Work environment for hospital nurses in Japan: The relationships between nurses' perceptions of their work environment and nursing outcomes.

AIM: To investigate nurses' perceptions of their work environment and to investigate the relationships between variables measuring the work environment (WE) and nursing outcomes (NOs ). DESIGN: A 2-year prospective longitudinal survey (2013-2015). METHOD(S): Descriptive statistics of nurse demographics, organizational WE and NOs were calculated by position. The associations between Practice Environment Scale of the Nursing Work Index (PES-NWI) and NOs were examined for each unit. RESULTS: The participants were 2,992 staff nurses, 137 nurse managers (NMs), and 8 chief nursing officers in Phase 1 and 7,849, 371 and 23 in Phase 2, respectively. The higher the job position, the better the WE was rated. The higher the PES-NWI scores, the better the outcomes. Descriptive statistics about organizational WEs and NOs and the statistically significant associations between the two were identified.

The nurses' occupational stress components and outcomes, findings from an integrative review.

AIM: To identify, evaluate and summarize the components, factors and outcomes of nurses' occupational stress published between 2009-2019. DESIGN: Integrative literature review. METHODS: A literature search was conducted on PubMed, CINAHL and PsycINFO databases for articles published in English, between 2009-2019. RESULTS: The review included 132 studies. Most studies were conducted in the Confucian Asia and Anglo countries, but a growing number of studies were done in other countries. Almost all studies used a quantitative design, and changes in the use of scales indicated an increasing attention to career-related components. Factors were categorized into sociodemographic, work environment and personal resources. Sociodemographic factors were inconsistent across countries. Outcomes were categorized into health status, capability, affective and behavioural responses to work, and organizational performance with generally consistent results. Model validation studies showed the non-linear or non-direct associations between stress and outcomes.

Nurses' educational needs when dealing with aggression from patients and their families: a mixed-methods study.

OBJECTIVES: To explore the type of education needed for nurses when dealing with aggression from patients and their families. DESIGN: A two-phase sequential mixed-methods study. SETTING: This study was conducted in Japan, with phase I from March to November 2016 and phase II in November 2018. MAIN OUTCOME MEASURES: The challenges faced by nurses when dealing with incidents of aggression from the neutral perspective of neither nurse nor patient/family and perceptions of the educational contents developed in this study. Descriptive analyses were used to examine the data retrieved from both phases. PARTICIPANTS: Phase I entailed semistructured interviews among 11 neutral-party participants who observed aggressive incidents between nurses and patients/families. Phase II consisted of a web survey conducted among 102 nursing students and 308 nursing professionals. RESULTS: Phase I resulted in the identification of the following five main educational components: understanding the mechanisms of anger and aggression, maintaining self-awareness, observant listening, managing the self-impression, and communicating based on specific disease characteristics. Each component was related to improved communication through self-awareness. The results of phase II indicated that participants positively perceived these educational contents as likely to be effective for dealing with aggression from patients/families. CONCLUSIONS: This study clarified the type of education needed for nurses when dealing with aggression based on multiple viewpoints. Specifically, neutral-party interviews revealed that communication should be improved through self-awareness. A subsequent survey among nurses and nursing students showed that the identified educational contents were positively received.

Pain Prevalence, Pain Management, and the Need for Pain Education in Healthcare Undergraduates.

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.

Dynamic nuclear polarization magnetic resonance imaging and the oxygen-sensitive paramagnetic agent OX63 provide a noninvasive quantitative evaluation of kidney hypoxia in diabetic mice.

Renal hypoxia may play an important role in the progression of diabetic nephropathy. However, tools that noninvasively and quantitatively measure oxygen tension in the kidney are lacking. Here, we evaluated the feasibility of a noninvasive and quantitative imaging technique using dynamic nuclear polarization magnetic resonance imaging (DNP-MRI) in combination with the oxygen-sensitive paramagnetic agent OX63 for measuring oxygen tension in the kidney. Our results demonstrate that the DNP-MRI technique can yield quantitative maps of oxygen tension in the mouse renal cortex. Using this procedure, we also showed that oxygen tension was less elevated in the renal cortex of both streptozotocin-induced type 1 diabetic mice and db/db mice, a model of type 2 diabetes, than in the renal cortex of age-matched control mice of each respective model. Oxygen tension in streptozotocin-exposed mice was significantly improved by insulin treatment. Thus, the noninvasive and quantitative DNP-MRI technique appears to be useful for studying the pathophysiological role of hypoxia.

Nurse managers' attributes to promote change in their wards: a qualitative study.

AIM: The aim of this study was to explore the processes that nurse managers use to promote change in their wards. DESIGN: Qualitative research. METHODS: A grounded theory approach was used. Participants were 23 nurse managers and 17 nurses in Japan. Interviews were conducted between March 2014 - December 2015. Mainly, nurse managers' data was analysed. RESULTS: The change process led by the nurse managers was depicted as a four-phased process of "having beliefs and empathizing with staff nurses to achieve goals explored by self." Four attributes of nurse managers, "having both micro and macro perspectives," "respecting own beliefs and external standards," "being proactive," and "having empathy for staff nurses," were identified as indispensable factors promoting change in their wards. Nursing administrators should support the cultivation of nurse managers' attributes for successful change.

Is nurse managers' leadership style related to Japanese staff nurses' affective commitment to their hospital?

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.

Brachial-ankle pulse wave velocity predicts all-cause mortality and cardiovascular events in patients with diabetes: the Kyushu Prevention Study of Atherosclerosis.

OBJECTIVE: Whether brachial-ankle pulse wave velocity (baPWV), a noninvasive marker for arterial stiffness, is a useful predictive maker for cardiovascular events in subjects with diabetes is not established. In the present cohort study, we evaluated the benefit of baPWV for the prediction of cardiovascular morbidity and mortality in subjects with diabetes. RESEARCH DESIGN AND METHODS: A total of 4,272 outpatients with diabetes were enrolled in the Kyushu Prevention Study of Atherosclerosis. Of these, 3,628 subjects, excluding those with an ankle-brachial index of <0.9, were prospectively followed for 3.2 ± 2.2 years. The baPWV at baseline was classified by recursive partitioning (RP) for each end point. We plotted the Kaplan-Meier curves for high- and low-baPWV groups, which were designated based on the cutoff points, and calculated Cox proportional hazards models. RESULTS: The elevation of baPWV quartiles was significantly correlated to the incidence of coronary artery events, cerebrovascular events, and all-cause mortality. RP revealed baPWVs of 14 and 24 m/s as statistically adequate cutoff points for cardiovascular events and mortality, respectively. High-baPWV classes showed significantly low event-free ratios in Kaplan-Meier curves for all end points and remained independent risks for all-cause mortality and cerebrovascular events, but not for coronary artery events after adjustments for age, sex, BMI, hypertension, hyperlipidemia, smoking, and hemoglobin A1c by Cox proportional hazards models. CONCLUSIONS: This large-scale cohort study provided evidence that high baPWV is a useful independent predictor of mortality and cardiovascular morbidity in subjects with diabetes.