job satisfaction in operating-room nurses

Purpose : The purpose of this study was to investigate the operating environment, degree of operating-room nurses’, and to clarify the job satisfaction, experience, and emotions categorized characteristics operating-room nurses. Method : The study surveyed 1177 operating-room nurses. For 38 questionnaire items, a 5-point Likert scale was applied regarding job satisfaction, workplace environment, experiences, and emotions. Classification was performed by cluster analysis based on operating-room nurses’ job satisfaction. Results : Results of cluster analysis were classified into five groups with unique characteristics based on factors such as age, years of nursing experience, years of operating-room nursing experience, workplace environment, experience, and emotion. Conclusion: Results suggest providing support tailored to characteristics of each of the five groups to optimize their job satisfaction

Factors related to the occurrence of phlebitis in acute phase stroke patients receiving intravenous nicardipine

This study investigated the incidence of phlebitis associated with continuous nicardipine infusion in patients with acute-phase stroke. To identify patient factors related to the occurrence of phlebitis, and considering blood pressure values during nicardipine administration, we retrospectively investigated the nursing and medical records of 301 patients who were hospitalized for stroke. Of these, 92 patients met the inclusion criteria and had data showing whether phlebitis had occurred. We confirmed that phlebitis occurred in 38 patients (41.3%). Factors found to be significantly related to phlebitis onset were Glasgow Coma Scale (GCS)-verbal (V; p = .020) and -motor (M; p = .007), level of consciousness (total GCS score [(p = .009)]), nicardipine administration time (p = .001), nicardipine dose (p = .000), mean nicardipine rate of administration (p = .000), nicardipine dilution rate (p = .000), mean arterial blood pressure at first insertion (p = .030), and difference in the diastolic blood pressure at first insertion (p = .032). Multiple logistic regression analysis indicated that nicardipine administration time (odds ratio: 1.042, 95% confidence interval: 1.023–1.062, p = .000) was a related factor. Results also suggested that a decreased level of consciousness after the stroke onset (V3 or below and M5 or below) is related to phlebitis occurrence. Patients with stroke having a lower level of consciousness (total GCS score of 12 or below), who are being administered continuous nicardipine infusion, may require more frequent and careful infusion management and needle insertion site observation. Because phlebitis onset occurs after 24 h of continuous infusion, peripheral insertion site catheter replacement should be performed within 24 h

Medication-taking behavior in CI patients

Purpose : The aim of this study was to clarify the changes in medication-taking behavior and related factors over time in patients with initial mild cerebral infarction up to 12 months after onset. Methods : Thirtyone patients with initial mild cerebral infarction were surveyed a total of four times : on admission to hospital, 3 months after onset, 6 months after onset, and 12 months after onset. Patients were surveyed regarding medication compliance, awareness of taking medication, perceived behavioral control, lifestyle risk factors, and subjective norms. Results :Medication compliance improved over time from the time of admission, but no changes were seen in awareness of taking medication. A cluster analysis based on changes in medication compliance over time revealed a “Persistently high compliance group” and a “Persistently low compliance group” for medication compliance. The health locus of control in the “Persistently high compliance group” was perceived as the result of chance and fate. Conclusions : Assessing the current state of medication compliance and the health locus of control during hospitalization permitted an understanding of patient characteristics, and indicated a need for recurrence prevention education and medication guidance tailored to each patient’s cognitive and behavioral characteristics

片麻痺擬似体験後の看護学生のイメージの変化

看護学生の片麻痺疑似体験前後の片麻痺患者に対するイメージの変化を明らかにするため，学生が記載したレポートについて質的に内容分析を行い，比較した．対象は３年次看護学生のうち研究協力が得られた６５名であった．片麻痺擬似体験は，片麻痺患者を約２０分間体験した．片麻痺の設定は利き手側の上下肢とし，片麻痺患者役は日常生活動作を実施した． その結果，擬似体験後の片麻痺患者に対するイメージの記述数は増加し，イメージの内容がより具体的となった．体験後は「片麻痺患者は想像しにくい」の記述がなくなり，カテゴリーとして抽出されなかった．カテゴリーやサブカテゴリーは，体験前の否定的なイメージから，麻痺があっても可能なことはあるなど肯定的なイメージが増えた．また，学生は片麻痺患者の体験するストレスを実感することで，心理面に対する共感的イメージをもつことにつながった．さらに，擬似体験は，机上の学習では気づくことができない患者を想像する貴重な機会となっていた．In order to show the changes in the image that nursing students have regarding hemiplegic patients before and after simulated experiences of hemiplegia, a content analysis of the reports made by the students was qualitatively conducted, and comparisons were performed. The subjects were６５students in Junior year, all participants signed an informed consent. During the implementation of the simulated hemiplegic experiences, the students experienced becoming hemiplegic patients for approximately ２０ minutes. Hemiplegia was set for the upper and lower limbs on the side of the dominant hand, and students who took the part of hemiplegic patients experienced various activities associated with daily living. As a result, the number of descriptions of their image of hemiplegic patients after the simulated experiences increased, and the descriptions of such images were also more specific. After the experience, as their response “it is not easy to imagine what it is like for hemiplegic patients” was no longer observed, and thus it was not included as a category. The details of the image of the categories and the subcategories showed a more positive image, such as things that they can do in spite of their paralysis, compared to negative details before the experience. In addition, the students felt the stress that hemiplegic patients have, which resulted in them having a more empathetic image regarding psychological aspects. Furthermore, the simulated experiences provided a good opportunity todevelop an image of the patients, which cannot be obtained from reading books or articles

physical activity in heart failure patients

This study aimed that we were classification of physical activity in patients with heart failure categorized as New York Heart Association (NYHA) class I or II. We were a survey using a researcher- administered questionnaire, SF-8, the Specific Activity Scale (SAS), and the Scale to Measure Self-Care Behavior of Patients with Heart Disease. We included 70 patients who were treated in the Department of Cardiovascular Medicine at Hospital A. Regarding patient characteristics and clinical information after the cluster analysis, there were significant differences in the NYHA class (p = 0.001), BNP level (p = 0.012), self-management of medication adherence (p = 0.000), and exercise habits (p = 0.005). We summarized characteristics of each group as follows : Group A showed high tolerance to physical activity and near-perfect self-management; Group B showed moderate tolerance to physical activity but was not willing to commit to daily exercise and self-management; and Group C showed low tolerance to physical activity and often requested others to handle medication management. We needed that tolerance to physical activity and proposals for tailored instruction according to patient conditions, and needed that instructions tailored to the characteristics of heart failure patients in groups A–C

臨地実習で糖尿病患者を受け持った学生の学び

学士課程３年次での成人看護学実習で，糖尿病患者を受け持った看護学生（以下，学生）３４名の学びの内容について検討することを目的に，学生の記述したレポート内容を質的帰納的に分析した．その結果，４カテゴリー（「療養行動が主体的に実践できるための具体的な支援方法」「学生が感じた困難感や達成感」「療養生活支援のために必要な看護技術」「療養生活を送る対象の理解」）と１７サブカテゴリーが抽出された．学生は糖尿病患者を理解し，療養生活行動が主体的に行えるための支援方法を考えていた．そして，患者の行動変容を目指した介入の難しさを実感しながら，患者が主体的に療養行動を実践できるように支援することの大切さについて考え，学生としての立場での看護実践の喜びを感じていた．今後は，学生の学びについて，個々の事例ごとの確認を丁寧に行いながら，学びの内容を卒業時の到達目標と照らし合わせて確認する方法を考案することの必要性が示唆された．Purpose : To clarify what nursing students（hereafter referred to as students）learned during their clinical practice experiences with individuals with diabetes mellitus. Methods : Subjects were 34 nursing students enrolled in a bachelor program. Following clinical practice in adult nursing, data were obtained from students’ written reports on what they learned during nursing interventions for individuals with diabetes mellitus. Data were analyzed inductively. Results : Four categories and 17 sub-categories were extracted. The 4 categories were : “concrete nursing interventions for helping individuals with diabetes mellitus carry out their daily regimen”, “students’ feelings of difficulty and satisfied after the clinical practices”, “the necessity of nursing arts for facilitating a daily regimen”, and “knowledge about individuals with diabetes mellitus.” Conclusions : Through nursing practices, the students learned about individuals with diabetes mellitus and nursing interventions for individuals with diabetes mellitus. These findings suggest that teachers should carefully confirm what students learned in terms of both quality and quantity. Such confirmation ensures that students learn nursing interventions that are suitable for individuals with diabetes mellitus, and how to practically apply such nursing interventions. These findings will contribute to the improvement of nursing practices and education

糖尿病患者に対する看護介入の効果と評価 : 文献検討

医学中央雑誌Web版（Ver．３）を用いて，１９９４年から２００４年の過去１０年間に，糖尿病を有する人を対象に，看護師が行った教育や指導などの看護介入行為のうち，その効果が患者の持つ問題の解決に有効であると報告されている研究論文の分析を行い，以下の結果が得られた． １．対象となった論文は１６編あった． ２．介入内容は食に関連するものが１１編あった．看護師は，患者の持つ問題の明確化，その具体的な対応，到達目標の設定に対して，患者が主体的に取り組むことができるように，患者の情緒面も含めて援助していた． ３．介入内容の評価を看護師が行っていたものは１３編あった．評価項目は糖尿病の血糖コントロール指標としてのHbA１cがすべての文献で用いられていた． 以上のことより，今後は，患者の自己管理を支援するために，患者が一貫して主体的に取り組めるような介入方法を開発することが必要である．また，介入結果の評価においては，血糖コントロール指標に加えて，患者の行動や心理の変化を適切に評価できる評価方法や評価指標を開発する必要があると考えられた．Objective : The purpose of this study was to review published studies focusing on nursing interventions, which were effective in solving problems for persons with diabetes mellitus（hereinafter persons） in Japan. Method : We used the Ichushi-Web（Ver．３）to search from １９９４ through to ２００４. Results : １．We finally selected １６ primary studies. ２．Eight nursing interventions were related to diet and eating. Nurses supported that persons independently decide their own clinical goals, persons understood what were their problems and what they should do. Nursing involved emotional supports in this situation. ３．Thirteen evaluations were conducted by nurses, and all of evaluations used HbA１c as their control indexes for diabetes mellitus. Conclusion : To be able to support self controlled persons we have to develop ways to intervene, so persons can decide their clinical goals. Allowing them to learn to face their problems independently. It is necessary to evaluate not only HbA１c as diabetes control but also the changes of persons' activities and emotions in order to assess the effects of interventions suitably

Study on the difference in observation points between students before and after experiencing related nursing practice : on the observations of vital signs and oxygen inhalation by use of an acute stage dummy

本研究は術後急性期の状況を設定したモデル人形を用い，実習開始前と実習終了後の学生が行なった術後患者に対する観察のちがいを分析し，今後の実習指導に生かすことを目的に行った． 対象は成人看護実習（急性期患者の看護）の実習開始前の学生７２名と実習終了後の学生４５名であった． 方法は実習室でモデル人形を用いて，１０分間学生に自由に観察させた．この時の観察用紙に記入された記入項目を分析対象とした．分析方法は「ドレーン・チューブについて」「輸液について」「バイタルサインについて」を自由に記載してもらい，筆者らが『観察できた』『誤認』『記入なし』の３つに分類した． その結果，「モニター上に表示：心拍数」は実習終了後の学生の方が観察できていなかった．「酸素流量」は，『誤認』がどちらの学生も他の項目より多く，酸素流量計の見方を正確に把握していないことがわかった．「モニター上に表示：深部体温」，「酸素濃度」に関してはどちらの学生も『記入なし』であった．今後は学生の術後患者に対する観察能力が，より向上するように指導を行なっていく必要性が示唆された．そのためには急性期モデル人形を活用することで観察の機会を多くして練習を重ねるとともに，演習時および実習時において観察が的確になされているかを教員が確認する必要が示唆された．The difference in observation points for postoperative patients between two groups of nursing students was analyzed in terms of the students’ experience of related training for the purpose of improving the training tutorial. The object was 72 students before starting adult nursing training (nursing of the acute stage patient) and 45 students after the training termination. The students were allowed to observe an acute stage dummy for 10 minutes and to write down the observation results of the ‘drains and tubes’, ‘fluid therapy’, and ‘vital signs’. The descriptions about these three items were analyzed by classifying them into ‘correct’, ‘mistaken’, and ‘no description’. The main results are as follows. The percentage of nursing students who correctly reported the ‘heart rate on the monitor’ was lower in the group after training termination comparing to the other group. As for the ‘oxygen flow rate’, many mistakes were found in the both groups, indicating the technical problem on the monitoring of the oxygen flow meter. In the both groups, no student described ‘core temperature on the monitor’ and ‘oxygen concentration’. These results suggest the necessity of developing tutorial method to improve the students’ observation ability for postoperative patients. The use of an acute stage dummy would be helpful for the practice of observations. It is also necessary for the teachers to check the observation behaviors of students during the exercises and practices in order to make the observations correct

The learning in the practices of the students who care the disturbance of consciousness patients from the analysis of their process

意識障害患者を学生に受け持たせ，看護過程の展開の実習を行った．実習終了後の学生の学びを内容分析した結果，看護基礎教育で必須に学ばなければならない清潔などの基本的技術項目や合併症の予防や，意識障害患者に必要な観察や回復支援方法やその大切さを学んでいた．さらに，モデリングとしての看護師の実施するケアの気づきや，学習後の充実感や達成感，患者が回復する事の喜びなどがあった．また，コミュニケーションや状態把握の難しさも学びとして表現していた．このように，意識障害患者を受け持つことで，多くの学習内容を学べることが明らかとなった．We make my students care the disturbance of consciousness patients. This study examines their practice developments by watching their process and analyzing their reports. They learned the followings : （１）The basic technical items（ex. the importance of the cleaning）and the prevention of the complication. （２）How to observe and support the disturbance of consciousness patient. （３）The existence of the nurses as modeling. （４）the emotional reactions such as the fulfillment, the accomplishment and the pleasure after caring and learning. （５）The difficulty to communicate with the patients and to grasp the situations. This result shows how necessary the students care the disturbance of consciousness patients because they learn many points