Mitsue Maru

Introduction This study established an independent evaluation index for patients with childhood-onset chronic diseases in Japan. Methods From November to December 2020, three Delphi rounds were conducted. Thirty-nine participants completed at least one survey. We asked them about targets of social independence for 10 types of activities (education/labor/finance/acquisition of necessities/housing/transportation/leisure/social relationship/intimate relationships/sexuality). The Delphi technique was to be repeated until a consensus of over 80% of participants was reached. Results The targets chosen for measuring independence in patients with childhood-onset chronic diseases were as follows: “Graduation from high school,” “Labor for livelihood (including temporary turnover),” “Financially independent (including temporary turnover, excluding students),” “Buy or rent a house and buy the daily necessities and get the public services you need to live,” “Do housework alone,” “Plan alone and use transportation to get around,” “Participate in play/recreation/leisure activities on own initiative,” “Engage in relationships with other people outside of a limited environment (home, school, office, hospital, etc.),” “Create and maintain intimate or romantic relationships between individuals (couples, lovers, sexual partners),” and “Use or know how to use contraceptives and how to prevent sexually transmitted diseases.” Conclusions We established an independent evaluation index for patients with childhood-onset chronic diseases in Japan through a three-round Delphi process. The assessment of social independence using our independent evaluation index may help plan for and provide appropriate support and assistance to these patients.

AIM: To clarify the details of mothers' employment status after the completion of their child's cancer treatment. DESIGN: A cross-sectional exploratory study. METHODS: Data are collected from 62 mothers of childhood cancer survivors using self-report questionnaires. Fisher's exact test was used to determine the statistical significance of factors between the mothers who worked and those who did not work after their child's cancer treatment had been completed. RESULTS: Thirty-two mothers worked after the completion of their child's cancer treatment. There were significant differences in age, education level, employment status at the diagnosis and time elapsed since the diagnosis between the working mothers and non-working mothers. Twenty-two non-working mothers reported that they had some motivation to work, but the most common reason for not working was "To nurse or care for the child with cancer". Some mothers also stated that they did not work due to anxiety about cancer recurrence.

Since the Japan Pediatric Society published its “Recommendations on Transitional Care for Patients with Childhood-Onset Chronic Diseases” in 2014, there has been an increased interest in the health care transition of adolescents with childhood-onset chronic diseases in Japan. However, the actual status of healthcare transition was not studied yet. The purpose of this study was to explore the prevalence of transitional support for adolescent patients with childhood-onset chronic disease and the factors hindering their transition. We conducted an anonymous questionnaire survey in August 2020, targeting physicians and nurses involved in health care transition at 494 pediatric facilities in Japan. Survey items included demographic data, health care systems related to transition to adult departments, health care transition programs based on Six Core Elements (establishing transition policy, tracking and monitoring transition progress, assessing patient readiness for transition, developing the transition plan with a medical summary, transferring the patient, completing the transfer/following up with the patient and family), barriers to transition (34-item, 4-point Likert scale), and expectations in supporting transition (multiple-choice responses), which consisted of five items (78 questions); all questions were structured. Descriptive statistics were used for analysis. Of the 225 responses collected (45.5% response rate), 88.0% were from pediatricians. More than 80% of respondents transferred patients of 20 years or older, but only about 15% had took a structured transition process of four or more based on the Six Core Elements. The top transition barriers were “intellectual disability/rare disease” and “dependence on pediatrics” as patient/family factors, and “lack of collaboration with adult healthcare (relationship, manpower/system, knowledge/understanding)” as medical/infrastructure factors. The study provides future considerations, including the promotion of structured health care transition programs, development of transitional support tailored to the characteristics of rare diseases and disorders, and establishment of a support system with adult departments.

Adolescent and young adult (AYA) with cancer are at risk for developing sexual and reproductive problems; therefore, they have special needs. AYA with cancer treated in both pediatric and adult wards are a minority in Japan; thus, accumulating experience for supporting this unique patient population is difficult for nurses. Hence, this study aimed to clarify nurses’ perceptions on support for sexual and reproductive issues among AYA with cancer. A questionnaire survey was administered to nurses at designated cancer hospitals across Japan who had been working for at least 1 year in a department involved in the treatment or follow-up of patients aged 15–39 years. Nurses were asked regarding their perceptions on support for sexual and reproductive issues faced by AYA with cancer. A total of 865 nurses responded to this survey; nurses affiliated with adult departments, those with more experience in cancer nursing, those affiliated with cancer-related academic and professional societies, and certified nurse specialists or certified nurses significantly recognized insufficient support for sexual and reproductive issues. However, nurses were hesitant and found it difficult to intervene in such issues. Nurses recognized the importance of providing support for sexual and reproductive issues but faced difficulties in addressing them. They need to discuss these issues and improve the care provided to AYA with cancer.

Abstract According to national cancer registry data in Japan, approximately 20,000 adolescents and young adults (AYAs, age 15–39 years) are newly diagnosed with cancer each year. Improvements in treatment and care for AYAs with cancer are included in the Phase Three Basic Plan to Promote Cancer Control Programs in Japan. This article reviews current cancer incidence and survival for AYAs with cancer in Japan using population-based cancer registry data. Mortality data through 2019 from the Vital Statistics of Japan are also described. Encouragingly, the 5-year survival probability for AYA cancers has continued to improve, in parallel with childhood cancers, and the mortality rate has decreased. There has been increasing attention to these vulnerable patients and improved partnerships and collaboration between adult and pediatric oncology; however, obstacles to the care of this population still exist at multiple levels. These obstacles relate to specific areas: research efforts and enrollment in clinical trials on AYA malignancies, AYA-specific psychosocial support such as education, financial support, and oncofertility care, and cancer care systems. It is important for Japanese oncologists, health care providers, and health policy makers to recognize that the AYA population remains vulnerable and still have unmet needs.

Aim: We examined accuracy of nurses’ clinical judgement of graft-versus-host-disease (GVHD) symptoms and related factors using Common Terminology Criteria for Adverse Events (CTCAE) for patients who developed chronic cutaneous GVHD after haematopoietic stem cell transplants. Design: Cross-sectional design using nationwide survey. Methods: A questionnaire survey based on Tanner's clinical judgement model to assess patients with chronic cutaneous GVHD using CTCAE was used. Free-text descriptions and statistical analyses of relationship between correct responses and demographic data were performed. Results: The rate of correct responses for main symptoms of skin GVHD was < 50%; there was no statistical significance between correct responses and demographic data, knowledge about GVHD and collaborative practice with physicians. The accuracy of cutaneous GVHD clinical judgements was not directly related to nurses’ background. Educational opportunities that reinforce nurses’ abilities to reflect on knowledge and experiences to interpret patient symptoms are essential for improving accuracy of clinical judgement.

The purpose of this study was to clarify information sources and participants’ satisfaction with them, information needs, and information sources needs regarding sexuality and reproduction among childhood, adolescent and young adult (AYA) cancer survivors. We conducted a cross-sectional, self-administered online survey among adult survivors who had been diagnosed with cancer at 0–29 years of age. Questionnaire items included information sources and participants’ satisfaction with them, information needs, and information sources needs regarding sexuality and reproduction. We used data from 107 participants (mean age of 31.2 years old). Their most common information sources were friends, school, and the Internet (74–81%). Less common sources were doctors (34%) and nurses (17%). The top information needs were as follows: effects of diseases and treatments on their ability to reproduce and how to deal with them; illness disclosure to partners and their families; and other survivors’ stories about romantic relationships and having children. The information sources needs were the Internet, booklets (about 50%), same type cancer survivors, and doctors (around 40%). The information needs included not only reproductive information but also illness disclosure and survivors’ stories. Results show that it is necessary to provide information that meets survivors’ needs. Survivors want more information than ever about reproduction from medical professionals, who must make efforts to establish an information provision system. In the future, further studies are necessary to investigate whether survivors’ information needs are being met and to provide information that improves their quality of life.

Purpose: Childhood and adolescent survivors of cancerous lower-extremity bone tumors may be at unique risk of uncertainty about their future because of their specific cancer and/or physical disabilities secondary to treatment. This study aimed at clarifying survivors' uncertainty and related factors, including physical functioning, limb pain, and management of affected limbs. Methods: Self-administered questionnaires were distributed at two cancer hospitals in Japan. Thirty-six survivors diagnosed with osteosarcoma or Ewing sarcoma were included in our study. Uncertainty was evaluated by using Mishel's Uncertainty in Illness Scale-Community Form (MUIS-C), and physical functioning was evaluated by using The Toronto Extremity Salvage Score (TESS). Results: The average score of MUIS-C was lower that than reported for other previously studied childhood cancer survivors. Uncertainty was significantly higher in survivors who had lower levels of education, pain in their limbs, and difficulty managing their affected limb. Correlational analyses indicate that high scores for TESS, less limb pain, and high ability to manage affected limbs were related to low uncertainty. Conclusion: Health care providers need to assess survivors' degree of limb pain and their self-management for general health and affected limbs. It might be possible to improve their daily life. Assisting childhood and adolescent survivors of bone tumors to manage affected limbs and limb pain could prevent chronic uncertainty.

In addition to malignant diseases, hematopoietic stem cell transplantation (HSCT) is also a vital option as a curative therapy for non-malignant diseases, such as immunodeficiency, and other hematological disorders. Not only for malignant diseases, but for non-malignant diseases, cytotoxic therapy of conditioning regimens are associated with high risks of adverse effects; however, clinical details regarding the long term outcomes of cytotoxic therapy for non-malignant diseases are not documented yet. To clarify the endocrinological consequences of pediatric HSCT for non-malignant disease patients, we conducted a retrospective analysis. From 1983 to 2014, 75 patients that underwent HSCT for non-malignant diseases were selected for this study. Of these, 23 patients (19 men, 4 women) were continuously followed up in our institute, with regular health check-ups for late effects. Based on a multiple linear regression analysis, the glucocorticoid treatment duration for chronic graft-versus-host disease (cGVHD) and the conditioning regimen were found to be independent predictors of growth retardation. All four female patients developed hypogonadism, and required hormone replacement therapy. The conditioning regimen for the four female patients with hypogonadism was based on the use of alkylating agents, and two female patients were treated with a reduced-intensity conditioning (RIC) regimen. Our study revealed that even the RIC regimen was toxic for the gonads in female patients, and that the survivors of both non-malignant and malignant diseases should be followed up carefully after pediatric HSCT.

Background: Hematopoietic stem cell transplantation (HSCT) is a curative treatment for life-threatening malignancies and related diseases. Recently, the long-term prognosis of HSCT during childhood has greatly improved; however, the late adverse effects of HSCT have been found to cause substantial morbidity among long-term survivors. Although metabolic complications, such as diabetes mellitus (DM) and hyperlipidemia (HL), are the major late effects of pediatric HSCT, the clinical details are not clarified sufficiently. Methods: From 1983 to 2013, 75 participants underwent HSCT in our institute because of malignant or other related diseases. We retrospectively evaluated metabolic complications of eligible 22 participants (14 men and 8 women), and their clinical backgrounds. Results: Among 22 participants, 4 and 9 participants developed DM and HL after HSCT, respectively, and all participants with DM developed HL. None of the participants with DM were obese, and all had substantial insulin resistance. Total body irradiation (TBI) was performed in 10 participants, including 4 participants with DM and 5 participants with HL, revealing that TBI is an independent risk factor for DM. The age at TBI for participants with DM was significantly lower than that for participants without DM (p = 0.01), and all participants with DM received TBI before the age of 6. Conclusions: Our data suggested that TBI was a risk factor for DM after HSCT, and TBI before the age of six increased the possibility of DM without obesity.

Background: Female childhood cancer survivors who develop gonadal dysfunction require female hormone replacement therapy (HRT) from puberty until menopause. However, the support provided in such cases has not been studied. We investigated the physical and social characteristics and support needs of adult female childhood cancer survivors who underwent HRT. Methods: Forty-nine adult female childhood cancer survivors completed self-administered questionnaires. We compared the clinical characteristics, health status, and social conditions between a group that underwent HRT and a group that did not, and we surveyed support needs of the group that underwent HRT. Results: The median age of the subjects was 25.0 years (range 20−41). Twenty subjects (40.8%) underwent HRT. A significantly high number of those who underwent HRT also underwent radiation therapy (p < 0.01) and hematopoietic stem cell transplantation (p < 0.001), and none of them had a history of pregnancy or childbirth (p < 0.05). There were no significant differences in physical symptoms and social characteristics between the groups. Those who experienced anxiety regarding fertility required information about HRT, a platform to share their concerns, and psychological support and cooperation among healthcare providers. Conclusions: Although the subjects of this survey exhibited good social adjustment regardless of whether or not they underwent HRT, they were anxious about fertility. It is important to understand the concerns and anxieties unique to female childhood cancer survivors and to enhance psychological support in addition to providing educational support so that HRT can be administered.

Purpose: We investigated the marital status and the presence or absence of children in survivors of childhood, adolescent and young adult (AYA) high-grade sarcoma and examined the influence of these factors on the quality of life (QOL) of these survivors. Methods: Thirty-eight survivors of childhood and AYA high-grade sarcoma (18 males, 20 females) participated in a questionnaire survey on marital status and presence or absence of children, as well as on the health-related QOL (HR-QOL), using the Short Form 36 Health Survey. Diagnoses among these survivors were osteosarcoma (28 participants), Ewing’s sarcoma (4 participants), synovial sarcoma (4 participants) and others (2 participants). Results: Of the 18 males who participated in the survey, eight (44.4 %) were married, of whom five (62.5 %) had children. Fifteen (75.0 %) of the 20 females were married, of whom 14 (93.3 %) had children. The proportions of surviving male patients who were married and who had children, respectively, were lower than those of surviving female patients. The proportion of ifosfamide-treated men with children was significantly lower than that of non-ifosfamide-treated men (p = 0.018). With respect to the relationship between marital status and HR-QOL, the scores for the vitality and mental health domains of the SF-36 of survivors who were married were significantly higher than those of unmarried survivors. Conclusions: The results of our questionnaire survey reveal that among the male survivors of high-grade sarcoma, the proportions of those who were married and of those with children were lower than those of female survivors, suggesting that strategies providing support for marriage and child-rearing may be necessary for the male survivor group. In the married group, mental QOL was high.

Background: The Self-Directed Learning Readiness Scale for Nursing Education (SDLRSNE) assesses the extent to which an individual has the characteristics, capabilities, and attitudes required for self-directed learning. This study aimed to validate the Japanese version of the SDLRSNE with graduate-level nursing students. Method: Confirmatory factor analyses, using data from a cross-sectional online survey of 376 nursing students, were conducted to examine construct validity. Relationships with potential related factors were analyzed to evaluate construct validity. Reliability was evaluated with item analysis and Cronbach’s alpha. Results: Factor analyses revealed that three-factor and individual subscale models had a moderate-to-poor fit. No meaningful relationship with potential related factors was noted. Reliability measurements indicated a moderate fit to data. Conclusion: This study could not confirm that the Japanese version of the SDLRSNE had acceptable levels of reliability and validity when tested with graduatelevel nursing students. Further research is needed to examine the psychometric properties of the Japanese version of the SDLRSNE with other adult nursing learners or with graduate-level nursing students in other countries.

Background: Family members of children with cancer experience various long-term effects as a result of cancer diagnosis and treatment. Therefore, comprehensive and long-term support is needed. As the employment rate of women has increased in recent years, support for working mothers with children diagnosed with cancer is also required.

Self-directed learning is a process in which learners take initiative in determining their own learning needs and in choosing and evaluating appropriate methods of learning. Self-directed learning readiness describes the degree to which individuals, for instance adult learners in nursing, possess the necessary attitude and capabilities for self-directed learning, and can be measured by the Self-Directed Learning Readiness Scale for Nursing Education (SDLRSNE) developed by Fisher et al. The aim of this study was to develop a Japanese version of the SDLRSNE. After translation permission from the original developers was secured, development of the Japanese version of the SDLRSNE was conducted in the following three steps: translation from English to Japanese, back-translation, and pilot testing. We were able to establish the face validity of the Japanese version of the SDLRSNE. A Japanese version of the SDLRSNE may be useful to consider and evaluate the learner’s learning methods and to conduct international comparisons. We will examine and report on the validity and reliability of the Japanese SDLRSNE in the future.

PURPOSE: To examine the relationship between cancer-related fatigue (CRF) and physical activity in daily living in premenopausal disease-free cervical and endometrial cancer survivors.

本研究では、早産児の経口哺乳開始後における、母子相互作用、早産児のcueの種類と生起頻度、母親の早期産体験の癒し、の特徴を明らかにするとともに、母子相互作用との関連性の検証を行った。対象は、双生児3組を含む合計17組で、母親による授乳開始後、授乳場面をビデオ撮影し、Nursing Child Assessment Feeding Scale(NCAFS)を用いてコーディングを行い、母親に早期産体験の癒し尺度修正版を使用した質問紙調査を行った。結果は、児の修正週数上の発達に見合った役割を母親と児が互いに遂行することで、母子相互作用は行われていた。また、全児が何らかのcueを発しており、cueを介して母親とのコミュニケーションが可能であると考えられる。この時期の母親は、罪悪感や今後の不安を抱えつつも、早期産体験を内省し、かつ客観的に捉え前向きに意味づけていた。母親が早期産体験を内省し、前向きに意味づけるといった癒しが、母子相互作用と高い相関がみられた。NICU入院中、経口哺乳開始後の時期に、母親が、早期産体験を内省し前向きに意味づけることは、母子相互作用を遂行するうえで重要である。(著者抄録)

本研究は、小児がんの子どもの死を経験した看護師が、子どもが亡くなった時に感じることについてと、看護師へのグリーフケアにおいて望むことについての認識を明らかにすること目的とした。小児がん看護に携わる看護師を対象に質問紙調査を行い、104名から回答を得た。看護師はケアをしていた子どもが亡くなった時に、『チームで協力してケアを行えた』、『チームで考えを共有できた』、『親の意思を尊重できた』という回答が多かったが、『子どもの意思を尊重できた』という回答は最も少なかった。また、『悲しみやさびしさを感じる』、『子どもへのケアに対する無力感がある』という回答が多かった。看護師へのグリーフケアを目的としたカンファレンスについては、約4割の看護師があると回答し、『病棟スタッフと気持ちを共有することができた』という感想が最も多かった。終末期ケアを行う看護師は、子どもが亡くなる前後から様々な支援を求めており、継続教育の中にグリーフケアを位置付けていけるような取り組みが必要であることが示唆された。(著者抄録)

小児がん長期フォローアップに関する看護体制と看護の実態について明らかにすることを目的に調査を行い、小児がん治療を行う施設の外来看護管理者27名、病棟看護管理者36名より回答を得た。長期フォローアップ外来があると回答した18施設のうち、専任看護師を設置していないのは10施設で半数以上を占めていた。フォローアップ外来における看護内容として、診療の補助、身体計測、検査処置はほとんどの施設で行われていたが、長期的視点を持った看護を実施している施設は少なかった。36病棟のうち19病棟が入院治療終了時の説明を行っており、その方法としては看護師が患者家族用のパンフレット等を用いて説明していた。また、外来と病棟双方の申し送りについては外来14施設と、病棟16施設においてその内容が定まっていなかった。外来管理者および病棟管理者が治療終了後の小児がん経験者の看護において困難を感じた事例については、26事例の回答があった。GVHD等による複数の合併症・後遺障害や心理社会的な問題を重複して持つケースが多くみられ、特に家族に関する問題が多く挙げられていた。長期フォローアップにかかわる看護師は小児がんと治療による長期的影響に関連した健康教育の重要性に関する知識を持つ必要性が示唆された。また、小児がん経験者と家族への質の高いケアを提供するために、人的資源の不足と看護管理を改善する必要性が示唆された。(著者抄録)

小児がん経験者の長期フォローアップにおける支援のあり方を検討するために、全国の小児がん治療を行っている206施設の看護師を対象に小児がん経験者への看護経験の有無と優先度に関する認識、小児がん経験者の支援体制に関する認識について調査を実施し、136名より回答を得た。その結果、小児がん経験者の外来における看護では、身体面や心理面の把握、病状や治療に関する理解の促進は優先度、実施度ともに高い傾向であったが、進路・社会生活に関する支援、自立に向けた支援は優先度、実施度ともに低い傾向であった。治療による長期的影響に関する看護のうち、定期的な受診や健康的な生活習慣を勧めることについては重要度、実施度ともに高い傾向であったが、二次がん等への予防的介入はほとんど実施されていない状況であった。小児がん経験者の支援体制が整っていると回答した看護師は全体の3割で、チームにおける課題として支援体制の整備が挙げられた。また、小児がん経験者を支援するチームにおいて、看護師は多職種との連携・調整、セルフケア支援、日常生活に関する相談、心理的支援などさまざまな役割を担う必要性が認識されており、小児がん経験者の長期フォローアップにおける看護の専門性をよりいっそう向上させる必要性が示唆された。(著者抄録)

小児がんの子どもの終末期から死後の過程におけるケアと、看護師へのメンタルヘルスケアの実態を明らかにすることを目的に質問紙調査を行い、小児がん治療を行う施設の36病棟の病棟看護管理者より回答を得た。緩和ケアチームがある病棟は28病棟であり、ギアチェンジに関する方針があるのは10病棟であった。遺族へのグリーフケアを行っているのは6病棟のみであった。21病棟が終末期の患者をケアする看護師へのサポート体制があるとし、患者の死亡前後で病棟カンファレンスを行っていた。予期的なメンタルサポートは、行っている5病棟、以前行っていた1病棟であった。患者が亡くなった後にグリーフケアを目的としたカンファレンスは、行っている18病棟、以前行っていた6病棟、行っていない10病棟であった。小児がん患者の終末期におけるケア体制は、多職種も含めて充実しているものの、遺族に対するグリーフケアや看護師へのケアは十分とは言えなかった。カンファレンスの運営方法を含めた継続教育の必要性が認められた。(著者抄録)

Objective: Japanese physicians' attitudes regarding the health-care needs of young adult childhood cancer survivors (CCSs) are not well described. Thus, we examined the self-reported preferences and knowledge of pediatric oncologists and surgeons. Methods: A mailed survey was sent to 858 physician members of the Japanese Society of Pediatric Oncology. We compared the responses of pediatric oncologists and pediatric surgeons. Results: The pediatric oncologists' response rate was 56% (300 out of 533) and that of pediatric surgeons 32% (105 out of 325). The median age of respondents was 46 and 48 years, respectively; 79 and 84% were men. When comfort levels in caring for CCSs were described (i.e. 1 = very uncomfortable; 7 = very comfortable), the mean levels were 4.4 and 3.8 with CCSs ≤ 21 years, 3.6 and 3.6 with 21 years < CCSs ≤ 30 years, and 2.8 and 3.3 with CCSs > 30 years, respectively. In clinical vignette questions, 62% of the pediatric oncologists and 43% of the surgeons answered three or more questions appropriately. Pediatric surgeons reported significantly lower familiarity with long-term follow-up guidelines than pediatric oncologists. Most pediatric oncologists and many surgeons conducted truth-telling of cancer diagnosis to adult CCSs now. They thought that the most important issues are an original long-term follow-up guideline suitable for the Japanese situation and collaborations with adult-based general physicians. Conclusions: Many Japanese pediatric oncologists are uncomfortable with caring for survivors as they age and have suboptimal knowledge regarding late effects. The change in truth-telling situation and preference for collaboration with adult-based physicians was demonstrated also in Japan. © The Author 2012. Published by Oxford University Press. All rights reserved.

Background: Advances in medical science have enabled many children with chronic diseases to survive to adulthood. The transition of adult patients with childhood-onset chronic diseases from pediatric to adult healthcare systems has received attention in Europe and the United States. We conducted a questionnaire survey among 41 pediatricians at pediatric hospitals and 24 nurses specializing in adolescent care to compare the perception of transition of care from pediatric to adult healthcare services for such patients.Findings: Three-fourths of the pediatricians and all of the nurses reported that transition programs were necessary. A higher proportion of the nurses realized the necessity of transition and had already developed such programs. Both pediatricians and nurses reported that a network covering the transition from pediatric to adult healthcare services has not been established to date.Conclusions: It has been suggested that spreading the importance of a transition program among pediatricians and developing a pediatric-adult healthcare network would contribute to the biopsychosocial well-being of adult patients with childhood-onset chronic disease. © 2012 Ishizaki et al; licensee BioMed Central Ltd.

Chronic pain is a common problem in pediatric practice. The prevalence of chronic pain in children is >30%. Because pain indicates emotional expression as well as the physiological reaction toward infection, injury, and inflammation, both physiological and psychological assessments are essential to determine primary interventions for chronic pain. The Japanese Society of Psychosomatic Pediatrics Task Force of clinical practice guidelines for chronic pain in children and adolescents compiled clinical evidence and opinions of specialists associated with the primary care of pediatric chronic pain in the Japanese 'clinical guidelines for chronic pain in children and adolescents' in 2009, which are presented herein. The guidelines consist of three domains: general introduction to chronic pain; chronic abdominal pain; and chronic headache. Each section contains information on the physiological mechanism, psychological aspects, assessment methods, and primary interventions for pediatric chronic pain. These guidelines are expected to help disseminate knowledge on primary interventions for chronic pain in children and adolescents. © 2011 Japan Pediatric Society.

Nursing Child Assessment Teaching Scale(NCATS)日本語版の簡易版作成の予備的研究として、施策簡易版を作成し、その信頼性を検討した。そのため、0〜36ヵ月の乳幼児とその母親150組の遊び場面の録画データを分析対象とした。専門家、専門職者への質問紙調査の結果、施策簡易版によるコーディングに要した時間は1件あたり平均7分45秒であった。簡易版NCATSによるアセスメントの上で、やはり関係性に問題があると思われた親子には、家庭訪問や発達相談など、別の場面において、フルスケールの日本語版NCATSによるアセスメントと、専門家による面接を行う手順が望ましいと思われた。また、項目数を減らした簡易版で見落としてしまうであろう内容についての検討も重要な課題であり、簡易版作成には慎重な検討を繰り返す必要があると考えられた。

本研究は、病弱教育に携わる教員を対象に、10代慢性疾患患者の闘病生活支援、情報提供に関する考えについて調査を実施したものである。その結果、既存のインタラクティブメディアの使用経験は約3割であったが、子どもの理解を促すためには有効であると評価されていた。10代慢性疾患患者への情報提供の必要性は高く認識されており、情報提供の方法としてインタラクティブメディアを用いることに肯定的な意見が多く得られた。病弱教育に携わる教員は、学習指導だけでなく、子どものストレス軽減や心理的サポートを積極的に行っており、医療と教育が連携し、お互いの専門性を発揮しつつ、協力して子どもの闘病生活を支援していくことが求められていた。(著者抄録)

GCU(Growing Car Unit)を退院する前後の時期において、7組の早産母子と10組の満期産母子のcueと母子相互作用を比較検討した。母子相互作用とcueの観察にはNursing Child Assessment Feeding Scale(NCAFS)を用い、分析は統計学的分析と事例検討を合わせて行った。早産児群と満期産児群では大半のcueが共通しており、早産母子に対するNCAFSのcueを活用したコミュニケーション支援の可能性が示唆された。NCAFS得点は全ての下位尺度得点において両群間で差がなく、同質の母子相互作用が観察された。両群のNCAFS得点の変化および事例検討の結果より、母子相互作用の親得点には子どもとの相互作用の経験と学習が影響し、子どもに対する母親の注意力が強いときにcueに対する感受性が高まる可能性が示唆された。本研究の結果より、母親が子どもに接する経験の支援や、cueを教え、子どもへの注意力を高めるような看護援助が、母子相互作用促進に対し有用であると考えられた。(著者抄録)

小児癌看護に携わる看護師への支援に向けた「小児癌看護ケアガイドライン」開発のための基礎資料とすることを目的に、小児癌の子どもと家族の看護に携わっている看護師4名を対象に、小児癌の子どもと家族へのケアにおける困難についてフォーカス・グループ・インタビューを実施した。内容分析の結果、看護師が感じている困難として、件数の多い順に、1)感染予防対策、2)復学の問題、3)小児癌の子どもをもつ家族との関わり方、4)終末期における病状説明・意思決定、その後のフォローとケアの提供について、5)病名・病気についての説明、6)小児癌の子どもと家族の入院環境、7)看護記録内容の不足やスタッフ間の情報共有の難しさ、8)看護師の未熟さや知識の不足、のカテゴリーが抽出された。

小児癌看護に携わる看護師への支援に向けた「小児癌看護ケアガイドライン」開発のための基礎資料とすることを目的に、小児癌看護経験2年以上の看護師を対象に、小児癌をもつ子どもと家族のケアに関して問題に感じていることについて自由記述によるアンケート調査を実施し、235名より回答を得た(回収率24.5%)。内容分析の結果、看護師が感じている問題として、件数の多い順に、「家族への関わりに関連した問題」「子どもへの関わりに関連した問題」「病状や治療の段階に伴う問題」「病名告知に関連した問題」「病棟の環境や体制から生じる問題」に分類された。

小児癌の子どもと家族のケアのガイドラインの開発に資することを目的に、全国の施設を対象に小児癌の子どものケア環境についてアンケート調査を実施し、100施設(大学病院40、総合病院40、小児専門病院17など)より回答を得た(回収率45.7%)。その結果、小児専門病院では、スタッフや設備面で他の病院より環境が整っていたが、面会制限や付き添いの許可などの病棟規則が他の病院より規制される傾向にあることが分かった。

小児癌をもつ子どもと家族のケア29項目に関する看護師の認識を明らかにすることを目的に、全国の小児癌看護経験2年以上の看護師を対象にアンケート調査を実施し、209名より有効回答(21.8%)を得た。その結果、小児癌看護に携わる看護師は、子どもの気持ちを理解するために子ども自身や親と関わりをもつことを最もよく実施していると捉えていた。一方、最も難しいと認識していたのはターミナルケアで、地元の学校との退院後の調整についても難しさを感じていることが分かった。

児童虐待59件(男23件,女33件,不明3件).回答者は看護師27件(A群),保健師18件(B群),保育士14件(C群)であった.身体発育或いは知的発達に遅れのある子どもは各々41%,46%で,A群に多かった.虐待の種類が重複しているのが64%で,身体的虐待はC群,心理的虐待はB群に多かった.虐待者は実母が80%で,非虐待経験者は39%であった.虐待を疑ったきっかけはA群,C群では子どもや親の態度・症状,B群では他施設からの連絡や親からの訴えが多かった.援助で他機関と連携はA群70%,B群89%,C群50%で,B群では多種類の機関と連携していた.家族に対しては全体の46%が関りを持っていたが,A群では26%であった.子どもに対してA群は入院による保護,B群はフォローアップ的な援助,C群は心理面への対応が多く,援助継続はA群48%,B群94%,C群57%であった.虐待による問題は情緒行動的な問題が多く,その後虐待がなくなったのは15件,継続が22件,不明は21件であった

type:text 子どもに関わる看護・保育職を対象とし,子ども虐待に関する知識を深め,早期発見・対応できる能力を高める事を目的とした教育セミナーを計画,実施した.教育セミナー内容を,子ども虐待に関する情報や意識,対応を必要とした事例の実態についての調査,教育セミナーに対する要望に基づいて検討し,(1)子ども虐待に関する基礎知識,(2)A市の子ども虐待の現状,(3)看護・保育職の意識調査をもとにした,子ども虐待の早期発見・早期対処の視点,(4)シンポジウム「子ども虐待への取り組みの実際」の構成で実施した.教育セミナーの評価のため,参加した看護・保育職計155名を対象にアンケートを実施し,117名(74.0%)から回答を得た.その結果多くの参加者が子ども虐待事例に関わる場合に必要な知識や,実際の対応方法について,セミナーに参加して考えを深められたと回答していた.また,子どもに関わる各専門職が求める情報ニードや地域性に密着した,各専門職向けの個別の教育プログラムの必要性が示唆された. source:Journal of School of Nursing, Chiba University

type:text 本研究の目的は,子どもに関わる専門職である看護職の子ども虐待に対する意識を,保育職との比較から明らかにすることである.人口約90万の首都近郊都市であるA市内で子どもに関わっている看護職と保育職,合計598名を対象に自記式質問紙調査を行った.その結果両専門職は,外傷や暴力に関することなど子どもの身体症状からは虐待に気づきやすい傾向があった.しかし,虐待に気づきにくい点として,子どもや養育者の生育歴や社会的背景など,虐待に結びつく可能性のあるものや,養育者の仕事や育児方針などでやむを得ないと思われやすいが,子どもにとっては不適切である行為の,2点があることが明らかとなった.また,看護職の虐待に対する意識に影響する因子として,虐待のケースと関わった経験があることや,家庭に子どもがいて育児の経験があることがあげられ,保育職よりも,子どもの発達上の問題や身体的な傷に関して意識が高く,子どもの生活行動に関する問題に意識が低いことが明らかとなった. The purpose of this study was to identify nurses' perceptions of child abuse and neglect including comparing with those of nursery school teachers. Subjects were 598 nurses and nursery school teachers in the city with a population of 900,000. Two questionnaires were used to clear nurses' assessment abilities and nurses' perceptions of child abuse and neglect. The results indicated that 1) nurses had difficulty to suspect child abuse or neglect based on the background information of child and parents, 2) having children and working experiences of abuse cases promoted nurses' perceptions of child abuse and neglect, 3) suspecting child abuse and neglect based on physical symptoms or developmental problems of children was easier for nurses than nursery school teachers, 4) based on the situations of children's daily life was more difficult for nurses than nursery school teachers. source:Journal of School of Nursing, Chiba University