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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 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]

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 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 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]

The aim of this study was to develop an instrument to assess difficulties in daily life experienced by patients with osteoarthritis of the knee and to investigate factors influencing difficulties in daily life. Osteoarthritis of the knee is commonly associated with clinical symptoms and disabilities. No scale has been available to assess the comprehensive and subjective difficulties felt in daily life by patients affected in social and cultural lifestyle. Therefore, little is known about difficulties in osteoarthritis of the knee patients and supportive care necessary for them. A scale development and descriptive study. The participants consisted of 362 patients with osteoarthritis of the knee. The scale development involved several phases including item development, reliability testing, criterion-related validity testing and construct validity testing. The exploratory factor analysis included three domains: 'suffering in social life', 'hardship in activities in daily life' and 'apprehension about the future life'. A confirmatory factor analysis confirmed validity of the construct, with a demonstrated good fit between the factor structure of the new scale and the observed data. Difficulties in daily life scores were significantly influenced by pain, loss of balance, muscle weakness, stiffness and swelling. We developed a reliable and valid scale for the measurement of difficulties in daily life experienced by patients with osteoarthritis of the knee. It is important for healthcare professionals to understand these difficulties in daily life experienced by patients with osteoarthritis of the knee and to educate patients with practical information and self-management strategies. This new scale could provide useful information to guide clinical practice in assessing and managing difficulties in daily life experienced by patients with osteoarthritis of the knee. [ABSTRACT FROM AUTHOR]

To analyse Japan's labour market for nurses and determine reasons for the continuing excess demand. Japan has long been experiencing a shortage of nurses. The situation has been worsening over the past few years, as is reflected in the growing media coverage of the issue. We constructed an economic model of wage setting for Japanese nurses and analysed those wages applying standard labour economics theories. We constructed a nurse labour market data base from various public sets and estimated a few alternative wage functions from this data base. We then interpreted these parameters and the differences of some parameters by function to make an evaluation of relative importance of labour market forces and policies on the setting of the Japanese nurse wages. The government's move to improve the nursing staff-inpatient ratio and the shorter inpatient hospital stays have had a positive impact on the wages of registered nurses (RNs) and licensed practicing nurses (LPNs). Yet, the nursing labour market imbalance remains. The findings show that individual hospitals and clinics could take three steps to help fill the nursing vacancies. First, they could introduce a reorientation program for those nurses no longer in the labour market. Second, they could restructure the working arrangements for those nurses with family responsibilities. Third, they could be instrumental in having the current wage system reassessed. [ABSTRACT FROM AUTHOR]