Professional behaviours and factors contributing to nursing professionalism among nurse managers.

AIM: To examine the perception of professional behaviours and factors contributing to nursing professionalism among nurse managers. BACKGROUND: Professional behaviours influence nursing professionalisation and managers' behaviours strongly impact professional development. In Japan, few studies have examined professional nursing behaviours from the nurse managers' perspective. METHODS: The Behavioural Inventory for Professionalism in Nursing was performed with 525 nurse managers representing 15 facilities in Japan. RESULTS: The highest professional behaviours score obtained was 'competence and continuing education' and the lowest behavioural score was 'publication and communication'. The results demonstrate that higher nursing professionalism is related significantly to the increased length of nursing experience, a higher level of educational preparation and the current position as a nurse administrator. CONCLUSION: This study demonstrated that nursing professionalism is influenced by years of experience and nursing management education. IMPLICATIONS FOR NURSING MANAGEMENT: Awareness of extrinsic professional factors is important continually to maintain nursing professionalism. The findings of our study may help nurse managers to continue their self-development and to realise the potential of their nursing staff by developing professionalism. These findings also provide an understanding of international professionalism trends to achieve higher levels of nursing professionalism through the evaluation of professional nursing behaviours.

A longitudinal study of gender differences in quality of life among Japanese patients with lower rectal cancer treated with sphincter-saving surgery: a 1-year follow-up.

BACKGROUND: Up to 80% of patients with rectal cancer undergo sphincter-saving surgery, and almost 90% of them experience subsequent physical changes. The number of studies on gender differences in response to this surgery has increased, and the connection between gender and symptoms and patient outcomes has generated increasing interest. Nevertheless, little is known about the gender differences in quality of life and cancer-related symptoms. We examined gender differences and quality of life changes over a 1-year period among patients with lower rectal cancer who were treated with sphincter-saving surgery. METHODS: Patients (men = 42; women = 33) completed a self-administered questionnaire on their quality of life and related factors before surgery and 1, 6, and 12 months afterwards. The questionnaire was developed by the European Organization for Research and Treatment of Cancer (EORTC QLQ-C30/CR-38). RESULTS: Scores on physical, role, and social functioning and global health status/quality of life decreased 1 month after surgery, improved after 6 months, and returned to baseline within 12 months, with the exception of social functioning in men. Factors related to quality of life changed after surgery and differed between men and women. Women's global health status/quality of life was affected by fatigue, weight loss, defecation problems, and future perspective, while that of men was affected by fatigue, weight loss, future perspective, and role functioning, which was affected by pain, defecation problems, and financial difficulties. CONCLUSIONS: Gender differences should be considered when predicting the quality of life of cancer patients undergoing surgery. Identifying gender differences will help health care providers anticipate the unique needs of patients undergoing surgery for rectal cancer.

The relationship between characteristics of nursing performance and years of experience in nurses with high emotional intelligence.

The aim of this study was to elucidate characteristics of nursing performance among nurses with high emotional intelligence (EI) and examine the influence of years of experience on nursing performance and EI. A survey, including The Emotional Intelligence Scale and the Six-Dimension Scale of Nursing Performance, was administered to 1395 nurses working at general hospitals in Japan from November 2010 to March 2011. We received 1045 responses (76% response rate). There was a significant positive correlation between EI and nursing performance. Nurses with high EI reported more professional development activities, suggesting that they continue learning, attain licenses and actively improve their nursing skills. High-performing nurses had high situational abilities and showed improved nursing performance with experience. However, nurses with low situational abilities demonstrated no improvement in nursing performance related to experience. EI involves skills that can be acquired from training. Therefore, educational programmes to improve EI could improve nursing performance.

Nursing professionalism: a national survey of professionalism among Japanese nurses.

The aim of this study was to quantify the professionalism of nurses in Japan. The Japanese version of the Behavioural Inventory for Professionalism in Nursing was conducted as a national survey. Computer-generated random selection of nurses in Japan obtained responses from 1501 nurses. A descriptive design examined the levels of and differences in nursing professionalism. Comparisons of the total level of professionalism in educational preparation, current position, years of experience, and current practice setting were analysed by one-way analysis of variance and post hoc Tukey-Kramer multiple comparison test. The results revealed that Japanese nurses had low levels of professionalism, and professionalism was related significantly to higher educational preparation, years of experience as a nurse, and current position as a nursing administrator or faculty. The results can be used as a benchmark for continued assessments of the level of nursing professionalism and for further development of nursing professionalism.

Effect of information and communication technology on nursing performance.

The aim of this study was to investigate the influence of information and communication technology use and skills on nursing performance. Questionnaires were prepared relating to using the technology, practical skills in utilizing information, the Six-Dimension Scale of Nursing Performance, and demographics. In all, 556 nurses took part (response rate, 72.6%). A two-way analysis of variance was used to determine the influence of years of nursing experience on the relationship between nursing performance and information and communication technology use. The results showed that the group possessing high technological skills had greater nursing ability than the group with low skills; the level of nursing performance improved with years of experience in the former group, but not in the latter group. Regarding information and communication technology use, the results showed that nursing performance improved among participants who used computers for sending and receiving e-mails, but it decreased for those who used cell phones for e-mail. The results suggest that nursing performance may be negatively affected if information and communication technology are inappropriately used. Informatics education should therefore be provided for all nurses, and it should include information use relating to cell phones and computers.

[Health effects and psychological stress in pregnant women engaged in work outside the home].

Modern society demands working conditions in which pregnant women can successfully deliver children and maintain a professional position. The aim of this study is to investigate the effects of work on the health and psychological stress in working women and their newborns. We reviewed twenty-eight publications and found that health problems in working women occur at high rates. However, there is no report investigating the mechanism by which health problems occur, or describing the precise working conditions and symptoms in pregnant women who are engaged in work outside the home. In addition, the literature uses subjective evaluations, including psychological tests, to quantify stress and anxiety, but no biochemical analyses of stress-related substances were conducted. We suggest that a standard index to represent working conditions and job category, as well as an investigation of the workload of house-keeping, is needed to understand the total work effort by pregnant women in modern times. Finally, measurement of stress-related biological markers may be effective in the investigation from various perspectives of occupational stress in pregnant women.

[The development of a method to evaluate general ward nursing care practices targeted at families of cancer patients--identification and selection of items for evaluation].

As a first step to develop a method to evaluate general ward nursing care practices targeted at families of cancer patients, the current study aimed to identify and select items for evaluation. Forms of nursing care considered to be necessary for the families of cancer patients were extracted from previous literature and categorized. We identified 5 categories, and 20 items were created to reflect the type of nursing care in these categories. A paper questionnaire evaluation composed of the 20 items was given to 77 general ward nurses. Valid responses were obtained from 67 (87.0% response rate). Factor analysis revealed 6 subscales which included "encourage family to participate in patient care", "commitment and adjustment", "adjust nursing care to meet family member needs", "realize the burden on family members", "attend the death", and "respect family decisions". Items for evaluation were refined based on other responses in the questionnaire, and a total of 26 items regarding nursing care were selected for use in the evaluation.

[The outcomes of program based on complex decongestive physiotherapy for a patient with secondary lymphedema caused by infection on the leg].

Lymphedema is a chronic problem causing distress and loss of functions throughout the lifespan. Complex decongestive physiotherapy (CDP) is in common use in developed countries but has only recently been used in Japan for people in outpatient settings. CDP is a representative conservative treatment for lymphedema, conducted by combining four kinds of physical therapies: skin care, manual lymph drainage (MLD), bandage and exercise. This research project lead by a nurse is underway using CDP in an outpatient department. We report a case of secondary lymphedema caused by infection successfully treated by CDP. A 22-year-old man suffered from cellulitis of unknown origin when he was a high school student. After this event, he had been repeatedly admitted to hospital with infections as a result of the lymphedema. He underwent MLD once or twice monthly and received health education for skin care, self-massage and exercise, and was advised to wear compression stockings. Within 7 months the leg swelling had significantly reduced and his feelings of malaise and pain disappeared. Fourteen months later the circumferences of his knee and ankle had kept the sizes, and he has not re-entered hospital for infections. For this man, CDP had a positive outcome, as it has for many others around the world. Our experience has found it very important to establish adequate support systems for such people in outpatient and community settings. However, more research and knowledge sharing are required to understand the usefulness and effectiveness about this program as a primary treatment combined with health education in community settings in Japan.

[Relation between self-evaluation of skills and learning strategy in the acquisition of the hygienic nursing skills].

The purpose of this study is to investigate which learning strategies nursing students use to acquire the nursing skills of cleanliness. The investigation of 71 first-year nursing students consists of self-evaluation of shampooing and bed-bath/foot-bath/changing the night-clothes (19 questions each) and learning strategies (15 questions). To compare the difference between 2 groups in the acquisition of learning strategies, we used the Mann-Whitney U test to calculate the average evaluation of each skill, the self-evaluation, and the total scores of each of cognitive domain, psychomotor domain and affective domain, categorizing the students into higher evaluation and lower evaluation. The recovery rate of questionnaires was 81.7%. The psychomotor domain in the self-evaluation was high, but the cognitive domain and affective domain were low. As for the learning strategies used, the higher evaluation group in total self-evaluation used lectures and prior learning and nursing practice (P < 0.05, P < 0.01). Moreover, the higher evaluation group of the cognitive domain used explanations by the teacher in lectures and practice, and the higher evaluation group of the psychomotor domain used explanations of basic activity in lectures and training and guidance in the practice room (P < 0.05, P < 0.01). Also, the higher evaluation group of the affective domain didn't use learning strategies to acquire skills of the affective domain. In the future, it is necessary to consider learning strategies in acquiring the affective skills.

[Themes and trends in nursing research on cancer patients' families].

The purpose of this study was to identify trends in nursing research on cancer patients' families published within the past 12 years (1996-September 2007, present) and examine their research themes. Five core categories were identified: 1) cancer nursing at home, 2) terminal care in a general ward, 3) family's experience in a terminal period and after bereavement, 4) family's experience and care during treatment, and 5) family systems. Findings showed that the following areas of research are being conducted: nursing research on a variety of therapies and care environments, research on nurses' awareness of the families of cancer patients and how this affects treatment, interventional research on how to implement study findings, and research activities based on family nursing.

Effect of work conditions and work environments on the formation of 8-OH-dG in nurses and non-nurse female workers.

The purpose of our study was to examine the effects of job stress factors on oxidative DNA injuries among female workers. The levels of urinary 8-hydroxydeoxyguanosine (8-OH-dG) were measured along with a survey on work conditions and environments. The result showed that female workers in shift work excreted increased levels of 8-OH-dG in comparison with the result of those who were engaged in part time work (P < 0.01). Moreover, the nurses who marked higher depressive scores excreted significantly increased levels of urinary 8-OH-dG than the nurses who scored lower depressive states. The result revealed a positive correlation between 8-OH-dG levels of nurses in the 35-45 age group and the individual scores of their depressive states (r = 0.32, P < 0.05). Together, it was suggested that a heavy burden of work in addition to daily domestic roles increases urinary excretion levels of 8-OH-dG.

[An investigation of factors affecting job satisfaction among psychiatric nurses--focussed on stress-coping and a character tendency].

The relation between stress, stress coping behavior and job satisfaction was investigated for psychiatric nurses who work in the northern part of Kyushu and the Chugoku district of Japan. As a result, the people with high job satisfaction had a tendency for the stress coping ability to be high, the daily stress of the people with low job satisfaction was high, and a relation with the character which is the individual characteristic was also seen. In the relation between stress management factor and job satisfaction, those who can have change of action by a hobby, amusement, etc., those with a strong tolerance to stress and the people with social support showed a tendency for job satisfaction to be high. The people especially with a high degree of satisfaction with their professional status showed the tendency for the stress management factor to be high. On the contrary, the people with a high stressor of daily hassles showed the tendency for job satisfaction to be low. Moreover, anger, nervousness and the people with a tendency to take a Type A action pattern showed the tendency for job satisfaction to be low. From these findings, it is suggested that a stressor or not only coping behavior but character tendency is related to job satisfaction.

The Current Status of Nursing Professionalism Among Nursing Faculty in Japan.

BACKGROUND: The faculty of nursing schools plays an important role in the successful execution of nursing education. Therefore, faculty behavior strongly affects the professional development of nurses. However, few studies have examined professional nursing behaviors from the perspective of nursing faculty. PURPOSE: Members of nursing faculty in Japan were surveyed regarding their perspectives on behaviors related to professionalism. METHODS: The model, Miller's Wheel of Professionalism in Nursing, was used as the theoretical framework. The Behavioral Inventory for Professionalism in Nursing (BIPN) was completed by 74 full-time nursing faculty who were currently working at 10 institutes of nursing education in Japan. RESULTS: The mean BIPN score for the participants was 11.56 (SD = 6.08) of a possible total of 27. The highest and lowest BIPN category scores were for "research development, use, and evaluation" and "community service," respectively. Professionalism was found to relate significantly to higher educational preparation (F = 32.17, p < .0001). The Tukey-Kramer multiple comparison test found a significant association between having a graduate degree and higher scores for professionalism (p < .0001). The Spearman correlation coefficient was significant and positive for the relationship between professionalism and both educational preparation (r = .85, p < .0001) and number of years as a nursing educator (r = .31, p = .0077). CONCLUSIONS: The results support the idea that a higher level of educational preparation and more years of experience as a member of a nursing faculty are associated with higher levels of nursing professionalism. The professional behavior scores suggest that "community service" is an issue that requires further improvement among Japanese nursing faculty. Awareness of extrinsic factors such as education is important to maximize nursing professionalism. The findings of this study may help nursing faculty continue their self-development.

[The preparatory education of electronic patient record for nursing students before practical nursing training].

Preparatory education has been provided for both nursing students and teachers to understand the electronic patient record (EPR) since 2004 when EPR was introduced to the hospitals where students are allocated to undertake their work experience. First, the training and management board contacted our medical information department for an appointment and sent us a working group. They taught the nursing training staff how to use EPR and how to assign students to the proper patient record in the EPR system. Second, as preparatory education for the students, they explained the procedure for the use of EPR and the protection of personal information. Students practiced with training in the EPR system, focusing on the functions which are used frequently in practical tasks. As a result of this preparatory education, students understood the protection of personal information very well, although their understanding of the operation and management of the equipment was relatively poor and adversely affected their practice. We need to review our education contents more often. We also need to examine the present state of understanding of EPR and the problems of teaching in practical nursing training.

[Relationship between bone metabolism and effects of lifestyles after gastrectomy].

The aim of this study was to examine the effects of bone metabolism impairment after a gastrectomy, as well as the effects of dietary life and physical activity on bone density, in order to obtain basic information on lifestyles that prevent osteoporosis. The study subjects were 27 male patients who had been diagnosed as having gastric cancer at a university hospital and had received a gastrectomy. All subjects gave their informed consent. The level of the bone metabolism impairment was examined by bone cell density measurement, ultrasound densitometer and by the measurements of bone metabolism parameters, i.e., BAP, DPD, NTx, corrected Ca. Physical activity was measured by the number of steps, and dietary life was investigated using a questionnaire. The SOS value, which is an index to the bone metabolism impairment, decreased 3 weeks after the gastrectomy. Although the SOS value recovered once, it decreased after 6 months again. Afterwards, it recovered to the preoperative level in 12 months. The levels of BAP, which are the osteogenesis markers, significantly decreased 3 weeks after the gastrectomy and increased three months later. DPD level, which is a bone resorption marker, increased significantly. The effect of physical activity and dietary life on the bone density was not recognized. Though the bone metabolism impairment appeared 3 weeks after the gastrectomy, the bone formation process after bone resorption was affected by individual differences. Consequently, it was impossible to clarify the factors of lifestyles which affect bone metabolism impairment.

The effect of lemon fragrance on simple mental performance and psychophysiological parameters during task performance.

The purpose of this study is to effectively utilize fragrance in order to form a comfortable working environment, for which we obtained necessary data. The subjects were 14 female students. We made them do addition work in laboratories with and without lemon fragrance, and investigated their task performances, physiological changes and mood conditions. Our results showed that, although the existence or nonexistence of fragrance did not affect their work efficiency, it was revealed that fragrance mitigated exhaustion and maintained vigor.

A very low level of magnetic field exposure does not affect a participant's mental fatigue and stress as much as VDT work.

Exposure to Magnetic Fields (MF) may affect the health of workers in an occupational environment. However, there is no clear evidence that the emission of MF from the visual display terminals (VDT) affects workers'mental status or induces stress in office environments. The purpose of our study was to investigate whether exposure to the MF during VDT work affects mental fatigue or induces stress related to psycho-physiological changes in workers. Thirty-seven students were voluntarily recruited to participate in this study. We created experimental conditions that a pair of the liquid crystal display (LCD) terminals separated by screens was closely placed in front of the visual suface of the cathode ray tube (CRT) units. All participants were not able to recognize whether the power of the CRT Units was ON or OFF while they worked with the LCD terminals. When the CRT unit was ON, participants who worked with the LCD terminal were called CRT-ON group. On the other hand, when the CRT unit was OFF, participants who worked with the CLD terminal were called CRT-OFF group. Incredibly short profiles of mood states (ISP)and subjective symptom questionnaires were used as indices of the mental fatigue as well as psychological stress before and after VDT work. Furthermore, salivary chromogranin A and urinary 8-hydroxydeoxyguanosine (8-OH-dG) were collected to measure physiological changes before and after VDT work. The results of the questionnaires and salivary and urinary stress markers showed that the exposure to the MF during VDT work did not significantly induce mental fatigue or psychological stress in comparison with the CRT-OFF group. Contrary to the results from the exposure, mood states of vigor decreased greatly (P < 0.05) whereas the states of fatigue and confusion increased significantly (P < 0.001) after VDT work. In the questionnaires for subjective symptoms, participants complained remarkably regarding 14 out of 25 conditions after VDT work. Moreover, urinary 8-OH-dG excretion increased significantly after VDT work. Taken together, the results of this study did not detect any bad health effects of MF exposure on the VDT participants but suggested that VDT work itself affects their mental fatigue and psycho-physiological status.

[Changing of emotions by the stimulation of visual and auditory senses--an analysis of heart rate variability (HRV)].

The purpose of this study was to clarify the effect of visual and auditory stimulation on emotions and autonomic nervous systems. Four kinds of video films, which themes were humor, discomfort, fear or gentleness were presented to 14 subjects. Spectral analysis of heart rate variability (HRV) was observed as the autonomic nerve responses. The four kinds of video films caused different emotional reactions (the difference in the reaction of the autonomic nervous systems to each video film are shown). It was confirmed that the autonomic nerve responses differed in accordance to how the video film was recognized by the subjects. When television and videos are utilized for nursing care, it is important to offer them to patients, taking into consideration their character and preference. In addition, individual care should be carried out by observing the emotional reactions of patients.

[A survey of public health nurses regarding their awareness of the abilities, skill and knowledge necessary to fulfill an occupational health nurse's role, and proposal of a new curriculum for occupational nurse specialists at the master level].

The areas of conduct and professional roles in occupational health nursing in Japan has not been defined as yet, even though occupational health nurses have contributed to implementing jobs related to the health examination in workplaces every year. We surveyed public health nurses regarding their awareness of the abilities, skills and knowledge necessary to fulfill an occupational health nurses' role. When answering, they became aware of deficiencies in their abilities, skills and knowledge. This was particularly true in counseling, health assessment skills and management abilities, specialized knowledge of occupational safety and health, ergonomics and environmental health. We propose a curriculum at the master level for occupational health nurse specialists with reference to the core curriculum for occupational and environmental health nursing in the USA.

Defining the roles and functions of occupational health nurses in Japan: results of job analysis.

The purposes of this study were to obtain descriptive information about the job duties and tasks of Japanese occupational health nurses and to compare the roles and functions of occupational health nurses in the United States and Japan. A modified version of a job analysis survey developed by the American Board for Occupational Health Nurses was used to collect data. The findings indicated 62% of Japanese occupational health nurses perform direct care roles, approximately half perform educating or advising and consulting roles, and approximately 40% perform management roles. Details related to specific tasks and differences in nurses with varying preparation also are presented. Although there were many similarities in the types of tasks performed by nurses in Japan and the United States, the proportion of time devoted to specific tasks in the two countries varied. These results support the need for developing an educational system to enhance occupational health nursing practice in Japan. The information derived from the study provides a knowledge base that can be used to provide guidance and direction to the content of occupational health nursing programs.