Verifying the Japanese version of the Healthy Aging Brain Care Monitor self-report tool for evaluating post-intensive care syndrome.

BACKGROUND: Post-intensive care syndrome (PICS) requires the use of multiple assessment tools because it affects multiple domains: Cognitive, Functional, and Behavioural/Psychological. Therefore, this study translated the self-report (SR) version of the Healthy Aging Brain Care Monitor (HABC-M), spanning multiple domains, into Japanese and analysed its reliability and validity in a post-intensive care setting. METHODS: Patients aged 20 years or older and admitted to the adult intensive care unit from August 2019 to January 2021 were included and surveyed by questionnaire. The 21-item Dementia Assessment Sheet for the Regional Comprehensive Care System was used to validate cognitive and physical aspects, and the Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7, and the Post Traumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders 5th edition were used to validate emotional aspects. Reliability was assessed by Cronbach's alpha, and congruent validity by correlation analysis. Multivariate linear regression models were used to identify potential factors for PICS. RESULTS: A total of 104 patients (mean age: 64 ± 14 years) with 3 median mechanical ventilation days (interquartile range: 2-5) were enrolled. The Cognitive domain of the HABC-M SR was highly correlated with memory and disorientation (r = 0.77 for each), while the Functional domain was highly correlated with Instrumental Activities of Daily Living Scale (r = 0.75-0.79). The Behavioural/Psychological domain highly correlated with the Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, and Post Traumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders 5th edition (r = 0.75-0.76). Multivariate analysis revealed longer ICU stays associated with lower Cognitive and Functional (p = 0.03 for each) domains and longer mechanical ventilation days with a lower Behavioural/Psychological domain (p < 0.01). CONCLUSION: The translated Japanese HABC-M SR showed high validity for assessment of the Cognitive, Functional, and Behavioural/Psychological domains of PICS. Therefore, we recommend that the Japanese version of the HABC-M SR be routinely used in the assessment of PICS.

Severity and prevalence of burnout syndrome in paediatric intensive care nurses: A systematic review.

OBJECTIVES: The aim of this study is to identify burnout syndrome severity and prevalence in paediatric intensive care unit nurses. DESIGN: Systematic review. SETTING: Paediatric intensive care unit. MAIN OUTCOME MEASURES: A librarian was consulted on methodology before the search process. MEDLINE (via PubMed), EMBASE, the Cochrane Library, CINAHL, and PsycINFO were searched for full-text studies published before September 2019 in any language. Only those observational studies exploring burnout syndrome, including paediatric intensive care unit nurses, were included. Two authors independently screened studies. We assessed the risk of bias within each study based on the Office of Health Assessment and Translation tool. RESULT: After screening 1238 articles, we identified six studies which met the systematic review criteria. All studies included were published after 2012 and participant sample sizes were between 35 and 195 nurses. Three studies were conducted in the United States of America while the others were from the United Kingdom, Turkey and Taiwan. Prevalence of burnout syndrome in pediatric intensive care unit nurses was reported in these studies as between 42% and 77%. The assessment tools used in these studies were the (abbreviated) Maslach Burnout Inventory, Abbreviated Maslach Burnout Inventory, Occupational Burnout Inventory, and Professional Quality of Life Scale Version 5. We could not conduct a meta-analysis due to the lack of studies. CONCLUSION: Our systematic review identifies that a low number (6 total) of relevant studies focused on burnout syndrome for pediatric intensive care unit nurses with a prevalence of burnout syndrome in paediatric intensive care unit nurses of between 42% and 77%.

St. Luke's International University and University of North Carolina at Chapel Hill collaboration project to develop the first DNP program in Japan.

We report an international collaborative project to develop the first Doctor of Nursing Practice (DNP) program in Japan. We described the development and implementation of the first DNP program at the St. Luke's International University in Tokyo and the collaboration with the University of North Carolina at Chapel Hill in the United States. Faculty perceptions in both parties gradually evolved from the traditional perspective of international collaboration to the transitional and the beginning of the holistic partnership perspectives. The collaboration resulted in an innovative DNP program that directly addressed the gap between nursing education programs and Japan's clinical needs. The collaborative project cultivated a holistic international partnership. Rather than reporting a manual for international collaboration, we present our reflections and outcomes as narratives that others could use to achieve a holistic global partnership.

Severe COVID-19 Infection Associated with Endothelial Dysfunction Induces Multiple Organ Dysfunction: A Review of Therapeutic Interventions.

Since December 2019, the SARS-CoV-2 (COVID-19) pandemic has transfixed the medical world. COVID-19 symptoms vary from mild to severe and underlying chronic conditions such as pulmonary/cardiovascular disease and diabetes induce excessive inflammatory responses to COVID-19 and these underlying chronic diseases are mediated by endothelial dysfunction. Acute respiratory distress syndrome (ARDS) is the most common cause of death in COVID-19 patients, but coagulation induced by excessive inflammation, thrombosis, and disseminated intravascular coagulation (DIC) also induce death by multiple-organ dysfunction syndrome. These associations imply that maintaining endothelial integrity is crucial for favorable prognoses with COVID-19 and therapeutic intervention to support this may be beneficial. Here, we summarize the extent of heart injuries, ischemic stroke and hemorrhage, acute kidney injury, and liver injury caused by immune-mediated endothelial dysfunction that result in the phenomenon of multi-organ dysfunction seen in COVID-19 patients. Moreover, the potential therapeutic effect of angiotensin receptor blockers and angiotensin-converting enzyme inhibitors that improve endothelial dysfunction as well as the bradykinin storm are discussed.

Learning experiences and identity development of Japanese nursing students through study abroad: a qualitative analysis.

OBJECTIVES: This study aimed to qualitatively analyze the experiences and perceptions of students at a nursing college in Japan who studied abroad in Asia and North America, thereby identifying the full range of benefits of study abroad programs for Japanese nursing students. METHODS: We conducted a qualitative analysis of the reflection papers and free-response questionnaire items completed by 50 Japanese undergraduate nursing students who participated in 9 study abroad programs in Asia and North America. Content analysis of the data proceeded from typological and deductive to data-driven and inductive, recursively and collaboratively. RESULTS: The results reveal perceived benefits in the areas of English language proficiency and motivation; knowledge of nursing practices, healthcare systems, and global health; cultural awareness and sensitivity; and various types of identity development (second-language motivation and identity, national/ethnic identity, professional identity, identity as a global citizen, and personal growth). It was also shown that students' perceptions of what they learned or gained varied according to the specific characteristics of each study abroad program. CONCLUSIONS: Study abroad experiences are often critical turning points that enhance nursing students' identity formation in the context of multiple and overlapping communities of practice. They also enhance core elements of the educational mission of a nursing college, particularly relating to liberal arts and internationalization. These findings can inform the development of assessment tools to be used in conjunction with study abroad programs at nursing colleges.

Effectiveness of the "Elevated Position" Nursing Care Program in promoting the reconditioning of patients with acute cerebrovascular disease.

AIM: Over 34,000 Japanese patients suffer from a persistent disturbance of consciousness. The purpose of this study was to investigate the effectiveness of the "Elevated Position" Nursing Care Program (EPNCP) in promoting the reconditioning of patients with acute cerebrovascular disease (ACD). The primary assumption of this study was that they could experience the reconditioning process and would reach a reconditioned state through their involvement in the EPNCP, thus improving their level of consciousness and quality of life. METHOD: A historical controlled trial study, based on an intention-to-treat analysis of hospitalized patients with ACD who became participants the day after starting medical or surgical treatment, was used. Trained nurses implemented the EPNCP from May to September 2005 for an experimental group of 45 participants. The data on two independent control groups of 92 and 40 patients with ACD were gathered from historical medical records. The six measures were: Japan Coma Scale; Level of Cognitive Functioning Assessment Scale; number of days from the intervention to sitting in a wheelchair; number of participants who left the intensive care unit (ICU) by wheelchair; Barthel Index; and modified Rankin Scale. RESULTS: Significant differences were found regarding the number of participants who left the ICU by wheelchair, length of time from the EPNCP's commencement to the wheelchair-sitting position, and the Barthel Index 1 week after leaving the ICU. CONCLUSION: The EPNCP was safe for the reconditioning of patients with ACD and somewhat effective in improving their physical function. A comprehensive nursing care program now exists for elevating patients with cerebrovascular disease during the early phase following the onset of symptoms or immediately after surgery. Further research should be conducted, extending the duration of the intervention program and the length of the measurement period, followed by a careful analysis of the results.

Sitting without back support position for prolonged consciousness disturbance patients: an intervention program case study.

The purpose of this research was to document and compare the before and after levels of consciousness of patients with prolonged consciousness disturbance (PCD) who sat for a specified length of time in a specially designed backless chair (Suwarou-Kun). Three patients were selected as participants using the PCD criteria described by Jennet and Plum in 1972. The Kohnan Vegetative Score (henceforth referred to as the Kohnan PCD Scale) and electroencephalography (EEG) measurements, together with direct observation of subtle changes, were used to record each participant's overt behavior and autonomic responses. A single-case observation/intervention time series design was used in this study. Length of exposure to the intervention and mean exposure time per session were as follows: case 1, 65 days and 30 minutes; case 2, 36 days and 11 minutes; and case 3, 43 days and 36 minutes. The Wilcoxon's rank sum test was used to analyze the pair of Kohnan PCD Scale and EEG scores collected before and at the midway point of each intervention session. Because more than two variables were being measured, the data were reanalyzed using repeated-measure analysis of variance. In cases 2 and 3, there were significant differences in the Kohnan PCD Scale and EEG scores during the "sitting without back support position" (SB) intervention period as well as at the midway point of each session (p < .05) compared with the measurements taken before the intervention. In all three cases, there also were subtle changes during the intervention, for example, eye movement, finger or thumb movement, strength of voice, and salivation. Alpha and beta waves were greater after the introduction of the SB intervention and preceded the behavioral response changes. The SB intervention resulted in at least some improvement in the level of consciousness for each participant. It remains an open question, however, whether longer exposure would have brought about further change. The SB intervention is costly in terms of human time and effort, and its beneficial effects beyond those measured in this study will require additional research.