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Objectives: This study aims to investigate the effects of mindful meditation and yoga on reducing burnout and stress in care workers who assist elderly individuals. Knowing how to reduce burnout is important because that of care workers is associated with the quality of client care, worker productivity, and job turnover. Patients and Methods: The participants included 44 care workers who worked for elderly care facilities in rural Fukuoka. They were randomly assigned to one of three intervention groups: control, yoga, or mindfulness. In the yoga intervention group, a certified yoga instructor taught a 60-minute yoga session each week for six weeks. In the mindfulness group, an experienced medical doctor instructed a mindful meditation program for the same length. Participants were asked to complete the Japanese Burnout Scale (JBS), and the research team collected the level of α-amylase in saliva using NIPRO: T-110-N pre- and post-interventions. Results: MANOVA was performed with each intervention (control, yoga, mindfulness) as the independent variable on the three subscales of the JBS (emotional exhaustion, depersonalization, and personal achievement) and a biomarker of stress level (α-amylase). The results indicated a significant main effect of interventions, and a follow-up ANOVA showed a significant effect of interventions on emotional exhaustion and personal achievement. Conclusion: The results indicate that practicing mindful meditation or yoga for 60 minutes once a week for six weeks can reduce care workers’ burnout. This study was notable because the biomarker of stress also improved. It is strongly recommended and encouraged that institutions caring for the elderly population provide mindful meditation or yoga intervention to reduce burnout, which benefits not only care workers but also their clients.

Coronavirus disease 2019 (COVID-19) has spread rapidly worldwide and it has been a widespread concern. Japan had some problems in psychiatric wards such as long hospital stay. The purpose of this study investigated recognition of nurses in psychiatric wards for future care. We conducted questionnaire research for psychiatric nurses and they described recognition of nursing in free de-scription. Qualitative analysis was performed on description. Results showed that six categories were chosen like “Increase of stress and fatigue caused of infection control,” “Negative effects to body and mind of patients,” “Effects to nursing care in psychiatric nursing,” “Differences of attitude toward infection control in the hospital,” “Cognition for social movement related to Coronavirus,” and “New recognition by Coronavirus infection and future.” These results suggest the following, 1) some kind of supports will be needed for nurses’ stress for infection control, 2) supports or interventions for palliate of patients stress like limitation of prolonged quarantine, limit of visiting or home stay overnight, 3) integrated leaderships to cognition and behavior for infection control in a hospital.

Cervical cystic vagal schwannomas sometimes mimic lateral neck cysts because of their extremely rare cystic appearance. Accurate diagnosis of this tumor and preservation of neural function are important because permanent neural injury may occur in patients with cervical schwannomas. During surgery, tumor enucleation of the true capsule of the tumor protects the nerve of origin. In this report, we discuss the case of a 27-year-old woman with cervical cystic vagal schwannoma mimicking a lateral neck cyst, who underwent successful tumor enucleation without suffering permanent neurological deficits. This case report aimed to present the extremely rare cystic changes that may occur in cervical schwannomas, and to improve diagnostic accuracy in relation to this disease. Herein, we discuss the details of enucleation, the methodology of which has not been standardized, and advocate the need for surgery in accordance with the pathogenesis of schwannoma.

Persons with mental illness feel symptoms like depression, anxiety, or fatigue. It is important for them to decrease symptoms and increase well-being. The present study investigated efficacy of mindfulness yoga on mood and self-compassion of persons with mental illness. Participants were persons with mental illness who lived in a community. Thirteen participants received once mindfulness yoga practice for 60 hours in a welfare facility. They completed POMS 2 (Profile of Mood Scale) and Self-Compassion Scale. Anger-Hostility, Confusion-Bewilderment, Fatigue-Lethargy, Tension-Anxiety significantly decreased. Self-kindness of Self-Compassion Scale significantly increased. Impression for participating for this program were “Refreshed both mentally and physically” or “Relaxed” and so on. These results suggest that the Mindfulness Yoga may be useful to maintain mood comfortable and increase self-compassion partially of persons with mental illness living in community.

Background: Globally, there a problem of disequilibrium between donation and organ transplantation, this equilibrium is remarkable in Japan. Especially there are few donations from brain death, and researches from the view point of nurses in clinical situation were needed. Purpose: The purpose of this study was to clarify the recognition of nurses in organ transplantation nursing, required care for families of patients, and required support for nurses to promote quality of nurses in organ donation. Methods: We conducted this research within 2 months in 2019 in Western Japan. A researcher conducted a semi-qualitative interview for nurses in organ transplantation nursing about their recognition of nursing, required care for family members, and required support for nurses once. Results: Nurses recognized that some family members who knew patients’ thoughts made decision easily and some who didn’t know had difficulties. Many nurses felt insufficiency for family cares and some confronted ethical problems. Though some nurses felt conflict about their own thoughts or religion, they took care of patients or family members with responsibility. As for care for families, nurses thought practice of care considering families’ feeling, support of decision making, and care for family to live positively after transplantation as required care. About support for nurses, nurses required education of transplantation, increase of staff members, chance to share dilemma, and mental care. Discussion: Nurses recognized the importance of decision making, and felt an insufficiency for family care or dilemmas. To propose high quality of nursing and organ donation or transplantation, education about transplantation including family care, management about resolution of dilemma or mental health may be required.

Background: The experiences of death conference (DC) are regarded as improving the quality of nurses’ terminal care and developing nursing minds. Few studies in Japan clarify quantitatively how nurses’ participation in DC is related to nurses’ terminal care. Aim: This study aims to clarify the relationship between DC experiences and nurses’ terminal care using the prepared Terminal Care Nursing Self-Assessment Sheet. Method: The study is approved by the Ethics Review Board of St. Mary’s College, and the hospital where the survey was conducted. This study was an observational and cross-sectional study using an anonymous, self-completed questionnaire composed of the newly created Terminal Care Nursing Self-Assessment Sheet. Its evaluation items consist of six categories (Reflection, Cooperation, Response to patients, Response to patients’ family, Specific measures for nursing, and Feelings of the nurse), and 14 questions. The questionnaires were conducted for 144 nurses in the ER, ICU, and Palliative Care Ward (Hospice Ward) in a general hospital in Japan. For analysis, JMP ver.14.2 was used to perform a Chi-square test, Wilcoxon/Mann Whitney test, univariate, and multivariate logistic regression analysis. Results: One hundred thirty-nine participants (97%) were included in the final analysis. Forty-three nurses had DC experiences, and 96 had no experience. The median number (IQR; interquartile range) of DC experiences was 5.5 (2 - 22.5). There were significant differences in five of the above categories; however, there was no significant association in the five questions of the nurse’s stress on response to patients and patients’ family and specific measures for nursing regarding postmortem treatment for patients between DC experiences and Nurses’ terminal care. Conclusion: DC that looks back on terminal care has significance as an opportunity to consider the way of terminal concerns and direction of future care. It is required to raise the quality of DC for focusing on reducing nurses’ stress on terminal care and anxiety about postmortem treatment for patients.

The purpose of the present study was to investigate the mediating roles of resilience on the relationship between groups (exercise/mindfulness/control) and minor psychiatric disorders measured. Then, the effects of exercise and mindfulness-based yoga programs on resilience were examined using randomized control design. The data were collected from three community centers in Fukuoka, Japan, and a total of 55 participants, who were over 65 years of age and met inclusion criteria, were randomly assigned to one of the three groups. Then, the participants were asked to complete the demographic survey as well as the GHQ-12. The results of the path mediation analyses showed that resilience fully mediated the relationship between group and minor psychiatric disorders. Furthermore, there was a significant difference in resilience and psychiatric disorders between exercise/mindfulness groups and the control group, while there were no differences between the exercise and mindfulness-based yoga groups. Potential intervention programs are discussed.

Background: Increasing the number of DC (Death Conference) experiences, nurses are expected to improve the quality of nurses’ terminal care and developing nursing minds. Therefore, there is a need for further evidence on the impact of repeated DC experiences on nurses’ terminal care. Aim: This study aims to clarify the impact of repeated DC experiences on nurses’ terminal care and nursing in DC using the prepared Death Conference Nursing Self-Assessment Sheet. Method: The study is approved by the Ethics Review Board of St. Mary’s College, Chukyo Gakuin University, and the hospital where the survey was conducted. This study was an observational and cross-sectional study using an anonymous, self-completed questionnaire composed of the newly created Death Conference Nursing Self-Assessment Sheet. Its evaluation items in the Death Conference Nursing Self-Assessment sheet consist of four categories (Cooperation, Future direction of nursing, Specific measures for nursing, and Feeling of the nurse) and 14 questions. The questionnaires were conducted on 144 nurses in the ER, ICU, and Palliative Care Ward (Hospice Ward) in a general hospital in Japan. For analysis, JMP ver.14.2 was used to perform Fisher’s exact test, Wilcoxon/Mann Whitney test, univariate, and multivariate logistic regression analysis. Results: Thirty-four participants (23.6%) who answered the number of DC experiences were included in the final analysis. Seventeen nurses had DC experiences, and 17 had no experience. There were significant differences in all of the above categories impacting nurses’ terminal care and nursing in DC. Conclusion: Repeated DC affected nurses’ terminal care and nursing in DC using the Death Conference Nursing Self-Assessment Sheet. In the future, verification of the reliability, validity of the questionnaire, and more evidence of the way of terminal concerns by raising the quality of DC for developing nursing minds will be needed.

The prime aim of this study was to find a psychological process model of patients with terminally ill in home hospice investigating the contents of a narrative, and the secondary aim was to create a narrative approach program for nurses. Ten patients narrated their thinking or feelings along with some prepared questions in two sessions. Patients’ narrative data were categorized by a qualitative analysis and 34 categories were chosen. They perceived good points in home hospice like “Being able to spend time freely”, “Close relationships with care staffs and strong confidence”, though they perceived trouble points like “Suffering from putting burden on the people around me” or “Worries about economic problems”. They perceived psychological changes through illness like “Having peace of mind and becoming kind” “Desire for a natural death”. Moreover they perceived their life like “Acceptance of one’s life including illness” “My life lived with satisfaction”. They regarded as important things such as “Spending life time usefully” “Feelings of my family members and of those around me”, and as hopes “Hope to leave my living proof” “Living left time to the fullest”. From these categories, we propose an acceptance model of patients’ life and a narrative program for nurses.

Goal: The aim of this study was to examine the perception of nurses who worked at the clinic which proposed home hospice and contents of care to better understand home hospice and enhance home care. Methods: Six nurses who worked at the clinic where proposed visiting medical treatment participated voluntarily. They received one interview for approximately one hour, in which they narrated their perception of home hospice and content of nursing care. The narrative was recorded by an IC recorder and analyzed as contents analysis. This study was approved by the Ethical Board at St. Mary’s College. Results: About the content of nursing care, some categories were selected such as “Understanding a patient as a living person,” “Examining if a patient and caregiver live at ease,” or “Caring for a caregiver accepting a loved one’s death and care given at death.” Nurses perceived the theme as “Time and space for listening carefully,” the theme as “Feeling of responsibility and attractiveness of work,” the theme as the “Economics and manpower to continue home hospice,” the as a “Required connection between hospitals and home hospice clinics.” Conclusion: Visiting medical treatment nurses understand a patient and a family as living people based on intimate relationships, support them as the disease progresses, and connect to a visiting nurse station. They perceived that “patients can enjoy freedom; the nurses had responsibility and strong relationships. They felt the economic or man-power needs to continue and the requirement of a connection between hospitals and home hospice clinics.

Aim: To identify evidence in the literature on the significance of death conferences for nurses. Method: This is an integrative literature review, consisting of scientific articles published on “Ichushi-Web”, an Internet-based retrieval service by the Japan Medical Abstracts Society (JAMAS), PubMed, Medline, Cochrane library, and Google Scholar for ‘the whole year,’ combining the keywords “death conference”, “nurse”, and “KJ method”. The significance of death conferences was reviewed by comparison of prior qualitative studies analyzed by the KJ method. Result: Seven studies, all from Japanese, were identified. The significance of death conferences showed “refraction”, “cooperation”, “directionality of nursing”, “caring for patient”, “caring for family”, “specific methods of nursing”, and “feelings of nurses”. Conclusion: The significance of death conferences is considered to be the effect on nurses for amelioration in the quality of patient and family care, development of human relations, and growth as a nurse. The quality of death conferences should be enhanced based on the guidelines for its clear definition.

Goal: The aim of this study was the development of a narrative approach program for family caregivers at home hospice. We examined the effect on quality of life (QOL) and the factors of their narrative. Methods: Ten family caregivers who were taking care of a patient with a terminal illness at home at the time of the study participated voluntarily. They received two interviews in the narrative approach, in which they narrated about one hour per interview. They completed the questionnaires about quality of life (positive emotion in Caregiver Quality of life Index-Cancer: CQOLC), Life Satisfaction, and mental health (General Health Questionnaire: GHQ). Data was analyzed by quantitative and qualitative analysis. This study was approved by the Ethical Board at St. Mary’s College. Results: The CQCLC score significantly increased (p < 0.05) and the GHQ score decreased, though not to a significant extent. Life satisfaction didn’t change because of ceiling effect. The categories about importance, changes after getting disease, hopes are selected. Conclusion: Narrative Approach may be useful to increase family caregiver’s Quality of life (positive emotions), and have the possibility to reduce mental health problems. Selected categories suggested psychological process of caregivers, and that the narrative approach might promote the recognition of positive aspects or resilience. We propose a narrative approach program as a pilot study.

Objective: Home hospice is one of the most important places to spend time at the end of life. It is necessary to clarify the perception of home hospice for family caregivers in order to choose home hospice. The aim of the study was to examine the perceptions of family caregivers about the reasons of decision making for home hospice care, benefits, difficulties with home hospice, and copings. Methods: Ten family caregivers who were taking care of a patient with a terminal illness at home at the time of the study participated voluntary. They participated in two interviews in the narrative approach. In the first session, they narrated reasons of decision making for home hospice, benefits, difficulties, and copings. In the second session, they narrated importance or growth in self. We analyzed narratives in the first session using qualitative analysis. This study was approved by the Ethical Board at St. Mary’s College. Results: Categories of the reasons for the decision making to undergo home hospice were “Being natural to take care of a loved one at home” or “Home hospice matching a family caregiver’s life”. Categories of benefits at home hospice were “To strengthen family’s ties” or “Both a loved one and a family spending time together”. Categories of difficulties were “Difficulty of economic problems” or “Difficulties of mental and physical symptoms”. Conclusion: We concluded that family caregivers perceived benefits and difficulties, and they could cope with difficulties, though spiritual pain remained. We need continuous support for family caregivers at home hospice.

BackgroundEnd-stage kidney disease is highly prevalent worldwide. Currently, one of the most effective treatment modalities is dialysis therapy, which leads to serious side effects. Furthermore, psychiatric illnesses are prevalent among dialysis patients. Recently, researchers asserted that psychological resilience and family support could be helpful to maintain or improve patients’ mental well-being. Therefore, the purpose of this study was to examine the mediating effects of resilience on the relationship between family functioning and mental well-being in these patients.MethodsTo investigate the aim of this study, a cross-sectional design was employed. A total of 110 hemodialysis patients, who were receiving outpatient treatment from dialysis units at the University of Fukuoka and St. Maria Health Care Center in Japan, participated. Only the patients who met the criteria and who were willing to participate in this 30-min study were given The General Health Questionnaire-12, Conner-Davidson Resilience Scale, and Family Assessment Device. Structural Equation Modeling (SEM) was performed to test the hypothesis that resilience would mediate the relationship between each subscale of family functioning, namely, cohesion, adaptability, communication, and mental well-being. Then Sobel’s test was employed to examine the indirect effect.ResultsThe results of the SEM showed that the model had an acceptable fit (RMSEA = .077; CFI = .93; and IFI = .94). According to the results, resilience fully mediated the relationship between family functioning, specifically family adaptability and communication, and mental health well-being of the dialysis patients. However, family cohesion was not associated with resilience.ConclusionsThe present study revealed that higher family adaptability and communication resulted in greater resilience, thus associated with better mental health. Given that poor mental health among dialysis patients is significantly associated with a decreased likelihood to adhere to treatment plans, it may lead to a significant risk to therapeutic compliance. As such, patients may experience detrimental consequences, such as death. This study showed that in order to maintain healthy mental well-being, developing resilience is a vital factor for hemodialysis patients., ResearchArticle number: 233 (2020)

Moral distress of psychiatric nurses may affect their job satisfaction or quality of nursing care, thus examination of their moral distress is a significant issue for practice. The purpose of this study was to investigate the level of moral distress and job satisfaction, and association between moral distress and job satisfaction. One hundred and thirty nurses who worked in psychiatric wards in a hospital in Japan completed the Moral Distress Scale for psychiatric nurses (MDS-P) and the Job Satisfaction scale (JS). The MDS-P consisted of subdomains such as “unethical conduct by caregivers,” “low staffing,” and “acquiescence to violations of patients’ rights” in intensity and frequency; the JS consisted of seven subcategories. An institutional review board in the researcher’s college approved this study. Results showed that the “acquiescence to violations of patients’ rights” was the highest of the subdomains of MDS-P, and the “interactions among nurses” was the highest of the subdomains of the JS. The unethical conduct by caregivers (MDS-P) score was negatively correlated with administration (JS) for intensity (r = -.40, p < .001) and frequency (r = .37, p < .001). Moreover “acquiescence to violations of patients’ rights (MDS-P)” was also negatively correlated with the “task requirement (JS)” score for intensity (r = -0.49, p < .001) and for frequency (r = -0.50, p < .001). These results suggest that reduction of moral distress increases job satisfaction particularly for administration and task requirement in nursing care.

The aim of this study was to investigate the feasibility of the Mindfulness Art Therapy Short Version for Japanese patients with advanced cancer. Patients learned mindfulness practices and then made art to express their feelings in the first session. After receiving instruction on practicing mindfulness 2 weeks later, they participated in a second session. The Profile of Mood States and Functional Assessment of Chronic Illness Therapy—Spiritual Well-Being Scale were administered before the first session and after the second. Results suggest that this intervention may be effective for increasing vigor and reducing fatigue; for reducing tension, depression, and confusion; and for improving overall mood.

The aim of this study was to investigate changes in autonomic nervous system (ANS) activity and mood caused by Mindfulness Art Therapy Short version (MATS). The participants were 20 Japanese college students who were separated into high and low risk groups based on the median score of the General Health Questionnaire (GHQ). MATS consisted of mindfulness exercise and making of art in one session. ANS activity (TP: total energy, LF/HF: sympathetic nervous, HF: parasympathetic nervous system, LF: both sympathetic and parasympathetic) and mood (TA: tension arousal, EA: energy arousal) were measured psychologically before and after MATS. In the high risk group, TP significantly decreased and LF, HF, and LF/HF did not change significantly; while TA significantly decreased and EA significantly increased. In the low risk group, TP and LF significantly increased and HF and LF/HF did not change significantly; while TA significantly decreased and EA showed a non-significant increase. These results suggest that MATS affects the ANS differently for participants with different states of mental health, and particularly promotes activity in low-risk participants. Psychologically, MATS decreased tension or anxiety and increased energy. These findings justify further use of this therapy.

The aim of this study was to examine the mediating effects of resilience, morale, and sense of coherence on the relationship between physical activity and respondents’ perceived physical/mental health and depression among community-dwelling older adults in Japan. The study included 369 participants with an average age of 74 years from Kasuishimohara District in Fukuoka Prefecture, Japan. They completed a survey that included the Resilience Scale, the Sense of Coherence Scale, the Medical Outcomes Short Form 8, the Philadelphia Geriatric Center Morale Scale, the Geriatric Depression Scale (Short Form), and a demographic questionnaire. The results of the path mediation analyses revealed that resilience and morale fully mediated the relationship between physical activity and perceived physical/mental health and depression. However, sense of coherence was not a significant mediator. Some intervention programs are suggested to maximize the effects of physical activity on one’s well-being. At-risk populations who need such programs are also discussed.

Objective:The aim of our study was to investigate the utility of bereavement life review (BLR) to elevate spiritual well-being and alleviate depression among Hawaiian-American caregivers, and to identify changes that occur when caring for their loved ones up to the time of death.Method:Bereavement life review therapy was provided for 20 bereaved Hawaiian Americans. In the first session, subjects reviewed memories of the deceased with a therapist, who recorded their narratives and collected them into a personal history book. During the second session, subjects discussed the contents of this book. Caregivers completed the Functional Assessment Chronic Illness Therapy–Spiritual (FACIT–Sp) questionnaire and the Beck Depression Inventory, Second Edition (BDI-II) pre- and post-intervention. Subjects also described changes in their views that occurred during the caring process in response to questions.Results:FACIT–Sp scores significantly increased from 34.1 ± 9.63 to 36.3 ± 10.6 (t = –2.6, p t = 2.27, p Significance of Results:These findings show the applicability of bereavement life review therapy for Hawaiian families, including efficacy for spiritual well-being and depression. The comments of the caregivers also indicate the potential of the therapy for identifying the positive aspects of caring for terminally ill patients.

The present study examined the potential of Mindfulness Art Therapy Short version on mood of healthy people. The Mindfulness Art Therapy Short version consisted of two sessions and included factors of both mindfulness and art therapy. The Art Therapy alone consisted of two sessions including factors of art therapy. Seventeen college students received the Mindfulness Art Therapy Short version and twenty-two students received Art Therapy alone. All participants completed the Profile of Mood States pre- and post-interventions in each session. In the Mindfulness Art Therapy Short version group, scores for Tension-Anxiety, Depression-Dejection, and Fatigue-Inertia reduced and those for Vigor-Activity significantly increased after the program. In the Art Therapy group, although scores for Tension-Anxiety and Fatigue-Inertia decreased, the scores of Depression-Dejection and Vigor-Activity did not significantly change. The score of Total Mood significantly decreased only in the Mindfulness Art Therapy Short version. These results suggest that the Mindfulness Art Therapy Short Version may be more affective for improving mood, particularly depression and vigor, compared to Art Therapy alone.

The present study aimed to investigate difficulties in caring for a patient with cancer at the end of life at home and to examine relationships between difficulties with care and complicated grief. The 45 bereaved family members completed the Family Difficulty Scale (FDS) and the Inventory of Complicated Grief (ICG). The FDS score for “ Patient’s pain and condition” was the highest, followed by “ Caregivers did not want home care” and “No support from others.” There was a significant relationship between FDS and ICG scores. These results suggest that the condition of the patient, the view of the caregiver on home care, and the absence of other support are important factors contributing to difficulties of family caregivers, and that these difficulties may lead to complicated grief.

Objectives:The goals of this study were to investigate the changes experienced by bereaved family members in Japan and to determine what activities they would value in the future based on narratives from a bereavement life review, which is a type of psychotherapy used to treat depression and promote spiritual well-being.Methods:The participants were 20 bereaved Japanese family members who underwent two sessions of bereavement life review over a period of two weeks.Results:Using qualitative analysis, we identified four areas of changes (“learning from the deceased's death and self-growth,” “healing process,” “relating with others,” “relating with society,” and “performing new family roles”) and five categories of valued activities (“continuing grief work,” “living with a philosophy,” “attaining life roles,” “keeping good human relationships,” and “enjoying life”).Significance of results:“Learning from the deceased's death and self-growth” and “relating with others” are common in Japan and Western countries, whereas “relating with society,” “healing process,” and “performing new family roles” are more characteristic of Japan. The strength of bonding with the deceased may influence the values of bereaved family members. We concluded that bereavement life review therapy can contribute positively to their grief work.

This study aimed to examine the possibility of adaptation of the transtheoretical model (TTM) to narratives from the Bereavement Life Review. Narratives from 19 bereaved family members were recorded, transcribed into sentences, and allocated into stages based on the TTM criteria. Those who lived in fantasy were allocated to the precontemplation stage and who recognized the patient's death but could not adjust to the death were allocated to the contemplation stage. Those who understood the need for changes and had new plans were allocated to the preparation stage, and those who were coping were allocated to the action stage, and those who had confidence to remember the loved one who died were allocated to the maintenance stage. These results provide deeper understanding of a bereaved family member and suggest that a different intervention method may be useful in each stage.

The present study aimed to investigate the effects of the Bereavement Life Review on depression and spiritual well-being of bereaved families in a setting that does not specialize in palliative care. The participants were 20 bereaved family members who underwent the Bereavement Life Review over 2 sessions in 2 weeks. Beck Depression Inventory Second Edition scores significantly decreased from 14.4 ± 9.2 to 11.6 ± 7.4 ( t = 2.15, P = .045) and Functional Assessment Chronic Illness Therapy–Spiritual scores increased from 24.3 ± 10.1 to 25.9 ± 11 ( t = −1.0, P = .341) from pre- to postintervention. These results show that the Bereavement Life Review can decrease depression and improve spiritual well-being of bereaved families after the death of a family member in a setting without specialized palliative care. The results also suggest the universality of this therapy.

This study aimed to investigate the feasibility of art therapy for Japanese patients with cancer of the blood and bone marrow, to determine the efficacy on mood and spiritual well-being, and to record comments on the art. The subjects were 7 patients with stable disease who were recruited by a primary physician. In the first session of art therapy, the patients talked about their diseases and then made art to express their emotions. In the second session, they also made art. Drawing, colored pencils, collage, and pastels were used in both sessions and the patients commented on their art. The POMS (Profile of Mood Scale) and FACIT-Sp (Functional Assessment of Chronic Illness Therapy-Spiritual) were used to measure mood and spiritual well-being, respectively. POMS Depression and Fatigue scores tended to decrease after art therapy, while FACIT-Sp scores did not change and were standard for cancer patients. The explanations of the art reflected expressions of desire in the first session and hopes for the future in the second session. These results suggest that art therapy can decrease depression and fatigue in Japanese cancer patients, and promote expression of emotions, desires, and hopes with understanding of the seriousness of the disease.

Background: Since moral distress affects psychological aspects of psychiatric nurses, it is an important theme. Previous studies showed relationships between moral distress and job satisfaction; however, there are few studies which investigate relationships between moral distress and other effective variables and then we highlighted relationships among these variables. Objective: This study aimed to (1) examine relationships among moral distress, sense of coherence, mental health, and job satisfaction and (2) clarify the most predictive variable to job satisfaction. Research design: This study is a cross-sectional study. Participants were 130 psychiatric nurses in a hospital in Japan. They completed the Moral Distress Scale for Psychiatric nurses (Unethical conduct, Low staffing, and Acquiescence to patients’ rights violations), the sense of coherence scale (Comprehensibility, Manageability, and Meaning), the General Health Questionnaire, and the Job Satisfaction scale. Ethical consideration: This study was approved by the ethical board of St Mary’s College. Nurses participated voluntarily and were anonymous. Results: Results showed that subscales of the Moral Distress Scale for Psychiatric nurses negatively correlated to the sense of coherence and the Job Satisfaction. A multiple regression analysis showed that “Acquiescence to patients’ rights violations” of the Moral Distress Scale for Psychiatric nurses and “Meaning” of the sense of coherence influenced the Job Satisfaction much more than other variables. These two variables were correlated to job satisfaction scale, and other variables without them did not significantly correlate to job satisfaction scale. Discussion: These results suggest that moral distress negatively related to sense of coherence and job satisfaction, a subscale of the Moral Distress Scale for Psychiatric nurses and that of the sense of coherence affected the job satisfaction the most. Conclusion: Decreasing of acquiescence to patients’ rights violations and finding meaning in nursing may improve job satisfaction.

The aim of this study was to investigate the responses of Japanese psychiatric nurses to ethical problems, and the results of those issues. The participants were 130 nurses who worked in psychiatry wards in a hospital. The nurses answered the question "how did you respond when you faced an ethical problem and what results did you get?" in free description. Seven categories were selected qualitatively from their responses: "Lack of action and no change," "Experiencing problems and feeling gloomy," "Pointing out misconduct and being hurt," "Consultation among staff and resolution or not," "Consultation with physicians and getting positive or negative responses," and "Searching for and providing evidence-based care," and "Thinking for themselves." The facts that some nurses do not cope with ethical problems and some face moral distress without knowing what to do suggest that "improvement of moral efficacy to cope with ethical problems", "proposing resolution methods", and "organizational ethics support" may be useful.

Purpose: This study was performed to compare nursing students' attitudes toward death among South Korea, Japan and Indonesia, and to confirm the need for death education in nursing. Methods: A total of 294 nursing students completed a questionnaire titled as the Death Attitude Profile-Revised (Wong, Recker, Gesser. 1994). Participating students were from two nursing schools in South Korea, two in Japan and one in Indonesia. Data were analyzed by using descriptive statistics and inferential statistics including, -test, ANOVA and multiple comparison analysis. Results: The total mean score of the DAP-R for the three countries combined was . By country, the mean was the highest for Indonesian students (), followed by Korean () and Japanese () respectively. In relation to subcategories, Indonesian students showed the highest mean score for death avoidance () and approach acceptance (). Korean students marked the highest () in neutral acceptance and Japanese students scored the best () in escape acceptance. Nursing students who had an experience of caring terminally ill patients tended to be affirmative in approach acceptance (P=0.047). There were significant differences in each of the four subcategories except fear of death among the three countries (P

Objective: The aims of the study were to develop a Simple Life Review Interview as psychotherapy for terminally ill cancer patients with slight cognitive impairment, and to examine the feasibility and effects of this approach on spiritual well-being and quality of life. Methods: The participants were 5 terminally ill cancer patients in a palliative care unit. They completed questionnaires for the Functional Assessment of Chronic Illness Therapy-Spiritual (FACIT-Sp) scale, Good Death Inventory (Hope, Burden, Human Relationship, Respect as an Individual), and Distress and Impact Thermometer. Results: The Simple Life Review Interview consisted of viewing a DVD and reviewing the patient's life using questions that are applicable to terminally ill cancer patients with slight cognitive impairment. Overall, the FACIT-Sp score and the scores for Hope, Human Relationship, and Respect as an Individual on the Good Death Inventory increased, while the Burden score and the Distress and Impact Thermometer score decreased. However, there were some exceptions to these results. Conclusion: The Simple Life Review is feasible for terminally ill cancer patients with some cognitive impairments, and might be effective for improving spiritual well-being, Good Death, and psychological distress in these patients.

The aim of the study was to investigate the potential of Reminiscence Cognitive Behavior Therapy (RCBT) for improvement of spiritual well-being and self-esteem in patients. Five patients received the therapy over three sessions. The patients received RCBT consisting of reminiscence therapy and cognitive behavior therapy. They completed the FACIT-Sp, Rosenberg’s Self-Esteem scale, numeric rating scales for Suffering (from 0 to 6) and Depression (from 0 to 6). The FACIT-Sp scores increased from 19.2 ± 4.6 to 26 ± 1.6 (Z = –1.8, p = 0.078, n = 5), the Self-Esteem scores significantly increased from 40.0 ± 2.5 to 45.2 ± 2.4 (Z = –2.0, p = 0.042), the Suffering scores decreased from 3.6 ± 2.0 to 2.0 (Z = –1.5, p = 0.13), and the Depression scores decreased from 2.8 ± 2.2 to 1.8 ± 0.8 (Z = –0.9, p = 0.357). These results suggest that RCBT can improve the spiritual well-being and self-esteem of cancer patients.

The primary goal of the study was to assess the efficacy of mindfulness-based meditation therapy on the psychological well-being and sense of coherence of nurses with respect to coping with stress. The participants were 28 nurses working in a ward for elderly patients, with 15 included in the intervention group and 13 in the control group. Nurses in the intervention group received two sessions of mindfulness-based meditation therapy, including breathing, yoga movement and meditation. Each nurse was taught the program in the first session, then exercised at home with a CD, and subsequently met with an interviewer in a second session after two weeks. Nurses in the control group did not receive any interventions. The participants completed the General Health Questionnaire (GHQ), including subdomains of physical symptoms, anxiety and sleep disturbance, interference with social activities, and depression; and the Sense of Coherence (SOC) questionnaire, which includes three subdomains of comprehensibility, manageability, and meaningfulness pre- and post-intervention. The GHQ scores of the intervention group showed a significantly greater decrease than those of the control group. The SOC scores of the intervention group showed a significantly greater increase after the intervention compared to those in the control group, with the highest score for the meaningfulness subdomain. These results indicate that mindfulness-based meditation therapy is effective for improving the psycho-logical well-being and sense of coherence of nurses, which helps them to cope with stress.

This study was a secondary analysis of our parent study to examine the effects of the Short-term Life Review on spiritual well-being and psychological distress of terminally ill cancer patients and to identify factors associated with improvement of spiritual well-being. The subjects were 13 terminally ill cancer patients. The Short-term Life Review consisted of two sessions, and patients reviewed their lives with a psychologist. The patients completed the Functional Assessment Chronic Illness Therapy-Spiritual Well-being Scale and Hospital Anxiety and Depression Scale before and after the therapy. Factors were extracted from the narrative from the therapy using a text-mining PC software. The mean Functional Assessment Chronic Illness Therapy-Spiritual Well-being Scale score increased significantly from 15.92 ± 8.4 to 22.70 ± 8.1 after the intervention (Z= −2.3, P = .026), and the Hospital Anxiety and Depression Scale scores decreased significantly from 15.92 ± 6.37 to 11.23 ± 5.21 (Z = −2.38, P = .017). Improved spiritual well-being was associated with factors including "good family memories," "feeling of attainments," and "integrative life review." The Short-term Life Review can be effective for improvement of spiritual well-being and psychological distress.

Context Some bereaved families experience low spiritual well-being, such as lack of meaning of life or purpose and psychological distress like severe depression. Objectives The primary aim of this study was to investigate the effects of the Bereavement Life Review on the spiritual well-being of bereaved family members. The secondary aim was to investigate the effects of this therapy on depression. Methods Participants were 21 bereaved family members who lost loved ones in various palliative care units in Japan. They received the Bereavement Life Review, which consisted of two sessions for about 60 minutes each. In the first session, a bereaved family member reviewed memories with a clinical psychologist and answered some question. After the first session, the clinical psychologist made an album. In the second session, the family member and the clinical psychologist confirmed the accuracy of the contents of the album. The duration of the therapy was two weeks. The family member was assessed using the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being (FACIT-Sp) scale and the Beck Depression Inventory®-II (BDI-II) pre- and postintervention. Results FACIT-Sp scores increased from 19.9±5.8 to 22.8±5.1 (Z=−2.2, P=0.028 by Wilcoxon signed-rank test) and BDI scores decreased from 10.8±7.7 to 6.8±5.8 (Z=−3.0, P=0.003). Conclusions The Bereavement Life Review has the potential to improve spiritual well-being and decrease depression of bereaved family members. A further study with more participants is required to confirm the present findings.