Reiko Sakashita

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.

The literature on nursing leadership tends to be mainly based on Western perspectives and models, which could be viewed as an imperialistic and colonialist aspect of nursing knowledge development. Furthermore, leadership competencies and skills could differ across countries due to variations in cultural backgrounds. The purpose of this discussion paper is to identify essential competencies of leaders from Asian nurse leaders’ perspectives and provide suggestions for future nursing leadership. Four themes related to the leadership competencies were identified: “harmony,” “visionary,” “political activism,” and “good character.”

ABSTRACT Background The development of nursing leaders is an important topic in changing healthcare environments. Successful nursing leadership is critical to the reconstruction, implementation, and evaluation of healthcare systems worldwide. However, the characteristics of successful nursing leadership remain unclear, especially in a global context. Furthermore, despite the growing importance of cultural intelligence, cross-cultural concepts of successful nursing leadership have been inadequately addressed in the literature. Purpose This study was designed to identify the characteristics of successful leadership in nursing from the perspective of Asian leaders in four countries (United States, Taiwan, Korea, and Japan) and to make recommendations for successful leadership in nursing in the future. Methods A qualitative approach employing five strategies, including in-depth discussions through face-to-face and email discussions, an integrated literature review using multiple databases, responses to 10 topics related to nursing leadership, and written note summaries of the characteristics of successful leadership, was used in this study. A total of 10 nursing leaders from four countries were recruited as participants using snowball sampling. The collected qualitative data were analyzed using line-by-line coding and simple content analysis to extract the characteristics of successful leadership in nursing. Results The final sample included seven nursing leaders aged between 55 and 70 years. All of the participants were in nursing leadership positions at schools/colleges of nursing or professional organizations for at least two decades and had extensive leadership experience through their schools/colleges, professional organizations, and/or governments. Five key themes related to the characteristics of successful leadership were identified from the participants: (a) culturally and historically prescribed, (b) overcoming gendered experience, (c) equipped with good character, (d) guiding with a vision, and (e) with contextualized leadership. Conclusions/Implications for Practice Five characteristics of successful leadership were identified from the perspective of Asian nursing leaders. All of the participants recommended that successful nursing leadership be based on contextual leadership and that successful nursing leadership help meet rapidly changing needs, enable mutual trust, and actively commit and complete necessary risks. Moreover, future successful leadership should have a clear vision and strongly guide the implementation of changes as well as be equipped with cultural intelligence. Finally, successful nursing leadership should be based on ethical, trustable, and humane behaviors while promptly and adequately responding to the changing needs of their institutions/organizations. Cross-regional research on successful nursing leadership is essential to enrich the global evidence and knowledge on developing the next generation of nursing leaders.

The raison d’être of nursing is caring for human beings. Mainly due to its close link to the nursing discipline’s raison d’être, “caring,” translational science is recently getting more attention from nursing scientists across the globe. This paper is to discuss the current status of translational science in nursing across four countries (the USA, Taiwan, South Korea, and Japan). The data used in this discussion paper included: (a) written notes on issues related translational research/science in individual countries; (b) written memos on exemplars/cases from their own experiences; and (c) summaries of literature reviews. The data analysis was conducted using a simple content analysis. Four themes reflecting the current status of translational science across the countries were identified: (a) “contextualized in unique culture and history of nursing”; (b) “connecting basic science to clinical practice”; (c) “an extension of evidence-based practice”; and (d) “highly promoted, but still minimal translation of nursing knowledge.”

The process by which stroke survivors move toward health while facing various difficulties can be construed as a "transition." Importantly, nurses need to understand and support this state of transition effectively. This study developed a situation-specific theory to explain post-stroke transition by integrating the findings of a qualitative study that explored the rehabilitation experiences of stroke survivors with dysphagia with a scoping review of qualitative studies using the theoretical framework of transition theory. This theory will help understand the transitions that stroke survivors with dysphagia undergo during recovery and provide a framework for exploring nursing care to support healthy transitions.

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.

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.

The purpose of this article is to discuss the current status of research mentoring in nursing across 4 countries (the United States, Taiwan, South Korea, and Japan) and to make suggestions for future research mentoring. Seven leaders reflected on the current status of research mentoring in nursing, provided exemplars/cases from their own experiences, and their reviews of the literature. Six themes were discussed: (a) "culturally defined"; (b) "professionally contextualized"; (c) "teaching research integrity and research practice"; (d) "with mutual respect and care"; (e) "based on effective communication"; and (f) "supported by institutional and governmental commitment and infrastructure."

OBJECTIVES: Breast milk is a valuable and useful source of nutrition; however, surplus milk is routinely discarded for hygiene reasons despite an unclear scientific basis. Here, we profiled the microbiota of expressed breast milk before and after feeding with an artificial nipple and examined the bacterial survival in breast milk stored at 4°C. METHODS: Eleven mother-baby pairs were included in the study. Samples of expressed breast milk were collected before and after feeding with an artificial nipple and examined both immediately (0 h) and after storage for 3 and 12 h at 4°C. Each sample was inoculated onto a blood agar plate and incubated anaerobically and aerobically at 37°C. Genomic DNA was extracted from individual bacterial colonies, which were identified by 16S rRNA gene sequencing. RESULTS: Before feeding, the bacterial counts at 0 and 12 h were (1.4 ± 1.6) × 105 colony-forming units (CFU)/mL and (1.4 ± 0.6) × 105 CFU/mL, respectively. Staphylococcus (47.7% and 41.9%, respectively), Cutibacterium (20.7% and 36.0%, respectively), and Streptococcus (16.1% and 6.6%, respectively) were identified among the samples. In contrast, after feeding, the bacterial counts at 0 and 12 h were (2.7 ± 1.7) × 105 CFU/mL and (2.1 ± 2.5) × 105 CFU/mL, respectively. Staphylococcus (30.1% and 37.4%, respectively), Cutibacterium (11.7% and 31.7%, respectively), and Streptococcus (41.5% and 25.2%, respectively), were identified among the samples. CONCLUSIONS: Bacteria were present in the breast milk before feeding. Although the main component of the microbiota shifted from Staphylococcus to Streptococcus species after feeding, these results suggest that surplus expressed breast milk may be preserved safely in a refrigerator for at least 12 h after feeding with an artificial nipple.

OBJECTIVES: To clarify the characteristics and growth of bacteria that may infiltrate liquid baby formula during feeding and after storage for more than 3 h, the transfer of oral bacteria through artificial nipples, and bacterial survival in liquid baby formula and a baby drink were examined immediately after drinking and after storage at 4 °C for 12 h and 24 h. METHODS: Thirteen human subjects (aged 19-24 years) were asked to drink approximately 50 mL of liquid baby formula and a baby drink, via the artificial nipple of a baby bottle. Samples of the remaining liquid after storage at 4 °C for 12 h and 24 h were inoculated onto blood agar plates and incubated anaerobically at 37 °C for 7 days. Genomic DNA was extracted from individual colonies, and the bacterial species were identified by 16S rRNA gene sequencing. RESULTS: The mean concentrations of bacteria in the liquid baby formula were (2.6 ± 2.8) × 104 and (4.1 ± 6.6) × 104 colony-forming unit/mL after storage at 4 °C for 12 h and 24 h, respectively. Streptococcus (43.2%), Veillonella (9.3%), and Schaalia (8.2%) species were recovered from the remaining liquid baby formula after storage at 4 °C for 12 h. In contrast, no bacteria were detected in the remaining baby drink after storage at 37 °C for 24 h. CONCLUSIONS: The levels of bacteria immediately after drinking and after storage at 4 °C for 12 h or 24 h were similar, suggesting that remaining liquid baby formula may be preserved safely in a refrigerator for more than 3 h.

This longitudinal study aimed to clarify the relationship of oral health in infancy with that in adulthood among participants who were the subjects of the oral health promotion project (OHPP) conducted in Miyako Island, Okinawa Prefecture, Japan, since 1984. Twenty-seven subjects, around 35 years of age, were examined for dental caries, periodontal diseases (community periodontal index), dental plaque, occlusion, and bite-force and compared with those at 4 and 13-15 years of age. The dental caries status and maximum bite force in adulthood was significantly reflected for those at 4 and 13-15 years of age (p < 0.05). CPI in adulthood was related to the dental caries status at 4 and 13-15 years of age but not to the gingival score at 4 years of age, and it was weakly related to the gingival score at 13-15 years (r = 0.264, p > 0.05). Most of the normal occlusion at 4 years of age became normal permanent occlusion in adulthood (88.9%). Most of the cases involving the discrepancy factor retained the same condition in both the deciduous and permanent dentitions (83.3%) (p < 0.001). Those who participated in the OHPP soon after birth showed significantly fewer DMFT (p < 0.05) compared with those who did not. This study revealed that oral health at 4 years of age was related to that in adulthood, suggesting that fostering good oral health soon after birth is of great importance.

[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.

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.

[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.

Mutual respect and harmonious relationships between people can be viewed as the fundamental spirit of Japanese culture. Japanese leaders try to keep the peace in human relations, rather than to achieve a goal. They become leaders due to internal and external conditions, rather than their own abilities. Japanese society has been basically male-dominated though the ratio of women leaders has increased recently. Higher education and development of academic societies in nursing have been very successful during the last two decades and nursing is one of the most trusted professions in Japan. However, some Japanese people still think a nurse is just an assistant to doctors. The purpose of this paper is to clarify features of women's leadership in Japan from the nursing point of view. In Japanese culture, leaders need to possess human resource leadership as an indispensable element, while good leaders may have advantages in all four frames of leadership including structural, human resource, political, and symbolic frames. Japanese organizations are also supported by excellent followership which might be influenced by the structure of Japanese society which is called "the vertical society" where leaders are fostered from among followers. What is important in Japanese leadership is to have a vision that leadership leads to the happiness of all people in a shareable form.