秋山 美紀

東京医療保健大学保健医療学部看護学科は、学科開設10年を機に将来構想「五反田vision2030」を策定した。看護学科FD委員会は、五反田ビジョン実現に向けて教員個々の身に付けたい力と抱える課題を明らかにすることを目的にFD研修会に参加した看護学科教員を対象にアンケート調査を行った。その結果、五反田ビジョンの6つのピースの中で実現したいピースは、「グローバル化への対応と発信」7名と最も多く、次いで「技と心の育成」6名、「自由な発想と研鑽」5名であった。五反田ビジョン実現に向けての課題として、教育力の向上や時間、資金、人員の確保等が挙げられた。看護学科FD委員会は、実現したいと回答した人数が多かったピースの実現を促進する支援を検討すると共に、実現したいと回答した人数が少なかった「変革と創造」と「チームで地域共創」も実現できるよう、他学科との共同研究の推進や企業、行政及び地域住民との情報交換の機会を設ける必要がある。(著者抄録)

【目的】ポジティブ心理学のアプローチで、新人看護師のレジリエンスを高めるプログラムを作成し効果を確認することである。【方法】研究対象は、2病院の新人看護師で本研究の参加に同意した37名であった。レジリエンスプログラム介入前後で、有効回答数34名について対応のあるt検定を行い、自由記載欄の質的分析を行った。【結果】資質的レジリエンス(p<0.001)は介入後に有意に向上した。また、ポジティブ感情(p<0.05)、セルフコンパッション(p<0.001)も有意に向上した。しかし獲得的レジリエンスには有意な差は見られなかった。【結論】本プログラムは、資質的レジリエンスの向上に効果がみられた。また、ポジティブ感情とセルフ・コンパッションの向上も見られ、一定の効果の可能性が示された。今後は獲得的レジリエンスの向上も目指したプログラムの精選、コントロール群を設けた検証、縦断的な研究が望まれる。(著者抄録)

本研究の目的は、精神看護学実習にストレングスモデルを適用させる方法を検討することであった。ストレングスの視点を導入した精神看護学実習を行う4病院の臨地実習指導者16名を対象に、同意のもと半構成的インタビューを実施した。逐語録の内容分析の結果、臨地実習指導者の困難感と懸念として【ストレングスモデルを看護実践と照合し理解する難しさ】【ストレングスの視点導入に対する懸念】、【学生のストレングスの視点に取り組む難しさ】が抽出された。それをもとに適用方法を検討したところ、ストレングスモデルの導入に際しては、臨地実習指導者の看護実践能力に敬意を払いながら理解を求め、ストレングスモデルと看護実践を照合する機会提供、実習課題の精選、導入後は、ゆとりある実習指導環境の整備、学生が適切にストレングスモデルを活用できるように教員と臨地実習指導者との連携などが必要であると考察した。(著者抄録)

This study primarily aimed to identify future actions required to promote palliative care in Japan. The future actions regarded as effective by the general population were improve physicians' skill in palliative care (61%), create a counseling center for cancer (61%), and improve nurses' skill in palliative care (60%). In contrast, future actions regarded as effective by the health care professionals were set up a Web site that provides information about cancer (72%), promote consultation with specialists in palliative care (71%), and open an outpatient department specializing in palliative care (70%). The results suggest (1) development and maintenance of settings; (2) enhancement of palliative care education and training programs for health care providers; and (3) improvement in distributing information about cancer and regional palliative care resources to the general population.

Background: The appropriate utilization of community services by people with mental health difficulties is becoming increasingly important in Japan. The aim of the present study was to describe service needs, as perceived by people with mental health difficulties living in the community and their service providers. We analyzed the difference between two necessity ratings using paired data in order to determine implications related to needs assessment for mental health services. Methods: This cross-sectional study used two self-reported questionnaires, with one questionnaire administered to mental health service users living in the community and another questionnaire to staff members providing services to those users at community service facilities. The study was conducted in psychiatric social rehabilitation facilities for people with mental health difficulties in Japan. The paired client and staff responses rated needs for each kind of mental health and social service independently. The 19 services listed in the questionnaire included counseling and healthcare, housing, renting, daily living, and employment. Overall, 246 individuals with mental health difficulties were asked to participate in this study, and after excluding invalid responses, 188 client-staff response dyads (76.4% of recruited people, 83.6% of people who gave consent) were analyzed in this study. A Wilcoxon matched-pairs signed rank test was used to compare the perceived needs, and weighted and unweighted Kappa statistics were calculated to assess rating agreement within client-staff dyads. Results: Over 75% of participants in our study, who were people with mental health difficulties living in the community, regarded each type of mental health service as "somewhat necessary," or " absolutely necessary" to live in their community. Most clients and staff rated healthcare facilities with 24/7 crisis consultation services as necessary. Agreement between client and staff ratings of perceived needs for services was low (Kappa = .02 to .26). Services regarding housing, renting a place to live, and advocacy had the same tendency in that clients perceived a higher need when compared to staff perceptions (p &lt; .01). Conclusions: It is essential for the service providers to identify the services that each user needs, engage in dialogue, and involve clients in service planning and development.

Context. The role of general practitioners (GPs) and district nurses (DNs) is increasingly important to achieve dying at home. Objectives. The primary aim of this region-based representative study was to clarify 1) clinical exposure of GPs and DNs to cancer patients dying at home, 2) availability of symptom control procedures, 3) willingness to participate in out-of-hours cooperation and palliative care consultation services, and 4) reasons for hospital admission of terminally ill cancer patients. Methods. Questionnaires were sent to 1106 GP clinics and 70 district nursing services in four areas across Japan. Results. Two hundred thirty-five GPs and 56 district nursing services responded. In total, 53% of GPs reported that they saw no cancer patients dying at home per year, and 40% had one to 10 such patients. In contrast, 31% of district nursing services cared for more than 10 cancer patients dying at home per year, and 59% had one to 10 such patients. Oral opioids, subcutaneous opioids, and subcutaneous haloperidol were available in more than 90% of district nursing services, whereas 35% of GPs reported that oral opioids were unavailable and 50% reported that subcutaneous opioids or haloperidol were unavailable. Sixty-seven percent of GPs and 93% of district nursing services were willing to use palliative care consultation services. Frequent reasons for admission were family burden of caregiving, unexpected change in physical condition, uncontrolled physical symptoms, and delirium. Conclusion. Japanese GPs have little experience in caring for cancer patients dying at home, whereas DNs have more experience. To achieve quality palliative care programs for cancer patients at the regional level, educating GPs about opioids and psychiatric medications, easily available palliative care consultation services, systems to support home care technology, and coordinated systems to alleviate family burden is of importance. J Pain Symptom Manage 2012; 43: 59-67. (C) 2012 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

Aims: The aims of this study were: (i) to clarify the general quality of life (QOL) of patients with intractable neurological disease; (ii) to clarify the general QOL of the caregivers of these patients; and (iii) to explore the association of QOL in patient-caregiver pairs. Methods: A cross-sectional survey was conducted between November 2003 and May 2004 among community-dwelling patients diagnosed with Parkinson's disease (PD), spinocerebellar degeneration (SCD), multiple system atrophy (MSA), and amyotrophic lateral sclerosis (ALS) and their caregivers using a mailed, self-administered questionnaire. To measure QOL, we used the Medical Outcome Study 36-Item Short Form (SF-36) for patients and the short form of the health-related QOL scale SF-36 (SF-8) for caregivers. Results: A total of 418 questionnaires were analyzed. For the patients, all of the general QOL domains of the SF-36 were significantly lower than the national standard value for all of the diagnoses. Physical function, role physical, and role emotional domains were also low. For caregivers, all of the QOL summary scores of the SF-8 for all diagnoses were significantly lower than the national standard value. Although there were several significant correlations of QOL between patients and caregivers, overall the correlations were low. Conclusions: Support for patients with neurological diseases and their caregivers is needed in order to maintain physical and mental QOL.

To investigate the cross-sectional association between organizational justice (i.e., procedural justice and interactional justice) and psychological distress or work engagement, as well as the mediating roles of other job stressors (i.e., job demands and job control, or their combination, effort-reward imbalance [ERI], and worksite support). A total of 243 workers (185 males and 58 females) from a manufacturing factory in Japan were surveyed using a self-administered questionnaire including the Organizational Justice Questionnaire, Job Content Questionnaire, Effort-Reward Imbalance Questionnaire, K6 scale, Utrecht Work Engagement Scale, and other covariates. Multiple mediation analyses with the bootstrap technique were conducted. In the bivariate analysis, procedural justice and interactional justice were significantly and negatively associated with psychological distress; they were significantly and positively associated with work engagement. In the mediation analysis, reward at work (or ERI) significantly mediated between procedural justice or interactional justice and psychological distress; worksite support significantly mediated between procedural justice or interactional justice and work engagement. The effects of organizational justice on psychological distress seem to be mediated by reward at work (or ERI) while those regarding work engagement may be mediated by worksite support to a large extent, at least in Japanese workers.

The possible associations of intragroup and intergroup conflict at work with psychological distress and work engagement were investigated in a cross-sectional study in a manufacturing factory in Japan. A self-administered questionnaire was sent to all employees, and 255 responses were returned (a response rate of 84%). Data from 247 workers (187 males and 60 females) with no missing values were analyzed. Intragroup and intergroup conflict at work, psychological distress, and work engagement were measured by the NIOSH-GJSQ, K6, and Utrecht Work Engagement Scale (UWES-9), respectively. An ANCOVA was conducted to compare K6 and UWES-9 scores among the tertiles on intragroup conflict or intergroup conflict scores, adjusting for demographic and occupational variables as well as worksite social support, separately for males and females. Intragroup conflict was associated with greater psychological distress for males (p for trend=0.009). Intergroup conflict was marginally significantly associated with psychological distress for both males and females (p for trend=0.050 and 0.051, respectively). Contrary to expectation, intergroup conflict was significantly associated with greater work engagement for females (p for trend=0.024). For males, intragroup and intergroup conflict at work may increase psychological distress for females, intergroup conflict may increase both psychological distress and work engagement.

The possible associations of intragroup and intergroup conflict at work with psychological distress and work engagement were investigated in a cross-sectional study in a manufacturing factory in Japan. A self-administered questionnaire was sent to all employees, and 255 responses were returned (a response rate of 84%). Data from 247 workers (187 males and 60 females) with no missing values were analyzed. Intragroup and intergroup conflict at work, psychological distress, and work engagement were measured by the NIOSH-GJSQ, K6, and Utrecht Work Engagement Scale (UWES-9), respectively. An ANCOVA was conducted to compare K6 and UWES-9 scores among the tertiles on intragroup conflict or intergroup conflict scores, adjusting for demographic and occupational variables as well as worksite social support, separately for males and females. Intragroup conflict was associated with greater psychological distress for males (p for trend=0.009). Intergroup conflict was marginally significantly associated with psychological distress for both males and females (p for trend=0.050 and 0.051, respectively). Contrary to expectation, intergroup conflict was significantly associated with greater work engagement for females (p for trend=0.024). For males, intragroup and intergroup conflict at work may increase psychological distress; for females, intergroup conflict may increase both psychological distress and work engagement.

The purpose of this study was to clarify administrators' perspectives on availability of recommended strategies for end-of-life (EOL) care for cancer patients at long-term care (LTC) facilities in Japan. A cross-sectional survey was conducted with administrators at Japanese LTC facilities. Participants were surveyed about their facilities, reasons for hospitalization of cancer patients, and their perspectives on availability of and strategies for EOL care. The 97 responses were divided into medical facility (n = 24) and non-medical facility (n = 73) groups according to physician availability. The most frequent reasons for hospitalization were a sudden change in patient's condition (49.4%), lack of around-the-clock care (43.0%), and inability to palliate symptoms (41.0%). About 50% of administrators believed their facilities could provide EOL care if supported by palliative care experts. There was no significant difference between facility types (P = 0.635). Most administrators (81.2%) regarded unstable cancer patients as difficult to care for. However, many (68.4%) regarded opioids given orally as easy to administer, but regarded continuous subcutaneous infusion/central venous nutrition as difficult. Almost all administrators believed the most useful strategy was transferring patients to hospitals at the request of patients or family members (96.9%), followed by consultation with palliative care experts (88.5%). Although LTC facilities in Japan currently do not provide adequate EOL care for cancer patients, improvement might be possible with support by palliative care teams. Appropriate models are necessary for achieving a good death for cancer patients. Interventions based on these models are necessary for EOL care for cancer patients in LTC facilities.

Objective: Three job stress models/concepts (the job demands-control [DC] model, the effort-reward imbalance [ERI] model, and organizational justice) have been linked to coronary heart disease (CHD) at work. In recent years, oxidative DNA damage has been identified as a new risk factor for CHD. However, evidence for the association between these job stressors and oxidative DNA damage is limited. The present cross-sectional study investigated the association between these job stress models/concepts and oxidative DNA damage as a possible mediator of the adverse health effects of job stress. Methods: A total of 166 male and 51 female workers of a manufacturing factory in Japan were surveyed using a mailed questionnaire regarding job stressors and demographic, occupational, and lifestyle variables. Urinary concentrations of 8-hydroxy-2&apos;-deoxyguanosine (8-OHdG), a biomarker of oxidative DNA damage, were also measured. Results: In male subjects, the urinary concentrations of 8-OHdG were significantly higher among the group with lower interactional justice, one of the two components of organizational justice; however, no association was observed with the DC model or the ERI model. In female subjects, high job demands/control ratio was significantly and positively associated with the urinary concentrations of 8-OHdG. Conclusion: Interactional justice among male workers and the DC model-based strain among female workers may be associated with increased urinary concentrations of 8-OHdG which possibly reflects oxidative DNA damage. (C) 2009 Elsevier Inc. All rights reserved.

Objectives: The aims of this study are to describe the care burden on caregivers of individuals with intractable neurological diseases and to clarify the prevalence of depression in caregivers and factors related to the presence of depression. Methods: A cross-sectional survey was conducted among caregivers who provide home care to patients with neurological diseases such as Parkinson disease (PD), spinocerebellar degeneration (SCD), multiple system atrophy (MSA), and amyotrophic lateral sclerosis (ALS), using a mailed, self-administered questionnaire. We used the Burden Index of Caregivers; to measure multi-dimensional care burden and the Center for Epidemiologic Studies Depression scale to determine the presence of depression among caregivers. Results: A total of 418 questionnaires were analyzed. Although several domains of care burden for caregivers were significantly different among the four diseases, the intensity of caregiving and hours spent caregiving were the main definitive variables. In addition, we described different aspects of the care burden using the multi-dimensional care burden scale. The prevalence of depression in caregivers was high (PD, 46%: SCD, 42%: MSA, 63%: ALS, 61%). Hours required for close supervision of the patient (P=0.015), intensity of caregiving (P=0.024), and low household income (P=0.013) were independently-related variables for depression in caregivers. Conclusions: The care burden of caregivers was mainly explained by the intensity of caregiving and hours spent caregiving per day, not only according to the disease. The high prevalence of depression indicates the need for effective interventions, especially for caregivers of patients with MSA and ALS. (C) 2008 Elsevier B.V. All rights reserved.

Reliability and Validity of the Japanese Version of the Organizational Justice Questionnaire: Akiomi INOUE, et al. Department of Mental Health, Graduate School of Medicine, The University of Tokyo-Objectives: Previous European studies reporting low procedural justice and low interactional justice were associated with increased health problems have used a modified version of the Moorman's Organizational Justice Questionnaire (OJQ, Elovainio et al., 2002) to assess organizational justice. We translated the modified OJQ into the Japanese language and examined the internal consistency reliability, and factor-based and construct validity of this measure. A back-translation procedure confirmed that the translation was appropriate, pending a minor revision. Methods: A total of 185 men and 58 women at a manufacturing factory in Japan were surveyed using a mailed questionnaire including the OJQ and other job stressors. Results: Cronbach alpha coefficients of the two OJQ subscales were high (0.85-0.94) for both sexes. The hypothesized two factors (i.e., procedural justice and interactional justice) were extracted by the factor analysis for men; for women, procedural justice was further split into two separate dimensions supporting a three-rather than two-factor structure. Convergent validity was supported by expected correlations of the OJQ with job control, supervisor support, effort-reward imbalance, and job future ambiguity in particular among the men. Conclusion: The present study shows that the Japanese version of the OJQ has acceptable levels of reliability and validity at least for male employees.

Few studies have revealed the impact of tele-coaching on patients with intractable diseases, including intractable neurological diseases. This study aimed to analyze and describe subjective evaluations of coaches and intervention subjects on the functions of tele-coaching intervention for patients with spinocerebellar degeneration. This qualitative descriptive study was conducted between December 2005 to July 2006. Immediately prior to data collection three experienced coaches had delivered individual 10 session semi-structured tele-coaching interventions to 24 subjects. Data from the 24 logs kept by coaches and individual interviews with the three coaches and nine patients were analyzed using a content analysis technique. Although patients' subjective evaluations varied, the themes that emerged from the data analysis were generally positive: that the tele-coaching enabled patients to tell their own stories in a daily-life setting, encouraged them to experience and adopt fresh points of view, and helped them to start working towards attainable goals without giving up. Our results indicate that it is especially important to encourage patients with intractable diseases to become aware of their latent desires and goals. For patients such as those with spinocerebellar degeneration the time frame for coaching interventions might be extended when required to accommodate treatment of their changing medical and mental condition.

Background: We constructed a concise multidimensional care burden scale that reflects circumstances unique to Japan, with a focus on intractable neurological diseases. We surveyed 646 family caregivers of patients with intractable neurological diseases or stroke using 28 preliminary care burden scale items obtained from qualitative research. The results were used to finalize the feeling of care burden scale (BIC: burden index of caregivers), and verify its reliability and validity. Methods: The survey was conducted among caregivers providing home health care to patients with intractable neurological diseases (PD [ Parkinson's disease], SCD [ spinocerebellar degeneration], MSA [ multiple system atrophy], and ALS [ amyotrophic lateral sclerosis]) or CVA ( cerebrovascular accident) using a mailed, self-administered questionnaire between November, 2003 and May, 2004. Results: Response rates for neurological and CVA caregivers were 50% and 67%, respectively, or 646 in total ( PD, 279; SCD, 78; MSA, 39; ALS, 30; and CVA, 220). Item and exploratory factor analyses led to a reduction to 11 items, comprising 10 items from the 5 domains of time-dependent burden, emotional burden, existential burden, physical burden, and service-related burden; and 1 item on total burden. Examination of validity showed a moderate correlation between each domain of the BIC and the SF-8 ( Health related quality of life scale, Short Form-8), while the correlation coefficient of the overall BIC and CES-D was 0.62. Correlation between the BIC and ZBI, a preexisting care burden scale, was high ( r = 0.84), while that with the time spent on providing care was 0.47. The ICC ( Intraclass correlation coefficient) by test-retest reliability was 0.83, and 0.68 to 0.80 by individual domain. Conclusion: These results show that the BIC, a new care burden scale comprising 11 items, is highly reliable and valid.