看護学における専門職大学院の展望

広島大学大学院保健学研究科 第1回国際シンポジウ

The process of forming a cooperative structure for dietary therapy by families of predialysis patients with chronic kidney disease

保存期慢性腎臓病患者の食事療法における家族員の協力体制形成過程を明らかにするため，計8人に対しフォーカスグループインタビューを行った結果，4のカテゴリーと15のサブカテゴリーが抽出された．協力体制は，第1段階【家族（患者）が腎臓病と生きることと向き合う】第2段階【食事療法の協力者として動機づけられる】第3段階【協力者という役割を獲得し始める】第4段階【協力者としての役割を継続する】の過程を経て形成されていた．保存期腎臓病患者の家族員らは，まず，患者の病気の診断や予後の説明に対し，衝撃を受け，悲嘆のプロセスを踏んでいた．その後，協力者としての信念・使命感によって動機づけられ，どの程度協力できるか模索していた．また，患者のノンコンプライアンスと格闘しながらも，食事療法実施によるポジティブな変化の気づきや，患者の感謝による再動機づけによって，協力を継続していた．結論として，協力体制形成の促進要因では，自己効力感，維持要因では，協力者としての信念・使命感，協力成果の確認，限界感やストレスへの対処，患者からの感謝の言葉，協力者となったことによるポジティブな変化が抽出された．To understand the process of forming a collaborative union among family members regarding dietary therapy for patients with predialysis chronic kidney disease, we conducted a focus group interview and abstracted 4 Categories 【】 and 15 Subcategories 《 》 from the results. The collaborative situations were formed through the following process: 1st stage 【Facing the fact that the family (patient) must live with kidney disease】, 2nd stage 【Being motivated to become collaborators in dietary therapy】 , 3rd stage 【Starting to perform a role as collaborators in dietary therapy】, and 4th stage 【Maintaining a role as collaborators in dietary therapy】. First, subjects were shocked by diagnosis of kidney disease and description of the prognosis, and stepped on the process of crisis. Then, they were motivated by a belief in their role and a sense of mission and sought how they could collaborate. Finally, they maintained their collaboration by gaining motivation from the patient's gratitude and positive changes in his/her condition. Consequently, it was shown that psychological support, education, encouragement, and peer support are very important for the family members of patients with predialysis chronic kidney disease

Factors That Facilitate Discussion and Documentation of End-of-Life Care among Community-Dwelling Older Adults: A Cross-Sectional Study

We aimed to clarify the regional cultural characteristics in areas with different death rates at home, and to identify factors that influence the discussion and documentation of end-of-life care (EOLC) among community-dwelling older adults. This study was a cross-sectional study using a self-administered questionnaire survey, and participants were Japanese older adults. A chi-square test and multiple regression analysis were conducted. Among the 227 respondents, 143 were analyzed. There were no statistical differences by area. Participants who had intentions to discuss EOLC tended to discuss EOLC with their families and family doctors and tended to create documents to show their wills on EOLC (p < 0.05). The following factors that influence the intentions to discuss EOLC were extracted: experience in providing EOLC; information on EOLC; having religious and spiritual beliefs, and not avoiding the subject of death as part of beliefs related to life and death. These results indicate that beliefs and intentions regarding EOLC may be similar across Japan. Moreover, our findings suggest that to increase the interest of older adults on EOLC, it is important to provide opportunities for older adults to share and discuss information about EOLC with healthcare professionals and others who have experience providing EOLC

Structured review of the literature of type 2 diabetes self-management: Toward the development of a patients' characteristics-based assessment tool

2型糖尿病患者の特性に応じた教育・支援を行うためのアセスメントツールの開発を目指して,自己管理に影響する要因を文献から抽出した.検索方法は,2型糖尿病の自己管理に関連したキーワードを設定し,MEDLINE,CINAHL,医学中央雑誌のデータベース過去10年間を検索した.ヒット件数は,各々1162,860,691件であった.次いで,ADA(American Diabetes Association)Evidence guideline(2002年)の水準を参考に研究デザインを吟味した.その結果,該当する文献は71件で,国内文献が20件あった.有意差を認めた因子を整理したところ86因子あり,「知識・教育」「心理面」「満足度」「個人的要因」「治療」「収入・保険」「関係」の7カテゴリーに分類できた.しかし,介入方法の分類に結びつく因子(特性)や因子間の関係性は不明であり,効果的な介入を導くためのアセスメントツールを開発するためには,これらを検討する必要性が示唆された.To develop an assessment tool for education and follow-up for type 2 diabetes patients related to their characteristics, a structured literature review was conducted. The method of the review was by key words related to self-management/self-care for type 2 diabetes taken from the database for the past 10 years of MEDLINE, CINAHL, and Japan Medical Abstract Society. One-thousand one- hundred and sixty-two articles were obtained from MEDLINE, 860 from CINAHL, and 691 from the Japan Medical Abstract Society. Research designs were then examined, based on the ADA (American Diabetes Association) Evidence guideline (2002) evidence level. As a result, 71 articles, of which 20 were domestic, were retained. Eighty-six factors were found statistically significant, and were categorized in groups under the headings “knowledge/education", “psychological aspects", “level of satisfaction", “personal factors",“therapy/treatment", “income/insurance", and “family/relationship". Factors/characteristics lead toselecting interventional strategies. However, their overall relations have not been examined yet, whichsuggests that these need to be tested to develop an assessment tool which leads to an effectiveintervention program

Health-Seeking Behaviors in Mozambique: A Mini-Study of Ethnonursing

In settings where traditional medicine is a crucial part of the healthcare system, providing culturally competent healthcare services is vital to improving patient satisfaction and health outcomes. Therefore, this study sought to gain insight into how cultural beliefs influence health-seeking behaviors (HSBs) among Mozambicans. Participant observation and in-depth interviews (IDIs) were undertaken using the ethnonursing method to investigate beliefs and views that Mozambicans (living in Pemba City) often take into account to meet their health needs. Data were analyzed in accordance with Leininger's ethnonursing guidelines. Twenty-seven IDIs were carried out with 12 informants from the Makonde and Makuwa tribes. The choice of health service was influenced by perceptions of health and illness through a spiritual lens, belief in supernatural forces, dissatisfaction with and dislike of the public medical system on grounds of having received poor-quality treatment, perceived poor communication skills of health professionals, and trust in the indigenous medical system. This study confirmed the need for health professionals to carefully take cultural influences into consideration when providing care for their patients. We recommend an educational intervention that emphasizes communication skills training for healthcare workers to ensure successful physician/nurse-patient relationships

Identifying key factors for successful formulation and implementation of healthcare policies on non-communicable diseases: a multinational analysis

Objectives: Non-communicable diseases (NCDs) are a major public health concern that accounts for 74% of global deaths each year. The increasing burden of NCDs exhausts public health resources and threatens the achievement of the 2030 agenda for sustainable development. The purpose of this study is to thematically analyze the contributory factors in the health policy process and reforms to strengthen the prevention of NCDs across borders, as well as the milestones achieved through the process of policy-making, change, and implementation. Method: This study informs and draws on the findings of contributory factors in the health policy process for preventing NCDs across borders: United States, England, Sweden, Bangladesh, Singapore, South Korea, and Thailand. Ten experts from the seven countries were recruited purposively for a semi-structured interview (e-Interview) on the NCD policy-making process in their countries, either through health ministries or the authors’ network. This descriptive qualitative study design is guided by the “Three I’s” framework of public policy (institutions, ideas, and interests). In addition to the information obtained from the interviewee, data were also sourced from relevant documents and homepages suggested by the interviewee, as well as health homepages of the countries. Result: The following themes were generated: (1) environmental policies and social determinants, (2) multistakeholder involvement, (3) interministerial collaboration, (4) independent evidence and review institution, (5) integrated health data, and (6) primary care system. There was a shift from individual-targeted policies to environmental policies and social determinants. Notably, national campaigns were developed through non-governmental organizations (NGOs) for the primary prevention of NCDs. Conclusion: The shift from behavioral modification and treatment to social determinants is important. NCDs are broad and require a multisector and multilevel approach. Establishing an organization or hierarchical body to overlook NCDs could result in increased awareness, focus, and surveillance and enhance the policy process

Assessing Burden, Anxiety, Depression, and Quality of Life among Caregivers of Hemodialysis Patients in Indonesia: A Cross-Sectional Study

Family caregivers endure the burden of caring for patients receiving hemodialysis, which can affect their psychological status and may disrupt the care process. This study aims to assess the level of burden, anxiety, depression, and quality of life (QOL) among family caregivers, to investigate the influence of caregivers’ sociodemographic factors and patients’ clinical conditions on the level of burden, and investigate how burden affects anxiety/depression and QOL. A descriptive, cross-sectional study was conducted from September to October 2020. A total of 104 caregivers with a mean age of 44.4 ± 12.7 years (63.5% women) in the hemodialysis department of a hospital in Indonesia were examined. Zarit Burden Interview (ZBI), Hospital Anxiety and Depression Scale, and WHOQOL-BREF were used. Descriptive analysis was conducted to assess the level of psychological status, and multiple regression analysis and path analysis were performed to evaluate the association among all factors. As result, regarding burden, 10.2% had a moderate-to-severe burden, and in terms of anxiety and depression, 25% and 9.6% showed abnormal cases; the mean scores of 4 domains of QOL were about 60 points. Burden and anxiety/depression were significantly negatively associated with all domains of QOL (p < 0.001); however, sociodemographic and clinical factors were not associated with any of the QOL domains. The path analysis results showed that burden positively correlated with anxiety/depression and negatively correlated with QOL via anxiety/depression. In conclusion, family caregivers’ QOL was found to be indirectly influenced by burden through anxiety/depression. Further evaluation of clinical significance and implications for caregiver’s lifestyle regarding anxiety and depression, which result in caregiver burden, is warranted

The Effectiveness of Telenursing for Self-Management Education on Cardiometabolic Conditions: A Pilot Project on a Remote Island of Ōsakikamijima, Japan

Introduction: Providing self-management education for residents with cardiometabolic conditions in remote islands is a challenge due to the shortage of primary care practitioners (PCPs), specialist physicians, and nurses. Therefore, we applied telenursing with lifestyle-related chronic diseases in remote island residents in Japan. This project aimed to improve the self-management behavior, cardiometabolic indicators, self-efficacy, and quality of life (QoL) of residents with cardiometabolic risks. Methods: We chose Ōsakikamijima Island, Hiroshima Prefecture, Japan, which is designated under the Remote Islands Development Act. The project was conducted from 2013 to 2014. The residents aged over 40 and under 75 years old, selected from the annual specific health check-up examination and from PCPs for screening cardiometabolic risks (urinary protein, glycohemoglobin A1c, systolic and diastolic blood pressure (BP), Low-density lipoprotein cholesterol, High-density lipoprotein cholesterol, and triglyceride) were included. The effectiveness of telenursing for self-management education was 6-month-long with a 6-month follow-up and evaluated by a single-group pre-and post-test design. Face-to-face health education was applied at the initial interview followed by telenursing (biweekly telephone calls till third-month, and a monthly telephone call during the fourth and fifth-month) by the trained nurses outside the island. To enhance participants’ self-monitoring health behavior changes, the nurses used motivational interviewing and behavior change techniques based on the transtheoretical model. Results: A total of 130 residents, 42 agreed to participate, 41 finished the 6-month program, and 33 completed the 12-month follow-up. Most of their behavior changes like self-management behaviors, cardiometabolic indicators, and self-efficacy at 6-month were improved significantly except QoL. Among the 12-month study periods, self-management behaviors, body mass index, systolic BP, diastolic BP, and self-efficacy (sense of control), (all P &lt; .05) showed significant improvement. Conclusion: This study results indicated that telenursing might be effective to improve the lifestyles-related behaviors in chronic diseases on the remote island of Ōsakikamijima, Japan

An unnatural base pair system for efficient PCR amplification and functionalization of DNA molecules

Toward the expansion of the genetic alphabet, we present an unnatural base pair system for efficient PCR amplification, enabling the site-specific incorporation of extra functional components into DNA. This system can be applied to conventional PCR protocols employing DNA templates containing unnatural bases, natural and unnatural base triphosphates, and a 3′→5′ exonuclease-proficient DNA polymerase. For highly faithful and efficient PCR amplification involving the unnatural base pairing, we identified the natural-base sequences surrounding the unnatural bases in DNA templates by an in vitro selection technique, using a DNA library containing the unnatural base. The system facilitates the site-specific incorporation of a variety of modified unnatural bases, linked with functional groups of interest, into amplified DNA. DNA fragments (0.15 amol) containing the unnatural base pair can be amplified 107-fold by 30 cycles of PCR, with <1% total mutation rate of the unnatural base pair site. Using the system, we demonstrated efficient PCR amplification and functionalization of DNA fragments for the extremely sensitive detection of zeptomol-scale target DNA molecules from mixtures with excess amounts (pmol scale) of foreign DNA species. This unnatural base pair system will be applicable to a wide range of DNA/RNA-based technologies