Natsuko Seto

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.

Involvement of Recipient Transplant Coordinators in Transplant Outpatient Clinics in Japan: Current Status and Transplant Physician's Thoughts on Follow-Up Clinics.

Context: Transplant recipients require long-term immunosuppressive therapy, so continued medical follow-up is necessary for long-term survival. Objective: To investigate the current role of recipient transplant coordinators (RTCs) in the outpatient care of organ transplant recipients in Japan. Methods: We sent a questionnaire survey to doctors in transplant facilities affiliated with the Japan Society for Transplantation probing attitudes on the role of RTCs in outpatient clinics. The questionnaire assessed responses using an ordinal scale of 5 ranks. Results: In total, 139 responses were obtained from 233 transplant facilities. Respondents were divided into 2 groups, doctors currently working with RTCs (group A) and doctors not currently working with RTCs (group B). Differences in response rates between groups were analyzed using the Mann-Whitney U test. The overall attendance rate of RTCs in outpatient clinics was only 45%. Of all items on transplant outpatient clinics, group A exhibited a significantly higher response rate of “strongly agree” for “The involvement of an RTC in outpatient work can be expected to help prevent complications in transplant patients” (P < .01) and “The involvement of an RTC in outpatient work can be expected to help prevent or reduce drug-related side effects in transplant patients” (P < .01). Those with the highest rate of “strongly agree” were “It is necessary for RTCs to provide outpatient follow-up for transplant patients alongside doctors” (82.1% vs 67.3%, P < .07). Conclusion: We suggest that Japanese RTCs must participate more frequently in posttransplant outpatient care.

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.

Classification of Support Needs for Elderly Outpatients with Diabetes Who Live Alone.

OBJECTIVES To investigate the support needs of elderly patients with diabetes and to classify elderly patients with diabetes living alone on the basis of support needs. METHODS Support needs were derived from a literature review of relevant journals and interviews of outpatients as well as expert nurses in the field of diabetes to prepare a 45-item questionnaire. Each item was analyzed on a 4-point Likert scale. The study included 634 elderly patients with diabetes who were recruited from 3 hospitals in Japan. Exploratory factor analysis was performed to determine the underlying structure of support needs, followed by hierarchical cluster analysis to clarify the characteristics of patients living alone (n=104) who had common support needs. RESULTS Exploratory factor analysis suggested a 5-factor solution with 23 items: (1) hope for class and gatherings, (2) hope for personal advice including emergency response, (3) supportlessness and hopelessness, (4) barriers to food preparation, (5) hope of safe medical therapy. The hierarchical cluster analysis of subjects yielded 7 clusters, including a no special-support needs group, a collective support group, a self-care support group, a personal-support focus group, a life-support group, a food-preparation support group and a healthcare-environment support group. CONCLUSIONS The support needs of elderly patients with diabetes who live alone can be divided into 2 categories: life and self-care support. Implementation of these categories in outpatient-management programs in which contact time with patients is limited is important in the overall management of elderly patients with diabetes who are living alone.

A study of pattern management performed by nurses certified in diabetes nursing in Japan and clarification of the related factors

Introduction: To reveal the actual conditions of blood glucose pattern management (BGPM) performed by nurses certified in diabetes nursing (DCNs) in Japan and clarification of the related factors. DCNs are the specialists for people with diabetes and are certified by the Japanese Nursing Association (JNA). BGPM refers to a method aimed at improving blood glucose control by ascertaining changes (patterns) in blood glucose levels and conducting a systematic and multi-dimensional analysis of the factors contributing to these patterns. Method: Subjects were DCNs (n = 303) whose names and affiliations were publicly available on the JNA website in November 2011. The study was conducted through a postal questionnaire, involving items about how they were conducting guidance, the details of the BGPM (i.e. method and target) and the state of their overview of facilities, from January 2012 to February 2012. Result: The questionnaire was returned by 148 respondents. Regarding the statement ‘Looking with the people with diabetes for patterns in their blood glucose levels brings unexpected discoveries’, 140 (95.2%) selected ‘Agree’ or ‘Somewhat agree’. The respondents’ coefficient analyses showed a significant correlation between ‘I am very good at finding changes (patterns) in blood glucose or HbA1c levels’ and ‘The doctors at our facility are cooperative when it comes to BGPM’. Conclusion: In this study, most of the DCNs performed BGPM for people with diabetes and recognized that performing BGPM has been useful for most people with diabetes. In addition, building a good relationship between doctors and nurses is suggested for performing BGPM effectively.

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.