本田 順子

We organized a family nursing seminar employing virtual simulation for home visiting nurses. The seminar utilized gamification and a digitally simulated family to enhance family nursing competence. This study aims to evaluate the effectiveness of a seminar by conducting a β test of a virtual simulation. This study employed a descriptive design. Study period was from November of 2022 to January of 2023. Study participants were seven home visiting nurses at four Home-Visit Nursing Agencies in Japan. In the virtual simulation, participants communicated with the digitally simulated family created with Unreal Engine 5.0.0. Before and after the seminar, participants were asked to complete the Family Nursing Competency Scale and data were gathered through an open-ended questionnaire. The total scores on the Family Nursing Practice Competence Scale all increased after the seminar. In feedback, the instructor commented that the simulation scenarios and level of difficulty were appropriate but that the time schedule needed to be revised. Participants also commented on the reality and tension in the digitally simulated family and the lack of discussion. The integration of gamification and the digitally simulated family was positively accepted and increased the sense of reality and tension of the participants. However, there were problems with the recognition of achievement, time management of the debriefing sessions. Further modifications to this seminar design are needed.

Type 1 diabetes mellitus (T1DM) is typically diagnosed in pediatric patients. Transitioning from supported management in childhood to self-management in adolescence is an important step. Parental psychosocial influence is a possible factor in adolescents' disease control. This review summarized the effects of parental involvement on glycemic control in adolescents with T1DM by focusing on hemoglobin A1c (HgbAIc). A scoping review per the Guidance for Systematic Scoping Reviews was conducted with the following inclusion criteria: (a) studies in English, (b) focused on adolescents with T1DM, (c) outcomes included HgbAIc, and (d) focused on parental influence of children with T1DM. Of 476 articles, 14 were included. The study outcomes were classified based on direct or indirect influence. "Parental support for adherence" and "parental conflict" significantly affected HgbAIc control. This study provides current evidence on parental influence on glycemic control in adolescents.

There exists an international consensus on the importance of family-centered care (FCC) in intensive care settings and the evaluation of collaboration between nurses and families; however, FCC is currently practiced blindly in Japan. In this study, we developed a Japanese version of the questionnaire, Factors that Influence Family Engagement (QFIFE-J) and examined its reliability and validity. A web-based survey was conducted with 250 nurses working in the intensive care unit (ICU). Exploratory and validatory factor analyses were used to ascertain factor validity. Criterion-related validity was tested using correlation analysis with the ICU Nurses’ Family Assistance Practice Scale. Internal consistency and reproducibility were verified for reliability. Following exploratory and confirmatory factor analyses, a 15-item measure emerged comprising four factors: “ICU environment”, “nurses’ attitudes”, “nurses’ workflow”, and “patient acuity”. Confirmatory factor analyses showed a generally good fit. Cronbach’s α for the overall scale was 0.78, indicating acceptable internal consistency. The intraclass coefficient for test–retest reliability was 0.80. It was found that the QFIFE-J was reliable and valid and may help determine the factors that promote or inhibit FCC. Additionally, this study has also clarified the current status and family support related issues in ICUs in Japan.

Stigma among healthcare workers during the coronavirus disease 2019 (COVID-19) pandemic is an issue that requires immediate attention, as it may otherwise lead to the collapse of healthcare systems. In this study, we developed the COVID-19-related stigma scale for healthcare workers (CSS-HCWs) and assessed its reliability and validity. Data were collected online from 500 participants, including physicians and nurses involved in COVID-19 care. The first item of the draft scale was developed based on a literature review and qualitative study. The draft scale consisted of 24 items, which were rated on a six-point Likert scale. Descriptive statistics were calculated and the data distribution was analyzed. To assess the scale’s validity and reliability, structural validity was evaluated through an exploratory factor analysis. Criterion-related validity was examined through a correlation analysis using the E16-COVID19-S, a COVID-19 scale developed for physicians in Egypt. Reliability was evaluated by examining the scale’s stability and internal consistency. The findings revealed that the stigma scale was a valid and reliable instrument. The final scale consisted of 18 items across three domains: personal stigma, concerns of disclosure and others, and family stigma. In conclusion, the scale is a valid and reliable instrument that can measure COVID-19-related stigma among healthcare workers.

BACKGROUND: Critical illness is distressing for families, and often results in negative effects on family health that influence a family's ability to support their critically ill family member. Although recent attention has been directed at improving care and outcomes for families of critically ill patients, the manner in which nurses engage with families is not fully understood. OBJECTIVES: To describe nurses' perceptions and practices of family engagement in adult intensive care units from a global perspective. DESIGN: A qualitative-descriptive multi-site design using content analysis. SETTINGS: The study was conducted in 26 intensive care units of 12 urban, metropolitan, academic medical centers in ten countries, spanning five continents. PARTICIPANTS: A total of 65 registered nurses (77% women, age of M = 39.5, SD = 11.4 years) participated. Most held intensive care certification (72%) and had worked on average 10 (SD = 9.6) years in the ICU. METHODS: Semi-structured, individual interviews (M = 38.4 min, SD = 12.0) were held with ICU nurses at the hospital (94%) or their home using an interview guide. Qualitative interview data were analysed using inductive content analysis. RESULTS: We found that nurse-family engagement was an ebb and flow of relational power that needed to be carefully negotiated and balanced, with nurses holding and often exerting more power than families. Constant fluctuations in nurses' practices of engagement occurred in day-to-day practice from shift-to-shift and from nurse-to-nurse. Family engagement was dependent on individual nurses' attitudes and perceptions of family, the patient's condition, and workload. Lastly, family engagement was shaped by the ICU context, with team culture, collaborative relationships, unit structures and organizational resources either enabling or limiting nurses' ability to engage with families. CONCLUSIONS: This global study provides an in-depth understanding of the way nurses engage with families in ICU and reflects many different cultures and health systems. We found that nurse-family engagement was marked by a shifting, yet often unequal power distribution in the nurse-family relationship, inconsistent nurse engagement practices, both of which resulted in variable family engagement in intensive care. Our research contributes a detailed description of engagement as practiced in the everyday delivery of health care. A more concentrated team effort, based on a shared culture and defined framework of family care is needed to ensure that families of critically ill persons are fully engaged in all aspects of intensive care.

AIM: This study aimed to develop a Family Concordance Competency Scale for Family System Units (FCCS-Fa) for families with children having chronic disease, and to evaluate its reliability and validity. METHODS: FCCS-Fa was developed by taking the following steps: (a) drafting based on the elements comprising concordance between healthcare professionals and families with patients suffering from chronic illness; (b) evaluation of face and content validity by an expert panel; and (c) re-examination of face and content validity by semi-structured interviews with 16 families. Criterion-related validity was evaluated using the existing scale and construct validity was evaluated using exploratory factor analysis. Analysis of each FCCS-Fa evaluation item, internal consistency, and the 2-week test-retest reliability was also conducted. An anonymous self-reported questionnaire survey was conducted, targeting families with chronically ill children who were outpatients at three hospitals. RESULTS: A total of 196 subjects were analyzed. As results of FCCS-Fa item analysis and exploratory factor analysis, a scale structure comprised of 17 evaluation items and three factors were adopted. In addition, a significant correlation with several existing scales was identified and the criterion-related validity was also confirmed. The Cronbach's α coefficient for the overall scale was .927, the intraclass correlation coefficient applying the retest method was .905, and internal consistency and test-retest reliability were both confirmed. CONCLUSIONS: We developed FCCS-Fa with reliability and validity. Assessing family concordance competency using this scale and supporting families to achieve family concordance can lead to self-management by families.

Down syndrome (DS) is the most common genetic cause of intellectual disability worldwide. The purpose of this analysis was to determine the internal consistency reliability of eight language versions of the Family Management Measure (FaMM) and compare family management of DS across cultures. A total of 2,740 parents of individuals with DS from 11 countries completed the FaMM. The analysis provided evidence of internal consistency reliability exceeding .70 for four of six FaMM scales for the entire sample. Across countries, there was a pattern of positive family management. Cross-cultural comparisons revealed parents from Brazil, Spain, and the United States had the most positive family management and respondents from Ireland, Italy, Japan, and Korea had the least positive. The rankings were mixed for the four remaining countries. These findings provide evidence of overall strong internal consistency reliability of the FaMM. More cross-cultural research is needed to understand how social determinants of health influence family management in families of individuals with DS.

This literature review explored the factors promoting interprofessional collaborative practice for the child maltreatment prevention in Japan. We searched the Japanese database of ICHUSHI-web, focusing on studies published between 1990 and 2015. The studies were examined for methodological quality using the critical appraisal checklists. We initially identified 161 articles and finally selected eight studies that met the selection criteria and were analyzed. The Collaborative Practice Circle based on the Interprofessional Education for Collaborative Patient-Centered Practice framework, was used as a conceptual framework to analyze the data and to discuss the review findings. Data analysis continued until categories were saturated using content analysis. Five categories as interactional factors, two categories as organizational factors and three categories as systemic factors were identified. The findings revealed that interactional factors were composed of practical competencies and experiences of professionals. Our findings also indicate that educational programs for improving practical competencies of professionals at the individual level and establishing a system of training and human resource development at the organizational level are required. Further research is warranted to examine the impact the challenges outlined in the interactional factors, the organizational interventions and support for clients.

OBJECTIVE: To describe the current status of withholding or withdrawal of life-sustaining interventions (LSI) for neonates in Japan and to identify physician- and institutional-related factors that may affect advance care planning (ACP) practices with parents. STUDY DESIGN: A self-reported questionnaire was administered to assess frequency of withholding and withdrawing intensive care at the respondent's facility, the physician's degree of affirming various beliefs about end-of-life care that was compared to 7 European countries, their self-reported ACP practices and perceived barriers to ACP. Three neonatologists at all 298 facilities accredited by the Japan Society for Neonatal Health and Development were surveyed, with 572 neonatologists at 217 facilities responding. RESULTS: At 76% of facilities, withdrawing intensive care treatments was "never" done, while withholding intensive care had been done "sometimes" or more frequently at 82% of facilities. Japanese neonatologists differed from European neonatologists regarding their degree of affirmation of 3 out of 7 queried beliefs about end-of-life care. In hospitals that were more likely to "sometimes" (or more often) withdraw treatments, respondents were less likely to affirm beliefs about doing "everything possible" or providing the "maximum of intensive care". Self-reported ACP practices did not vary between neonatologists based on their hospital's overall pattern of withholding or withdrawing treatments. CONCLUSION: Among NICU facilities in Japan, 21% had been sometimes withdrawing LSI and 82% had been "sometimes" withholding LSI. Institutional treatment practices may have a strong association with physicians' beliefs that then affect end-of-life discussions, but not with self-reported ACP practices.

【目的】本研究では、国内の先行研究のレビューにより、わが国の透析療法を要する子どもをもつ家族の体験と家族への支援について明らかにし、その知見を統合することを目的とした。【方法】医中誌Webを用いて、先行研究の文献検索を行った。選択基準に該当した30件を分析対象とし、透析療法の経過別に家族の体験と家族への支援について内容分析を用いて分析、統合した。【結果】家族の体験として、家族の意思決定、日常管理のスキル習得、治療・療養に対する負担や不安、家族の役割調整などが明らかとなった。また家族への支援については、意思決定を支える支援、家族の不安を軽減する支援、透析の手技や管理に関する指導、在宅医療移行や日常療養管理への支援などが明らかとなった。【結論】本研究により、各時期における「家族の体験」が明確化できた。それらに沿った対応策を事前に考えておくことが重要である。(著者抄録)

BACKGROUND: The older adult population is increasing in number, and elder abuse is expected to become a more pressing problem. Developing tools to assess the presence and severity of elder abuse is important to both effectively prevent this abuse and provide increased support for families. PURPOSE: This study was intended to test the validity of an Assessment Tool for Domestic Elder Abuse (ATDEA). The items that constitute this tool were derived from a literature review. METHODS: Two rounds of self-administered questionnaire surveys were conducted with nurses working at home-visit nursing stations. Round 1 was used to evaluate the face validity, and Round 2 was used to test the content using the content validity index (CVI). RESULTS: Two hundred forty nurses participated in the two studies. In Round 1, 56 nurses evaluated 38 items derived from a literature review, resulting in the development of a 36-item ATDEA. In Round 2, 184 nurses evaluated the content validity of the 36-item ATDEA. The Item-CVI (I-CVI) scores ranged from .61 to 1. Twenty-eight of the items met or exceeded the I-CVI threshold of .78, whereas the eight items assessing self-neglect did not. The overall Scale-CVI score for the assessment tool was .90, which met the threshold of .90. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The results of validity testing established the preliminary validity of this assessment tool. In addition, as self-neglect is known to damage the well-being of older adults, six of the eight items assessing self-neglect were retained in the ATDEA despite their failure to meet the threshold I-CVI of .78. The remaining two self-neglect items were not included in the ATDEA because of excessively low I-CVI scores (< .70). Thus, the final version of the ATDEA includes 34 items. The authors recommend that nursing professionals use the ATDEA as a checklist to assess the presence of elder abuse and to discern the subtypes and severity of this abuse. When evaluating elder abuse, the higher the degree of severity, the greater the urgency to provide support.

背景と目的:慢性疾患患者やその家族の療養管理における効果的なセルフマネジメントには、コンコーダンスという家族と医療職者の関係に着目した概念が重要である。本研究の目的は、家族同心球環境理論にもとづく家族ケア/ケアリングモデルを理論的基盤とした慢性疾患患者・児がいる家族と医療職者の家族コンコーダンスの構成要素を明らかにすることとした。方法:医中誌Webとハンドサーチから得られたコンコーダンスに関する46件の文献・書籍を対象とし、内容分析により個人のコンコーダンスの構成要素を明らかにした。これからインタビューガイドを作成し、慢性疾患患者・児がいる9家族に対して半構造化面接調査を実施し、家族と医療職者との家族コンコーダンスの構成要素をGraneheimとLundmanによる内容分析を参考にして分析した。結果:家族コンコーダンスの構成要素として、【家族システムユニットと医療職者間における協働】【対等な関係の構築】【知識と価値観にもとづくやりとり】という家族システムユニットと医療職者間における事象、【家族内における協働】【家族の意思決定】という家族システムユニット内部における事象、【医療職者間における協働】という医療職者間における事象が抽出された。考察と結論:家族コンコーダンスは、家族ウェルビーイングに作用する家族環境に焦点化した家族同心球環境理論の枠組みでとらえることができ、この概念にもとづく家族支援は家族のセルフマネジメントの実現と家族ウェルビーイングに寄与できることが示唆された。(著者抄録)

養育期家族の父親はさまざまな役割をもつが、役割獲得不全も起こり得る。本研究は、父親役割獲得不全への影響因子を文献検討により明らかにすることを目的とした。医中誌WebとPubMedで「父親役割」などをキーワードにして最新10年分の論文を検索した。法橋が提唱した家族同心球環境理論に基づき32件の論文の内容分析を行い、影響因子を抽出した。危険・原因/促進因子は【母親/妻の予期せぬ妊娠】など8カテゴリー、予防・阻止/抑制因子は【良好な夫婦関係】など10カテゴリー、状況依存性因子は6カテゴリーがあり、家族同心球環境理論の視座から、これらの影響因子に働きかけて父親役割獲得を促す家族支援が必要である。(著者抄録)

背景と目的:慢性疾患児と家族にとって退院がその後の在宅療養の継続につながるために、家族の意向や意思決定に着目した家族支援を行うことが必要である。家族の意向や意思決定には家族/家族員ビリーフが影響しているため、本研究では、慢性疾患児の退院に影響する家族/家族員ビリーフの全体像を明らかにすることを目的とした。方法:慢性疾患児の退院や在宅移行に関する国内の看護研究73本の文献検討の結果、さらに、慢性疾患児の退院支援を実施した経験をもつ12名の看護師と退院を経験した12家族への半構造化面接の結果を対象として、KJ法を参考に分析した。結果:[在宅療養生活へのサポート]など、慢性疾患児の退院に影響する35の家族/家族員ビリーフが明らかとなった。これらは、【患児の成育環境】【患児と一緒に暮らす家族像】【退院後の家族システムユニットの生活】という3つの媒介的なビリーフ、【実人生の羅針盤】という1つの核心的なビリーフに分類できた。考察:とくに【退院後の家族システムユニットの生活】にある[在宅療養生活へのサポート]が多くの家族/家族員ビリーフの影響を受けており、サポートのニーズがあるが得られないという家族/家族員ビリーフの存在が明らかになったので、ソーシャルサポートを充実させる退院支援は有効であると考えられる。また、慢性疾患児に関する家族/家族員ビリーフだけでなく、同胞など慢性疾患児以外の家族員に関する家族/家族員ビリーフが存在することが明らかとなり、家族全体を視野に入れた家族支援が重要である。(著者抄録)

近年の小児がん治療の進歩により、患肢温存手術もしくは切・離断術を含むがん治療の後に社会復帰を果たす小児がん経験者は増加傾向にある。しかし、患肢温存手術もしくは切・離断術を受けた子どもに焦点をあてた研究は少ない。本研究では、入院中に焦点を当て、学童期・思春期に小児がんを発症し、患肢温存手術もしくは切・離断術を受けた小児がん経験者の入院生活での体験を質的に明らかにし、支援を検討することとした。合計10名の小児がん経験者に半構成面接を実施した結果、入院生活での心配事として、【治療に関する苦痛・不安】など3カテゴリーが、困難として【身体機能の変化に伴う日常生活に関する困難】など4カテゴリーが、入院生活で得たこととして【治療に対する前向きな感情】など4カテゴリーが明らかとなった。患者が手術後の身体機能の変化や術後の状態を想定しながら、生活をイメージし、理解できるようにする支援が必要であることが示唆された。(著者抄録)