The strategies of Japanese public health nurses in medication support for high-risk tuberculosis patients.

OBJECTIVE: The purpose of this study was to describe the support provided by Japanese public health nurses (PHNs) to high-risk tuberculosis (TB) patients, focusing specifically on the support aimed at preventing interruptions in treatment. DESIGN AND SAMPLE: A qualitative descriptive approach was used with a convenience sample of 11 PHNs in Japan who cared for TB patients at highest risk for medication adherence problems. MEASURES: Semi-structured interviews were conducted to learn the scope and practice of PHNs with high-risk TB patients. Data were analyzed using a qualitative descriptive analysis process. RESULTS: One main theme was identified: "Supporting the patients in overcoming tuberculosis, regaining health, and living a healthier life." Three categories with five subcategories described the nurses' activities: (1) empathetic and reliable support, (2) motivational strategies for medication adherence, and (3) developing a foundation for healthier life. CONCLUSIONS: The nurses interviewed described creative and extraordinary strategies used to promote medication adherence and facilitate development of a healthy posttreatment lifestyle. Their approach was patient-centered and culturally congruent. Findings may be transferrable to PHN practice in other regions as care for this economically disadvantaged and marginalized population is a critical need.

Perspectives on barriers and facilitators to self-care in Lebanese cardiac patients: A qualitative descriptive study.

BACKGROUND: Cardiovascular disease is the leading cause of mortality worldwide. Cardiac self-care practices are essential for managing cardiac illness and improving quality of life. However, these practices may be affected by factors that may hinder or facilitate self-care especially in countries that experience political and economic instabilities. OBJECTIVES: The purpose of this study was to explore self-care practices among Lebanese cardiac patients. Another aim was to reveal factors that might influence these self-care practices. DESIGN: This is a qualitative descriptive study. SETTING: Participants were recruited from a referral medical center in Beirut, Lebanon and interviews took place in their homes. PARTICIPANTS: Purposive sample of 15 adult participants, seven females and eight males, diagnosed with coronary artery disease at least a year ago and not in critical condition recruited from the cardiology clinics of the medical center. METHODS: Data were collected through semi-structured audio-recorded interviews that took place in their places of residents. RESULTS: Three themes emerged from the data: I. The behaviors of cardiac patients demonstrated selected self-care practices; II. Patients identified barriers to self-care reflective of the Lebanese political and socio-economic situation; and, III. Patients described facilitators to self-care consistent with the Lebanese socio-cultural values and norms. The most common self-care practices included taking medications and eating properly. Participants emphasized avoiding stress and being upset as a self-protective measure for cardiac health. Health care costs, family responsibilities, psychological factors and the country's political situation impeded self-care practices whereas family support facilitated them. CONCLUSION: Lebanese patients reported select self-care practices in dealing with their cardiac illness. Barriers and facilitators to their self-care behaviors reflected the Lebanese context and culture. Thus health care providers must assess their patients' practices within their sociocultural context so that interventions to promote self-care are tailored accordingly.

The Cultural Meaning of Cardiac Illness and Self-Care Among Lebanese Patients With Coronary Artery Disease.

BACKGROUND: Cardiac disease is the leading cause of death in Lebanon, accounting for 22% to 26% of total deaths in the country. A thorough understanding of perceptions of cardiac illness and related self-care management is critical to the development of secondary prevention programs that are specific to the Lebanese culture. PURPOSE: To explore the cultural perceptions of cardiac illness and the associated meaning of self-care among Lebanese patients. DESIGN: Using a qualitative descriptive method, semistructured interviews were conducted with a purposive sample of 15 Lebanese cardiac patients recruited from a medical center in Beirut, Lebanon. FINDINGS: The qualitative descriptive analysis yielded one overarching and two other themes describing perceptions of cardiac illness and self-care within the Lebanese cultural context. The overarching cultural theme was, "Lebanese cardiac patients were unfamiliar with the term concept and meaning of self-care." Lebanese cardiac patients thanked God and accepted their fate (Theme I). The participants considered their cardiac incident a life or death warning (Theme II). IMPLICATIONS FOR PRACTICE: Health care providers need to consider patients' cultural perception of illness while planning and evaluating cardiac self-care programs.

Function and practice of public health nursing in Japan: a trial to develop the Japanese Purpose-Focused Public Health Nursing Model.

AIM: To clarify the significance of public health nurses' practice, we introduced the activities of Japanese public health nurses and tried to develop a model based on the purpose of their work. BACKGROUND: Despite international efforts toward clarifying public health nurses' practice, earlier models based on the purpose of their activities were underdeveloped. METHOD: Japanese terms describing public health nurses' activities were gathered from the literature, nine researchers analysed and brainstormed the activities to develop a model. Seven municipality public health nurses and three researchers in both Japan and the USA validated the model. RESULTS: The model includes three categories: creating the basis for support; working with individuals, families to enhance their health; and enhancing the health of individuals, families, groups, communities/regions by working with the community. CONCLUSION: The Japanese Purpose-Focused Public Health Nursing Model was based on the purpose of public health nurses' practice which was considered significant for assisting public health nurses to explain the meaning of their work.