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Aim: The aim of this study is to analyse the risk factors for unplanned readmissions within 1 month after hospital discharge to develop a seamless support system from discharge to home care. Background: With shorter hospital stay lengths, understanding the characteristics of patients with multiple risk factors is important to prevent rehospitalization. Design: This is a single‐centre retrospective descriptive study. Methods: Logistic regression and decision tree analyses were performed using eight items from the records of 3117 patients discharged from a university hospital between April–September 2017 as risk factors. Results: Unplanned readmission risk was significantly associated with emergency hospitalization (odds ratio [OR]: 3.12, 95% confidence interval [CI]: 2.04–4.77), malignancy (OR: 2.16, 95% CI: 1.44–3.24), non‐surgical admission (OR: 1.76, 95% CI: 1.07–2.88), hospital stay of ≥ 15 days (OR: 1.66, 95% CI: 1.14–2.43) and decline in activities of daily living owing to hospitalization (OR: 1.68, 95% CI: 1.06–2.64). The highest risk combinations for rehospitalization were as follows: emergency hospitalization and malignancy; emergency admission, non‐malignancy and a hospital stay of ≥15 days; and scheduled hospitalization, no surgery and a hospital stay of ≥15 days. Conclusions: Patients with multiple risks for unplanned readmission should be accurately screened and provided with optimal home care. Summary statement: What is already known about this topic? Although the characteristics of patients at high risk of rehospitalization include malignancy, heart failure, conditions such as chronic obstructive pulmonary disease and other diseases prone to recurrence, old age, reduced activities of daily living and emergency hospitalization, few studies have reported on cases with multiple risks. What this paper adds? The most frequent risk types for unplanned readmissions within a month were emergency admissions for malignant tumours, emergency admissions for non‐malignant tumours with a hospital stay of 2 weeks or more and scheduled admissions for non‐surgical purposes with a length of stay of 2 weeks or more. The implications of this paper: The risk of unplanned readmission within 1 month of discharge increased due to a combination of multiple risks.This study helps us identify patients who are at high risk for readmission early in the hospitalization process and in providing nursing support for transition to their homes. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Recovery‐oriented services have been shown to promote recovery in people with mental illness; their implementation is important for current psychiatric practice and is being considered by many professional institutions.The Japanese government released the policy 'A Vision for Reform of Mental Health and Medical Welfare' (Ministry of Health, Labour and Welfare, 2004; https://www.mhlw.go.jp/topics/2004/09/dl/tp0902‐1a.pdf), aiming to update public consciousness, reorganize the mental healthcare welfare system and strengthen the foundation of mental healthcare to promote a basic policy focusing on the transition 'from hospital to community life'. What the paper adds to existing knowledge?: This is the first study to clarify recovery‐oriented attitudes among psychiatric nursing directors and related factors in Japan. It shows an association between recovery‐oriented attitudes and hospital size. What are the implications for practice?: A relationship exists between the recovery knowledge and recovery‐oriented attitudes of psychiatric nursing directors. It may thus be valuable for directors to see and hear about the experiences of patients living in the community during their recovery process. As hospital size and organizational climate may hinder the successful implementation of recovery‐oriented practices, these factors must be considered when introducing such practices.Further research is needed on the relationship between psychiatric nursing directors' recovery‐oriented attitudes and practices. Moreover, to develop intervention studies that uncover success factors for enhancing recovery‐oriented attitudes, organizational factors that enable recovery‐oriented practices must be further investigated. Introduction: Recovery‐oriented practices in mental health services have become a global priority. Despite their proven effectiveness, Japanese hospitals have not widely implemented such practices. Aim: This study clarified psychiatric nursing directors' recovery‐oriented attitudes and factors regarding promoting recovery‐oriented practices to identify methods for developing these practices in Japan. Method: This cross‐sectional study used a questionnaire survey with 250 nursing directors from 1287 Japanese psychiatric hospitals. Multivariable regression analysis assessed how socio‐demographic variables and Recovery Knowledge Inventory (RKI) scores affected Recovery Attitudes Questionnaire (RAQ‐7) scores. Results: The analysis revealed that more clinical and managerial experience was associated with more negative recovery‐oriented attitudes. High RKI scores, knowledge of strength, hospital size and outpatient work experience were associated with more positive recovery‐oriented attitudes. Discussion: Implementing recovery practices requires consideration of knowledge and experience in recovery and hospital size alongside recovery training based on a hospital's organizational structure. Although the low response rate could influence the study's generalisability, it could also indicate low interest in recovery‐oriented practices among professionals. Implications for Practice: Acquiring more knowledge and experience regarding recovery promotes recovery‐oriented attitudes among nursing directors. An appropriate organizational culture and consideration of hospital size are required when introducing such recovery practices. [ABSTRACT FROM AUTHOR]

Aims: This study aimed to investigate the relationship between family caregivers' health‐related quality of life and health outcomes in care recipients. Methods: A total of 160 female caregivers in Japan were initially assessed using self‐reported baseline questionnaires to determine physical and mental aspects of their health‐related quality of life. Based on these scores, they were divided into three groups: lower, middle, and higher quality of life. We followed up with the 133 participants (after excluding those that did not respond) 6 years later to assess the health of their care recipients; 36 caregivers continued to provide home care, while 97 reported that their care recipient had died or been admitted into institutionalized care. Results: Statistically, a higher risk for care recipients' health deterioration was strongly associated with the mental component score in the lower caregivers' quality of life group of than for the middle group, after adjusting for the care recipients' age, health status, and caregivers' age at baseline. There was no significant association between deterioration of health of care recipients and physical component scores of the caregivers. Conclusion: Caregivers' poor health‐related quality of life, particularly poor mental health, may be linked to the deterioration of care recipients' health. Summary statement: What is already known about this topic? Family caregivers reportedly have lower quality of life than noncaregivers.While factors associated with decreased quality of life of caregivers such as high caregiving burden and longer care duration are being identified, they remain difficult to prevent.Lower caregiver quality of life may negatively influence the care recipients. What this paper adds? Poor mental health in caregivers, calculated with health‐related quality of life scores, is associated with health deterioration of care recipients.Physical health in caregivers is not associated with health deterioration of care recipients. The implications of this paper: Support for improving the health‐related quality of life of caregivers is necessary, especially in relation to their mental health, from the viewpoint of maintaining the health status of care recipients. [ABSTRACT FROM AUTHOR]

Abstract: Aim: To describe changes in prevalence of shoulder stiffness, back pain, and wrist pain during the first 6 months postpartum, and to examine the association of these symptoms with maternal age and parity. Methods: Participants were recruited from 13 Japanese hospitals between 2012 and 2013. A total of 2709 (response rate 71.9%) women provided longitudinal data, using self‐report questionnaires at 5 time points: during their hospital stay, and at 1, 2, 4, and 6 months postpartum. Shoulder stiffness, back pain, and wrist pain were measured, using checklists with yes‐no responses. The effects of age and parity were assessed in 4 groups of younger (<35 years) and older (≥35 years) mothers: 983 younger primiparas, 481 older primiparas, 649 younger multiparas, and 596 older multiparas. Chi‐square tests and Cochran's Q tests were used to assess effects of group and time. Results: Prevalence of shoulder stiffness, back pain, and wrist pain during the hospital stay significantly increased up to 1 month postpartum for older primiparas, who were also the most vulnerable to back pain and wrist pain at 1 month postpartum. Conclusion: Special attention should be given to older primiparas in assessing and providing nursing care for physical symptoms, especially during the first month postpartum. [ABSTRACT FROM AUTHOR]

The aim of the study was to assess fatigue, depressive symptoms, and maternal confidence or satisfaction among older primiparae during the first month postpartum. The number of older Japanese primiparae has rapidly increased. Older primiparae are believed to be at high risk for puerperal morbidity. A multicentre prospective cohort study design was used. Data were examined from 2854 Japanese women who participated in a 6-month prospective cohort study conducted between May 2012 and September 2013. The women were classified into 4 groups based on maternal age and parity. All participants completed the Postnatal Accumulated Fatigue Scale, Japanese Edinburgh Postnatal Depression Scale, Postpartum Maternal Confidence Scale, and Postpartum Maternal Satisfaction Scale. Primiparae in all age groups were more severely fatigued and had a higher risk of postpartum depression than multiparous mothers during the first month postpartum. Older primiparae had significantly lower scores on maternal confidence and maternal satisfaction than the other 3 groups at 1 month postpartum. These findings suggest that postpartum nursing should focus on promoting adequate sleep, providing emotional support, and fostering the process of maternal role adaptation among older Japanese primiparae, particularly during the first postpartum month. [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 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]

This study aimed to investigate relations between ease of venous palpation and various venous factors, and to elucidate characteristics of hardly palpable veins. Healthy adult volunteers (n = 110) were enrolled. The ease of venous palpation was scored from 0: impalpable to 3: well palpable. Venous factors, namely venous depth, elevation, area and minimal pressure that starts to collapse vein, were measured using an ultrasonography before and after tourniquet inflation at 60 mmHg for 60 s. Tourniquet inflation significantly increased the venous area and venous palpation score. The four venous factors correlated significantly with venous palpation score with the following correlation coefficient: Depth (r = -0.542), Elevation (0.486), area (0.258) and start-to-collapse pressure (-0.220). The characteristics of hardly palpable veins were small size, deep location and little elevation. Although vasodilatation facilitated venous palpation, venous depth and elevation were also important and should be included in future studies in which vasodilatation methods are evaluated. [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]

The purpose of this cross-sectional survey was to explore relationships between life-space mobility and the related factors in elderly Japanese people who attend orthopaedic clinics. The study measures included surveys of life-space mobility (Life-space Assessment ( LSA) score), social support (social network diversity and social ties), physical ability (instrumental self-maintenance, intellectual activity, social role), orthopaedic factors (diseases and symptoms) and demographic information. The questionnaire was distributed to 156 subjects; 152 persons responded, yielding 140 valid responses. Mean age of the sample was 76.0 ± 6.4 (range, 65-96 years), with 57.9% women ( n = 81). In a multiple regression analysis, the six factors were significantly associated with LSA. Standardized partial regression coefficients (β) were gender (0.342), instrumental self-maintenance (0.297), social network diversity (0.217), age (−0.170), difficulty of motion (−0.156) and intellectual activity (0.150), with an adjusted R2 = 0.488. These results suggest that outpatient health-care providers need to intervene in not only addressing orthopaedic factors but also promoting social support among elderly Japanese. [ABSTRACT FROM AUTHOR]

The Integrated Circuit tag monitoring system became available to measure wandering in terms of the distance moved by dementia patients. The purposes of the study were to describe degree of ambulation in patients with Alzheimer's disease ( AD) and to examine factors associated with the distance moved. AD patients were recruited at a dementia care unit in Asakayama Hospital, Osaka, Japan. The monitoring system generated the distance moved per day. Demographic and clinical data were abstracted from medical records. Mini- Mental State Examination was used to measure cognitive function. A multiple linear regression was used to predict the distance moved per day. The research was approved by the ethics committee of the university and the hospital, and written informed consent was obtained from the patients' proxies. Majority of the AD subjects monitored had moderate to advance stage of dementia. Patients' age and cognitive function were predictors of the median distance moved/day, and these two variables explained almost half of the variance. Older age and lower cognitive function were associated with reduced median distance moved per day in AD patients. [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]

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]