Psychometric evaluation of the Ethical Caring Competency Scale in nursing.

BACKGROUND: An ethical competence list for nurses could guide educators and managers in the field of health care to both support the development of ethical conduct and improve the assessment of ethical competence in health care. AIM: This study aimed to verify the reliability and validity of the Ethical Caring Competency Scale (ECCS) and to obtain suggestions for its use as an evaluation form in rubric format among a sample of Japanese nurses. RESEARCH DESIGN: This research employed a descriptive and cross-sectional design. PARTICIPANTS AND RESEARCH CONTEXT: A self-administered questionnaire was distributed to 1157 nurses working in two hospitals in Japan. The contents of the survey were demographic data, a draft of the ECCS consisting of 22 competencies from four core competencies, questions regarding experience in learning about medical/nursing ethics, and the Work Motivation Measurement Scale for Nurses. Three levels of difficulty for the 22 items were established using relative comparisons of the mean scores within the four core competencies. Three groups, namely, an expert group, a middle group, and a beginner group, were categorized according to the quartiles of the total ECCS score. ETHICAL CONSIDERATIONS: This study was approved by the Clinical Research Ethics Committee of Hamamatsu University School of Medicine (Decision no. 18-267). The ethical principles of voluntary participation, anonymity, and confidentiality were considered. FINDINGS: A total of 962 valid responses were analyzed. The ECCS scores for the three levels of difficulty were significantly different from each other. Stability was confirmed by the test-retest of the total ECCS scores (r = .900, p < .0001). The total ECCS scores for the three groups showed significant differences in all pairs. The Cronbach's α coefficient ranged from .72 to .89 for each core competency, and internal consistency was confirmed. CONCLUSION: The reliability and validity of the ECCS as a scale were statistically verified, and we were able to obtain suggestions for its application as a form of evaluation in rubric format.

Development of the Clinical Interpersonal Reactivity Index to evaluate nurses' empathy.

We determined the validity and reliability of the Clinical Interpersonal Reactivity Index in a sample of Japanese nurses. Participants were registered nurses at national university hospitals and nursing researchers in Japan. A postal questionnaire was conducted. Construct validity was analyzed by exploratory and confirmatory factor analysis, and convergent validity demonstrated using the Interpersonal Reactivity Index. The Clinical Interpersonal Reactivity Index has an 18-item, two-factor structure with Cronbach's alpha values of 0.87 and 0.73. Confirmatory factor analysis showed a goodness-of-fit index of 0.917, an adjusted goodness-of-fit of 0.894, a root mean square error of approximation of 0.60, and a comparative fit index of 0.911. Correlation analysis between the Clinical Interpersonal Reactivity Index and Interpersonal Reactivity Index indicated the factors were significantly correlated for empathic concern and perspective taking (r = 0.439-0.401). Test-retest assessment showed reliability coefficients for the first factor as r = 0.859 and the second factor as r = 0.709. The Clinical Interpersonal Reactivity Index demonstrated validity and reliability for Japanese nurses. The two factors evaluated perspective taking and unconditional positive regard.

The development and validation of the Ethical Sensitivity Questionnaire for Nursing Students.

BACKGROUND: Recent advances in medicine and an increasingly demanding healthcare environment are causing various complicated ethical problems. Nursing students need to prepare to deal with ethical issues in their future roles. Ethical sensitivity is a key aspect of the ethical decision-making process; however, there is no scale to measure nursing students' ethical sensitivity. Therefore, we developed a scale and verified its reliability and validity. METHODS: The Ethical Sensitivity Questionnaire for Nursing Students (ESQ-NS) was developed in three phases. First, questionnaire items were formulated after a literature review and interviews with nursing students. Next, its face and content validity were examined by an expert panel and piloted among nursing university graduates. Then, a final draft questionnaire survey was administered to nursing university students from 10 Japanese universities in 2015 and an exploratory factor analysis was performed. Criteria-related relevance was examined to compare established scales (i.e. the Japanese version of the Moral Sensitivity Test (JMST) and the Japanese version of the revised Moral Sensitivity Questionnaire (JMSQ)) using single regression analysis. A second questionnaire survey was conducted in one of the 10 universities to examine reliability. RESULTS: Initially, 48 items including ethical conflict in clinical nursing practice were formulated, and 47 items were approved by the expert panel. Five-hundred and twenty-eight nursing students responded to the final draft questionnaire. Participants' mean age was 20.4 (standard deviation = 3.1) years. The questionnaire was reduced to 13 items and three factor structures were determined by exploratory factor analysis: 'respect for individuals', 'distributive justice', and 'maintaining patients' confidentiality'. The Cronbach's alpha values for items in each domain ranged from 0.77-0.81, and the Cronbach's alpha for the entire ESQ-NS was 0.82. The ESQ-NS was significantly associated with specific domains: ?Judgment of the care conflict' from the JMST and 'Sense of Moral Burden' from the JMSQ. Pearson's correlation coefficient of the ESQ-NS between the first and second survey was 0.42 (p < .01). CONCLUSIONS: The EAQ-NS, which was developed to evaluate the ethical susceptibility of nursing students, showed good validity, internal consistency, and reliability. This questionnaire can be used to evaluate nursing students' ethics education by self-evaluation.

Atrial electromechanical interval may predict cardioembolic stroke in apparently low risk elderly patients with paroxysmal atrial fibrillation.

BACKGROUND: A considerable number of patients with atrial fibrillation (AF) develop cardioembolic stroke (CE) despite low CHADS2 score. We examined the possibility that use of the atrial electromechanical interval (AEMI) improves prediction of CE in patients with paroxysmal AF (PAF), particularly those with low CHADS2 score. METHODS: We consecutively enrolled 108 patients with nonvalvular PAF and 52 healthy subjects as controls. The PAF patients were divided into 2 groups depending on presence (n = 36) or absence (n = 72) of the history of CE. Left atrial (LA) volume index (LAVI), peak myocardial velocity during late diastole (a'), and AEMI as time from onset of P-wave to onset of lateral a' were measured. RESULTS: Patients with PAF had significantly larger LAVI, longer AEMI, and lower lateral a' than those in controls. Area under the curves for LAVI, lateral a', and AEMI for identifying patients with PAF were 0.70, 0.69, and 0.88, respectively. Multivariate logistic regression analysis indicated that age, use of antiarrhythmic drugs, and AEMI, but not LAVI or a', were independently associated with history of CE in patients with PAF. PAF patients were categorized into low risk by CHADS2 score (i.e. CHADS2 score = 0 or 1, n = 60), those with prolonged AEMI (>82 msec) had significantly higher rates of CE than those with ≤ 82 msec (48% vs. 15%, P < 0.05). CONCLUSION: As compared with echocardiographic parameters of LA size and LA function, AEMI appears to be more useful for identifying PAF patients. AEMI may enable to detect high risk PAF patients, especially those categorized into low risk by CHADS2 score.

Living with pleasure in daily life at the end of life: recommended care strategy for cancer patients from the perspective of physicians and nurses.

OBJECTIVE: One of the most important goals of palliative care is achieving a good death. Most Japanese believe that "having some pleasure in daily life" is necessary at the end of life. The aim of this study was to identify, from the perspective of physicians and nurses, a care strategy that ensures that cancer patients have pleasure in daily life at the end of life. METHOD: We conducted semistructured interviews with experts in palliative care units. A total of 45 participants included 22 palliative care physicians and 23 nurses. Transcripts of the interviews were analyzed using a content analysis method. RESULTS: Care for end-of-life cancer patients that ensures they have some pleasure in daily life was classified into five categories: "Pain assessment and pain easing" aimed to offer physical and psychological pain assessment and relief. "Maintenance of recuperative environment" aimed to offer care that arranged for assistive devices and equipment in the patient's room. "Support of daily life" aimed to offer care that eased accomplishment of daily activities. "Care that respects individuality" aimed to offer care that assessed sources of pleasure for the patient. "Events and complementary and alternative therapies" aimed to offer such care as aromatherapy and massage. SIGNIFICANCE OF RESULTS: The elements of care identified in this study are useful for all end-of-life cancer patients, even those who do not enter palliative care units. The next step of research is to test the efficacy of interventions that reflect the five identified categories of care for end-of life cancer patients.

Feather follicles express two classes of pro-opiomelanocortin (POMC) mRNA using alternative promoters in chickens.

Feather coloration in chickens mainly depends on melanin produced by melanocytes located in the feather follicles. The melanocortin 1 receptor (MC1R) on follicular melanocytes regulates melanin synthesis; however, the source of the melanocortins that interact with the receptors remains unclear. In this study, we examine the potential expression of melanocortins and characterize the mRNAs for the precursor pro-opiomelanocortin (POMC) in chicken feather follicles. Reverse transcription-polymerase chain reaction (RT-PCR) revealed the expression of mRNAs for POMC, prohormone convertase 1 (PC1) and PC2, and western blotting detected adrenocorticotropic hormone (ACTH)-related products of POMC processing in feather follicles, suggesting that melanocortins are produced locally in the tissues of chickens. A combination of 5'RACE (rapid amplification of cDNA 5' end), 3'RACE and RT-PCR analyzes identified two classes of POMC mRNA, class a and class b, which encode the same full-length POMC protein but have different non-coding leader exons. Class a mRNAs were expressed specifically in feather follicles, whereas class b mRNAs were expressed in the pituitary, hypothalamus, and various peripheral tissues that we examined. Within the feather follicles, the class a mRNAs were distributed in epidermal layers from middle to distal locations, whereas the class b mRNAs were mainly expressed in pulp at proximal locations. Our findings suggest that feather pigmentation is regulated by locally produced melanocortins, and indicate that the melanocortins encoded by the different classes of POMC mRNAs may play different intra-follicular roles in chickens. This is the first report that demonstrates alternative promoter usage generating different full-length POMC mRNAs in vertebrates.

Actual Situations and Factors Related to Nursing Activities in Supporting the Transition to Homecare Settings for End-Stage Cancer Patients in General Wards in Japan.

This study aimed to investigate actual situations of nursing activities in supporting the transition to homecare settings for end-stage cancer patients and to determine factors related to executing such nursing activities from the perspectives of communication skills and interprofessional collaboration. A cross-sectional study was conducted with 513 nurses who worked at designated cancer care hospitals in Japan. A total of 318 valid responses were obtained (valid response rate: 62.0%). Scores for nursing activities were higher for the following items: sharing information regarding the transition to homecare settings, intentionally engaging with patients after their medical conditions were explained, providing care for families, and understanding a patient's will about the transition to homecare settings. On the other hand, scores were lower for items that were related to guiding juniors and self-improvement. A multiple regression analysis was performed with nursing activities as the dependent variable. 8 factors related to nursing activities were determined: experience in supporting the transition to homecare settings as a primary nurse, contribution to a team (Team Approach Assessment Scale [TAAS]), years of nursing experience, function of a team (TAAS), regulation of interpersonal relationship (ENDCOREs communication skills scale), experience of participation in homecare nursing education or seminars, verbal communication skills for good communication (End-of-life Care Nurses' Communication Skills scale), and educational background. Future challenges include developing an educational program based on the results of the present study and promoting educational intervention studies.

[Relationship between emotional labor and job-related stress among hospital nurses].

OBJECTIVES: To clarify the effects of factors of emotional labor, defined as the suppression of own emotions to better maintain other peoples' emotional conditions, on job-related stress responses among hospital nurses, the relationship between emotional labor and job-related stress was analyzed. SUBJECTS AND METHODS: A self-reported questionnaire was distributed among 147 nurses of five hospitals in Japan. Complete answers were collected from 123 nurses (83.7%, 107 females and 16 males). Emotional labor was assessed by the Emotional Labor Inventory for Nurses (ELIN) (26 items), which consisted of five subscales, i.e., "suppressed expression," "surface adjustment," "deep adjustment," "exploring and understanding" and "expression on caring." Job-related stress was evaluated using the Brief Job Stress Questionnaire (BSQ) consisting of 57 items. Stepwise multiple regression analysis was performed to examine the relationships of stress responses (BSQ) with ELIN and job stressors (BSQ). RESULTS: Subjects working in an inpatient department showed significantly higher total ELIN scores than those working in an outpatient department. The stepwise multiple regression analysis showed the following: Scores on "anger" and "fatigue" in BSQ positively related to "suppressed expression" scores in ELIN; those on "anxiety" positively related to "deep adjustment" scores; and those on "depression" positively related to "surface adjustment" scores. Similarly, scores on negative stress responses (BSQ) such as "anger," "fatigue," "anxiety," "depression," and "somatic stress responses" positively related to scores on job stressors (BSQ), e.g., physical work load, whereas "vigor" scores positively related to "job worthwhileness" in BSQ. CONCLUSION: The aspects of "suppressed expression," "deep adjustment," and "surface adjustment" of emotional labor seem to be the major occupational stressors for nurses, as well as job-related stressors measured by BSQ. Working in an inpatient department appears to be a potent stressor for nurses.