Effects of an ethics education program on nurses' moral efficacy in an acute health care facility.

AIM: This study aimed to evaluate an ethics education program developed to increase moral efficacy among nurses in an acute health care facility. BACKGROUND: Moral distress among nurses can cause serious problems in terms of hospital organisations and patient safety. To reduce moral distress and promote professional confidence in nursing practice, a strategic intervention program is needed. METHODS: An ethics education program introduced methods to increase self-efficacy in accordance with Bandura's social cognitive theory. Eight nurses were recruited from 2017 to 2019, and all conversations and discussions regarding the ethics consultation were recorded on IC recorders and analysed qualitatively. RESULTS: Four core categories-Convinced to take an active role in ethical issues; Progressed in nursing practice with ethical agency; Experienced professional transformation; and Empowered by the presence of colleagues-emerged as outcomes of the ethics education program that related to moral efficacy. CONCLUSIONS: The four core outcome categories suggested that the participants had gained confidence after taking part in the ethical education program. IMPLICATIONS FOR NURSING MANAGEMENT: The results of the participants' described behaviours and actions suggested that they would be proactive in contributing to reductions in moral distress in the future.

[The relationship between the contents and the level of achievement of objectives in an occupational health nursing practicum].

The purpose of this study was to evaluate the program and teaching methods of the occupational health nursing practicum in order to enforce students' learning experience in the clinical practice. Self-evaluation sheets graded from levels 1 to 4 were from 63 students, and statistical analysis was performed in relation to their performance levels. The results of the analysis of 63 students' performance sheets indicated that the students achieved 3 points above average in all 14 course objectives. Scales analysis of the students' evaluation sheets also revealed that students' achievement levels were lower at the Industrial Health Organization in comparison with those at the industrial enterprises. To make students' practice more valuable, students' assessment skills of the workers and working environment should be emphasized in the classroom teaching and experience of learning at the laboratory. Moreover, the course objectives should be sufficiently linked to the practice areas in order to differentiate between the features of the Health organizations and enterprises.

[Report on role of occupational health nurses in the United States].

The purpose of this paper is to present the differences and similarities in the roles of occupational health nurses (OHNs) between the United States and Japan by reporting the results of interviews with seven OHNs who work at seven industries in the city and the suburbs of San Francisco. Four out of seven OHNs responded that one of their essential roles was "Case Manager", in regard to the prevention of work force reduction and the scaling back of workers' medical expenditures associated with work-related accidents. Only one of them responded that "Health Promotion Specialist" was the leading role, whereas 30% of the Japanese OHNs were engaged in this role, according to the results of a previous study. Similarly to the other roles of the Japanese OHNs, they also consider Clinicians, Managers, and OHS Coordinators as their important roles. Together, the result of interviewing the nurses indicated that the differences in the role delineation of the OHNs between the two countries depend upon their educational system of licensing as well as implementation of their responsibilities to the laws and regulations, including the Occupational Health and Safety Act, health examination of the OSHA Standard and employment of occupational medical doctors, medical insurance and compensation for workmen's accidents, etc. Furthermore, this visiting opportunity gave the authors suggestions for the advancement of educational programs to reinforce the professional activities of occupational health nursing in Japan.

[Current status of employment and labor of occupational nurses in external agencies for industrial health].

The purposes of this study were to survey the actual conditions of the employment status and activities of occupational health nurses who are employed in Japanese Industrial Health Organizations (IHOs), and to investigate whether the OHNs provide quality health services to employees. We mailed 1,780 questionnaires to nurses who belong to 92 IHOs (members of the National Federation of Industrial Health Organizations). A total of 976 questionnaires were returned (54.8% valid response rate) and 968 questionnaires were considered eligible for analysis. The results showed the following issues: 1) most public health nurses belonged to the department of occupational health service, but they did not have enough experience with industrial hazards or workers safety or health; 2) public health nurses want to participate more directly in care for workers; 3) Public Health Nurses provided health counseling in the charge of their enterprises, but they did not take managerial roles, including place-of-work patrol, attendance to safety, and health committees in their workplaces; 4) they were not satisfied with the present roles demanded by the other staff and their managers; 5) they did not have enough opportunities to attend the job training. Together, the results of this study suggest that the OHNs in IHOs need to have more opportunities to perform their expertise in industrial health & safety and job training in order to provide autonomous health services to the workers.

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 social support networks for working mothers].

The purpose of our study was to investigate the social support network for working mothers, including physical, emotional and informational sources, and to discuss strategies to reduce stress caused by their multiple role strain. We asked 18 participants to fill in a questionnaire and conducted semi-constructed interviews. The results of this study showed that more than half of the working mothers want to continue their career because of self growth and the rewards from their job. Many mothers responded that a sympathetic understanding by their husbands, families and people at workplaces is essential to create a balance between their career and housework. As a result, their husbands mainly provide physical support in housekeeping and child caring, whereas their mothers provide physical and emotional support from knowledge based upon their own experience. Almost all working mothers complained of a shortage of nurseries and child caring facilities as well as limited availability of flexible services. In conclusion, the results of our study suggested that the identity of the traditional gender role needs to be changed to a contemporary one, like a husband fully participating in his child's rearing activities by reconsidering his working hours. Moreover, community services to support working mothers should be increased.

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.

[Students awareness of health teaching: evaluation of "health education" course and the occupational health nursing practice].

The "health education" course is an important part of the baccalaureate curriculum in nursing. It is essential to teach students effective health education in a client oriented way. In order to improve the quality and content of this course, we extracted students descriptions from records of 44 students who had carried out group health education during nursing practice for the occupational health nursing course. We then analyzed students written sentences on their views concerning health teaching. After sentence analysis, we categorized these concepts into groups and titled them. The results of clarification of categories showed that the most common student awareness was in regard to technical and instructional skills, such as precise and suitable language selection for laymen, and utilization of teaching devices or mediums, during implementation of health teaching(43.6%). Secondly, assessment of health needs for a certain working population(10.3%), and effective teaching types such as instructional participant volunteers and full participation(9.2%) were deemed important. Thirdly, identification of the role of the occupational nurse(7.7%), and lastly the necessity of evaluation(2.3%) were considered necessary. Over all, in this study we found that students were most concerned about the instructional skills during the presentation of health education. Also, these results suggest that development of contents in the "health education" course to reinforce students assessment and evaluative abilities should be incorporated into the course. Furthermore, faculties who teach a "health education" course should provide a large variety of teaching materials and creative instructional methods for the students.

[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.

[Study on lower back pain in home helpers and development of materials for occupational health education].

People who are engaged in home health care services often have to transfer clients while in a half standing posture using repetitious movement including gravitational changes. Transferring heavy patients at homes for the severely mental and physical handicapped is equivalent to the care giving work, listed in the "guideline for prevention of lower back pain in work places" (1994/9/6). The purpose of this study was to investigate incidences of lower back pain and injuries among home helpers as well as to determine the relationship between their level of protective knowledge and prevalence of lower back pain. The results of the study revealed that home helpers complained of a mild type of lower back pain. Although almost all of them had the protective knowledge for lower back injuries that was taught in their training courses, they still felt the need for more knowledge through continuous education regarding protective measures for lower back injuries and pain. Regarding the method of teaching, they want to learn by TV programs, books, texts and self-learning materials. Few of them wanted to learn by computer assisted instructions or the internet. Based upon the results of this study, we have developed new teaching materials for home helpers which explain adequate postures in home care through utilizing their protective knowledge to avoid lower back pain.

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.

Effect of organizational factors and work environments on newly graduated nurses' intention to leave.

AIM: The purpose of this study was to investigate intention to leave in relation to organizational factors and work environments among newly graduated nurses (NGN). METHODS: A questionnaire was delivered to NGN (n = 762) from baccalaureate programs as well as diploma schools from 19 R-hospitals (R-hospitals were designated as "public medical institutions" by the 1951 Medical Law) in 2010. Spearman's rank correlation coefficients and Mann-Whitney U-test were used to test statistical significance. RESULTS: Only 148 questionnaires were returned for a return rate of 19.4%. The authors found that 8.1% of respondents had a highly to extremely likely desire to leave nursing. Intention to leave was significantly associated with Nursing Work Index total (P < 0.01), social support (P < 0.001), work barriers (P < 0.001), commitment to workplace (P < 0.001), job satisfaction (P < 0.001), and burnout (P < 0.001). Those who graduated from R-schools run by the R-organization had significantly positive impressions of their organizations and significantly lower intentions to leave compared to other graduates. CONCLUSION: The study results suggest that NGN intention to leave the workplace and nursing predict actual early intention to leave. In order to reduce burnout and turnover, support from colleagues and supervisors appears to be essential in organizational and psychosocial work environments for NGN to experience job satisfaction and be committed to their workplace. The results of this study also suggest that a longitudinal study is needed to reveal the long-term effects of organizational factors and work environments on NGN and how they impact role transition and adaptation of the NGN to professional practice roles.

Challenges and opportunities for occupational health nurses in Asia.

This article provides a brief overview of the effect of economic globalization on Asia, presents occupational health issues from select countries, and discusses challenges and opportunities for occupational health nurses.