坂下 玲子

The process by which stroke survivors move toward health while facing various difficulties can be construed as a "transition." Importantly, nurses need to understand and support this state of transition effectively. This study developed a situation-specific theory to explain post-stroke transition by integrating the findings of a qualitative study that explored the rehabilitation experiences of stroke survivors with dysphagia with a scoping review of qualitative studies using the theoretical framework of transition theory. This theory will help understand the transitions that stroke survivors with dysphagia undergo during recovery and provide a framework for exploring nursing care to support healthy transitions.

目的：看護小規模多機能型居宅介護（看多機）に特徴的なサービス情報の発信と運営状況との関係を明らかにする． 方法：介護サービス情報公開システムに公表された全国の看多機のテキスト情報を厚生労働省から入手し，KH Coderを用いて語の使われ方の特徴を分析した．看多機に特徴的である医療依存度や看取りに関する語を使用していた事業所とそれ以外に分け，利用者数や従業員数，サービスの実施状況を比較した． 結果：医療依存度や看取りに関する語を使用していた事業所は，使用していない事業所よりも要介護5の利用者数，看護職員の常勤人数が有意に多く，処置の実施率も人工肛門の1項目を除く，12項目で有意に高かった． 結論：医療依存度や看取りに関する語を発信していた事業所は，より多くの利用者を確保し多様なサービスを展開していることが示唆された．今後は事業所管理者が看多機サービスの理解を深め，運営に反映できるような支援が求められる．

背景・目的:本研究では,先行研究において抽出された看護小規模多機能型居宅介護(以下,看多機)で働く看護師に求められるコンピテンシーの内容と,実際に看多機で働く看護師の優れた看護実践から,コンピテンシーの内容妥当性を検討することを目的とした.方法:看護師や施設管理者11名を対象にフォーカスグループインタビューを2回実施し,コンピテンシー評価指標(大項目・小項目)案の内容妥当性を検討した.結果:その人の希望に沿いながら「生きる」ための支援を重視するという意見から【看取りを支える】は【最期まで「生きる」を支える】に修正された.また【その人を支えるチームをつくる】は,平時から地域資源を活用する必要性の指摘を受けて【その人を地域で支えるチームをつくる】に修正された.家族の介護負担を軽減する支援の重要性から【家族を支える】が新たに追加された.変更のなかった【その人の生活の中で歩み寄りを続ける】【その人や家族の強みを引き出し生活に取り入れる】【個々に合わせ臨機応変にケアを創造する】【命をまもる】【その人の居場所をつくる】と合わせ,大項目は8つとなった.小項目の妥当性についても検討と修正した結果,37項目から48項目となった.考察:フォーカスグループインタビューでは利用者だけでなく家族支援が望まれていた.本調査を経て,看多機で働く看護師のコンピテンシーが精錬され,内容妥当性は確保された.(著者抄録)

Background Japan is a superaging society unparalleled in the world. Elderly people who need medical care do not receive adequate support in the community. As a new service to address this issue, a small-scale multifunctional in-home care nursing service called Kantaki was created in 2012. Kantaki, in collaboration with a primary physician, operates 24 hours a day and provides various nursing services (home visits, home care, day care, and overnight stays) to older people living in the community. The Japanese Nursing Association is working hard to promote this system; however, its low utilization rate is an issue. Objective This study aimed to determine factors influencing the utilization rate of Kantaki facilities. Methods This was a cross-sectional study. A questionnaire on the operation of Kantaki was sent to all administrators of Kantaki facilities operating in Japan from October 1 to December 31, 2020. A multiple regression analysis was used to determine factors associated with a high utilization rate. Results Responses from 154 of the 593 facilities were analyzed. The average utilization rate for all valid responding facilities was 79.4%. The average number of actual users and the break-even point were almost equal, resulting in little surplus profit from facility operations. A multiple regression analysis showed that factors that had a significant impact on the utilization rate included the break-even point, a surplus of users relative to the break-even point (ie, the margin of revenues), the number of months in office of the administrator, the type of corporation (ie, nonprofit), and Kantaki’s profit from operating home-visit nursing offices. The break-even point, a surplus of users relative to the break-even point, and the number of months in office of the administrator were robust. In addition, support for reducing the burden on family helpers, a service sought by the system, significantly and negatively affected the utilization rate. In the analysis that removed the most influential factors, the cooperation of the home-visit nursing office, Kantaki’s profit from operating the home-visit nursing office, and the number of full-time care workers were significantly related. Conclusions To improve the utilization rate, managers need to stabilize their organization and increase profitability. However, a positive relationship was found between the break-even point and utilization rate, suggesting that simply increasing users did not contribute to cost reduction. Moreover, providing services that meet the needs of individual clients may result in lower utilization rates. These results, which are inconsistent with common sense, reflect the divergence between the assumptions underlying the system’s design and actual conditions. To solve these issues, institutional reforms, such as an increase in nursing care fee points, may be necessary.

【目的】本研究では,2型糖尿病が強く疑われる人とそうでない人の生活習慣の比較を行うことを目的とした。【方法】A市において2008年度から2019年度までに国民健康保険の健康診査を受診した30歳以上の男女のうち,解析項目に欠損がある人,既に生活習慣改善に取り組んでいる人を除く10,401名を解析対象とした。糖尿病が強く疑われる人を「HbA1c(NGSP値)が6.5%以上かつ/または血糖値を下げる薬の服薬ありの人」と定義し,χ2検定を用いて糖尿病の疑いの有無の2群間で生活習慣の比較を行った。その後,糖尿病が強く疑われる/それ以外を従属変数,各生活習慣項目を独立変数,性別と年齢で調整した二項ロジスティック回帰分析を行った。解析は65歳未満と以上で行った。【結果】二項ロジスティック回帰分析の結果,65歳未満の対象者においては,日常生活において歩行または同等の身体活動を1日1時間以上実施していない人,他の人と比較して食べる速度が速い人,就寝前の2時間以内に夕食をとることが週に3回以上ある人は,そうでない人と比較して糖尿病が強く疑われる人のオッズ比がそれぞれ1.69倍(95%信頼区間:1.22-2.32),1.31倍(1.01-1.72),1.52倍(1.12-2.07)であった。一方,お酒を時々あるいは毎日飲み,かつ1日当たり1～2合飲む人では,ほとんど飲まない・飲まない人と比較して糖尿病が強く疑われる人のオッズ比が0.65倍(0.46-0.92)であった。65歳以上の対象者では,日常生活において歩行または同等の身体活動を1日1時間以上実施していない人,ほぼ同じ年齢の同性と比較して歩く速度が速くない人,他の人と比較して食べる速度が速い人は,そうでない人と比較して糖尿病が強く疑われる人のオッズ比がそれぞれ1.41倍(1.18-1.70),1.21倍(1.01-1.45),1.29倍(1.09-1.53)であった。【結論】本研究より,糖尿病予防のためには65歳未満,65歳以上の人に共通して身体活動を行うこと,早食いをしないことが重要であり,加えて65歳未満の人では就寝前2時間以内の夕食摂取に注意すべきことが示唆された。(著者抄録)

The purpose of this article is to discuss the current status of research mentoring in nursing across 4 countries (the United States, Taiwan, South Korea, and Japan) and to make suggestions for future research mentoring. Seven leaders reflected on the current status of research mentoring in nursing, provided exemplars/cases from their own experiences, and their reviews of the literature. Six themes were discussed: (a) "culturally defined"; (b) "professionally contextualized"; (c) "teaching research integrity and research practice"; (d) "with mutual respect and care"; (e) "based on effective communication"; and (f) "supported by institutional and governmental commitment and infrastructure."

OBJECTIVES: Breast milk is a valuable and useful source of nutrition; however, surplus milk is routinely discarded for hygiene reasons despite an unclear scientific basis. Here, we profiled the microbiota of expressed breast milk before and after feeding with an artificial nipple and examined the bacterial survival in breast milk stored at 4°C. METHODS: Eleven mother-baby pairs were included in the study. Samples of expressed breast milk were collected before and after feeding with an artificial nipple and examined both immediately (0 h) and after storage for 3 and 12 h at 4°C. Each sample was inoculated onto a blood agar plate and incubated anaerobically and aerobically at 37°C. Genomic DNA was extracted from individual bacterial colonies, which were identified by 16S rRNA gene sequencing. RESULTS: Before feeding, the bacterial counts at 0 and 12 h were (1.4 ± 1.6) × 105 colony-forming units (CFU)/mL and (1.4 ± 0.6) × 105 CFU/mL, respectively. Staphylococcus (47.7% and 41.9%, respectively), Cutibacterium (20.7% and 36.0%, respectively), and Streptococcus (16.1% and 6.6%, respectively) were identified among the samples. In contrast, after feeding, the bacterial counts at 0 and 12 h were (2.7 ± 1.7) × 105 CFU/mL and (2.1 ± 2.5) × 105 CFU/mL, respectively. Staphylococcus (30.1% and 37.4%, respectively), Cutibacterium (11.7% and 31.7%, respectively), and Streptococcus (41.5% and 25.2%, respectively), were identified among the samples. CONCLUSIONS: Bacteria were present in the breast milk before feeding. Although the main component of the microbiota shifted from Staphylococcus to Streptococcus species after feeding, these results suggest that surplus expressed breast milk may be preserved safely in a refrigerator for at least 12 h after feeding with an artificial nipple.

目的:看護小規模多機能型居宅介護(以下,看多機)で働く看護師の行動特性を明らかにする.方法:看多機の施設長から推薦された看護師29名を対象に行動結果面接法を参考に半構造的面接を行い質的記述的に分析した.結果:看多機で働く看護師の成果は,【利用者・家族の生活の質の向上】【利用者・家族に提供するケアの質の向上】の2カテゴリーと8サブカテゴリー抽出された.これら成果につながる行動特性として【その人の生活の中で歩み寄りを続ける】【その人や家族の強みを引き出し生活に取り入れる】【個々に合わせ臨機応変にケアを創造する】【命をまもる】【看取りを支える】【その人の居場所をつくる】【その人を支えるチームをつくる】の7カテゴリーと37サブカテゴリーが抽出された.結論:今回抽出された看護師の行動特性によって,最期まで住み慣れた自宅や地域で暮らし続けていくという看多機の役割が促進されることが期待される.(著者抄録)

With the recent impact by the COVID-19 pandemic, nursing research has gone through unexpected changes across the globe. The purpose of this special report is to present the commonalities in the impact of the COVID-19 pandemic on nursing research across four countries, including the United States, South Korea, Japan, and Taiwan, and one region, that is, Hong Kong, and to make recommendations for future nursing research during the immediate postpandemic period and future pandemic situations. To identify the commonalities, seven researchers/leaders from the five countries/regions had discussions through 3 days of an international workshop. The content for this discussion paper derived from: (a) the exemplars/cases of the COVID-19 impact on the research process, (b) researchers/leaders' presentations on the COVID-19 impact, and (c) memos from the workshop. The materials were analyzed using a simple content analysis. The commonalities included: (a) "a heavy emphasis on teaching and fluctuating productivity," (b) "increased funding opportunities and governmental support," (c) "gendered experience complicated by professional differences," (d) "delays and changes/modifications in research process," (e) "limited research settings and difficulties in getting access," and (f) "increased online dissemination activities with positive changes in the image of nursing." With all collective wisdom that nurse researchers have obtained during the COVID-19 pandemic, nursing research will evolve again for the successful future of the nursing discipline.

OBJECTIVES: To clarify the characteristics and growth of bacteria that may infiltrate liquid baby formula during feeding and after storage for more than 3 h, the transfer of oral bacteria through artificial nipples, and bacterial survival in liquid baby formula and a baby drink were examined immediately after drinking and after storage at 4 °C for 12 h and 24 h. METHODS: Thirteen human subjects (aged 19-24 years) were asked to drink approximately 50 mL of liquid baby formula and a baby drink, via the artificial nipple of a baby bottle. Samples of the remaining liquid after storage at 4 °C for 12 h and 24 h were inoculated onto blood agar plates and incubated anaerobically at 37 °C for 7 days. Genomic DNA was extracted from individual colonies, and the bacterial species were identified by 16S rRNA gene sequencing. RESULTS: The mean concentrations of bacteria in the liquid baby formula were (2.6 ± 2.8) × 104 and (4.1 ± 6.6) × 104 colony-forming unit/mL after storage at 4 °C for 12 h and 24 h, respectively. Streptococcus (43.2%), Veillonella (9.3%), and Schaalia (8.2%) species were recovered from the remaining liquid baby formula after storage at 4 °C for 12 h. In contrast, no bacteria were detected in the remaining baby drink after storage at 37 °C for 24 h. CONCLUSIONS: The levels of bacteria immediately after drinking and after storage at 4 °C for 12 h or 24 h were similar, suggesting that remaining liquid baby formula may be preserved safely in a refrigerator for more than 3 h.

This longitudinal study aimed to clarify the relationship of oral health in infancy with that in adulthood among participants who were the subjects of the oral health promotion project (OHPP) conducted in Miyako Island, Okinawa Prefecture, Japan, since 1984. Twenty-seven subjects, around 35 years of age, were examined for dental caries, periodontal diseases (community periodontal index), dental plaque, occlusion, and bite-force and compared with those at 4 and 13-15 years of age. The dental caries status and maximum bite force in adulthood was significantly reflected for those at 4 and 13-15 years of age (p < 0.05). CPI in adulthood was related to the dental caries status at 4 and 13-15 years of age but not to the gingival score at 4 years of age, and it was weakly related to the gingival score at 13-15 years (r = 0.264, p > 0.05). Most of the normal occlusion at 4 years of age became normal permanent occlusion in adulthood (88.9%). Most of the cases involving the discrepancy factor retained the same condition in both the deciduous and permanent dentitions (83.3%) (p < 0.001). Those who participated in the OHPP soon after birth showed significantly fewer DMFT (p < 0.05) compared with those who did not. This study revealed that oral health at 4 years of age was related to that in adulthood, suggesting that fostering good oral health soon after birth is of great importance.

【目的】健やかな地域生活を促進するためのプログラムへの参加高齢者に対する,COVID-19の感染拡大防止対策の影響と,それによって生じた身体状況及び生活状況の変化を明らかにすることである。【方法】プログラム開始前,プログラム実施6ヵ月後,再開時の3回分の評価が揃っている参加高齢者13名(全員女性,平均年齢80.5歳)を対象とし,身体状況の計測値と生活状況の変化について分析した。【結果】プログラム開始前,プログラム実施6ヵ月後,再開時の比較で,体重,骨密度,2ステップテスト値に有意な変化が確認された。体重は51.4kg,49.1kg,51.2kgと変化し(p=.013),介入前と再開時の比較に減少が認められた。また,骨密度は66.0g/cm2,76.0g/cm2,73.2g/cm2と変化し(p=.013),介入前と介入6ヵ月後の比較で上昇が認められ,2ステップテスト値も0.9,1.1,1.0と変化し(p=.018),介入前と介入6ヵ月後の比較で上昇が認められた。また,生活上の変化として「体調に問題ない」と「外出を控えた/頻度が減少した」の回答者数は同数だったが,その半数に「足腰の弱りを自覚する」状況があり,転倒や骨折による入院に至ったケースもあった。【結論】本研究の結果より,COVID-19の感染拡大による半年以上の健やかな地域生活を促進するためのプログラム休止は,参加高齢者の外出頻度を低下させ,運動機能に影響を与えたことが分かった。高齢者にとって低下した運動機能を引き上げることは容易ではなく,骨折など受傷に伴う入院は廃用性症候群を引き起こす可能性もある。今後は感染対策下であっても,高齢者の活動の場を確保できるような新たな交流方法を整備するとともに,地域で生活する高齢者に持続的にアプローチできる支援活動が必要である。(著者抄録)

© The Author(s) 2020. Introduction: Because virtually no theories were available to explain unique characteristics of Asian women’s leadership in nursing, a middle-range theory on women’s leadership in Asian culture was previously published. To reflect recent political and social changes in different countries, there is a necessity to refine the theory. The purpose of this article is to present the refined middle-range theory on Asian women’s leadership in nursing. Methodology: Using an integrative approach, the theory was further developed based on two major sources: literature reviews and exemplars/cases from six different countries. Results: The Refined Middle-Range Theory on Women’s Leadership in Asian Culture has two main domains: (a) leadership frames and (b) leadership contexts. The domain of leadership contexts has been extended with two additional main concepts including demographic contexts and health workforce/system contexts. Discussion: The refined theory is expected to guide Asian women’s leadership in nursing across the globe.

© 2020 Sigma Theta Tau International Purpose: Despite the importance of research in the discipline of nursing, current trends in nursing research have rarely been discussed across countries. The purpose of this article was to identify current trends in nursing research across five countries, including the United States, South Korea, Taiwan, Japan, and Hong Kong, in order to provide directions for future global nursing research. Organizing Construct: A discussion article. Methods: To identify the current trends, seven leaders from the five countries had discussions through a series of workshops and conference presentations. After the most recent conference, all the leaders reflected for a month on their presentations and compiled the exemplars and cases from their experience and the existing literature in individual countries into a table. The tables and supporting references were collected at the completion of the reflection period. Then, the PowerPoint (Microsoft Corporation, Redmond, WA, USA) slideshows of the conference presentations by the leaders and the collected tables were analyzed using a content analysis. Findings: Six themes reflecting the current trends in nursing research were extracted: (a) demographic alterations; (b) increasing diversities and globalization; (c) technology innovation; (d) individualized or personal care and population health initiatives; (e) health policies and regulations; and (f) nursing workforce changes. Conclusions: Future directions for nursing research across the countries were proposed: (a) cost-effectiveness research; (b) implementation science; (c) data science; (d) training of the future generation of nurse researchers; (e) population health; and (f) team science. Clinical Relevance: This topic could be applied to any clinical settings.

© 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/). The aim of this study is to determine the effect of food consistency on health and related factors among residents in welfare facilities for seniors (n = 227; mean age, 86.2 ± 8.0 years; 78.9% female). Residents who ate regular food had a lower incidence of fever during the 3-month period (p < 0.001) and consumed more calories (1325.97 ± 220.2 kcal) than those who ate chopped (1125.0 ± 256.8 kcal), paste (1122.0 ± 288.5 kcal), and gastric tube food (812.5 ± 150.7 kcal) (p < 0.001). Modifying a resident's food by making it softer and finer did not reduce the incidence of choking. Logistic regression analysis (backward elimination method) revealed four factors related to eating regular food: vitality index, appetite, number of remaining teeth, and choking frequency. Causal relationships were not obtained because this was a cross-sectional study. The findings of this study suggest that a regular consistency of food positively influences the health of older individuals.

【背景】高齢化率の進展に伴い，地域包括ケアシステムが推進されている。2012年より，複合型サービス（現在名称は，看護小規模多機能型居宅介護，以下看多機）が創設され，訪問看護・訪問介護，通所，宿泊を組み合わせて包括的な生活支援ができるサービスが展開されているが，全国規模での開設・運営状況の情報は明らかにされていない。【目的】全国の看多機に関する情報や人口動態に関する情報を用いて，看多機の運営状況や開設地域の特徴を明らかにすることである。【方法】「介護事業所・生活関連情報検索」のウェブサイトを用いて，2018年12月31日の時点で登録されている全看多機を対象とし施設属性，運営状況，従業員情報等を抽出した。また，同ウェブサイトから都道府県別の看多機数，小規模多機能型居宅介護数（以下，小多機数），訪問看護事業所数を抽出した。「国勢調査」等から都道府県別の高齢化率，人口密度，人口の情報を収集した。分析は度数分布・記述統計分析，スピアマンの相関係数を用いた相関分析とした。【結果】全国の看多機数は479であった。都道府県別の看多機数は平均10.19±10.51であった。市町村別でみると，1724の市町村のうち233（13.5％）に看多機が所在した。看多機数と有意な相関（相関係数ρ）を認めたのは，小多機数（.765），訪問看護事業所数（.747），人口（.703），人口密度（.513）が正の相関，高齢化率（-.442）が負の相関であった。【考察】地域別の看多機数には大きなばらつきがみられ，高齢者の割合の高い地域ではなく，人口の多い地域や人口の密集した地域に多く開設されていた。過疎地では職員確保やサービス供給コストが影響する可能性があると考えられる。今後，どの地域でも安定して看多機が運営され，拡大するためには，現在生じている運営課題を明らかにしていくことが重要であると考えられる。

This study evaluated the effectiveness of a life-enhancement program designed to focus on dining conditions in welfare facilities for seniors living in Japan. Effectiveness was specifically evaluated based on whether improvements were achieved in (1) nutritional status, (2) oral health, (3) frequency of fever, and (4) vitality of appetite across three sites. As part of a comprehensive-care initiative that began with dining support, the program consisted of two main components: (1) a 3-month intensive program comprised of (a) collective experiential learning for residents and staff (including nutritionists, nurses, and physiotherapists) and (b) a tailor-made individual program for residents followed by (2) a 3-month continuation program. Participants included 168 individuals (31 males and 137 females) from a total of three facilities (average age was 85.9 [60-104] years). Results showed that the intensive program significantly improved nutritional status (e.g., BMI, caloric intake, and water intake; P < 0.000-0.005) and tongue movement (P < 0.000) while significantly reducing dental-plaque and tongue-coating indices (P < 0.000). Significant improvements were also achieved for degree of appetite and vitality indices (P < 0.000-0.001). However, incidences of fever were not reduced. These findings indicate that the program effectively improved nutritional status, oral health, vitality, and appetite. However, these effects did not sufficiently remain once the program was finished, thus suggesting the need for a continuous intervention.

【目的】看護学の発展のためには研究や実践と密接にリンクする理論が必要であることから， Situation Specific Theory（状況特定理論 以下，SST）という新しいタイプの理論が提案され，20年が経った。本研究では文献レビューを通して，SSTに関する論文数や内容の変遷，構築手法や活用された情報源を分析することを通じてSST構築の発展経過を明らかにするとともに，SST構築の今後の展望を得ることを目的とする。【方法】CINAHL，PubMed，医学中央雑誌を用い，国外誌には"situation specific theory" situation specific theories"をキーワードとし，国内誌にはさらに「状況特定理論」を加えて検索を行い，88件の論文が抽出された。スクリーニングを経て得られた50件の論文を対象とし，論文の発行年や論文内容で分類を行った。さらにSSTを構築した論文に対して，理論の構築手法と活用した情報源の分析を行った。【結果】英語論文は47件あり，理論構築，概念分析，理論の下位レベル概念の明確化，理論検証，理論を枠組みとした研究，総説・解説の6種類に分類された。また，論文の公表数は年代を経るにつれて増加していた。SSTとして構築された理論が検証され，研究の枠組みとして使われ，看護学の知の構築に貢献している状況が明らかとなった。SSTの構築が行われた論文は23件で，いずれも特定の領域や対象に限局された現象を取り扱っていた。構築手法としては統合的アプローチが最も多かったが，それ以外の手法を用いた論文も認めた。構築の情報源として，既存の理論，研究データ，文献レビューが多く活用されていた一方で，実践経験の活用は少なかった。【結論】SSTは数を増やし続けており，理論検証やSSTを枠組みとした研究もおこなわれ，これから看護学領域内での認識が拡大していくものと予想される。また，統合的アプローチ以外の構築手法も出現していることから，今後はより多様なアプローチを通して，より多くのSSTが生み出されていくことが期待される。

© 2019, Biomedical Research Foundation. All rights reserved. It is suspected that oral bacteria are transferred to the liquid baby formula through the artificial nipple and multiply in the bottle after feeding. In the present study, in order to understand the influence of bacteria on liquid baby formula after feeding, the transfer of oral bacteria through artificial nipples and their survival in liquid baby formula were examined immediately after drinking as well as after storage at 4°C for 3 h. Four healthy human subjects (20-23 years old) were asked to drink liquid baby formula (Aptamil®, ca. 50 mL) from baby bottles using artificial nipples. Samples of the liquid baby formula (immediately after drinking and 3 h later) were inoculated onto blood agar plates and incubated anaerobically at 37°C for 7 days. Salivary samples from each subject and 6 newborn infants were also cultured. Genomic DNA was extracted from individual colonies, and bacterial species were identified by 16S rRNA gene sequencing. The mean amounts of bacteria (CFU/mL) were (3.2 ± 3.0) ×104 and (3.4 ± 3.3) ×104 immediately after drinking and 3 h later, respectively. Streptococcus (41.6 and 40.5%), Actinomyces (24.3 and 21.5%) and Veil-lonella (16.2 and 11.0%) were recovered from the samples immediately after drinking and 3 h lat-er, respectively. On the other hand, Streptococcus (38.9%), Actinomyces (17.1%), Neisseria (9.1%), Prevotella (6.9%), Rothia (6.9%) and Gemella (5.1%) were predominant in the saliva of adult subjects, and Streptococcus (65.2%), Staphylococcus (18.5%), Gemella (8.2%) and Rothia (5.4%) were predominant in the saliva of infant subjects. From these findings, oral bacteria, e.g., Strepto-coccus, Gemella and Rothia, were found to transfer into the liquid baby formula through artificial nipples, and the bacterial composition in the remaining liquid baby formula was found to resem-ble that of human saliva. The bacterial levels were similar between immediately after drinking and when stored at 4°C for 3 h, suggesting that the remaining liquid baby formula may be preserved in a refrigerator for a specified amount of time.

© 2018 International Council of Nurses Background: Continuing education is vital for the development of the competencies of nurses and midwives. We analysed the effectiveness of a distance education programme for maternal and child health nurses and midwives in Mongolia, assessing its strengths and limitations and ways in which it could be improved. The aim of this research is to provide an analysis of the successes and failures of the programme, in order to improve future versions of this and similar programmes in Mongolia and elsewhere. Methods: We carried out a qualitative descriptive study in Mongolia in August 2015. This consisted of three semi-structured interviews and two focus groups in the Second National Hospital, Ulaanbaatar, and three semi-structured interviews and one focus group in Dornogovi Provincial Maternal Hospital, Sainshand, Dornogovi Province. In total, there were 22 participants in our research. Data from the interviews and focus groups were thematically coded and analysed using NVivo version 10. Findings: The distance education programme is well received by participants. They suggest that it has improved their clinical practice and education in a number of areas, and are anxious for the programme to continue. A number of alterations would be necessary to improve both the quality of the programme and the ability of participants to foster change on the basis of what they have learnt. This provides challenges for both the programme organizers and the providers of maternal and child health services in Mongolia. Implications for nursing and/or health policy: The success of the distance education programme suggests that collaborations of this type are a cost-effective method of disseminating best practice in policy and practice to improve the quality of care provided to mothers and children in low-resource settings. Conclusions: A distance education programme is vital to link maternal care providers in Mongolia to new trends in care. Mongolia's relative isolation means that this programme is particularly valuable there. However, the programme could work equally well in other developing country settings.

© 2018, The Author(s) 2018. Introduction: Asian cultures reflect patriarchal cultural values and attitudes, which likely have influenced women leaders in their countries differently from women in Western cultures. However, virtually no leadership theories have been developed to reflect the experiences and development of nursing leaders from Asian cultures. The purpose of this article is to present an emerging integrated middle-range theory on Asian women’s leadership in nursing. Methodology: Using an integrative approach, the theory was developed based on three major sources: the leadership frames of Bolman and Deal, literature reviews, and exemplars/cases from five different countries. Results: The theory includes two main domains (leadership frames and leadership contexts). The domain of leadership frames includes human resources/networks, structure/organization, national/international politics, and symbols. The domain of leadership contexts includes cultural contexts, sociopolitical contexts, and gendered contexts. Discussion: This theory will help understand nursing leadership in Asian cultures and provide directions for future nurse leaders in this ever-changing globalized world.

Mutual respect and harmonious relationships between people can be viewed as the fundamental spirit of Japanese culture. Japanese leaders try to keep the peace in human relations, rather than to achieve a goal. They become leaders due to internal and external conditions, rather than their own abilities. Japanese society has been basically male-dominated though the ratio of women leaders has increased recently. Higher education and development of academic societies in nursing have been very successful during the last two decades and nursing is one of the most trusted professions in Japan. However, some Japanese people still think a nurse is just an assistant to doctors. The purpose of this paper is to clarify features of women's leadership in Japan from the nursing point of view. In Japanese culture, leaders need to possess human resource leadership as an indispensable element, while good leaders may have advantages in all four frames of leadership including structural, human resource, political, and symbolic frames. Japanese organizations are also supported by excellent followership which might be influenced by the structure of Japanese society which is called "the vertical society" where leaders are fostered from among followers. What is important in Japanese leadership is to have a vision that leadership leads to the happiness of all people in a shareable form.

© 2017 TSI® Press. Objectives: A program fostering self-management for the elderly was implemented and the effects of the program and their continuities were assessed. Methods: Subjects consisted of 19 males and 131 females (average age, 73.1 ± 7.4; range, 60–94 years). The intervention program consisted of the collective experience learning and private consultation. The collective experience learnings included; (1) monitoring the oral condition and practicing oral self-care, (2) monitoring the oral function and practicing oral exercises, and (3) group discussion on continuing oral self-care. Outcomes were evaluated at the beginning and the end of the intervention program, and three months after the investigation by the scores in; (1) oral self-care (2) oral condition, i.e., decayed teeth, community periodontal index (CPI), deposits of plaque and dental calculus, (3) oral function such as RSST, oral diadochokinesis, (4) QOL (SF-8 v2™, and GOHAI), and (5) cognitive function (MMSE-J). Informed consent was obtained from all subjects, and this study was approved by the Research Ethics Committee of the University of Hyogo. Results and Discussion: At three months after intervention, 124 subjects continued participating and 88 subjects (71%) completed all data. On the oral self-care, subjects cleaned their teeth more often and longer than before (P < 0.001). The use of dental floss and interdental brushing significantly increased in number (P < 0.001), and 67 participants (54%) visited the dentist during the program. CPI and deposits of plaque were significantly reduced after intervention (P < 0.001). The scores of oral function also significantly improved (P < 0.001–0.05). The scores of QOL (physical health), oral QOL and cognitive function significantly improved (P < 0.001–0.05). These results suggest that this program not only promotes oral self-care, resulting in good oral health conditions, but also improves cognitive functions of the elderly.

© 2016 IEEE. In this paper, we discuss a classification method of nursing-care texts using the word2vec [1]. The word2vec is a tool which provides the continuous bag-of-words and skip-gram implementations for realizing word vectors. We have tackled to classify nursing-care texts, which are freestyle Japanese texts, for improving nursing quality in several years. Several machine learning methods have been used for classifying such texts. To train a machine learning method, we used a word list which contains words appeared in the training data. Since the word list is a mere list, the relation among words is not considered. Also the length of the list depends on the number of words. Word vector representation proposed in [2]-[4] realized word representations in arbitrary dimensional space. We use the word2vec as a alternative word list in this paper. And we propose a new feature vector definition which is based on dependency structures in a text. From experimental results, we compare the proposed definition with our previous works.

© 2015 Japanese Association for Oral Biology. Objectives The frequency of periodontitis among elderly is increasing in Japan. This study aimed to quantify the periodontitis-associated bacteria in subgingival plaques from elderly patients with periodontitis and from periodontally healthy subjects. Methods Subgingival plaque samples were collected from independent subjects (mean age=71.1 years, n=518). All samples were subjected to real-time PCR analysis to assess the presence of Porphyromonas gingivalis. In addition, we tested for Tannerella forsythia, Eubacterium saphenum and Streptococcus oralis in the earliest 95 samples; and performed fimA gene classification of P. gingivalis in the latest 49 samples. Results P. gingivalis and T. forsythia comprised a significantly higher proportion of total bacteria in subjects with periodontitis (1.1% and 5.1%) than periodontally healthy subjects (0.3% and 1.4%, respectively). The proportion of E. saphenum was low in both groups, whereas that of S. oralis was higher in periodontally healthy subjects. In 24 of 49 samples, fimA genotypes were detected and classified. Genotypes Ib (n=5) and II (n=7) were identified in those of subjects with periodontitis (n=15); while those of healthy subjects (n=9) were found to belong to genotypes I (n=2), II (n=2), III (n=2) and IV (n=3). In 4 out of the 5 subjects in whom P. gingivalis was detected at healthy sites, the fimA genotypes were identical between periodontitis and healthy sites, but the mean proportion of P. gingivalis was significantly higher at periodontitis sites (3.0%) than at healthy sites (0.5%) (P<0.05). Conclusions This study suggests that an increase in P. gingivalis and T. forsythia may be associated with periodontitis in the elderly, and we have identified characteristic pathogenic fimA genotypes that target this vulnerable group.

【目的】ニーズ調査に基づくオーダーメイド型の臨床看護研究支援プログラムを作成した。臨床看護師を対象に、そのプログラムを実施し評価することによって、支援プログラムの効果について検討した。【方法】臨床看護研究への支援を申し出た臨床看護師グループに対し、セミナーと演習、個別相談を組み合わせた臨床看護研究支援を行った。セミナーは4回開催した。評価方法として受講者(研究協力者)に、セミナー毎に「とても」を最もよい評価とし、「まあまあ」「ふつう」「あまり」「まったく」の5段階評価で無記名のアンケートを実施し、演習・個別相談については自由記載で回答を得て内容分析を行った。【結果】研究者は受講者(研究協力者)の研究計画段階から支援を始め、研究をまとめていくプロセスに沿って、オーダーメイドな支援を行っていた。データ分析は多くの場合、研究者が行っていた。受講者(研究協力者)へのアンケートで、5段階中4点以上の割合は「内容は理解できましたか」が76.2%、「あなたの期待する内容でしたか」が76.2%、「今後に役立つ内容でしたか」が95.3%で、高い評価を得たと言える。自由記載では(1)研究について知識を得た(2)思考が整理された(3)研究の困難さを実感した(4)研究についてスキルアップできた(5)研究支援への期待の5カテゴリーが抽出された。【考察】(1)受講者(研究協力者)へのアンケート結果から、今回提供した支援プログラムは臨床看護師に評価の高い内容であった。(2)データ分析を実践するには一定の訓練を要することがうかがえた。(3)各グループの支援過程の概要から、研究支援は早期から行う必要があることがわかった。(4)各グループの支援過程の概要から、研究者のタイムリーな支援が臨床看護師の不安や困難感を軽減していることが分かった。(著者抄録)

【目的】高齢者の食事の物性に関しては誤嚥防止の観点からしか十分な関心が払われていない。普通食は咀嚼を要するので、唾液分泌を促し免疫や口腔衛生に貢献し、また廃用性萎縮の防止や咀嚼嚥下機能の維持増進が期待できる。そこで、本研究は、1)食形態は肺炎の発生と関連があるか、2)食形態は栄養状態と関連するか、3)食形態とムセは関連するか、4)普通食摂取を可能にする要因は何か、という4つの研究疑問を解くことを目的とした。【方法】調査対象は一特別養護老人ホーム入居者80人(男性13人、女性67人)、平均年齢88.7歳であった。調査項目は、1)食形態(普通食、軟菜、キザミ食、ペースト食、胃瘻)、2)健康状態(要介護度、認知症高齢者の日常生活自立度、既往歴、発熱、BMI、摂取カロリー量、水分摂取量、食欲、ムセの頻度、Vitality index)、3)口腔状態(現在歯数、義歯数、う歯、咬合、舌機能)であった。本研究は兵庫県立大学看護学部研究倫理審査委員会の承認をうけ実施した。【結果・考察】1)食形態は肺炎の既往や発熱と有意な関連があった。過去3ヵ月間の発熱は、普通食摂取者25人中5人(20.0%)に対し、ペースト食摂取者22人中12人(54.5%)、胃瘻16人中10人(62.5%)と多かった(p=.045)。2)食形態は栄養状態と関連した。平均摂取カロリー量は、普通食(1320.5±231.9Kcal)、キザミ食(1209.2±231.9Kcal)、ペースト食(1150.0±211.0Kcal)、胃瘻(809±153Kcal)であった(p=.000)。3)食形態とムセは有意な関連はみられなかった。軟らかで細かい食形態であってもムセは改善しなかった。4)ロジスティック回帰分析(変数減少法)の結果、普通食摂取に有意に影響したのはVitality index、食欲、咬合状態の3項目であった。【結論】本研究は横断的研究であるため、因果関係に言及することはできないが、本研究の結果は咀嚼を要する食形態は、良好な健康状態と関連すると考えられた。(著者抄録)

© 2015, Springer Japan. All rights reserved. Aspiration pneumonia is the leading cause of death among the elderly. Modified-texture foods, i.e., foods with altered consistency, are recommended in order to maintain both normal swallowing and adequate nutrition, which is also expected to reduce aspiration pneumonia, when elderly people are suspected to suffer from disorders of eating and/or swallowing. However, it is reported that overly-restrictive diets have been provided to most residents given modified-texture diets. Furthermore, there is scant empirical evidence of the medical effectiveness of food texture-modification. Little attention has been paid to the effect of the consistency of food substances, as well as the ability of mastication, on general health. Our cross-sectional studies showed that eaters of regular foods have lower incidences of pneumonia and fever, while those eating modified-texture, i.e., softer and finer, foods have higher incidences of pneumonia and fever. In this review, the effects of interventions for prevention of aspiration pneumonia were overviewed then the impact of the consistency of food substances on the health of the elderly and the direction of further research was discussed.

In this paper, we propose a method of nursingcare text classification. We have proposed some nursing-care classification methods using fuzzy systems, standard three-layer neural networks, and support vector machines. Also we have proposed several types of feature vector definitions for expressing free style Japanese texts into numerical vectors. This paper proposes a novel feature vector definition and a support vector machine utilizing a decision tree (SVM-BDT) based classification system. From experimental results, the effectiveness of both feature definition and SVM-BDT-based classification system is shown.

Improving the quality of nursing care is crucial to maintaining the quality of life. Our objective is to develop a computer-aided evaluation system that enables nursing experts to improve the quality of nursing care. In our previous works, some classification systems based on fuzzy logic, neural networks, and SVMs were developed. Although a classification system with high performance for all nursing-care datasets is desirable, we focus on how to visualize the classification results in this paper. It is important to visualize the results for our nursing-care text classification system because the computer-aided system has to explain the reasons for obtaining such results to human experts. In this paper, a tree-type expression is considered for visualizing the classification results. To visualize classification results with the tree-type expression, we consider a decision tree technique. Word existence, dependency relations, and phrase-based feature vector definitions have been proposed in our previous works. In the present study, these three types of feature vector definitions are compared with one another from the viewpoint of understandability.

© 2014 TSI Press. The effect of the consistency of food substances on health has not been assessed. The ingestion of food substances which require mastication promotes salivary secretion and oral function, which may in turn lead to a lower incidence of aspiration pneumonia. Thus, this study aims to reveal the importance of ingesting regular solid food and inquires into the condition associated with ingesting regular food.

© 2014 IEEE. In the aging society such as Japan, it is very important to improve the quality of nursing-care for keeping our quality of life. Our final goal is to develop a computer aided evaluation system to improve the quality of nursing-care. For evaluating the quality of actual nursing, we have been collecting texts that are written by nurses using our Web based system. In our previous works, a SVM based classification system has been developed to classify such nursing-care texts, and a dependency relation based feature vector definition has also been proposed. The training data are pre-classified texts by a few nursing-care experts. Some texts in the training data are similar but classified into different classes. To classify the nursing-care texts with high accuracy, we need to tackle such ambiguous class labels in the training data. In this paper, we propose a k-nearest neighbor based classification system which can classify into classes with certainty grade.

<目的>臨床現場における看護研究活動にともなって看護師に生じる感情や認識等の体験を明らかにする。<方法>医療施設に所属する臨床看護研究を実施した経験のある看護師および看護研究の指導を行った経験のある看護師を対象とし、フォーカス・グループ・インタビューを実施した。インタビュー内容は、(1)過去または現在取り組んでいる研究テーマ、(2)研究の実施または指導で困難に感じたこと、(3)研究の実施または研究指導でうまくいったと感じたことであった。得られた録音データは逐語録にし、その中から看護研究実施にともなう看護師の体験に関連する箇所を抽出した。抽出したデータの意味内容を読み取り、1つの意味内容が含まれる単位データを作成し、さらにカテゴリー化し分析を行った。分析は複数の研究者が行い妥当性を高めた。<結果>臨床で看護研究を実施している3施設に所属する臨床看護研究実施者13名、臨床看護研究指導者13名の協力が得られた。得られたカテゴリーを【 】で示す。得られた単位データ(135)の分析を通して看護研究実施にともなう看護師の体験は、【臨床看護研究は義務付けられている】【臨床看護研究はやりたくない】【臨床看護研究はできそうにない】【臨床看護研究によって成長する】【研究成果を実践に活用できた】【臨床看護研究を実施する能力や知識がない】【研究指導に対するプレッシャー(指)】【研究指導による精神的負担(指)】の8カテゴリーが見出された。看護研究が看護師に義務付けられていることは看護師の負担感や不全感に関連していた。一方で看護師は研究に対して意義も見出していた。<考察>研究が義務化されていることや研究のための知識や能力の不足などが影響して看護師が研究活動に伴って体験する負担感は大きくなっている。臨床現場での研究活動には支援体制の整備が必要である。(著者抄録)

<目的>看護研究における臨床看護師が抱える困難を明らかにする。<方法>H県内の医療施設に所属する臨床看護研究の実施経験のある看護師および指導経験のある看護師を対象にフォーカス・グループ・インタビューを実施した。インタビュー内容は(1)過去または現在取り組んでいる研究テーマ、(2)研究の実施または指導で困難に感じたこと、(3)研究の実施または研究指導でうまくいったと感じたことであった。得られたデータから看護研究における臨床看護師が抱える困難に関連する箇所を抽出した。抽出したデータの意味内容を読み取り、1つの意味内容が含まれる単位データを作成し、複数の研究者によりカテゴリー化し、分析を行い妥当性を高めた。<結果>H県内の医療施設で看護研究を実施している中規模以上の3施設に所属する臨床看護研究実施者13名、臨床看護研究指導者13名の協力が得られた。看護師が抱える困難は研究プロセスにおける困難、研究の実施環境における困難に分けられ、得られたカテゴリーは、【 】で示した。研究プロセスにおける困難は【研究テーマの設定が難しい】【文献検索・文献検討の方法が不十分】【看護研究のプロセスが分からない】【研究計画書の立案が難しい】【研究結果のまとめ方が難しい】の5カテゴリーが得られた。研究の実施環境における困難は【研究するための設備の不足】【研究時間の不足】【研究資金の不足】【人員の不足】【研究支援体制の不足】【研究に要する能力・知識の不足】の6カテゴリーが得られた。<考察>臨床看護師は研究のプロセスすべてにおいて困難を抱えており、文献が手に入らない、支援体制の不足などがあり、適切に看護研究が実施できる環境ではなかった。そのため、臨床看護研究は大学等の教育機関と連携し、研究プロセスの各段階におけるセミナーを開催することや、支援体制を充実させることが望ましい。(著者抄録)

【目的】本研究の目的は、臨床施設と大学が連携した看護研究支援システム構築への第一歩として、臨床看護師がどのようなテーマに関心を持ち看護研究を行っているかを明らかにすることである。【研究方法】日本看護系学会協議会の会員学会名簿より、特定の大学や病院が運営しているため入会制限のある学会を除き、学会会員数が1,000名以上である20学会が、2012年に発行した学術集会抄録集を分析の対象とした。対象より臨床看護師が筆頭研究者である発表演題を抽出し、KH Coderを用いて発表演題名のテキストマイニング分析を行った。【結果】対象4,289演題のうち臨床看護師が筆頭研究者である発表演題は、1,947件(45.4%)であり、その内の68.5%が研究者が臨床看護師のみの発表演題であった。テキストマイニングを用いた分析より、頻出語上位は、『患者』、『看護師』、『看護』であった。さらに、『患者』の共起語として<受ける><家族><検討><化学療法><支援>、『看護師』の共起語として<要因><新人><影響><手術室><認識>、『看護』の共起語として<患者><家族><終末期><がん患者><外来>が抽出された。研究者が臨床看護師のみの発表演題と、大学教員が含まれる発表演題とで頻出語を比較すると、前者では『検討』『取り組み』『効果』などの言葉が、後者では『要因』『支援』『影響』などの言葉が上位を占めた。【考察】臨床看護師は、数多くの看護研究を行い学会で発表していたが、先行研究によれば論文に至るものは少ない。臨床看護師は、患者家族、化学療法患者、新人看護師、手術室看護師、がん看護、終末期看護、外来看護に関するテーマで数多くの看護研究を行っていることが推測された。その内容は、日々の看護援助の取り組みの報告や直面している課題に対してであることが推察された。今後、臨床看護研究に大学が携わることでEvidenceの構築と看護の質の向上へと繋がる可能性が示唆された。(著者抄録)

【目的】介護老人福祉施設入居者に歯科衛生士が実施する口腔ケアについて質的研究を行い、対象者が心地よいと感じ、効果が得られる可能性がある具体的なケアの方略を抽出することを目的とする。【方法】対象は、研究への同意が得られた歯科衛生士とその担当の口腔ケアを受け入れない認知症高齢者である。歯科衛生士に対しては、口腔ケアの参加観察と半構成的インタビューを実施し、入居者に対しては、口腔ケアの参加観察と施設記録の閲覧を行った。得られたデータは統合し、カテゴリー化され、帰納的にどのようなケアが心地よさに繋がるのか歯科衛生士の口腔ケアの方略と具体的な技術を明らかにした。【結果・考察】歯科衛生士による口腔ケアには、口腔ケアの導入、口腔ケアの実施、口腔ケアの終了、口腔ケアの保留、口腔ケアの中止の場面があり、10のカテゴリーと37のケアの方略が明らかになった。以下にカテゴリーは[ ]で、方略は< >で示す。例えば、口腔ケアの導入においては、3つのカテゴリーが抽出された。[口腔ケアへ誘う]ための方略として、<タイミングを図る><覚醒を促す><存在を示す><入居者に関心を示す><入居者の機嫌を良くする><安心感を与える><口腔ケアを勧める>の7つが抽出された。[口腔ケアの体勢を整える]ための方略として、<口腔ケアの準備をする>の1つが抽出された。[口腔ケアを受け入れてもらう]ための方略として、<口腔ケアの流れに乗せる><口腔ケアの糸口を探す><開口を促す><安心感を与える><励ます><緊張を和らげる>の6つが抽出された。【結論】本研究では、歯科衛生士らが用いていた多種多様な方略、すなわち入居者に関心を示し、口腔ケアの体勢を整え、持っている力を引き出し、快を提供するなどが明らかになった。それらを試行錯誤しながら実践し、その人にとって受け入れられる方法を探しそこから根気よく口腔ケア内容を広げていくことが示唆された。(著者抄録)

© 2014 IEEE. In the aging society such as Japan, we feel large importance for improving the quality of nursing-care to keep our quality of life. Development of a computer aided evaluation system for improving the quality of nursing-care is our final goal. In order to evaluate the quality of actual nursing in wide areas in Japan, we have been collecting texts that are written by nurses using our Web based system. A SVM based classification system has been developed to classify such nursing-care texts, and a dependency relation based feature vector definition has also been proposed in our previous researches. When we train the SVM based classification system, pre-classified nursing-care texts by a few nursing-care experts are used as a training data set. Some texts in the training data are similar but classified into different classes. To classify the nursing-care texts with high accuracy, we need to extract numerical features that can express characteristics of the original text. In this paper, we explain some feature vector definitions and propose a directed graph based feature vector definition.

In the aging society such as Japan, it is very important to improve the quality of nursing-care for keeping our quality of life. Our final goal is to develop a computer aided evaluation system to improve the quality of nursing-care. For evaluating the quality of actual nursing, we have been collecting texts that are written by nurses using our Web based system. In our previous works, a SVM based classification system has been developed to classify such nursing-care texts, and a dependency relation based feature vector definition has also been proposed. The training data are pre-classified texts by a few nursing-care experts. Some texts in the training data are similar but classified into different classes. To classify the nursing-care texts with high accuracy, we need to tackle such ambiguous class labels in the training data.In this paper, we propose a k-nearest neighbor based classification system which can classify into classes with certainty grade.

It is very important for us to improve the nursing-care quality. To improve the nursing-care quality, the "Web based Nursing-care Quality Improvement System" have been proposed and operating continuously. In the Web-based system, freestyle Japanese texts, which are called "nursing-care texts," are collected through the Internet in Japan for evaluating actual nursing-care process. The nursing-care experts can evaluate actual nursing-care process by reading the collected nursing-care texts carefully and then recommend some improvements to nurses. However, it is hard to do the above-mentioned evaluation process for a large number of nurses because the number of nursing-care experts who can evaluate the nursing-care texts is a few. In order to assist nursing-care experts in evaluating the nursing-care texts, a computer aided nursing-care text classification system has been developed. In this paper, we propose a novel feature definition for the nursing-care text classification system. Dependency relations between terms are extracted from the nursing-care texts. The extracted dependency relations are used as feature values that represent characteristics of the nursing-care text. © 2013 Copyright TSI® Press.