and vitality indices (P < 0.000-0.001). However, incidences of fever were not reduced. These findings indicate that the program effectively improved nutritional status, oral health, vitality, and appetite. However, these effects did not sufficiently remain once the program was finished, thus suggesting the need for a continuous intervention.

[Background] To promote an integrated community care system, the Japanese government created a multifunctional long-term care service model called Kantaki in 2012, aiming to provide a combination of services such as short-stay, day-care, and home visit by aides and/or nurses to meet various client needs. However, it is unclear how well this model has been utilized and accessed throughout Japan.[Objective] This study aimed to understand the distribution status of Kantaki through a secondary analysis of information on its operations and population trends released by public institutions.[Methods] The study determined the number of Kantaki, Shotaki (a service that is similar to the Kantaki model except it does not provide home visit service by nurses), and visiting nurse stations from the Ministry of Health, Labour and Welfare website registry. Population trend information was collected from the national census. Statistical processing included a correlation analysis using descriptive analysis and Spearman's correlation coefficient.[Results] As of December 31, 2018, there were 479 Kantaki operations throughout Japan. The mean number of Kantaki operations by prefecture was 10.19 ± 10.51. Of the municipalities, 233 (13.5%) out of 1,724 had Kantaki operations available. The number of Shotaki (.765), number of visiting nurse stations (.747), population (.703), population density (.513), and the rate of aging (-.442) were found to have a significant correlation with the number of Kantaki operations present.[Discussion] The number of Kantaki operations showed a large variation across regions, with a higher prevalence in population-dense urban areas, and lower prevalence in regions with a high aging rate. This reveals the distribution model is unrelated to the elderly population, who can be potential clients, and must be affected by other reasons such as staffing issues and operating costs. To promote Kantaki throughout Japan, such operational issues should be analyzed further.

[Objective] More than two decades have passed since the situation-specific theory (SST) was proposed. This literature review analyzes changes in the number of SST-related articles, their contents, methodologies, and sources for the construction. This study aimed to clarify the developing process and prospects in future SST constructions.[Methods] Using the CINAHL, PubMed, and ICHUSHI databases, we searched for papers in English with the key words of "situation-specific theory" and "situation-specific theories" and those words translated in Japanese. Eighty-eight articles were found and screened. At the end, fifty articles were to be reviewed, and they were sorted by year of publication and contents. Additionally, articles reporting SST construction were analyzed for the theory constructing methodologies and sources used for the constructions.[Results] All articles were classified into the following six categories: theory development, concept analysis, clarification of theory sub-concepts, theory testing, research based on theoretical framework, and review/commentary. The number of published articles is increased every year. The review of these articles revealed that constructions of SST were validated and utilized as research frameworks, and SST has been contributing to the construction of knowledge in the field of nursing science. SSTs were constructed in 23 articles, all of which focused on restricted phenomena in particular fields or subjects. The integrative approach was the most commonly employed for construction methods; however, other methods were found in some articles. The sources frequently used for the constructions were preexisting theories, research findings, and literature reviews, whereas practical experiences were rarely used as the sources.[Conclusion] Based on the increase in constructions of STT, utilization of SST as frameworks, and validation of the theory, the awareness of SST will grow in the field of nursing science. As construction methods other than the integrative approach are emerging, additional SSTs should be constructed with a broader range of approaches.