Consensus development of quality indicators for end-of-life care for elders in Japan.

AIMS AND OBJECTIVES: Quality indicators for end-of-life care have been published; however, none have been developed specifically for nursing in the cultural and traditional context of Japan. This study aimed to develop and build a consensus of quality indicators for end-of-life care for elders in Japan from the perspective of nursing science. METHODS: To develop the quality indicators, we used a literature review, expert panel process, and the Delphi technique among clinical nurse specialists in geriatrics. RESULTS: Quality indicators were identified in 7 major areas: advance directives and surrogate continuity, ethical daily care, care preferences and decisions about life-sustaining treatment, assessment and management of pain and other symptoms, daily care for the dying, family care, and institutional systems for end-of-life care. CONCLUSIONS: These quality indicators represent the first attempt to develop a best practices approach toward improving the quality of elderly end-of-life care in nursing.

Integrated Long-Term Care 'Neighbourhoods' to Support Older Populations: Evolving Strategies in Japan and England.

Western countries are currently facing the public health challenge of a rapidly aging population and the associated challenge of providing long-term care services to meet its needs with a reduced working age population. As people age, they will increasingly require both health and social care services to maintain their quality of life and these will need to be integrated to provide cost-effective long-term care. The World Health Organization recommended in 2020 that all countries should have integrated long-term care strategies to better support their older populations. Japan, with the most rapidly ageing society in the world, started to address this challenge in the 1990s. In 2017, it introduced a national policy for integrated long-term health and social care services at a local geographical level for older people. England has recently embarked on its first plan aiming for the integration of services for older people. In this article, we compare these approaches to the integration of long-term care systems, including the strengths of each. The paper also considers the effects of historical, cultural and organizational factors and the emerging role of technology. Finally, we identify critical lessons that can inform strategy development in other countries, and highlight the need to provide more international comparisons.

The Asian Research & Collaboration Center for Nursing & Cultural Studies in Japan.

The purpose of this paper is to describe current cultural issues in Japanese health-care services that have resulted from the increased immigration. Also described is the establishment of a new academic research centre that will focus on culturally appropriate nursing care. There are many health-care issues in Japan caused by a shortage of health-care workers and disparities in access to health care. The major issues are an increase in the number of foreign patients, foreign nurses and care workers. Despite the occurrence of similar issues in other countries, Japan's situation and the causes are different. In response to dynamic demographic and health-care changes in Japan, we launched the Asian Research & Collaboration Center for Nursing & Cultural Studies at Chiba University Graduate School of Nursing.

The experience of being a spouse of a person with dementia in respect to their marital relationship in Japan.

BACKGROUND AND PURPOSE: While the marital relationship with partners with dementia has an impact on spousal carers' well-being, the spousal understandings or expectations of their marital relationship have not been fully identified. As the marital relationship is formed by individual backgrounds including society, culture and psychological status, the aim of this study was to identify the experience of being the spouse of a person with dementia in the context of their marital relationship. The study was conducted in Japan. RESEARCH DESIGN: To identify spousal experience of being, Heideggerian perspectives of interpretive phenomenology were applied. STUDY SAMPLE: Seven couples aged over 65 years, each comprising one partner with dementia who received home nursing, and their spouse participated in this study. DATA COLLECTION: The couples were observed, and semi-structured interviews were conducted. DATA ANALYSIS: Interpretive data analysis based on the Hermeneutic circle of Heideggerian perspectives was applied. RESULTS: In the findings, the experience of being a spouse, contextualised by spousal understandings of marital relationship, was formed through seven themes. The main context for spousal understanding of their marital relationship was helping each other as husband and wife, and this relationship was seen as natural and unchanging. It reflected on spousal potentiality of being, that is, living together indefinitely as before. Spouses tried to provide suitable care for their partners using memories while preserving a sense of identity, maintaining external relationships and accepting unanticipated internal responsibility. CONCLUSIONS: In conclusion, fulfilling unmet needs could help spouses to ease intense care load, which re-acknowledges their own and their partner's identity, and their relationship by reminiscing their past.

Supportive Care Needs of Chinese Women With Newly Diagnosed Breast Cancer Prior to Adjuvant Chemotherapy.

PURPOSE: To describe the supportive care needs of Chinese women newly diagnosed with breast cancer prior to adjuvant chemotherapy. PARTICIPANTS & SETTING: 13 women newly diagnosed with breast cancer were recruited from a public teaching hospital in northern China. METHODOLOGIC APPROACH: Semistructured interviews were conducted, and data were analyzed following a qualitative descriptive approach and qualitative content analysis. FINDINGS: The following five themes emerged. IMPLICATIONS FOR NURSING: Nurses should focus on patients' prechemotherapy supportive care needs and comprehensively assess their specific needs and concerns related to post-surgery discomfort and chemotherapy, with considerations of the Chinese family concept, diet, and traditional culture. Targeted health information and psychological support are necessary to help patients transition to and adequately prepare for chemotherapy.

Characteristics of Diabetes Self-Care Agency in Japan Based on Statistical Cluster Analysis.

INTRODUCTION: Considering the situation where the number of people with diabetes is increasing, we need to find ways to support more efficient and effective outpatient clinics. Therefore, it is necessary to develop effective support methods and to elaborate a strategy as a system for support after grasping the characteristics of the entire population of people with diabetes. OBJECTIVE: The purpose of this study was to identify the characteristics of the diabetes population in outpatient settings by differences in self-care agency and to examine how to support them based on the recognized characteristics. METHODS: Participants were 261 people with diabetes under outpatient care in Japanese institutions from whom demographic data on age, gender, HbA1c, and treatment method were collected as well as self-care agency data based on the Instrument of Diabetes Self-Care Agency consisting of 40 items. The data were analyzed using cluster analysis to compare age, gender, HbA1c, duration of diabetes, type of diabetes, and insulin therapy between clusters. RESULTS: The analysis identified six clusters, including a group with favorable HbA1c but low total self-care agency scores that were likely to affect their blood glucose control in the future, although accounting for as small a portion as 3% of the total. In addition, a cluster with poor HbA1c and generally low self-care agency was also identified accounting for about a quarter of the total population. These clusters were considered to require further support. Clusters having markedly low self-care agency items, stress-coping ability, or the ability to make the most of the support available were also identified. CONCLUSION: The six clusters need to be assisted in focusing on mental or social support. Accordingly, consideration of the support system for people with diabetes based on an understanding of the cluster characteristics seemed to enable more efficient and effective support.

Structural model of self-care agency in patients with diabetes: A path analysis of the Instrument of Diabetes Self-Care Agency and body self-awareness.

AIM: The aim of this study was to examine a causal model of self-care agency by exploring the relationship between the structure of "body self-awareness" and the structure of the Instrument of Diabetes Self-Care Agency (IDSCA). METHODS: The participants were 353 patients with diabetes. The internal consistency of the six items for body self-awareness was examined by calculating the factor structure using principal factor analysis and Cronbach's alpha. In order to examine the relationship between the seven factors in the IDSCA, a path analysis was conducted. RESULTS: With regard to the factor structure, the factor loading of these five items was 0.511-0.743 (α = 0.739). In the path analysis, "body self-awareness" was influenced by the "ability to acquire knowledge" and had a direct effect (0.33) on the "motivation to self-manage", while "motivation to self-manage" had an effect (-0.32) on the "ability to self-manage". The Goodness-of-Fit Index was 0.974. CONCLUSION: "Body self-awareness" plays a part in the self-care operation process and serves as an intermediary factor to enable the performance of self-care operations by making the most use of self-care agency. Moreover, striking a proper balance between self-management that is focused on the treatment of diabetes and a person's ability for self-management of diabetes was found to be important.

Reliability and Validity of a Shortened Version of an Instrument for Diabetes Self-Care Agency.

PURPOSE: The purpose of this study was to develop a shortened version of the Instrument of Diabetes Self-Care Agency (IDSCA). METHODS: In the development of the shortened version of IDSCA, intraclass correlation coefficient 2 (ICC2) analysis was done to determine items to be deleted. However, the 7 subscales were retained. The shortened IDSCA was evaluated for internal consistency, reproducibility, concurrent validity, criterion-related validity, and goodness of fit. RESULTS: The shortened IDSCA included 35 items addressing 7 subscales. High ICC2 (.804) and a high Cronbach's alpha (.89) indicate internal consistency and reproducibility. A high correlation (.62) between the shortened version of the IDSCA and the Self-Care Agency Questionnaire indicated concurrent validity. CONCLUSION: The shortened IDSCA provides a reliable and valid measure of self-care agency of individuals with diabetes.

Nursing leadership in a rapidly aging society: implications of "the future of nursing" report in Japan.

The recent US Institute of Medicine (IOM) report about the future of nursing highlights the areas where nurses can serve, contribute, and move forward to improve health care in the United States. Japanese nursing scholars examined the IOM report for its implications in the Japanese context and explored the future of nursing in Japan. The purpose of this paper is to provide support for the premise that the report's recommendations could have implications for the future of nursing outside of the United States, especially in Japan. Particular areas and activities by nurses in Japan will be presented as examples of nurses taking leadership in designing care for the rapidly aging society of Japan.

Development of a support skill scale in insulin therapy: a nationwide study in Japan.

The aim of this cross-sectional, nationwide study in Japan was to develop a support skill scale for insulin therapy (IT-SSS) and to evaluate its validity and reliability. The sample consisted of 1604 nurses at 123 hospitals throughout the country. The factor validity, known-group validity, convergent validity, discriminant validity and internal consistency of IT-SSS were assessed. IT-SSS consisted of 26 minimum and 25 standard support skills. They included 4 subscales for minimum skills: management strategy for hypoglycemia, education about insulin injection technique, individual assessment and support about insulin rejection, and collaboration with medical professionals and patient/family. Three subscales for standard skills: apprehensions concerning the will and emotion of the patient, management for blood glucose control, and coordination in insulin management. Cronbach's alpha coefficient was between 0.75 and 0.90, suggesting strong internal consistency. Multitrait analysis showed that convergent validity was complete, and discriminant validity was found to be almost complete in both minimum and standard skill scales (scaling success rates of 97.6% and 98.7% across all subgroups, respectively). Known group analysis clearly showed that specialist nurses have significantly higher skills than general nurses. These findings indicate that IT-SSS has a reasonable factor validity, convergent validity, discriminant validity, known group validity, and internal consistency.