坂下 玲子

This study aimed to identify the current state of nursing theory development among Japanese scholars by analyzing the syllabi of doctoral nursing programs in Japan to examine the educational content relating to nursing philosophy and theory and by reviewing the related literature. Only 17.2% of the doctoral-level nursing programs in Japan offer courses in philosophy or theory. Florence Nightingale was the most frequently discussed figure in the literature. Middle-range and situation-specific theories originating in Japan have emerged relatively later than those introduced by Western theorists. Recently, the development of nursing theories, particularly situation-specific theories, has begun in Japan, showing promising prospects for advancement in the field.

The literature on nursing leadership tends to be mainly based on Western perspectives and models, which could be viewed as an imperialistic and colonialist aspect of nursing knowledge development. Furthermore, leadership competencies and skills could differ across countries due to variations in cultural backgrounds. The purpose of this discussion paper is to identify essential competencies of leaders from Asian nurse leaders’ perspectives and provide suggestions for future nursing leadership. Four themes related to the leadership competencies were identified: “harmony,” “visionary,” “political activism,” and “good character.”

ABSTRACT Background The development of nursing leaders is an important topic in changing healthcare environments. Successful nursing leadership is critical to the reconstruction, implementation, and evaluation of healthcare systems worldwide. However, the characteristics of successful nursing leadership remain unclear, especially in a global context. Furthermore, despite the growing importance of cultural intelligence, cross-cultural concepts of successful nursing leadership have been inadequately addressed in the literature. Purpose This study was designed to identify the characteristics of successful leadership in nursing from the perspective of Asian leaders in four countries (United States, Taiwan, Korea, and Japan) and to make recommendations for successful leadership in nursing in the future. Methods A qualitative approach employing five strategies, including in-depth discussions through face-to-face and email discussions, an integrated literature review using multiple databases, responses to 10 topics related to nursing leadership, and written note summaries of the characteristics of successful leadership, was used in this study. A total of 10 nursing leaders from four countries were recruited as participants using snowball sampling. The collected qualitative data were analyzed using line-by-line coding and simple content analysis to extract the characteristics of successful leadership in nursing. Results The final sample included seven nursing leaders aged between 55 and 70 years. All of the participants were in nursing leadership positions at schools/colleges of nursing or professional organizations for at least two decades and had extensive leadership experience through their schools/colleges, professional organizations, and/or governments. Five key themes related to the characteristics of successful leadership were identified from the participants: (a) culturally and historically prescribed, (b) overcoming gendered experience, (c) equipped with good character, (d) guiding with a vision, and (e) with contextualized leadership. Conclusions/Implications for Practice Five characteristics of successful leadership were identified from the perspective of Asian nursing leaders. All of the participants recommended that successful nursing leadership be based on contextual leadership and that successful nursing leadership help meet rapidly changing needs, enable mutual trust, and actively commit and complete necessary risks. Moreover, future successful leadership should have a clear vision and strongly guide the implementation of changes as well as be equipped with cultural intelligence. Finally, successful nursing leadership should be based on ethical, trustable, and humane behaviors while promptly and adequately responding to the changing needs of their institutions/organizations. Cross-regional research on successful nursing leadership is essential to enrich the global evidence and knowledge on developing the next generation of nursing leaders.

The raison d’être of nursing is caring for human beings. Mainly due to its close link to the nursing discipline’s raison d’être, “caring,” translational science is recently getting more attention from nursing scientists across the globe. This paper is to discuss the current status of translational science in nursing across four countries (the USA, Taiwan, South Korea, and Japan). The data used in this discussion paper included: (a) written notes on issues related translational research/science in individual countries; (b) written memos on exemplars/cases from their own experiences; and (c) summaries of literature reviews. The data analysis was conducted using a simple content analysis. Four themes reflecting the current status of translational science across the countries were identified: (a) “contextualized in unique culture and history of nursing”; (b) “connecting basic science to clinical practice”; (c) “an extension of evidence-based practice”; and (d) “highly promoted, but still minimal translation of nursing knowledge.”

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．

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.

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.

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.

【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。

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.