Certified nurse specialists in cancer nursing and prophylactic antiemetic prescription for chemotherapy patients.

PURPOSE: The prevention of chemotherapy-induced nausea and vomiting (CINV), a common chemotherapy side effect, should be attempted by oncology nurses. Certified nurses could be certified nurse specialists in cancer nursing (CNSCNs), who have high-level graduate education, or certified nurses in cancer chemotherapy nursing (CNCCNs), who have short-term training. The relationship between these certifications and compliance with the CINV prevention guidelines has not been investigated. We aimed to evaluate the association between certified nurse staffing and prescription of prophylactic antiemetic drugs for chemotherapy patients with high emetic risk. METHODS: We used health service utilisation data for cancer patients diagnosed in 2016 from 474 hospitals nationwide in Japan and a list of certified nurses published by the Japanese Nurse Association. Patients receiving highly emetic chemotherapy were included. A multilevel mixed-effect logistic regression analysis was conducted to estimate the prescription of prophylactic antiemetic drugs associated with CNSCN and/or CNCCN staffing. RESULTS: Data of 46,306 patients were analysed. Overall, 68.4% and 94.0% of the patients received chemotherapy at hospitals with CNSCNs and CNCCNs, respectively. Small cell lung cancer, non-small cell lung cancer, breast cancer, and oesophageal cancer were positively associated with the prescription of recommended antiemetic drugs. CNSCNs was significantly associated with the prescription of prophylactic antiemetic drugs, while CNCCNs was positively but non-significantly associated with antiemetic prescriptions. CONCLUSION: This study is the first to demonstrate that CNSCN placement was significantly associated with prescribing antiemetic drugs recommended by clinical guidelines. Patients are likely to receive appropriate supportive care with the proper placement of CNSCNs.

[Employment Support for Cancer Patients].

In Japan, the number of people who suffer with cancer once in their lives has increased since 1985, and the 5-year relative survival rate for cancer patients continues to improve. As a result, there have been reports on the difficulties faced by working age patients because they attempt to simultaneously undergo cancer treatment and work. In June 2012, the Ministry of Health, Labour and Welfare published the Basic Plan to Promote Cancer Control Programs with improved cancer countermeasures for working people and children to manage problems related to the employment of cancer patients, and it has been subsequently promoting these initiatives. A report on the needs and problems faced by medical facilities regarding the employment of cancer patients, survivors, and their family members was presented at an investigative commission in August 2014 that assessed ways to support the employment of cancer patients and survivors. In February 2016, the Ministry of Health, Labour and Welfare released its guidelines on providing workplace support to people attempting to simultaneously undergo treatment and continue working. The authors conducted an interview survey of clinical nurses who provided employment and life support to cancer patients. In this study, we present examples of employment support practices provided to cancer patients by clinical nurses that we hope will be helpful to medical facilities providing such support.

[Features and evaluations of organizational support provided by occupational health nurses in private practice for the implementation of sustainable health and productivity management in medium-sized enterprises].

OBJECTIVES: This study aimed to clarify the features and evaluations of the organizational support provided by occupational health nurses (OHNs) in private practice to promote sustainable health and productivity management (HPM) in medium-sized enterprises. METHODS: Corporate managers and employees of four enterprises with fewer than 300 employees received support from an experienced OHN in private practice through five support sessions per company, primarily targeting company managers. The OHNs documented their support steps and evaluations. After completing the support process, we conducted semi-structured interviews with company managers and OHNs to evaluate the support provided by the OHNs. The support processes were organized for each company according to an analytical framework based on the consolidated framework for implementation research; the support features of OHNs were extracted. The evaluations of the support provided by OHNs from the perspective of company personnel were categorized using content analysis. RESULTS: Six features of support by OHNs for the promotion of HPM were extracted, including clarifying corporate needs while focusing on relationships of trust with company representatives, providing appropriate health information, and introducing external resources to facilitate independent and continuous efforts in the company to promote sustainable HPM. The managers' evaluations of the support provided by the OHNs included the following six categories: 1) identified and recognized current internal health issues; 2) received specific assistance tailored to the company; 3) gained an opportunity to work on health promotion measures; 4) considered the development and continuation of future health promotion measures; 5) learned about the existence of OHNs as easy to consult with; and 6) identified aspects of support from OHNs that were different from what they expected. CONCLUSIONS: This study clarified the features and evaluations of the support provided by OHNs in private practice in medium-sized enterprises for the promotion of HPM. Our findings suggest that the involvement of OHNs in private practice may increase the number of medium-sized enterprises that can autonomously commit themselves to HPM in a sustainable manner.

Support for balancing cancer treatment and work by occupational health nurses: support structures and implementation status.

This study aimed to quantitatively grasp the structure of support for balancing cancer treatment and work among occupational health nurses (OHNs) with the current implementation status. The anonymous questionnaire was designed based on the findings of our previous qualitative study and distributed to OHNs. The degrees of support implementation for workers with cancer, superiors and colleagues, and human resource managers were assessed for each item. Factor analysis of support items was conducted, and Wilcoxon signed-rank test was carried out to compare the support scores between the factors. Support for workers with cancer comprised six factors in which the factor, concerning the provision of information regarding resources inside and outside the company, showed the lowest score. Support for superiors and colleagues was divided into three factors, and that for human resource managers comprised two factors. By Mann-Whitney's U-test, it was found that OHNs, who worked without full-time occupational health physicians for smaller companies, showed significantly higher implementation for several support factors, such as support to human resource managers. This study revealed the structure as well as implementation status of OHNs' support for balancing cancer treatment and work, which will provide suggestions for developing training programs for OHNs to promote these activities.

Development and evaluation of a training program for occupational health nurses regarding support for workers with cancer and their workplaces.

OBJECTIVES: This study aimed to develop and evaluate a training program for occupational health nurses (OHNs) regarding support for workers with cancer and their workplaces. METHODS: Based on our prior research, we engaged in multiple discussions on the development of training program for OHNs. For examining the effectiveness of the developed training program, we collected and analyzed the data from three repeated surveys conducted before, immediately after, and 3 months after the training on self-confidence levels of the participants regarding 23 items associated with support for workers with cancer and their workplaces. RESULTS: We made a 3-hour training program including a lecture and a group work. First, we gave a lecture explaining the support scheme consisting of 4 parts and the 12 hints in action phrase while using the guidebook. Second, we conducted the group work regarding the case of a female worker diagnosed with breast cancer. Of the participants who supported workers with cancer in actuality during the 3-month post-training, 86% acknowledged the utility of the training in implementing support. As for the pre-post evaluation of the training program, most items of the participants' self-confidence significantly increased from pretraining to immediately after and 3 months post-training. DISCUSSION: This study demonstrated that the developed training program was effective in that the participants learned the support schemes and skills and gained self-confidence in implementing supports in real-work settings. We hope that this training program will be extensively used in the future, enabling OHNs to contribute toward balancing cancer treatment and work.

Development of nurses with specialties: the nurse administrators' perspective.

AIM: This study clarified how Japanese nurse administrators consider the current status and future prospects of development and utilization of nurses with specialties. BACKGROUND: The demand for specialized nurses is not satisfied throughout the country. METHODS: Nine nurse administrators participated in three focus-group discussions. Data were analyzed using qualitative content analysis technique. RESULTS: On development of specialized nurses, four categories were abstracted: offering opportunities for career development; establishing an environment of life-term continuous learning; providing well-balanced support for the needs of organizations and individual nurses; and support for career development as a specialist. CONCLUSIONS: To develop specialized nurses effectively it is important to focus more attention on qualitative aspects of nurses' professional experience in in-service education and to support appropriate personnel for strategic human resource development. IMPLICATIONS FOR NURSING MANAGEMENT: Facilitating frequent contacts between specialized and general nurses should be highly valued as making an environment where nurses can face career goals daily leads to steady preservation of human resources. It is necessary for nurse administrators to keep human resources quantitatively and to clarify the developmental process after nurses obtain special roles to plan for continuous education.

Glove selection as personal protective equipment and occupational dermatitis among Japanese midwives.

This study was conducted to 1) evaluate the personal selection and use of protective gloves against bloodborne pathogens and management of glove selection in the workplace, 2) survey the experience with occupational dermatitis and other allergic symptoms, 3) explore the relationships between occupational dermatitis experience and glove use, and 4) determine the impact of glove selection upon occupational dermatitis among midwives. Subjects were 1,150 midwives working in Japan. Participants were selected from the members of Japanese Nursing Association and 835 responded to the survey. More than 30% of respondents wore gloves only when clients had an infectious disease, 41% reported experience of occupational dermatitis, 26% associated the dermatitis with medical glove use, and 2% had a diagnosis of latex allergy. Demographic variables that were significantly associated with occupational dermatitis included history of allergic symptoms other than due to occupational exposure, age, tenure and type of working institution. Using latex gloves during administering enema, shaving, changing pads, washing perineum, receiving newborns, suctioning, and handling waste significantly increased the risk of occupational dermatitis experience compared to not using gloves. Logistic regression analysis with backward stepwise elimination revealed glove selection management, such as availability of alternative glove types, using latex gloves for washing perineum, and using latex gloves for handling waste were significant predictors of occupational dermatitis. Occupational dermatitis is a significant issue and glove use as personal protective equipment is not standardized. Some occupational dermatitis may be preventable by managing appropriate glove selection.

Four factor research awareness scale for nurses in Japanese: instrument development study.

AIM: Research awareness is an important consideration necessary for providing superior nursing care. However, a gap exists between research and clinical practice. A major obstacle to integrating research into clinical practice is the absence of research awareness among nurses. Studies on research awareness have focused primarily on three factors: attitude, competence, and encouragement for conducting research. The Research Awareness Scale for Nurses (RASN) in Japanese incorporates a critical, yet generally overlooked fourth factor of flexible structure for research. The aim of this study was to develop a nursing research awareness scale that could be used to determine the reasons for the lack of interest in research among nurses and to help nursing administrators take steps to integrate research into clinical practice. METHODS: The RASN was developed and tested in three stages. An item pool for the scale was generated from a published work review and focus group interviews. The scale was then tested in a pilot study, and finally in a main study. Reliability and validity were examined by exploratory and confirmatory factor analysis, Cronbach's alpha, one-way anova and correlation analysis. RESULTS: The RASN exhibited good validity in the four factor structure ("attitude", "competence", "encouragement", and "flexible structure"). Cronbach's alpha exhibited good internal consistency. The RASN was significantly and positively correlated with research-related education and activities. CONCLUSION: The RASN had good internal consistency, content validity, discriminant validity, and construct validity. These findings demonstrate that the RASN is a useful instrument for evaluating approaches toward the integration of research into clinical practice.

Effects of mental workload on nurses' visual behaviors during infusion pump operation.

AIM: According to a national report on incident analysis, the mental workload that exists during the i.v. medication administration process might affect nurses' visual behavior and, thus, influence the accuracy of the process. This study examined changes in the visual behavior of nurses who operated an infusion pump under the influence of time pressure and dual tasking. METHODS: mTen nursing students, 13 experienced nurses, and nine inexperienced nurses, equipped with an eye tracker and instruments that measure the heart rate and breathing frequency, carried out an infusion pump operation in a simulated patient room under three mental workload conditions: without a mental workload, under time pressure, and while dual tasking. RESULTS: Under the time pressure condition, the total visual fixation duration of the procedures was shortened. The experienced and inexperienced nurse groups could shorten the tasks in order of priority but the student group could reduce the tasks only inconsistently. Dual tasking had no influence on the total fixation duration of the procedures. However, the fixation location was influenced by the dual-tasking condition. This condition caused dispersed attention in the student and inexperienced-nurse groups, but not in the experienced-nurse group. CONCLUSION: Time pressure appears to cause nurses to shorten the duration of infusion pump operation and to reduce the quantity of checking. Dual tasking appears to have no influence on the total visual fixation duration but causes dispersed attention, reducing the quality of checking.

Effect of procedure light on the physiological responses of preterm infants.

AIM: Current recommendations for illumination in the NICU state that procedure light should be controlled with a rheostat to protect infants from high illumination. However, overhead fluorescent lights without a dimmer switch are still used in Japan. The aim of this study was to assess the effects of three different procedure lighting conditions (fluorescent with on/off switch rapidly increasing the level of light [FRL], incandescent with on/off switch rapidly increasing the level of light [IRL], and incandescent with dimmer switch slowly increasing the level of light [ISL]) on the respiratory rate (RR) and oxygen saturation (SpO(2)) in preterm infants with or without oxygen therapy. METHODS: Eight preterm infants, with a gestational age of 29-31 weeks, were included in a repeated randomized cross-over study. ANCOVAs, based on general linear mixed models, were used to examine physiological changes over time and across lighting conditions. In addition, the minimum SpO(2) values, after increasing the level of light, were classified into SpO(2) < or = 85%, SpO(2) = 86-91%, and SpO(2) > or = 92% for each lighting condition. RESULTS: With and without oxygen therapy, the RR and SpO(2) under the ISL were higher than under the FRL and IRL. SpO(2) < or = 85% was only observed under the FRL and SpO(2) = 86-91% was observed under the FRL and IRL. CONCLUSIONS: These data suggest that differences in the light conditions influence physiological responses in preterm infants and slowly increasing the level of light might make it easier for them to slowly adapt to high illumination and prevent declining SpO(2) values in neonates.

The relationship between incident reporting by nurses and safety management in hospitals.

AIM: This study examines the relationship between nurses' perceptions of incident reporting, the frequency of incident reporting on wards, and safety management in hospitals. METHODS: A self-administered survey was conducted on 528 nurses in 8 hospitals that provide core medical care in rural areas of Japan. Each of these hospitals is equipped with more than 90 beds. The relationship among perceptions of incident reporting, the frequency of incident reporting on wards, and safety management was examined using Pearson correlation coefficients calculated using ward scores. RESULTS: Safety managers' attitudes and safety management at the ward level were found to have significant correlation with fear of reprisal caused by incident reporting, willingness to carry out incident reporting, and recognition of the importance of incident reporting. CONCLUSIONS: On wards where staff and safety managers discuss incidents and their root causes, staff are less fearful of incident reporting, understand the significance of incident reporting, and report incidents more willingly. There is a need for ward managers not only to demonstrate leadership in terms of safety management but also to discuss incidents with staff.

Mitogenic activity of oxidized lipoprotein (a) on human vascular smooth muscle cells.

Although oxidized lipoproteins may play an important role in the progression of atherosclerosis, no report has mentioned the significance of oxidized lipoprotein (a) (Lp[a]) in the pathogenesis of cardiovascular disease. Initially, we compared the mitogenic actions of Lp(a) and oxidized Lp(a) on human vascular smooth muscle cells (VSMC). Lp(a) significantly stimulated the growth of human VSMC in a dose-dependent manner, whereas oxidized Lp(a) showed a stronger stimulatory action on VSMC growth than native Lp(a). Interestingly, antioxidants probucol and fluvastatin inhibited the oxidation of Lp(a). Moreover, the stimulatory effect of oxidized Lp(a) on human VSMC growth was significantly inhibited by probucol. Finally, we elucidated the molecular mechanisms of how Lp(a) stimulated the growth of VSMC. Extracellular signal-regulated kinase (ERK), as those controlled by kinases, modulate critical cellular functions such as cell growth, differentiation, and apoptosis, was transiently phosphorylated by oxidized Lp(a) as well as native Lp(a) from 5 minutes, and the phosphorylation disappeared within 30 minutes. The degree of ERK phosphorylation by oxidized Lp(a) was much higher than that by native Lp(a). Administration of a specific inhibitor of MEK, PD 98059, significantly attenuated VSMC growth induced by native Lp(a) or oxidized Lp(a) in a dose-dependent manner (P<0.01). The current study demonstrated that oxidized Lp(a) is more potent than native Lp(a) in stimulating VSMC growth. Oxidized Lp(a) may play an important role in the pathogenesis of vascular disease.