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Aim: By describing the practice of a Japanese nurse practitioner, this descriptive case study discusses role development and outcomes before and after the intervention., Background: One of the first Japanese nurse practitioners intervened at a nursing home during the government-designated trial period for nurse practitioner practice., Conclusion: Because of the nurse practitioner's meticulous observation and timely care provision to the residents in collaboration with the physician and the other staff in the facility, comparative data showed improvement in daily health status management of every resident and decreased deterioration of residents' health conditions requiring ambulance transfer and hospitalization., (© 2014 The Authors. International Nursing Review published by John Wiley & Sons Ltd on behalf of International Council of Nurses.)

Aim: This paper describes the establishment of the first Japanese nurse practitioner graduate programme and legislative activities to institutionalize nurse practitioners in Japan., Background: To address the super-ageing population, Oita University of Nursing and Health Sciences initiated the first academic graduate level nurse practitioner programme in Japan, based upon the global standard defined by the International Council of Nurses., Conclusion: In 2010, Oita University of Nursing and Health Sciences graduated the first nurse practitioner. We believe that nurse practitioners will be highly valued in Japan for thoughtful nursing care to the fragile elders living in rural and urban Japan., (© 2014 The Authors. International Nursing Review published by John Wiley & Sons Ltd on behalf of International Council of Nurses.)

Death of a life partner and the subsequent bereavement are profound experiences for an individual. By far, the majority of bereavement research reported is focused on heterosexual couples, primarily married and often in the later years of life. The purpose of this study was to describe the bereavement experiences of lesbians whose life partners have died. The study used a descriptive, qualitative design informed by feminist scholarship and phenomenology to access the depth of personal experiences, as well as internally interpreted meanings of those experiences, among lesbian widows.

The culture and diversity of rural life and limitations of rural health systems to meet the changing health needs of an aging population lead to problems of obtaining appropriate care in rural America. In a program of nursing research involving three ethnographic studies in rural Colorado, transitions of older adults across differing levels of heath care were explored. The sample totaled 425 participants, of whom 25% were Hispanic. Five major themes emerged: circles of formal and informal care; integration of faith, spirituality, and family with health status; crisis nature of health care transitions; nursing homes as a housing option; and changing spirit of traditional rural nursing. Recommendations for providers included making their practices congruent with rural culture, being fully informed of available resources, facilitating acceptable health care decisions, and integrating physical, mental, and spiritual health care for elders and their families.

The purpose of this study was to explore the process of establishing the professional identity of Japanese nurses. Following a grounded theory design, data were generated by interviews, multisite participant observations and theoretical memos. Eighteen Japanese nurses who were selected by theoretical sampling were formally interviewed. Data were analyzed using methods of constant comparative analysis. Six categories emerged from the data: (i) learning from working experiences; (ii) recognizing the value of nursing; (iii) establishing one's own philosophy of nursing; (iv) gaining influence from education; (v) having a commitment to nursing and (vi) integrating a nurse into self. The core category, 'bonding into nursing', incorporated the relationship between and among all categories and explained the process of establishing the professional identity of Japanese nurses. 'Bonding into nursing' was described as an initial substantive theory, which is defined as the process by which each nurse established her/his professional identity as a nurse.

Meaningful examination of program outcomes is one of the most challenging tasks facing faculty and administrators involved in the design and delivery of educational programs. This article reports the outcomes for one doctoral program in nursing and elucidates salient conceptual and methodologic issues in educational outcomes research for this discipline. Career development, scholarly productivity, and professional leadership were the foci of this outcomes study. Three instruments were used; data were provided by alumni, graduate faculty, and alumni supervisors. Data analysis techniques included content analysis and descriptive and correlational statistics. Results showed that graduates embarked on diverse career paths with the majority employed in academic institutions. Most graduates reported active involvement in research, publications, presentations, and professional leadership. Employment pattern differences were noted between academic year and summer-only program graduates with associated divergence in career emphasis, research productivity, and job satisfaction. A positive correlation of time since degree conferral with scholarly productivity and professional leadership was noted. Recommendations for future research include refining outcomes, linking process to outcome, using longitudinal designs, and attending to unique nursing student and doctoral program characteristics.

Purpose: To develop an improved measure of "sekentei" (a social-psychological process that restricts behaviors that do not conform to social norms such as family caregiving) among family caregivers in Japan, and to describe the relationships among sekentei and caregiver's actual use of services, a reluctance to use services, and care burden., Design: Descriptive correlational study. Family caregivers (N = 260) of impaired elders responded to a structured questionnaire., Methods: Exploratory and confirmatory factor analyses were used to assess the construct validity of the sekentei scale for caregivers (SSC). With the SSC, the relationships among main variables were verified., Findings: The SSC showed satisfactory reliability and validity. Sekentei was significantly correlated with care burden, but not to actual use or reluctance to use services., Conclusions: Sekentei is an important factor related to caregiver burden in Japan. Further research might include the extent to which sekentei is a factor in care burden in other cultures.

The complex health, socioeconomic, and environmental problems experienced by many American elders often place them at high risk for disease and disability. Over time, acutely or chronically ill older persons experience numerous transitions across various health care settings. Although availability of health services is improving in rural areas, barriers such as distance, geography, and poor distribution often limit access to health care. In a longitudinal rural ethnography, the health care transition experiences of older adults, families, and health care providers were examined. A major ethnographic theme emerged from analysis data from interviews, participant observations, and photographs: the crisis nature of health care transitions experienced by rural older adults and their families and observed by rural nurses and other health care providers. Several patterns were observed including the crisis was compounded by surprise; limited knowledge of local resources exacerbated the crisis; inconsistent discharge planning disrupted transitions; changing family support necessitated admission to nursing homes; continuity of care in nursing home discharge lessened transition crisis; and rural home health care was identified as a strength. Recommendations were made for community-based interventions to improve the transition experience. Comprehensive care management services provided by public health nurses (PHNs) in the local rural community were recommended.

Little is known about the types of interventions that invite low-income women into partnerships that motivate self-care practices when living with human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS). The increasing incidence of HIV infection in low-income women with histories of inattention to self-care calls for nursing theories that address self-care practices. The purpose of this article is to describe a midrange theory developed from grounded theory research and to discuss implications of theoretical construction for future knowledge development. For the 12 women in this study, self-care practices developed over time and through four categories: focusing self, fitting resources, feeling emotions, and finding meaning. The core category, investing in self-care, linked the categories and carried explanatory power for developing midrange theory. Implications for nursing knowledge development through partnerships with low-income women are discussed.

Purposes: To explore how chronic illness is experienced and managed by rural Hispanic and non-Hispanic older adults and their families, and to identify how the health care system and community facilitate or inhibit the ability to manage chronic illness in a changing health care environment., Design: Descriptive ethnography with purposive sampling., Methods: Data-generation methods included audiotaped interviews from 42 Hispanic and White, non-Hispanic participants, participant observations, examination of documents and artifacts, and photography in rural Colorado. Interpretive ethnographic methods were used to identify an overarching cultural theme., Findings: Living with chronic illness was a proactive, reciprocal learning process shaped by interrelationships in the context of multiple, diverse communities. Participants expressed living with chronic illness as a quiet pride on the journey toward living a meaningful life., Conclusions: Findings provide an understanding of the webs of relationships that constitute the experience of elders living with chronic illness in rural communities. Viewing life as meaningful in the context of a broader understanding of health and well-being is important for nursing practice and future models of care.

Rural conditions and circumstances contribute to different perspectives on institutional long-term care. A rural ethnographic study revealed issues of transition into and out of nursing homes as identified and illustrated by older adults, their families, and care providers. Findings included the use of rural nursing homes as an alternate housing option because of limited assisted-living options, appropriate and inappropriate referrals to nursing homes, and strained family caregivers. Helping olders adults and families evaluate and access appropriate community resources, including housing, is essential to providing continuity of care.

Advanced practice nurses (APNs) in the community are in a prime position to respond to the changing health care environment stimulated by health care reform. An emerging practice model for APNs is parish nursing, community-based nursing practice set in communities of faith. Parish nursing stimulates shared public-private partnerships and is a consumer-oriented delivery system. The article describes the models, context, and practice of parish nursing, emphasizing the problem of evaluating outcomes. It also discusses implications for research and education. Parish nursing is a significant practice model affording APNs the opportunity to contribute to healthier communities.

Rural community and public health nursing are characterized by an impressive commitment of nurses to their communities and a connectedness of people to one another. Home care as an integral part of long-term and acute care for the older adult population has emerged as a vital practice area in community health nursing. The purpose of this ethnographic field study was to describe rural home care for frail older adults from the perspective of those providing and receiving care. More than 250 interviews were conducted with home care providers, recipients and their families, and other community members. The setting included eight culturally and geographically diverse counties in rural Colorado. One major theme is presented: the perceived change in the spirit of rural community nursing due to the overwhelming documentation required for home care reimbursement. Oppressive paperwork requirements impeded practice and resulted in fewer home visits per day, low job satisfaction, increased nursing staff turnover, decreased quality of care, and changed the spirit of community nursing from an emphasis on caring and community service to a focus on reimbursement. The study results have timely implications for health policy formulation as the United States undergoes major health care reform.

Recent legislation such as the Americans with Disabilities Act will have a significant impact on higher education in nursing. A survey was conducted to describe the extent to which BSN and ADN nursing programs in the United States admit and graduate special needs and chronically ill students, and to identify the accommodations which have been successful in providing nursing education to these students. Responses received from 86 schools of nursing in 44 states indicated that most schools have had contact with students with special needs such as visual, hearing, or mobility impairments, learning disabilities, and mental or chronic illnesses. Learning disabilities and mental impairment were cited most frequently as having been present among the student population. Few programs have had experience with students with vision problems. While most programs responding had little experience with providing special accommodations to special needs students, most were aware of accessibility on their campuses. Recent legislation aimed at creating opportunities for disabled individuals to successfully enter the work force creates challenges for schools of nursing in education of students with special needs. Issues are raised that must be addressed to meet this important challenge.

Rural dwelling, frail older adults are a vulnerable population owing to the complexity of health problems superimposed upon limited health care resources. Home care facilitates managing complex health needs and is congruent with rural valued independence. An ethnography was conducted to describe rural home care for frail older adults from the perspective of those delivering and receiving services. A major theme identified was "Circles of Care." Grounded in rural culture, the circles assisted the system of formal care to work in harmony with informal care, maintaining independence for vulnerable rural elderly and their families.

A community-analysis strategy, GENESIS (general ethnographic and nursing evaluation studies in the state), is a comprehensive, holistic portrait of communities obtained through secondary analysis of existing data and qualitative methods. The GENESIS method is delineated and examples of studies are presented. To explicate the method and illustrate the findings, an aggregate-focused GENESIS study and two studies in which entire communities were the targets are compared and contrasted. Other defining concepts of nursing, such as caring and health, are redefined or explicated to make them congruent with the recognition that for community health nurses, the community is the client.

The use of photography is described as a method embedded within an ethnographic investigation of rural home care for older adults. Photography fostered data generation, elicited participants' stories, and illustrated patterns of rural aging. Analysis of photographic data pooled with interview and observational data facilitated an in-depth understanding of rural aging and home health care.

To discover the process of admission and transition of older adults to home care following hospital discharge, or during periods of illness, ethnographic methodology was used to explore the experience of 65 participants in the "culture" of home care: patients, families, nurses, home care staff, and discharge planners. Two themes resulting from ethnographic analysis are presented: identification of patients and needs, and transfer of information. Support from family and friends was an essential addition to referral by discharge planners, physicians, and casefinding in facilitating transition to home care. Accurate, timely patient information was found to expedite home nursing assessment and insure continuity of care.

A survey of 66 hearing-impaired older women aged 54 to 96 years interviewed at home examined major influences on quality of life experienced by 27 prevocationally deaf and 39 later onset subjects. A causal model was specified; the predictors of quality of life included age, age at onset of hearing loss, financial adequacy, social hearing handicap, perceived health, and functional social support. The model proposed that health, social support, hearing handicap, and financial adequacy would directly affect quality of life as well as mediate the effect of the demographic variables, age and age at onset of loss, on this outcome. Later onset subjects were hypothesized to have lower quality of life due to increased social hearing handicap, decreased health, and decreased functional social support. Results of the path analysis showed the best predictors of quality of life to be social hearing handicap, functional social support, and perceived health. The later onset group had an overall lower perception of quality of life, this relationship being mediated as predicted. Generally, the hypothesized causal model was supported with 34% of variance explained. Descriptive findings also supported a difference in social hearing handicap between the two groups, yielding several implications for nursing interventions.

The effects of hearing loss on the lives of two groups of older women are described: those provocationally deaf (n = 27) and those who experienced a later onset of hearing loss with aging (n = 39). The women, aged 54-96 years, were interviewed in their homes using their preferred mode of communication; open-ended questions and the Hearing Handicap Inventory of the Elderly were used to assess social and emotional aspects of hearing loss and perceived handicap. Data were analyzed descriptively and the two groups compared on several variables. Both groups of women experienced a high degree of handicap, but expressed their problems differently. Later onset subjects emphasized emotional and situational problems while prevocationally deaf subjects expressed communication difficulty.

Multiple sclerosis (MS) is a complex disease, the symptoms of which may wax and wane on a daily basis. Conventional treatment for MS patients may involve numerous trips to a variety of clinics, physicians, and rehabilitation settings. This article describes a nurse-managed MS clinic which employs an interdisciplinary and holistic approach to treatment of MS patients with the goal of improving their quality of life and coordinating their health care. In this article, the services of the clinic are described, emphasizing the roles of the nurse practitioner (clinic manager), rehabilitation nurse specialist, and nursing director of the hospital-based home care program. A case study example of the interdisciplinary nature of this clinic's program with one MS patient is included.

Three research strategies for assessing the community health needs of the elderly population of an urban neighbourhood are described. Two primary research strategies, survey and ethnography, are contrasted with the types of health-related information available from the Census of Population and Housing. Different types of data emerged from each research strategy with census and survey data providing a global portrait of the community, and ethnographic data yielding more detail about the place of health in the lived experience of older residents.