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Aim: Work performance of nurses is a critical aspect that concerns the safety of both nurses and patients, but also secondarily influences nurses' turnover due to serious fatigue and burnout. Monitoring nursing performance as well as fatigue is important for appropriate safety management of patients and nurses, and the development of a monitoring tool is essential. The Nursing Performance Instrument (NPI) can provide comprehensive and brief monitoring of nursing performance. This study aimed to verify the validity and reliability of a Japanese version of the NPI (NPI‐J). Methods: A cross‐sectional study was conducted on nurses who work in inpatient care across five Japanese hospitals. We considered appropriate factor numbers with parallel analysis and the Velicer's minimum average partial test. The construct validity was evaluated using exploratory factor analysis, confirmatory factor analysis (CFA), and Pearson's correlation analysis. Cronbach's alpha was calculated for the internal consistency. Results: A three‐factor model eventually showed acceptable fit indices in the CFA. Moreover, the correlation results among the three factors indicated discriminant validity comparable to the original NPI. The correlation results with acute fatigue, chronic fatigue, and burnout verified convergent validity. Internal consistency was insufficient. Conclusion: The NPI‐J demonstrated acceptable construct validity. This instrument can assess nurses' perceptions of their performance by measuring each item. Future work on the reliability of the sub‐concepts will require additional items or reliability testing based on generalizability theory and item response theory. [ABSTRACT FROM AUTHOR]

Aim: To determine the factors associated with reduced research activities during the COVID‐19 pandemic in 2020 by comparing nursing researchers working in academic and clinical settings. Methods: This was a secondary analysis of data collected by the Japan Academy of Nursing Sciences, which conducted a cross‐sectional online survey when the pandemic began. We included respondents who worked in either academic or clinical settings and responded that the pandemic negatively affected their research activities. First, we computed a propensity score (PS) using a logistic regression model. Then we performed a one‐to‐one ratio matching between the groups based on the PS to control imbalances between the groups. We identified the factors negatively affecting research activities and who to consult about research concerns by comparing the groups using Chi‐square or Fisher's exact tests. Results: There were 1,532 participants, with a response rate of 16.1%. After PS matching, 214 participants (107 for each group) were included. We identified three significant factors associated with reduced research activities: (i) time required for learning new information and communication technology (ICT) skills; (ii) time required for supporting colleagues with ICT issues; and (iii) time required for preparing and evaluating teaching materials. Approximately 20% of our participants in both settings had nobody to consult regarding research concerns. Conclusion: We found that the time spent on ICT‐related issues negatively affected the research activities of nursing researchers when the pandemic began in Japan. In such an emergency, nursing researchers needed an opportunity to share their difficulties as a part of a support service. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to evaluate whether nurse‐initiated sedation management could provide more appropriate sedation compared to usual care in a Japanese intensive care unit (ICU). Methods: We conducted a single‐center, prospective observational study before and after implementing nurse‐initiated sedation using instruction sheets. Patients who had been admitted to a general adult ICU were enrolled. Before our ICU started nurse‐initiated sedation (pre‐implementation care), adjustment of sedatives and analgesics was performed only by a physician's written or verbal order; however, after implementing nurse‐initiated sedation, nurses titrated drugs using instruction sheets. The primary outcome was the efficacy of nurse‐initiated sedation, evaluated by the proportion achieving the target Richmond Agitation‐Sedation Scale (RASS) score. The analgesic status evaluated by Critical‐Care Pain Observation Tool (CPOT), days of delirium, ventilator days, ICU mortality and hospital mortality were also evaluated. Results: The study examined 30 patients in the pre‐implementation care phase and 30 patients in the nurse‐initiated sedation phase. The proportions achieving the target RASS were 68% in the nurse‐initiated sedation group and 42% in the pre‐implementation care group (mean difference, 25%; 95% confidence interval, 13.4%–37.5%; P <.001). Almost all measured CPOT were within the range of 0–3 during both phases. Days of delirium, ventilator days, ICU survival, and hospital survival did not differ significantly between the two groups. Conclusions: Nurse‐initiated sedation management achieved a significantly higher degree of target sedation status and was incorporated as part of the care in our ICU. It is a safe approach in countries, such as Japan, where sedation protocols are not widely used. [ABSTRACT FROM AUTHOR]

Aim: To explore the unclear association between temporary discharge home from the palliative care unit and achievement of good death, in the background of increases in discharge from the palliative care unit. Association between experiences and circumstances of patient and family and duration of temporary discharge was also examined. Methods: This study was a secondary analysis of data from a nationwide post‐bereavement survey. Results: Among 571 patients, 16% experienced temporary discharge home from the palliative care unit. The total good death inventory score (p <.05) and sum of 10 core attributes (p <.05) were significantly higher in the temporarily discharged and stayed home ≥2 weeks group. Among all attributes, "Independent in daily activities" (p <.001) was significantly better in the temporarily discharged and stayed home ≥2 weeks group. Regarding the experience and circumstance of patient and family, improvement of patient's appetite (p <.05), and sleep (p <.05) and peacefulness (p <.05) of family caregivers, compared to the patient being hospitalized, were associated with longer stay at home after discharge. Conclusions: Patient's achievement of good death was better in the temporarily discharged and stayed home longer group, but this seemed to be affected by high levels of independence of the patient. Temporary discharge from the palliative care unit and staying home longer was associated with improvement of appetite of patients and better sleep and mental health status of family caregivers. Discharging home from palliative care unit is worth being considered even if it is temporary. [ABSTRACT FROM AUTHOR]

Aims: This study aimed to explore mentoring competence in nursing student mentors during clinical practice by identifying different mentor profiles and connections between different competence areas among five European countries and Japan. Methods: The study implemented a cross‐sectional design in Finland, Italy, Lithuania, Slovenia, Spain, and Japan during 2016 and 2019. In total, 6208 mentors were invited, and 1862 participated from 58 healthcare organizations. The data were collected with a survey questionnaire by including background question items with the Mentor Competence Instrument. K‐clustering and structural equation modeling were used for data analysis. Results: Four mentor profiles, A (43%), B (30%), C (18%), and D (9%), were identified according to the seven mentoring competence areas with high statistical significance (p < 0.001). Higher mentoring competence (mean >3.50) was observed among Finnish, Lithuanian, and Slovenian mentors with university education in nursing, older ages, more work experience, and previous education in mentoring. Lower competence (mean <2.49) was observed among Japanese and Italian mentors with diplomas in nursing, younger ages, less work experience, and no previous education in mentoring. Conclusion: Mentoring requires motivated, highly competent mentors since mentoring is a critical aspect of nursing education. Mentoring roles should be given to nurses with higher education and mentoring training. Younger, less experienced nurses without formal mentoring training may need support from senior nurses when performing mentoring roles and could also facilitate a more balanced workload between patient care and mentoring for senior nurses. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to identify the factors related to complex care needs of older adults in community‐based integrated care centers. Methods: We sent 936 self‐reported questionnaires to community‐based integrated care center directors in the Kinki region of Japan. These questionnaires included questions not only about the directors' demographic data, but also regarding the sociodemographic, psychosocial, and family‐related dimensions of the older adults in the community centers. The directors divided their cases into two categories: "Complex cases" and "Straightforward cases." We compared the intergroup differences and examined the factors related to complex care needs in older adults. Results: A total of 232 directors responded. Complex cases were significantly associated with younger age, poor health conditions, and having a family member who needs care, as compared to straightforward cases where these associations were not present. Logistic regression showed that in older adults, factors of refusing support or social services, social isolation, and trouble with neighbors were associated with their complexities. Additionally, family members with a high likelihood of refusing social services, older adults without a key family member, and difficulties in forming their consensus regarding care were associated with older adults' complexities. Conclusion: Older adults with complex care needs could have the risk of self‐neglect, and their families faced difficulties in supporting them as family members. Healthcare professions should carefully assess these factors and develop needs‐oriented services for them without their family support as an upstream intervention. [ABSTRACT FROM AUTHOR]

Purpose The study purpose was to investigate whether years of clinical experience and experience of encountering heart failure affect perceptions of the need for physical assessment, and the nature of the association between perceptions and years of clinical experience. Methods: This study was survey‐based. Of hospitals in Japan with ≥200 beds, 298 hospitals were randomly selected as candidate research sites. Ultimately, 44 hospitals agreed to participate in this study. A self‐administered questionnaire measuring 48 physical assessment skills was developed and distributed to nurses. The questionnaire rated the perceived need for 48 skills assessing acute progression of heart failure. Results: Of 1,113 nurses sampled, 373 (33.5%) responded. Of these, 347 completed questionnaires (response rate: 93.0%). Nurses' perceived need for skills involving systematic or cardiovascular system assessment decreased with clinical experience. Nurses' perceived need for skills involving cardiovascular symptoms and circulatory failure assessment increased with clinical experience. We found four patterns of change for nurses' perceptions of physical assessment skills according to clinical experience. Conclusions: The findings showed that differences in nurses' perceived need for physical assessment skills were associated with differences in clinical experience. Nurses with more experience selected more suitable skills for detecting acute progression of heart failure. Nurses' perceptions of the need for specific skills were proportional to years of clinical experience, and there may be a threshold value of years of experience. [ABSTRACT FROM AUTHOR]

Aim: We aimed to develop a Recognition Scale for Female Intimate Partner Violence (IPV) Patients (RS‐FIPVP); measure the levels and clarify the structure of IPV recognition among clinical nurses; and confirm the validity and reliability of the scale. Methods: A cross‐sectional, anonymous, self‐administered questionnaire was administered to clinical nurses (n = 2570) at seven clinical settings in Okinawa, Japan. As a result, 1855 valid responses were obtained and used in the analysis. The statistical analysis examined an exploratory and confirmatory factor analysis, internal consistency, and construct validity. Results: Four factors, comprising 20 items, were extracted for IPV recognition among clinical nurses. The confirmatory factor analysis showed that the indices of fitness supported these results. The Cronbach's alpha coefficient was 0.83 for the total score and 0.71, 0.73, 0.74, and 0.71 for Factors 1, 2, 3, and 4, respectively. Four factors were extracted from the oblique factor analysis, with a cumulative variance of 50.0%: “understanding of the victim's situation”, “violence that is difficult to detect”, “patient characteristics”, and “support and coordination”. The four factors had a moderate correlation (0.27–0.47, P < 0.01) with each other, which indicated construct validity. These findings confirmed fit for the RS‐FIPVP. Conclusions: The RS‐FIPVP, a recognition scale to measure and evaluate the recognition of female IPV patients among clinical nurses, was developed. It may be used to improve the recognition of female IPV patients in nursing continuing education and also to measure and evaluate educational interventions. The reliability and validity of the scale were verified; however, further refining, testing, and evaluation are required. [ABSTRACT FROM AUTHOR]

Aim: To investigate the association between homebound status and functional decline over a 2 year follow‐up period and the sex difference in its association. Methods: The study subjects were 2956 independently living older individuals (1267 men, 1679 women). Homebound persons were defined as individuals who left home less than once a week. Subjects judged to be eligible for a support program or long‐term care by the committee of the long‐term care insurance system were considered functionally dependent. Using a Cox proportional hazard model, the present authors evaluated the association between homebound status and onset of functional dependence. Results: Of the 2946 subjects, 223 (7.6%) were homebound. During the follow‐up period, 153 subjects became functionally dependent. Adjusting for age and household type, the hazard ratio (HR) for onset of functional dependence in the homebound group (compared with the non‐homebound group) was 5.46 (95% confidence interval [CI], 3.00–9.94) for men and 2.62 (95% CI, 1.66–4.14) for women. After adjustment for locomotor function, cognitive function, depressive state, age, and household type, the HR for onset of functional dependence in association with homebound status remained significantly increased in men (HR, 3.12 [95% CI, 1.59–6.10]), but not in women (HR, 1.43 [95% CI, 0.87–2.35]). Conclusion: This study suggests that homebound status is a risk for functional dependence in both men and women. In men, being homebound despite intact functional ability was also a risk for functional dependence. Considering the respective characteristics of each sex may be important for planning support programs to prevent homebound for older persons. [ABSTRACT FROM AUTHOR]

Aim: The Magnet Recognition Program is a system in the USA that recognizes a hospital as a magnet hospital for having a high retention rate of nurses and providing high quality patient care. The purpose of this study was to examine the effect of nurses' work environment with characteristics that are similar to those of magnet hospitals on patient satisfaction in Japan. Methods: The authors distributed anonymous self‐administered questionnaires in August 2011 to all nurses via the directors of the nursing departments of four private hospitals. The response rates were 91% (n = 425) for nurses and 51% (n = 379) for patients. In the questionnaire for nurses, the items addressed basic attributes and a scale of work environment characteristics of a magnet hospital (the Japanese version of the Practice Environment Scale of the Nursing Work Index [PES‐NWI]). The questionnaire for patients addressed basic attributes, information about their hospitalization, and items to assess patient satisfaction. To examine the effects of the PES‐NWI subscales on patient satisfaction, the authors conducted multivariate logistic regression analysis for groups, which were dichotomized by 75 percentile of the scores of patient satisfaction. Results: The result of model 1 in the multivariate logistic regression analysis demonstrated that collegial nurse–physician relations showed significant relationships with low patient satisfaction (odds ratio = 0.144, P < 0.05), while the significance was diminished in model 2, in which dummy variables of hospitals were entered into the equation. Conclusion: These findings suggested that a favorable work environment for nurses, which is similar to that of magnet hospitals, may influence patient satisfaction in hospitals in Japan. [ABSTRACT FROM AUTHOR]

Aim: Older maternal age has become more common in Japan. Studies suggest that older maternal age and primiparity are associated with post‐partum depression. The present study aimed to identify predictors of post‐partum depression in older Japanese primiparas at 1 month post‐partum. Methods: Participants were 479 primiparas aged 35 years and over, drawn from a prospective cohort study. Data were collected using self‐report questionnaires. Depression was measured with the Japanese version of the Edinburgh Postnatal Depression Scale. Stepwise logistic regression analysis was conducted on binary outcome variables of depression at 1 month post‐partum, along with a stratified analysis based on the risk status of depression. Results: Five predictors were identified: (i) the depression score during hospital stay; (ii) financial burden; (iii) dissatisfaction with appraisal support; (iv) physical burden in daily life; and (v) concerns about infant caretaking. Stratified analysis identified dissatisfaction with instrumental support in the low‐risk group, and the Child‐care Value Scale score as unique predictors in the high‐risk group. Conclusion: These results highlight the importance of early assessment of depressive symptoms and the provision of continuous care. [ABSTRACT FROM AUTHOR]

Aim: The number of older primiparas is increasing in Japan. These women have been shown to be more vulnerable to post‐partum depression. This study aimed to identify factors for predicting post‐partum depressive symptoms during hospitalization after childbirth in Japanese primiparas aged 35 years and over. Methods: The present authors used the data of 479 primiparas aged 35 years and over from a prospective cohort study. Data were collected using self‐report questionnaires on the day before hospital discharge. The questionnaire consisted of: demographics and background information; depressive symptoms; fatigue; maternal confidence and maternal satisfaction; child‐care values; physical symptoms; perceptions of daily life during hospitalization; concerns about child care and daily life; and infant feeding. Additionally, vital records data were obtained from the hospitals. A stepwise logistic regression analysis was performed on the binary outcome variable of depressive symptoms, measured by the Japanese version of the Edinburgh Postnatal Depression Scale. Women who scored 9 or more were considered to be at high risk for post‐partum depression. The authors obtained informed consent from all participants and institutional ethics approvals before initiating the study. Results: The following six variables reliably predicted the risk of post‐partum depression: emergency cesarean section, lower satisfaction with birth experience, higher physical burden in daily life, long‐term complications with the newborn, more concerns about newborn caretaking after discharge, and more concerns about one's own life after discharge. Conclusion: Recognition of women with these factors will help nurses to identify those at risk for developing post‐partum depression and to provide appropriate care during hospitalization after childbirth. [ABSTRACT FROM AUTHOR]

Aim: This cross‐sectional study aims to explore the relationship between different types and sources of social support and psychological distress by age and sex among survivors living in temporary housing 10 months after the Great East Japan Earthquake. Methods: Self‐reported questionnaires/structured interviews administered from January to March 2012 recorded demographic characteristics, damage involving participants' families, social support, and psychological distress. Results: Data on 296 participants aged 20 years or more from nine temporary housing complexes in Otsuchi were analyzed; K6 scores indicating psychological distress averaged 5.1 (standard deviation, 5.9; range, 0–24). Multiple logistic regression analyses indicated differences among types and sources of social support with regard to psychological distress by age and sex among disaster survivors. For men aged less than 65 years, social support by family was related to lower psychological distress. For women aged 65 years or more, emotional support from family, informational and instrumental support, and social companionship from friends in their own temporary housing complexes were related to less psychological distress. Conclusion: Differences in age and sex were related to different sources of social support in relation to psychological distress. It is necessary to pay more attention to those who lost family members in the disaster, especially men aged less than 65 years. It may also be necessary to support survivors in making friends when they relocate to temporary housing, especially women aged 65 years or more. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to clarify conditions of women experiencing post‐partum anemia and identify factors that work against the alleviation of anemia. Methods: This was a retrospective longitudinal study, involving 246 women giving birth at five participating institutions, diagnosed with anemia on day 3 post‐partum, and given a blood sample at the medical examination 1 month after the birth. With answers about alleviation of anemia during the 1 month post‐partum period as an objective variable, and explanatory variables, multiple logistic regression analysis was performed. The explanatory variables included demographic data of the participants, information about anemia, following the nutrition instruction advice for anemia alleviation, family structure and others assisting the participants, and self‐management skills (measured by the Self‐Management Skill [SMS] scale). Results: The present authors collected 211 valid responses; the average age was 32.6 years. The mean hemoglobin values on the 3rd and 30th days post‐partum were 9.6 and 12.0 g/dL, respectively. One fifth of the participants (21.3%) showed no anemia alleviation. The mean value on the SMS scale was 28.35, and the anemia alleviated group (30.78) was significantly higher than the non‐alleviated group (19.38). Results of the multiple logistic regression analysis showed a strong relationship between anemia risk and self‐management skills. The absence of anemia alleviation increased 2.51 times as the total score of the SMS decreased 1 point. Conclusion: There is an urgent need to develop an intervention program to alleviate post‐partum anemia focusing on the low score items because self‐management skills strongly affect alleviation improvement. [ABSTRACT FROM AUTHOR]

Aim The purpose of this study was to investigate relaxation effects of back massage for puerperants on the first post-partum day using physiological and subjective indicators. Methods This randomized controlled trial included both primiparous and multiparous groups, each of which was divided into intervention and control groups. The intervention group was given a back massage for 20 min, while the control group maintained a sitting position for 20 min. Physiological measurements included heart rate variability, parasympathetic nerve activity (high frequency, HF), sympathetic nerve activity (low frequency, LF/ HF), and blood pressure. The subjective indicator was an assessment of the feeling of relaxation. Results The intervention group included 27 primiparous and 26 multiparous women, and the control group included 23 primiparous and 25 multiparous women. In both primiparous and multiparous women, there were significant differences in heart rate variability and sense of relaxation between the intervention and control groups, and a partial reduction of physical symptoms was found in the intervention groups. In the multiparous women, a significant difference in HF was also observed, and beneficial effects were found in the intervention group. Conclusion A back massage is considered to be one of the effective nursing care methods with which psychological relaxation can be given to puerperants in the early part of the puerperium. The multiparous group demonstrated the relaxation effects because a significant effect was observed in heart rate, HF, and diastolic blood pressure. However, no significant difference was seen in LF/ HF; therefore, further investigation of this relaxation effect using physiological indicators is warranted. [ABSTRACT FROM AUTHOR]

Aim Although the awareness of disasters has increased among nurses, the concept of disaster preparedness and response has not been sufficiently explored with undergraduate nursing students. The aim of this study was to assess and compare the perceptions of students regarding disaster preparedness and response that live in different earthquake-prone cities; Istanbul, Turkey and Miyazaki, Japan. Methods A cross-sectional study employing seven questions was conducted in a final group of 1053 nursing students from Istanbul, Turkey, and Miyazaki, Japan. Results Most study respondents were female, aged 18-22 years, with a high proportion of second year students in both cities. Istanbul's students had more knowledge about disaster preparedness and response in relation to age and year of university, showing statistically significant differences. Istanbul's highest rated responses to disaster characteristics were on structural elements and injuries/deaths, while Miyazaki's was 'unpredictable/sudden/disorganized'. Respondents in Istanbul identified earthquakes as the disaster most likely to occur, while respondents in Miyazaki identified typhoon/hurricane. Study participants responded that they could provide caregiver roles during a disaster event rather than triage or managerial roles as disaster responders. Conclusion Disaster characteristics were not described by one third of the students. Of the two-thirds that were described, most were of events that were highly predictable because of their frequencies in the given areas. Universities need to target and then focus on high-risk factors in their areas and have disaster plans for students who can provide triage and managerial nursing roles as disaster responders. [ABSTRACT FROM AUTHOR]

Aim This study investigated: (i) the relationship between admission day of the week and the timing of surgery; (ii) whether the admission day of the week predicted length of stay or patients' outcomes; and (iii) the relationship between the timing of surgery and mortality. Methods This was a retrospective, observational study of two community general hospitals in Japan. The inclusion criteria were patients aged 65 years or older who had experienced a hip fracture and undergone surgery during April 2007 to March 2011. Data on demographics, care processes, and health outcomes during hospital stays were collected from hospital records. A questionnaire was sent to patients and/or their family members about the patients' health outcomes after discharge from hospital for hip fracture surgery. Results Data were collected from a total of 714 patients. In both hospitals, orthopedic surgery was not scheduled every day, and the admission day was significantly related to the timing of surgery. In hospital 1, the admission day explained 38.1% of the variance in the timing of surgery, and in hospital 2, it explained 8.3%. The admission day with early surgery predicted an early discharge. The admission day with delayed surgery predicted better survival. There was no significant relationship between the timing of surgery and mortality in either hospital. Conclusion Earlier surgery, by daily operations, may reduce the length of hospital stays, but its effect on patient outcome remains unclear. It is necessary to carefully determine which patients will benefit from earlier surgery. [ABSTRACT FROM AUTHOR]