[Questionnaire Survey of Radiation Protection Education in Hospitals].

PURPOSE: The present study aimed to investigate the current situation of radiation protection education for designated radiation workers in hospitals. METHODS: A web-based questionnaire survey was conducted at 1,883 hospitals nationwide with 200 or more beds. RESULTS: Responses from 186 hospitals were included in the analysis. Seven hospitals (6.7%) regulated by the Act on the Regulation of Radioisotopes and six hospitals (7.4%) regulated by only the Ordinance on Prevention of Ionizing Radiation Hazards did not implement radiation protection education. In approximately 6% of the hospitals, designated radiation workers-including physicians, nurses, and radiological technologist-did not attend the education program. The education program attendance rate of physicians was lower than that of nurses. In more than 90% of the hospitals, the frequency of the periodical education program was once every year and lecture time spanned one or less than one hour. The topics of lecture in more than 90% of the hospitals were health effects of radiation and methods of radiation protection for occupational exposure. The radiological technologist was the instructor of the education program in approximately 70% of the hospitals. CONCLUSION: The implementation of radiation protection for designated radiation workers varied from hospital to hospital, and some hospitals did not comply with laws and regulations. Effective and efficient radiation protection education models should be implemented in hospitals.

Factors affecting early career registered nurses' views of building good relationships with patients: A qualitative empirical research study.

AIM: To clarify the factors affecting early career registered nurses' (ECRNs') views on building good nurse-patient relationships. DESIGN: An exploratory qualitative research design was implemented using detailed individual semi-structured interviews. METHODS: Interview data were analysed using a thematic approach based on the systematic text condensation analysis proposed by Malterud. DATA SOURCES: Eleven consenting nurses working in four hospitals. RESULTS: Six characteristics were identified that influenced ECRNs' perceptions of building good nurse-patient relationships: finding clues through reflection, observing patients' reactions, clarifying their role as a nurse, doing their best for the patients, treating each patient as an irreplaceable individual and receiving support. CONCLUSIONS: We discovered that the factors affecting ECRNs' views could be divided into two categories: factors that contribute to ECRNs' views on developing positive relationships with patients, and factors that influence ECRNs' relationships with patients but do not directly lead to positive relationships. It is critical for ECRNs to reflect on their experiences of poor relationship-building and observe patients' reactions. ECRNs seldom recognize that they have developed good relationships with their patients. It is critical to consider organizational environment and support as variables in developing a nurse-patient relationship so that the responsibility does not fall solely on ECRNs. IMPLICATIONS: The results of this study provide clues to help ECRNs overcome difficulties in building relationships with patients. Furthermore, they can be used to develop educational programme for ECRNs. Future studies should use these findings to provide support to ECRNs and help them build relationships with patients.

Implications of philosophical pragmatism for nursing: Comparison of different pragmatists.

Pragmatism emphasizes practical consequences and empirical explanations rather than introspective contemplations. However, the arguments of pragmatists are not uniform, as shown by the four prominent pragmatists presented in this article. The major difference between them is that Peirce and Haack acknowledge an objective truth, whereas James and Rorty do not. Thus, for a fuller understanding of the pragmatist view of our knowledge, both camps must be consulted. In the nursing field, pragmatism is occasionally referred to as a guiding philosophy. However, the influence of James and Rorty has been greater than that of Peirce and Haack on pragmatists, which may risk leading to a skewed understanding of pragmatism by nursing scholars. Still, the four pragmatists share naturalism, which rejects a metaphysics that defines the nature of knowledge before our enquiry and emphasizes experience and practice. Pragmatic naturalism can help ensure that nursing theory does not deviate from clinical practice. This article also explores the broad adaptability of the ideas of all four pragmatists to philosophical issues in nursing, such as mixed-methods research, epistemic relativism and realism. By showing that pragmatism can be relevant and stimulating to each of these topics, the article demonstrates that the different approaches to pragmatism can provide more inspiration for nurses and nursing researchers in the future.

The role of nursing members in research ethics committees in Japan.

The International Council of Nurses (2012) and the Council for International Organizations of Medical Sciences (2016) determined and published ethical standards relevant to nursing researchers and practitioners; based on these standards, nurses are expected to participate in committees where decisions on ethical issues are made. While clinical practitioners and nursing educators actively serve on research ethics committees, their precise role in these platforms has yet to be elucidated. In this study, medical, humanities/social science, lay, and nursing members in research ethics committees across Japan were invited to participate in a semi-structured interview; data were analyzed through a qualitative analysis method. Specifically, we interviewed 23 research ethics committee members in Japan to clarify the role of nursing members in the committee. Our qualitative analysis yielded six themes: share perspectives and experiences in nursing, protect research participants, evaluate the research design, represent the voice of research participants, confirm the informed consent documents and ascertain research participants' free will. The analyses revealed a slight difference between what other committee members expected of the role of nursing members and nursing members' recognition of their own role. Nursing members make an important and independent contribution to ethics committees on deliberations and decision-making regarding research ethics. Within the context of research ethics committees, member selection and training are essential issues, and this study contributes to the literature by showing how these topics relate to the role of the research ethics committees and of their members.

Development of a questionnaire to measure the moral sensitivity of nursing students.

Moral sensitivity is important for both, qualified nurses and nursing students. Currently, however, the instruments to measure moral sensitivity exist for qualified nurses only. The objective of this study is to develop a valid and reliable instrument to assess moral sensitivity of nursing students and to examine the development and differentiation of this sensitivity by school year, clinical training, and other educational variables. The study comprised semi-structured focus group interviews and a survey using a self-administered questionnaire. The questionnaire was developed using data obtained from the focus groups and distributed to 1,995 nursing students in three Bachelor of Science in Nursing programs (BScN) and eight Nursing Diploma programs. Completed questionnaires were obtained from 473 nursing students. An exploratory factor analysis indicated that 11 items and 3 factors were extracted: "Moral Strength," "Sense of Moral Burden," and "Moral Responsibility." The factors each demonstrated acceptable content- and criterion-related validity with the Resilience Measurement Scale for University Students. This three-factor structure was consistent with that of the Japanese version of the revised Moral Sensitivity Questionnaire. The mean score of each item ranged from 2.75 to 4.74 (SD = 1.04 - 1.34). A comparison of inter-year scores showed that third-year students had significantly higher Moral Strength scores in both the BScN and Nursing Diploma programs. The 11-item questionnaire developed for this study was consistent with a three-factor structure of registered nurses' moral sensitivity and successfully identified differences in moral sensitivity among nursing students. Using this type of questionnaire will allow nursing programs to improve the moral sensitivity of nursing students by allowing lecturers to develop tailored moral sensitivity programs.

Proxy evaluation of dignity expectations and satisfaction of older patients with dementia by family members and nurses.

AIM: Develop a proxy evaluation questionnaire for patients' family members and nurses to evaluate dignity expectations and satisfaction of patients with dementia. DESIGN: Cross-sectional study. METHOD: A proxy questionnaire draft was prepared with 30 items on expectations for dignity and 23 items on satisfaction with dignity. And administered to three paired groups: 81 older patients with intact cognitive function, 75 family members, and 77 nurses. RESULTS: 18 of 30 items and 21 of 23 were correlated between patients and their family members' responses on dignity expectations and satisfaction, respectively. When limited to nurses with clinical experience of ≥20 years, there were significant correlations between patients' and nurses' responses (p < .05). Exploratory factor analysis of patient's responses to significantly correlated items extracted 3 factors with 13 items of expectations for dignity but no factors of satisfaction with dignity. Using a questionnaire provides insight for proxy evaluation of expectations for dignity.

Developing a self-checklist of staff development behavior for associate nurse unit managers using the Delphi method.

The most significant influence on nurses' professional growth is through work under direct guidance in clinical settings. Associate nurse unit managers perform direct patient care with the staff, as well as assist management work of nurse unit managers. They can be excellent role models for the staff. We examined their behaviors that help promote staff development, aimed to identify effective behaviors, and created a self-checklist to evaluate them. We created 53 items to assess staff development behaviors, which were evaluated via a Delphi survey with 252 experts and a questionnaire survey with 124 associate nurse unit managers in Japan to evaluate whether the created item was appropriate. The results of the Delphi survey showed an agreement rate of over 90%, and associate nurse unit managers showed an acceptance rate of 82.6-99.2% for 40 of 53 items. Consequently, we created 40-item self-checklist of staff development behaviors for associate nurse unit managers with adequate validity. This checklist would be helpful for them to promote staff development while working in clinical settings and would contribute to enhancing the quality of nursing.

Health Information Sharing Among Muslim Women in a Japanese Mosque.

With the increase of foreign residents in Japan, most of them are suffering from inadequate health information. In reference to an ethnography, we conducted fieldwork using a participant observation and an interview with 36 foreign Muslim women. Our study clarified they especially needed health information on childcare because of a lack of such information in their native languages, and needed the support of Japanese Muslims because of problems in communication with healthcare personnel.

Concept synthesis of dignity in care for elderly facility residents.

BACKGROUND: Protecting the dignity of elderly residents of facilities and providing dignified care can be difficult. Although attempts have been made from several aspects, dignity is considered an area in which less real impact has been made in both theory and practice. OBJECTIVE: The objective of this study is to characterize the concept of dignity in care for elderly subjects in residential facilities from a practical perspective through concept synthesis. RESEARCH DESIGN: This study includes in-depth interviews with residents of elderly facilities and a literature review. PARTICIPANTS AND RESEARCH CONTEXT: A total of 12 residents of seven facilities in three prefectures in Japan were recruited via purposive sampling, and 27 interviews were conducted. Each digitally recorded interview was transcribed verbatim. The interview data were analyzed based on hermeneutic phenomenological research. The literature was searched using PubMed, CINAHL, and Web of Science with combinations of terms such as dignity, elderly, and residential facilities and then selected according to the predefined inclusion criteria. The descriptions about dignity in the included studies were divided into codes and compared with the results of the interviews. ETHICAL CONSIDERATIONS: This study was approved by the institutional review board of Nagoya University's Graduate School of Medicine. FINDINGS AND DISCUSSION: There were 1728 data codes for the interviews from which four themes were generated. In the literature review, 3716 titles were searched, and 28 articles were selected. Combining these results, five following themes and a conceptual matrix were obtained: individual dignity not affected by others; dignified care in a narrow sense; elements of the staff side; dignity in relation to family members, friends, society, and other residents; and dignity in relation to nursing care facilities and the nursing care system. CONCLUSION: According to the established matrix, we must consider the role of the care system, facility, family, and society in providing care with dignity and the individual dignity to residents and dignity in daily care.

Development of the Inpatient Dignity Scale Through Studies in Japan, Singapore, and the United Kingdom.

PURPOSE: The importance of human dignity in care is well-recognized. Care recipients' experiences with undignified care have been reported in many countries. However, few studies have measured these situations quantitatively, especially as there are no tools applicable to inpatients receiving ordinary daily care. This study aimed to develop a valid and reliable Inpatient Dignity Scale (IPDS) that can measure inpatients' expectations of and satisfaction with dignity in daily care. METHODS: We conducted a three-phase research project: item generation and a preliminary survey with 47 items related to patients' dignity in Japan, a main survey with 36 items with deliberate translation into English in Singapore, and a confirmatory survey with 35 items in England, with 442, 430, and 500 inpatients as participants in questionnaire surveys, respectively. Data from each survey were processed using factor analysis. RESULTS: Authors obtained a scale with a four-factor structure with acceptable reliability: (F1) respect as a human being, (F2) respect for personal feelings and time, (F3) respect for privacy, and (F4) respect for autonomy. CONCLUSION: The Inpatient Dignity Scale can be periodically used by hospital administrators or nurses to preserve inpatients' dignity in daily care by monitoring inpatients' views regarding their expectations of and satisfaction with dignity.

Evaluation of Nurses' Acceptance of Screen Display Methods with Temporarily Non-Display for Privacy Protection.

The purpose of this study was to explore nurses' acceptance of a screen display method that temporarily hides patient information for privacy protection. Using a questionnaire, we asked nurses to evaluate the display method from the viewpoints of safety and efficiency with respect to 22 personal information items. The nurses were favorably interested in introducing the display method into their hospital system; however, their acceptance varied.

Development of a Self-Report Checklist to Assess Dementia Care by Nurses in Hospital Settings.

Nurses working at general hospitals face difficulties in providing dementia care. The current study examined aged care nurses' dementia care practices in the hospital setting and developed a dementia care checklist that nurses can use to review their own care practice. A self-administered questionnaire was given to 676 participants; responses were collected from 595 participants. Exploratory factor analysis identified six factors (e.g., patient understanding prompted by concern and interest for the patient, respect for patients' voluntary behavior, early detection of abnormalities) among the questionnaire's 28 items. This analysis provided a framework for the checklist and verified that it had satisfactory internal consistency and construct validity. The frequency of care practices varied with participants' knowledge of dementia care requirements, satisfaction with their own dementia care practice, confidence in their ability to judge patients' physical condition, and cooperation with colleagues. This checklist might improve dementia care in hospital settings. [Res Gerontol Nurs. 2018; 11(2):91-102.].

Examination of an Electronic Patient Record Display Method to Protect Patient Information Privacy.

Electronic patient records facilitate the provision of safe, high-quality medical care. However, because personnel can view almost all stored information, this study designed a display method using a mosaic blur (pixelation) to temporarily conceal information patients do not want shared. This study developed an electronic patient records display method for patient information that balanced the patient's desire for personal information protection against the need for information sharing among medical personnel. First, medical personnel were interviewed about the degree of information required for both individual duties and team-based care. Subsequently, they tested a mock display method that partially concealed information using a mosaic blur, and they were interviewed about the effectiveness of the display method that ensures patient privacy. Participants better understood patients' demand for confidentiality, suggesting increased awareness of patients' privacy protection. However, participants also indicated that temporary concealment of certain information was problematic. Other issues included the inconvenience of removing the mosaic blur to obtain required information and risk of insufficient information for medical care. Despite several issues with using a display method that temporarily conceals information according to patient privacy needs, medical personnel could accept this display method if information essential to medical safety remains accessible.

Patients' Opinions on Display Methods to Protect Privacy.

The purpose of this study is to ascertain if patients will accept an electronic patient record system that temporarily conceals their private information. We interviewed 11 outpatients at a core hospital in Shizuoka prefecture of Japan. Most patients agree with our idea using temporary mosaic on the screen to protect their privacy.

Information-sharing ethical dilemmas and decision-making for public health nurses in Japan.

BACKGROUND: Information sharing is one of the most important means of public health nurses collaborating with other healthcare professionals and community members. There are complicated ethical issues in the process. RESEARCH OBJECTIVES: To describe the ethical dilemmas associated with client information sharing that Japanese public health nurses experience in daily practice and to clarify their decision-making process to resolve these dilemmas. RESEARCH DESIGN: Data were collected using a three-phase consensus method consisting of semi-structured interviews, self-administered questionnaires and a group interview. PARTICIPANTS AND RESEARCH CONTEXT: We surveyed administrative public health nurses in Shizuoka Prefecture, Japan. The semi-structured interviews were carried out with 12 administrative public health nurses, and the self-administered questionnaires were sent to all 899 administrative public health nurses. The group interview was carried out with eight administrative public health nurses. ETHICAL CONSIDERATIONS: Ethical approval was granted by the ethics committee of the School of Health Sciences, Nagoya University, Japan (8-158, 9-130). FINDINGS: Information-sharing ethical dilemmas occurred most often when clients' decisions did not coincide with the nurses' own professional assessments, particularly when they faced clinical issues that were inherently ambiguous. In their decision-making processes, nurses prioritised 'protection of health and life'. DISCUSSION: These findings suggest that, above all, they sought to address urgent risks to clients' lives while upholding the principle of client autonomy as much as possible. In such cases, the nurses made decisions regarding whether to share information about the client depending on the individual situation. CONCLUSION: Public health nurses should protect the client's health while taking into consideration their relationship with the client.

Display methods of electronic patient record screens: patient privacy concerns.

To provide adequate care, medical professionals have to collect not only medical information but also information that may be related to private aspects of the patient's life. With patients' increasing awareness of information privacy, healthcare providers have to pay attention to the patients' right of privacy. This study aimed to clarify the requirements of the display method of electronic patient record (EPR) screens in consideration of both patients' information privacy concerns and health professionals' information needs. For this purpose, semi-structured group interviews were conducted of 78 medical professionals. They pointed out that partial concealment of information to meet patients' requests for privacy could result in challenges in (1) safety in healthcare, (2) information sharing, (3) collaboration, (4) hospital management, and (5) communication. They believed that EPRs should (1) meet the requirements of the therapeutic process, (2) have restricted access, (3) provide convenient access to necessary information, and (4) facilitate interprofessional collaboration. This study provides direction for the development of display methods that balance the sharing of vital information and protection of patient privacy.

Development of the inpatient attitudes towards the patient role scale.

AIM: The purpose of this study was to develop a reliable, valid scale that can measure inpatients' tendencies and level of effort in dealing with their role of patient. METHODS: The question items were developed from interviews and a review of the literature. After examining the content validity, a pretest and pilot study were conducted. Then, the 27 item Inpatient Attitudes Towards the Patient Role Scale was created. A self-administered questionnaire survey with 399 inpatients was conducted in order to examine the reliability and validity of this scale. RESULTS: Two-hundred-and-sixteen patients completed and returned the questionnaire (54.1% response rate). The respondents were aged between 20 years and ≥80 years (median: 60s); 60% were male and 39% were female. Based on a factor analysis, the following four common factors were extracted from 21 out of the 27 original items: "patient adherence", "consideration", "self-expression", and "mental attitude". The evidence from an examination of the construct validity and stability suggests that the scale has good reliability and promising validity. Older adult patients tended to make more effort than younger patients. The patients who believed that it would take them a certain amount of time to recover and those who trusted the healthcare staff tended to make more effort. CONCLUSION: A reliable and valid scale to measure inpatient attitudes towards the patient role was developed. This scale might provide useful information for nursing practice.

Essential roles of clinical nurse instructors in Japan: a Delphi study.

In Japan, the clinical nurse instructor is a staff nurse who teaches in clinical practicums. However, there is no consensus on the essential roles that clinical nurse instructors are expected to perform. We conducted a three-round Delphi survey to clarify the essential roles of the clinical nurse instructor in clinical practicums in undergraduate nursing education. The participants were an expert panel of 48 professionals in nursing education and clinical practicums, who rated the importance of 58 role items that were established through a literature review and pilot survey. Thirty one of these items were identified as essential roles, based on agreement of 80% or more of respondents. Further investigation revealed nine of the 31 items to be core roles, defined as the minimum essential roles that must be performed by clinical nurse instructors, however busy they become. The nine core roles are related to proper preparation for the clinical practicum, patient safety, and coordination with the nursing school faculty. It is important for the nursing school faculty to support and work in cooperation with clinical nurse instructors to help them fulfill these roles.

Educational content in nurse education in Japan: a Delphi study.

The purpose of this study was to clarify the minimum necessary educational content in the area of nursing ethics in a basic nursing education program, and the level of students' mastery of this content, based on a Delphi study in both educational and clinical settings. A Delphi study was conducted in three rounds with faculty members who teach nursing ethics at all 158 four-year nursing universities in Japan as targeted panelists. In this study the opinions on nursing ethics of nursing instructors responsible for hospital education at all 82 special functioning hospitals were reflected in the panelists' opinions. Consensus was obtained on 41 items from a total of 63 items in 4 proposed frameworks. There were 20 items related to the Concept of nursing ethics, 7 items related to Ethical codes, 13 items related to Ethical issues and methods to resolve them, and 1 item related to Efforts and issues in practical and educational settings. Consensus as to desired level of mastery was reached on a total of 40 items. This agreed-upon level involved understanding of the concept for 22 items, the ability to explain the concept for 16 items, and the ability to act based on the concept for 2 items.