Harue Masaki

The Asian Research & Collaboration Center for Nursing & Cultural Studies in Japan

The purpose of this paper is to describe current cultural issues in Japanese health-care services that have resulted from the increased immigration. Also described is the establishment of a new academic research centre that will focus on culturally appropriate nursing care. There are many health-care issues in Japan caused by a shortage of health-care workers and disparities in access to health care. The major issues are an increase in the number of foreign patients, foreign nurses and care workers. Despite the occurrence of similar issues in other countries, Japans situation and the causes are different. In response to dynamic demographic and health-care changes in Japan, we launched the Asian Research & Collaboration Center for Nursing & Cultural Studies at Chiba University Graduate School of Nursing.

Consensus development of quality indicators for end-of-life care for elders in Japan

AIMS AND OBJECTIVES Quality indicators for end-of-life care have been published; however, none have been developed specifically for nursing in the cultural and traditional context of Japan. This study aimed to develop and build a consensus of quality indicators for end-of-life care for elders in Japan from the perspective of nursing science. METHODS To develop the quality indicators, we used a literature review, expert panel process, and the Delphi technique among clinical nurse specialists in geriatrics. RESULTS Quality indicators were identified in 7 major areas: advance directives and surrogate continuity, ethical daily care, care preferences and decisions about life-sustaining treatment, assessment and management of pain and other symptoms, daily care for the dying, family care, and institutional systems for end-of-life care. CONCLUSIONS These quality indicators represent the first attempt to develop a best practices approach toward improving the quality of elderly end-of-life care in nursing.

Reliability and Validity of a Shortened Version of an Instrument for Diabetes Self-Care Agency.

Purpose: The purpose of this study was to develop a shortened version of the Instrument of Diabetes Self-Care Agency (IDSCA). Methods: In the development of the shortened version of IDSCA, intraclass correlation coefficient 2 (ICC2) analysis was done to determine items to be deleted. However, the 7 subscales were retained. The shortened IDSCA was evaluated for internal consistency, reproducibility, concurrent validity, criterion-related validity, and goodness of fit. Results: The shortened IDSCA included 35 items addressing 7 subscales. High ICC2 (.804) and a high Cronbach’s alpha (.89) indicate internal consistency and reproducibility. A high correlation (.62) between the shortened version of the IDSCA and the Self-Care Agency Questionnaire indicated concurrent validity. Conclusion: The shortened IDSCA provides a reliable and valid measure of self-care agency of individuals with diabetes.

Qualitative study on nursing processes to support blood glucose pattern management in Japan

A structured approach to self-monitoring of blood glucose and blood glucose pattern management (BGPM) is crucial in diabetes management. However, nursing processes for supporting BGPM among people with diabetes has not been studied. Here we described the process used by nurses certified in diabetes nursing in Japan to support BGPM among people with diabetes. Eleven nurses certified in diabetes nursing in Japan, with actual experience in supporting BGPM. We conducted semi-structured interviews with participants using an interview guide. The interview content was recorded on an IC recorder after obtaining consent. Qualitative analyses of data were conducted by qualitative synthesis. Based on the interviews with the 11 participants, 8 themes regarding the process of supporting BGPM were identified. These themes were as follows: ‘underlying supportive environment: a place where you can state what has been on your mind’, ‘sharing goals: exploring the person’s interest and finding clues’, ‘collaboration: finding patterns and devising measures’, ‘collaboration: considering effective and less burdensome blood glucose measurement and recording methods’, ‘leading to the next step: a long-range step-by-step perspective’, ‘support of active learning: utilising experiences and fostering independent thinking’, ‘mutual confidence: reward their efforts and trust their potential’ and ‘team approach: multilateral care’. Thereafter, the eight themes were schematised and the process of supporting BGPM was determined. Thus, we clarified the process of supporting BGPM and provided suggestions on how to utilise BGPM in ordinary nursing.

Structural model of self‐care agency in patients with diabetes: A path analysis of the Instrument of Diabetes Self‐Care Agency and body self‐awareness

Aim The aim of this study was to examine a causal model of self‐care agency by exploring the relationship between the structure of “body self‐awareness” and the structure of the Instrument of Diabetes Self‐Care Agency (IDSCA). Methods The participants were 353 patients with diabetes. The internal consistency of the six items for body self‐awareness was examined by calculating the factor structure using principal factor analysis and Cronbachs alpha. In order to examine the relationship between the seven factors in the IDSCA, a path analysis was conducted. Results With regard to the factor structure, the factor loading of these five items was 0.511–0.743 (α = 0.739). In the path analysis, “body self‐awareness” was influenced by the “ability to acquire knowledge” and had a direct effect (0.33) on the “motivation to self‐manage”, while “motivation to self‐manage” had an effect (−0.32) on the “ability to self‐manage”. The Goodness‐of‐Fit Index was 0.974. Conclusion “Body self‐awareness” plays a part in the self‐care operation process and serves as an intermediary factor to enable the performance of self‐care operations by making the most use of self‐care agency. Moreover, striking a proper balance between self‐management that is focused on the treatment of diabetes and a persons ability for self‐management of diabetes was found to be important.

Development of a support skill scale in insulin therapy: a nationwide study in Japan.

The aim of this cross-sectional, nationwide study in Japan was to develop a support skill scale for insulin therapy (IT-SSS) and to evaluate its validity and reliability. The sample consisted of 1604 nurses at 123 hospitals throughout the country. The factor validity, known-group validity, convergent validity, discriminant validity and internal consistency of IT-SSS were assessed. IT-SSS consisted of 26 minimum and 25 standard support skills. They included 4 subscales for minimum skills: management strategy for hypoglycemia, education about insulin injection technique, individual assessment and support about insulin rejection, and collaboration with medical professionals and patient/family. Three subscales for standard skills: apprehensions concerning the will and emotion of the patient, management for blood glucose control, and coordination in insulin management. Cronbachs alpha coefficient was between 0.75 and 0.90, suggesting strong internal consistency. Multitrait analysis showed that convergent validity was complete, and discriminant validity was found to be almost complete in both minimum and standard skill scales (scaling success rates of 97.6% and 98.7% across all subgroups, respectively). Known group analysis clearly showed that specialist nurses have significantly higher skills than general nurses. These findings indicate that IT-SSS has a reasonable factor validity, convergent validity, discriminant validity, known group validity, and internal consistency.

Meta-Synthesis of Clinical Knowledge of Interpersonal Nursing Practice in Japan

The purpose of this study was to clarify the clinical knowledge of interpersonal nursing practice by meta-synthesis of Japanese nursing studies. We constructed the framework of the clinical knowledge of interpersonal nursing practice by meta-synthesis of 22 qualitative studies (published in the Journal of Chiba Academy of Nursing Science in 2002-2004, original papers of a thesis or a dissertation, and qualitative research about nursing interventions). As a result, the following were identified: nurse cognitionlaction and client (patient, family, citizen) cognitionlaction were changed through reciprocity between a nurse and a client. Nursing goals and interventions became equivocal, focused, holistic, and professional while clients grew and became empowered through reciprocity. The interpersonal nursing practice was composed of a process of a nurses cognition and behavior, a process of a clients cognition and behavior, and a process of nurse-client relationship. The process of a