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Aims: The aims of this paper are to (a) outline the design and implementation of an evidence‐based assertiveness communication workshop for Japanese nursing students; and (b) report on the evaluation of nursing students' satisfaction with the workshop using the Satisfaction with Assertiveness Communication Training Program Survey. Background: A body of research attests to the relationship between assertive communication and patient safety. This paper reports the design and evaluation of an assertiveness communication training programme designed to enhance students' ability to communicate safety in clinical practice. Design: A culturally appropriate and evidence‐based assertiveness communication workshop, informed by Gagne's instructional design principles, was implemented for third‐year nursing students in two Japanese higher educational institutions in December 2017. A descriptive study design was used to evaluate the workshop. Methods: Students' perceptions of the workshop were evaluated using the Satisfaction with Assertiveness Communication Training Program Survey, which includes ten items that are rated using a 5‐point Likert scale from strongly disagree [1] to strongly agree [5]. Data were analysed using descriptive statistics. The Revised Standards for Quality Improvement Reporting Excellence (SQUIRE 2.0) guidelines were used in the reporting of this study. Results: A total of 111 students from a population of 150 participated in the study giving a response rate of 74%. The overall mean satisfaction score was 4.12 indicating a high level of agreement with each of the survey items. With the exception of two items, the mean scores were above 4.0. "Confidence in using assertiveness communication skills" and "Utilising role‐plays to practice learnt skills" received mean scores of 3.71 and 3.90, respectively. Conclusion: Given the compelling research about the importance of assertive communication in health care, the results from this study support continuing investment in assertiveness communication training programmes for nursing students. Relevance to clinical practice: Assertive communication is an essential communication skill for safe nursing practice. Culturally appropriate assertiveness communication training programmes are of particular relevance in hierarchical healthcare contexts. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To develop a simple and reliable assessment tool for predicting falls in acute care settings. Background: Falling injures patients, lengthens hospital stay and leads to the wastage of financial and medical resources. Although there are many potential predictors for falls, a simple and reliable assessment tool is practically necessary in acute care settings. Design: A retrospective cohort study. Methods: The current study was conducted for participants who were admitted to a teaching hospital in Japan. Fall risk was assessed by the modified Japanese Nursing Association Fall Risk Assessment Tool consisting of 50 variables. To create a more convenient model, variables were first limited to 26 variables and then selected by stepwise logistic regression analysis. Models were derived and validated by dividing the whole dataset into a 7:3 ratio. Sensitivity, specificity, and area under the curve for the receiver‐operating characteristic curve were evaluated. This study was conducted according to the STROBE guideline. Results: Six variables including age > 65 years, impaired extremities, muscle weakness, requiring mobility assistance, unstable gait and psychotropics were chosen in a stepwise selection. A model using these six variables with a cut‐off point of 2 with one point for each item, was developed. Sensitivity and specificity >70% and area under the curve >.78 were observed in the validation dataset. Conclusions: We developed a simple and reliable six‐item model to predict patients at high risk of falling in acute care settings. Relevance to Clinical Practice: The model has also been verified to perform well with non‐random partitioning by time and future research is expected to make it useful in acute care settings and clinical practice. Patient or Public Contribution: Patients participated in the study on an opt‐out basis, contributing to the development of a simple predictive model for fall prevention during hospitalisation that can be shared with medical staff and patients in the future. [ABSTRACT FROM AUTHOR]

Aims and Objectives: This study aimed to examine the association between physical restraint duration and undesirable outcomes amongst inpatients comorbid with dementia and pneumonia in acute care hospitals. Background: Physical restraints are frequently used in the management of patients, especially amongst patients with dementia. No previous study investigated the potential undesirable effects of physical restraints in patients with dementia. Methods: This was a cohort study using a nationwide discharge abstract database in Japan. Patients aged ≥65 years with dementia hospitalised for pneumonia or aspiration pneumonia between April 1, 2016 and March 31, 2019 were identified. The exposure was physical restraint. The primary outcome was hospital discharge to the community. Secondary outcomes included hospitalisation costs, functional decline, in‐hospital mortality, and institutionalisation for long‐term care. Results: A total of 18,255 inpatients with pneumonia and dementia in 307 hospitals were included in this study. Of them, 21.5% and 23.7% had physical restraint during full and partial days of hospital stays, respectively. Discharge to the community incidence rates was lower in the full‐restraint vs. the no‐restraint group (27 vs. 29 per 1000 person‐days; HR, 1.05 [95% CI, 1.01–1.10]) and the partial‐restraint vs. the no‐restraint group (17 vs. 29 per 1000 person‐days; HR, 1.79 [95% CI, 1.71–1.87]). The risks of functional decline were higher in the full‐restraint vs. the no‐restraint group (27.8% vs. 20.8%; RR, 1.33 [95% CI, 1.22, 1.46]) and the partial‐restraint vs. the no‐restraint group (29.2% vs. 20.8%; RR, 1.40 [95% CI, 1.29, 1.53]). Conclusions: The use of physical restraints was associated with a lower incidence rate of discharge to the community and an increased risk of functional decline at discharge. Further research is needed to judge the benefit–risk balance of physical restraints in acute care settings. Relevance to Clinical Practice: Understanding the risk of physical restraints allows medical staff to improve the process of decision making in everyday practice. No Patient or Public Contribution. Reporting Methods: The reporting of this article conforms to the STROBE statement. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To explore the process by which people with hypersensitivity pneumonitis implement continuous antigen avoidance, alongside the situations that influence this process. Background: Antigen avoidance is the primary treatment for people with hypersensitivity pneumonitis. However, the best method to support antigen avoidance has not yet been established. Design: The present qualitative study used a constructivist grounded theory approach. Methods: The participants were inpatients or outpatients with hypersensitivity pneumonitis diagnosed at a Japanese urban university hospital. In parallel with semi‐structured interviews and a medical record survey from 2016 to 2021, we conducted coding, categorising, writing memos, theoretical sampling and continuous comparisons of experiences from finding physical abnormalities to implementing antigen avoidance. The COREQ checklist was followed for reporting. Results: Interpreting the experiences leading to the implementation of continuous antigen avoidance by 28 participants provided a process consisting of a core category: trying to maintain one's desired life under uncertain situations, and four phases: (1) searching for a convincing cause of the illness, (2) gradually understanding the disease, (3) realising the need for behaviour change and (4) seeking a good balance between behaviour change and one's desired life. The situations that influenced the process were also revealed. Conclusions: Being convinced of the cause of one's illness and realising its severity led to the participants' realisation of the need for a behavioural change to avoid antigens. The uncertainty of the cause of illness and measures taken, a lack of clear advice from healthcare providers and one's desired life influenced participants' implementation of continuous antigen avoidance. Relevance to clinical practice: This study provides important insights regarding how healthcare providers should better understand and support people with hypersensitivity pneumonitis in avoiding antigens. [ABSTRACT FROM AUTHOR]

Background and Aims: Falling generally injures patients, lengthens hospital stays and leads to the wastage of financial and medical resources. Although falls can occur at any stage after hospital admission, there are no studies that characterise falls with length of hospital stay in acute care settings. This study aims to clarify risk stratification of early and late falls in acute care settings. Methods: A retrospective cohort study was conducted for participants who were admitted to a teaching hospital in Japan. Patients' falls were divided into two groups based on the median of the fall date (day 10). Considering a 70/30 split, the logistic regression model was used to extract independent predictors for early and late falls for nine risk variables based on exploratory analysis among 26 items selected from the modified Japanese Nursing Association Fall Risk Assessment Tool, and risk models were validated. This study was conducted according to the STROBE guideline. Results: Of the 10,975 patients admitted, 87 and 90 with early and late falls, respectively, were identified. The five significant risk factors extracted for early falls were fall history, muscle weakness, impaired understanding, use of psychotropics and the personality trait of 'doing everything on one's own'; risk factors identified for late falls were being older than 65 years, impaired extremities and unstable gait, in addition to muscle weakness. Using these variables for early and late falls in the validation cohort, the concordance indices of the risk models were both over 0.80. Conclusions: By separately extracting risk factors for early and late falls in an acute care hospital setting, this study shed light on the characteristics of the respective types of falls. Relevant to clinical practice: As the risk factors of falls vary according to the length of hospitalisation, specific preventive care can be implemented to avoid fall incidents. [ABSTRACT FROM AUTHOR]

Aims and Objectives: The aim of this study was to examine and compare decision‐making preferences on end‐of‐life care for older people in Japan, the Hong Kong SAR and South Korea. Background: Cultural values and beliefs influence decision‐making on end‐of‐life care. Design: A cross‐sectional design was adopted. Methods: Community‐dwelling people aged ≥65 with additional requirements were recruited in 2016–2017 in the three regions. Their decision‐making preferences on end‐of‐life care were assessed using Pang et al.'s questionnaire. These preferences and their sociodemographic and personal experience variables were compared and analysed using univariate and multiple logistic regressions. The STROBE checklist was followed. Results: This study involved 415 participants. In all three regions, the most preferred decision maker and person with whom to discuss end‐of‐life care issues was a family member. Participants in the Hong Kong SAR were less likely to select a family member as their preferred decision maker than those in Japan (adjusted odds ratio = 0.129). Koreans were less likely to discuss end‐of‐life care issues with medical professionals than people in Japan (adjusted odds ratio = 0.278). More than 70% of the participants in each region indicated that they would not prefer to leave an advance directive to decide their end‐of‐life care. Conclusion: Older Asians prefer to make their own decisions after consulting others. Family members play an important role in helping older people plan their preferred end‐of‐life care arrangements, even acting as decision makers when older people become incapable of deciding for themselves. Relevance to clinical practice: Sufficient information should be provided to older people and their families for the older people to determine their preferred care. Helping families to understand and support the planned care and advance directives is a strategy for maximising family compliance with the care. Continuous efforts should be made to promote advance care planning and advance directives. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To examine the non‐linear dose‐response associations between nurse staffing levels and patient outcomes using a nationwide inpatient database in Japan. Background: Previous studies showed that higher nurse staffing levels were associated with better patient outcomes. However, it remains unclear whether there are thresholds for the associations between higher nurse staffing levels and improved patient outcomes. Designs: Retrospective observational study design following the STROBE guideline. Methods: We identified all patients aged ≥20 years who underwent one of six major cancer surgeries between July 2010 and March 2018 using data from the Diagnosis Procedure Combination database, a nationwide database for acute‐care inpatients in Japan. Restricted cubic spline regression analyses, the statistical method that allows non‐linear functional form, were performed with several scenarios of cut‐off points to examine the dose‐response associations between patient‐to‐nurse ratio per shift and failure to rescue, 30‐day in‐hospital mortality and postoperative complications. Results: Among 645,687 patients, restricted cubic spline regression analyses showed insignificant associations of patient‐to‐nurse ratio with failure to rescue and 30‐day in‐hospital mortality with no threshold, but a reverse J‐shaped association with postoperative complications with a threshold of patient‐to‐nurse ratio per shift of 5.4. Conclusions: In terms of postoperative complications, additional registered nurses were associated with decreased postoperative complications. However, this incremental benefit of additional registered nurses may disappear if hospitals allocate five to six number of registered nurses in general wards. Relevance to Clinical Practice: This study suggested that additional registered nurses over one per five to six patients may not bring the incremental benefit to decrease postoperative complications. [ABSTRACT FROM AUTHOR]

Aims and Objectives: This study aimed to comprehensively describe the psychosocial and behavioural consequences experienced by siblings of hospitalised children from the caregivers' perspective. Background: After children are diagnosed with a major illness, their siblings may begin to exhibit psychological and behavioural problems, coupled with decreased quality of life. Design: This study employed qualitative content analysis to describe the perspectives of 147 caregivers of siblings of hospitalised children, following the COREQ guidelines. Methods: From January to March 2015, data were collected from 33 medical institutions in Japan using a survey that utilised an open‐ended question. Results: Four themes comprising 13 comprehensive categories were extracted: (1) maintaining their usual self, (2) internalising difficulties, (3) externalising difficulties, and (4) personal growth. During data analysis, value judgments were avoided, with the focus instead placed on dividing the perspectives into positive and negative categories. Conclusions: The neutral data analysis enabled us to describe the psychosocial and behavioural adjustments that siblings make to 'maintain their usual self'. Relevance to clinical practice: This study's results can be used to educate healthcare providers, teachers and families about the psychosocial and behavioural effects of hospitalisation on siblings of hospitalised children to ensure that siblings struggling with psychosocial conflicts receive the necessary support. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To explore the differences in clinical practice activities and work‐related burden between nurses with past work experience other than nursing (second career nurses: SCNs) and nurses without any past work experience (nonsecond career nurses: NSCNs). Background: The number of SCNs is increasing. Some studies note that SCNs must perform additional clinical practice activities and experience more work‐related burden than NSCNs. However, there are no quantitative studies exploring SCNs' clinical practice and work‐related burden. Design: A cross‐sectional survey. Methods: Research was conducted according to the STROBE statement. Participants were 2,013 nurses working at 56 hospitals in Japan. A 30‐item questionnaire was developed to capture clinical practice activities using clinical ladders, asking about the types of clinical practice activities participants had practiced. Every practiced activity received a score of 1. The total count of each clinical practice activity was then summed. The quantitative workload (QW) scale score was used to investigate levels of QW. Higher QW scores indicated higher levels of work‐related burden. These variables were then compared between SCNs and NSCNs, and the factors that were associated with high QW among SCNs were examined. Results: Altogether, 961 participants (328 SCNs and 633 NSCNs) were included in the analyses. No significant differences were shown in clinical practice activities between the groups; however, SCNs' QW was significantly higher than was NSCNs' after controlling for demographic variables. SCNs' high QW was associated with the following variables: unmarried marital status, not having role model nurses and previous employment as a care worker. Conclusions: Quantitative workload was significantly higher among SCNs than among NSCNs. Tailored support for SCNs' high QW based on their specific needs should be considered. Relevance to clinical practice: These results can help nurse managers reduce SCNs' work‐related burden and illustrate future research directions for this minority group. [ABSTRACT FROM AUTHOR]

Aim and objective: To explore the accuracy with which nursing students can identify the fundamentals of care. Background: A challenge facing nursing is ensuring the fundamentals of care are provided with compassion and in a timely manner. How students perceive the importance of the fundamentals of care may be influenced by the content and delivery of their nursing curriculum. As the fundamentals of care play a vital role in ensuring patient safety and quality care, it is important to examine how nursing students identify these care needs. Design: Cross‐sectional descriptive design. Methods: A total of 398 nursing students (pre‐ and postregistration) from universities in Sweden, England, Japan, Canada and Australia participated. The Fundamentals of Care Framework guided this study. A questionnaire containing three care scenarios was developed and validated. Study participants identified the fundamentals of care for each of the scenarios. All responses were rated and analysed using ANOVA. Results: The data illustrate certain fundamentals of care were identified more frequently, including communication and education; comfort and elimination, whilst respecting choice, privacy and dignity were less frequently identified. The ability to identify all the correct care needs was low overall across the pre‐ and postregistration nursing programmes in the five universities. Significant differences in the number of correctly identified care needs between some of the groups were identified. Conclusions: Nursing students are not correctly identifying all a patient's fundamental care needs when presented with different care scenarios. Students more frequently identifying physical care needs and less frequently psychosocial and relational needs. The findings suggest educators may need to emphasise and integrate all three dimensions. Relevance to clinical practice: To promote students' ability to identify the integrated nature of the fundamentals of care, practising clinicians and nurse educators need to role model and incorporate all the fundamental care needs for their patients. [ABSTRACT FROM AUTHOR]

Aim and objective To clarify the characteristics of sub-groups of patients with stable chronic obstructive pulmonary disease having similar approaches to daily body condition management. Background Prior literature has shed light on the experience of patients with chronic obstructive pulmonary disease and revealed that these patients engage in many activities and try different things in their daily lives to regulate and manage their body condition. The research so far has all been qualitative, comprising mostly interviews, and no quantitative studies have been performed. In this study, cluster analysis was used to show that subgroups of patients with similar characteristics undertake similar approaches to body condition management. Design Descriptive, correlational study. Methods Invitations to participate in the survey were extended to patients with stable chronic obstructive pulmonary disease. Cluster analysis was performed on the basis of questionnaire scores relating to nine different categories of daily body condition management actions. The characteristics of the body condition management approaches, in each subgroup, were investigated using analysis of variance and multiple comparisons. Results The cluster analysis produced six subgroups, each defined by the effort expended as part of their body condition management. The subgroups also differed depending on patient age and disease severity. Conclusion Body condition management approaches taken by patients with stable chronic obstructive pulmonary disease are overall, comprehensive approaches. Relevance to clinical practice Patients with chronic obstructive pulmonary disease were subgrouped based on their engagement in body conditioning. Relationships between the subgroups and the engagement in body conditioning, age and shortness of breath severity were observed. The care of patient support should be comprehensive and depend on their age and the duration of the disease. In addition, it should be long term and recognise that the patients are living their own respective lives. Such considerations and focused perspectives are what we think will lead to an improvement in patients' quality of life and prevent their condition from worsening. [ABSTRACT FROM AUTHOR]

Aims and objectives. To explore the association between workplace bullying and workplace environment factors among nurses in Japan. Background. Workplace bullying among nurses is increasing globally and occurs more frequently than among other professions. However, there is little information on the impact of workplace environment factors on nurse bullying in Japan. Design. A cross-sectional survey using a self-administered questionnaire. Methods. Participants were 1152 nurses recruited at seminars or training courses outside of their workplaces in Tokyo. Workplace bullying was measured using the Negative Acts Questionnaire-Revised. Participants were considered to have been 'bullied' if they reported experiencing at least one negative act on a daily or weekly basis. Workplace environment factors were measured using the Practice Environment Scale of the Nursing Work Index, which comprises five domains: nurse participation in hospital affairs; nursing foundations for quality of care; nurse manager ability, leadership and support of nurses; staffing and resource adequacy; and collegial nurse-physician relationships. Results. A total of 898 (78-0%) questionnaires were returned, of which 825 (71-6%) were analysed. Altogether, 153 (18-5%) nurses were considered 'bullied.' The three most frequent negative acts reported as occurring on a weekly or daily basis were 'someone withholding information which affects your performance' (6-7%), 'being exposed to an unmanageable workload' (4-4%) and 'being shouted at or being the target of spontaneous anger (or rage)' (3-6%). Logistic regression analysis indicated that 'bullied' were associated with low scores on two work environment domains: nurse manager ability, leadership and support of nurses and staffing and resource adequacy. Conclusions. Effective nurse manager leadership and support as well as appropriate staffing management may positively influence workplace bullying among nurses in Japan. Authentic leadership styles and allowing nurses to easily request days off might also be important. Relevance to clinical practice. Nurse managers' leadership may influence nurses' workplace bullying. [ABSTRACT FROM AUTHOR]

Aims and objectives To describe what effects low back pain has on the daily lives of female family caregivers and to elucidate the caregiving factors associated with its development. Background Low back pain is a common musculoskeletal symptom in caregivers. However, few detailed studies have examined the association of low back pain with the daily lives of female family caregivers or which caregiving activities lead to their low back pain. The elucidation of these issues will contribute to the prevention and treatment of their low back pain. Design A cross-sectional study. Methods Japanese female family caregivers ( n = 156) completed a self-administered questionnaire assessing lifestyle, health status, daily activity and caregiving situation. Correlation analysis measured the association between low back pain and daily activity. Logistic regression analysis identified care activities related to low back pain. Results Thirty-five (22·4%) participants almost always experienced low back pain. The severity of low back pain was significantly and positively associated with difficulty in daily activities, especially bending and extending the lower back. As for care situation factors and caregiving activities, night care, assisting the family member to stand up and to lie down, dealing with problem behaviours, and taking medication were associated with the development of low back pain. After reclassifying the respective caregiving activities, those involving body repositioning and those mainly performed in a static position showed significant associations. Conclusions Low back pain in female family caregivers negatively affects their daily activities and certain caregiving activities are involved in the development of low back pain. Relevance to clinical practice Clinical nurses understand the situation of female caregivers and could prevent the development of low back pain with early intervention by providing adequate strategies to alleviate the burden of identified care activities related to low back pain. [ABSTRACT FROM AUTHOR]

Aims and objectives To identify the factors that predict maternal state anxiety when mothers and their sick children visit the outpatient unit of a paediatric hospital. Background While previous studies have focused on predictors of anxiety in mothers with ill children, the existing literature is limited in study design, research timing, respondent characteristics, sample size and data analysis. Design A cross-sectional design with self-administered questionnaires. Methods Mothers were recruited from the outpatient unit of a Japanese paediatric hospital ( N = 1077). Participants' state anxiety scores were collected using the Japanese version of Spielberger's State-Trait Anxiety Inventory. The independent variables were the mothers' and sick children's background information. Results Participants were 1077 mothers; 990 provided valid responses. Mothers' mean state anxiety score was 49·72. Significant predictors of maternal anxiety were mothers' childrearing anxiety, child age, the sick child having a fever, sick child having siblings, having a person providing childrearing support, the mother's first visit to the hospital, out-of-hours visit and severity of the child's illness. The overall model explained 21·6% of the variance (multiple regression analysis). Conclusions As various factors predicted maternal anxiety, identifying methods to address these factors may reduce maternal state anxiety. Relevance to clinical practice There is potential for improved understanding of the predictors of maternal state anxiety to aid in the development of materials that would best measure anxiety. The present findings may also suggest some means of providing appropriate information and support to anxious mothers. Our findings cannot demonstrate causation, however, and teaching methods and supportive practices were not investigated; therefore, a qualitative study on the concrete content of maternal anxiety and an intervention study to create support services for anxious mothers is required. In addition, prospective or longitudinal studies are also important for investigating causation. [ABSTRACT FROM AUTHOR]

Aims and objectives This study aimed to clarify why and how clinical nurses facilitate sitting without trunk support among patients with disorders of consciousness. Background Recent attention has focused on encouraging patients with disorders of consciousness to sit without trunk support, but no reports describe this intervention among patients with poor awareness and physical disuse. Design Qualitative research design. Methods We enrolled five clinical nurses with interventional experience in rehabilitating patients with disorders of consciousness to sit without trunk support. Participant observation and semi-structured interviews were used to collect data. The data were analysed by text-mining method. Results Three reasons for nursing in the sitting position were identified: to raise the patient's body to assess the recovery of activities of daily living, to adjust their circadian rhythm and encourage the will to sit, and to make it easier to breathe. Five practices were identified: moving the patient to the prone position to sit in safety and comfort, developing postural stability by improving the flexibility of the lower limbs, improving the flexibility of the hip joints, developing trunk balance and encouraging hand use for stability, and ensuring safety by terminating the sitting practice when symptoms of respiratory failure, heart failure, or excessive tiredness developed. Conclusions The rationale for nursing patients with disorders of consciousness to sit without trunk support was to establish a foundation for independent living. This was achieved by preparing patient's disused body for activity by improving the flexibility of hip joint in the prone position. This represents a new intervention for patients with disorders of consciousness that could facilitate independent living. Relevance to clinical practice This study provides empirical and practical evidence from nurses who perform novel clinical interventions that specifically promote independent living. Further accumulation of quantitative clinical results and physiological verification are required. [ABSTRACT FROM AUTHOR]

Aims and objectives The aim of this study was to test the adequacy of the Competence-Turnover Intention Model, which was developed to identify how nursing competence could affect nurses' turnover intention (nurses' intention to voluntarily leave an organisation). Background Recent studies have suggested that the level of nursing competence is negatively related to nurses' intention to leave their jobs, suggesting that a lack of competence threatens both the quality and quantity of the nursing workforce. However, the mechanism of how nursing competence affects nurses' turnover intention has not been explored previously. Design A cross-sectional survey design was used. Methods Surveys were distributed to 1337 Japanese registered nurses/midwives in October, 2013. The adequacy of the model was analysed using structural equation modelling. Results In total, 766 questionnaires were returned, with a return rate of 57%. The model fitted well with the data. The results showed that the level of nursing competence was related positively to the quantity of organisational rewards they felt they had received, and negatively related to the level of exhaustion they experienced. Moreover, the perceived organisational rewards and exhaustion were correlated with nurses' turnover intention through affective commitment. Conclusions The Competence-Turnover Intention Model is useful for explaining how nursing competence impacts on their turnover intention. Relevance to clinical practice Clinical implications derived from the findings are that: promoting nursing competence is key to improving not only the quality of care provided by nurses, but also to retaining the nursing workforce, and the model can be used to develop strategies that would mitigate their turnover intention. [ABSTRACT FROM AUTHOR]

Aims and objectives. To assess psychosocial profiles of children with achondroplasia using a nationwide survey. Background. Achondroplasia, showing short stature and disproportionately short limbs, causes physical inconvenience such as difficulty in reaching high objects. It is, however, still controversial whether the condition is associated with psychological problems, especially in childhood. Design. A cross-sectional descriptive design was employed. Methods. To evaluate psychosocial profiles and adaptation processes in children with achondroplasia, we developed an inventory of scales based on the psychological stress model of which conceptual framework was comprised of stressor, coping process, coping resource and adaptation outcome domains. Participants were recruited nationwide through the largest advocacy support group for achondroplasia in Japan. Of the 130 group members, 73 X-ray-diagnosed patients, aged 8-18 years, completed the inventory of questionnaires to be analysed. Results. As for the stressor domain, patients experienced short stature-related unpleasant experiences more frequently (z-score: +1.3 in average, +3.9 in physical inconvenience). Nevertheless, these experiences had little effect on the coping process (threat appraisal: -0.2, control appraisal: +0.1) and the adaptation outcome (stress response: +0.3, self-concept: 0.0). Interestingly, self-efficacy in the coping resource domain was noticeably increased (+3.1) and was strongly correlated with most variables in the coping process and in adaptation outcome domains. Conclusions. Although the children with achondroplasia experienced more short stature-related stressors, there was no evidence of any psychosocial maladaptation. This finding suggests that coping process as well as coping resources such as self-efficacy could be important targets for promoting psychological adjustment in children with achondroplasia. Relevance to clinical practice. To help children with achondroplasia adapt socially, nurses and other healthcare providers should routinely assess their psychological adaptation process, especially cognitive appraisal and self-efficacy. [ABSTRACT FROM AUTHOR]

Aims and objectives To determine the current status of dementia patient's quality of life and compare influencing factors in China and Japan to inform nursing care and potentially improve the patient's quality of life. Background The prevalence of dementia is increasing related to lack of a cure, thus prompting some researchers and clinicians to focus on patient's quality of life. Design A cross-sectional study. Methods A convenience sample of 200 mild-to-moderate dementia patients was obtained in Jinan city and 205 ones in Wakayama city. Then, we measured patient's quality of life and analysed the relation between general demographic information, cognitive function, activities of living, behavioural and psychological symptoms, and the patient's quality of life. Results The total score of Dementia Quality of Life in Jinan city was 89·82 ± 15·11; multiple linear regression showed that the influencing factors of quality of life were marital, economics, characteristics, activities of living, hypertension and irritability. And the total score in Wakayama city was 118·30 ± 14·56; the influencing factors were education, body mass index, activities of living and depression. Conclusions The total score of Dementia Quality of Life in Jinan city was significantly lower than Wakayama city. The same influencing factor between these two cities was activities of living. Relevance to clinical practice Nurses could implement interventions to focus on many of the patient's influencing factors, so that to improve their mental and physical health, which may slow the disease process and further improve the patient's quality of life. In addition, Chinese government could learn some experience from Japanese government, such as perfect the system of nursing insurance for elderly and introduce professional geriatric nursing talents to provide better service for the elderly. [ABSTRACT FROM AUTHOR]

Aims and objectives. To examine the characteristics of hypertension-related factors in female family caregivers in Japan who provide care in the home, in comparison with general community non-caregivers. Background. Hypertension is more frequently encountered in female caregivers than in non-caregivers. Lifestyle factors including sleep and eating habits differ in Japanese female caregivers and the general population. Therefore, hypertension-related factors in caregivers may also differ from those in the general population. Design. A cross-sectional study. Methods. The subjects were 150 female caregivers (aged 62·4, SD 12·2 years) who provided home care for persons with physical impairments and/or dementia and 154 female controls (aged 62·7, SD 2·2 years) who did not provide home care. Persons with a history of ischaemic heart disease or cerebral stroke were excluded. Subjects were examined using a self-reporting questionnaire that included a food frequency questionnaire and the tri-axial coping scale. Urine examinations and blood pressure measurements were also done. Logistic regression analysis was conducted for each group with the same variables as explanatory variables. Results. Hypertension was present in 46·7% of caregivers and 34·4% of controls ( p < 0·05). Menopause was a factor related to hypertension in both the caregivers and controls. In the caregiver group, hypertension was associated with the estimated 24-h Na excretion in urine and the carbohydrate-energy ratio for nutriti. BMI was associated with hypertension in the control group, but not in the caregiver group. Conclusions. Hypertension was associated with nutritional factors, such as greater Na excretion in urine and higher carbohydrate energy ratio, in Japanese female caregivers and with obesity in non-caregivers. Relevance to clinical practice. To prevent hypertension, it is necessary to carefully monitor salt intake and nutritional balance in female caregivers in Japan. [ABSTRACT FROM AUTHOR]

Aims and objectives. To investigate the prevalence of physical restraints in the long-term care hospitals in Japan and to examine the factors of physical restraint use, including the specific skills/techniques that the staff use to minimise the restraints. Background. Despite the national efforts to nullify physical restraint, it is still prevalent in long-term care facilities in and out of Japan. More detailed information regarding what affects physical restraint is needed. Design. Cross-sectional mail survey. Method. A questionnaire was sent to a nursing ward manager of the random sample of long-term care facilities in Japan. Results. The average rate of physical restraint was 25·5%. Altogether, 81·0% of the restrained clients were under restraint for more than one month. The most prevalent method of restraint was bilateral bedrails, followed by the use of coveralls and gloves. Factors of restraint were different depending on the type of restraint, suggesting specific approaches are needed for specific type of restraint. Conclusions. Physical restraint is still prevalent in Japanese long-term care hospitals, and nurses need to develop effective intervention approach to redesigning practice related to physical restraints. Specialised intervention approach seems needed depending on the types of restraint. Relevance to clinical practice. Specific approach should be developed to minimise the physical restraint in long-term care hospitals in Japan. [ABSTRACT FROM AUTHOR]