The purpose of this study is to evaluate the effect of narrative approach introduced into nursing based on the changes of narratives by old patients. Narrative approach was made three times to five patients of ages of 67 to 80 with given themes and the development of their narratives was qualitatively analyzed. Results their negative reactions were always expressed as wavering variation in their narratives. Such turning points in their lives as moving from a hospital another and decision on the date of operation and such events entailing actual feelings of recovery as the removal of stitches caused their narratives to change into positive ones about concrete ways of living, the will to live, and so on. The old patients expressed their apparent and latent reactions to illness and aging as wavering variation by narrating repeatedly. Such variation always took place and their listeners picked up leads on how to support them. Narrative approach with characteristic themes and several chances to narrate proved effective in helping old patients to find concrete methods of solving problems and remove obstacles to psychological changes.

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Among contemporary studies of children's notions of death, the cognitive approach, which applies formal properties of death based on an overreliance on Piagetian cognitive development theory, predominates. However, this does not explore what death means to children, or the extent of children's understanding of death. This study explores healthy Japanese children's lived experiences of grasping notions of life and death without predetermined components of death, such as finality, universality, and irreversibility. Interpretive phenomenology served as the philosophical underpinning and method of data analysis. A total of 16 healthy Japanese children (7 girls and 9 boys, mean age 8.9) were recruited through network sampling in the Tokyo area. Three interviews, each ranging from 15 to 90 minutes, were conducted with each child. Among the various emerging themes, this paper focused on the children's perception of death and afterlife. The study shows that Japanese children uniquely embraced the religiously incorporated view of death and the afterlife, reflecting the Japanese pantheistic belief system. The children had a comprehensive view of a flow from life through death to the afterlife, which constituted and consisted of the notions of life and death. In this successive flow, life and death were regarded as opposite yet connected. Although linear and circular types of flow from life to the afterlife were found in children's perceptions, in both cases the Christian God was perceived as the key.

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The purpose of this study was to determine methods of relating to children and practical nursing techniques that best bring out the potential ability of children about to undergo a medical procedure (for example, venipuncture, or IV cannulation), using an original care model for providing pediatric patients with an appropriate explanation suited to their comprehension level. For six months, we enlisted the cooperation of seven pediatric wards in five hospitals in the Kanto and Kansai areas in applying the care model on a trial basis and evaluating its effect. The effectiveness of the care model was evaluated in monthly meetings held with nursing staff participating in the study (nurses who executed our Care Model). From nursing discussions of 82 cases in such meetings, four categories were extracted. This study presents second category that has eight subcategories. First, factors related to effectiveness of the care model formed five subcategories. Children performed best when: provided with an explanation; able to select treatment circumstances by themselves; explanations took the form of continuous predictions while procedures were performed, and every aspect of the procedure was timed optimally, using a distraction technique. Second, considerations not included in the care model formed three subcategories: negotiations with children; cooperation of the mother and family, and children were influenced by their first impressions of and relationships with health care providers. We found that nurses executed procedures while accumulating experience and could best bring out the potential of children while protecting patient dignity.

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Much research has been undertaken concerning the care and prevention of pressure ulcers in spinal cord injuries patients. There are also some studies on sitting posture and pressure management for wheelchair using elderly. However, there is little research related to sitting positions and pressure ulcers in the elderly. Many elderly people have very brittle bones, and are effected by deformation and contracture from skinny body frames.
This research focuses on practices that can prevent of pressure ulcers in the buttocks of the elderly. Skin tissue form was obtained for inquiry into the special shapes and causes of pressure ulcers effected by sitting position. Subjects were sitting position patients (n=59), bedridden patients (n=31), and walking patients (n=23). Views of their buttocks skin were compared, and the shapes of the pressure ulcers obtained. Moreover, ulcers from sitting patients were obtained using a wheelchairs are made from transparent polyvinyl chloride and without any underlining; thus enabling contact areas of the ulcers to be observed. The contact area shapes were compared with lateral and the wheelchair positions.
Pressure ulcer wounds effected by sitting positions are shaped like a circle, a ring, a horse's hoof, butterfly and irregular shapes. The relationship between pressure ulcers and the contact area shapes was determined; circles and rings were related to pressures, while horse's hooves, butterflies and irregular shapes were related to shear forces.
Consequently, early care of pressure ulcers can be aided from the knowledge that the direction of the external force effecting the patient's condition can be determined from the shape of the pressure ulcer.

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The objectives of this study were to examine the level of offering nursing cares for family members of terminal cancer patients and the related variables in general hospitals. We examined the related factors that focused on nurses' experiences and features of care units. Staff nurses in twenty-seven care units from four general hospitals in the Tokyo metropolitan area were asked to complete a questionnaire and return it by mail individually. Consent to participate was identified by return of the questionnaire by mail. The nurses answered the level of four types of offering care for family members of terminal cancer patients. The investigated care items were (1) provision of information, (2) educational support to deal with the patient's physical and psychological problems, (3) death-related care, and (4) psychological support for family members. The levels of offering of each care items were 60-70%. The related variables of the level of each care items were analyzed using multiple regression analyses. The levels of disease-related cares of patients ((1)-(3)) were significantly correlated with the nurses' educational experiences such as attendance at large-sized educational sessions and self-learning with printed materials. On the other hand, psychological support for family members ((4)) was significantly correlated with the individual educational support from veteran nurses. The study showed that educational courses with large-sized sessions and printed materials are effective in enabling nurses to offer the patient disease-related care such as information provision and death-related care. The study also indicated that developing individual educational support systems is important for nurses to provide psychological care for families of terminal cancer patients.

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The purpose of the study was to explore the grief process of fathers who lost a child to cancer; how they experienced grief, accepted their child's death and changed themselves in the process. Subjects were five fathers, aged 39-49. The time since the child's death was between 3 years and 10 years. Data was collected by semi-structured interviews and analyzed using an inductive qualitative method.
Seven categories were identified. (1) Sorrow. (2) Confrontation of longing for the lost child. (3) Need to accept the reality of the child's death. (4) Acceptance of the child's death. (5) Transfiguration of values. (6) Transfiguration of the meaning of the sorrow. (7) Keeping a bond with the child.
Fathers grieved deeply and they experienced guilt and regret. However, the quality of these feeling was different from mother's guilt feelings. Work has a special role for father's grief process. In this study fathers were able to cry and express the full range of their sorrow and loss. This finding demonstrated that fathers who lose a child do not necessarily experience stunted affective expression of their grief due to their role expectations.

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With the aim of exploration of the factors affecting the diet-related quality of life (QOL) of diabetic patients, a self-administered questionnaire survey was conducted among diabetic patients in middle age followed up at the outpatient clinic. Among 238 outpatients who consented to participate in the survey, effective responses were obtained from 231 (effective response rate; 97.1%). The Diabetes Diet-Related QOL (DDRQOL) scale was used for determination of the diet-related QOL, and multiple regression analysis was conducted using the subscale scores as the criterion variables. The major factors associated with a better QOL were as follows: a good understanding of the purpose and method of the diet therapy was related to the subscale score for“satisfaction with diet,”low HbA_1c values were related to the subscale score for“burden of diet therapy,”implementation of self-management behaviors and support from family and friends were related to the subscale score for“perceived merits of diet therapy,”and implementation of self-management behaviors, support from family and friends, and low HbA_1c values were related to the subscale score for“general perception of diet.”In addition, the score for“restriction of social functions”was associated with lack of the need to be in charge of the cooking and lack of support from family and friends. Scores for“vitality”and“mental health”were affected by the stronger tendency of internal locus of control in the Health Locus of Control.
These results suggest that improvement of the understanding of all aspects of diet therapy, as well as care for the promotion of self-management behaviors are important, and that support from family and friends is necessary from the point of view of improvement of the diet-related QOL.

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The purpose of this study was to test validity and reliability of the Preoperative Cognitive Appraisal Scale (POCAS). This study was based on the theory of appraisal, stress and coping of Lazarus & Folkman. Responses to the initial POCAS were obtained from sample of 203 preoperative in-patients with laparotomy or thoracotomy. The age of subjects ranged from 23 to 83 years. The reconstructed POCAS was composed of four factors and 29 items. Construct validity was tested through factor analysis and based on the theoretical estimate. Reliability was calculated using Cronbach's alpha coefficient to measure internal consistency. Factor 1 was demonstrated to be positive emotion of a good opportunity and toward a good life following this event. Factor 2 was demonstrated to be optimistic and self-defense emotion that relies on medical treatment or comparison with other patients. Factor 3 was demonstrated to be emotions toward to prepared coping. Factor 4 was demonstrated to be emotions of depression and threat. Factor 1, factor 2, and factor 4 could be explained in terms of primary appraisal, while factor 3 was understood as secondary appraisal. Consequently, the reconstructed POCAS nearly matches Lazarus's theory. Cronbach's alpha coefficient was. 86 for the whole of the POCAS and ranged from. 81 to. 85 for the subscales. This indicates a high reliability of the scale. Validity and reliability of the POCAS were supported. The results suggest that the POCAS may be used as part of assessment of psychological stress in preoperative in-patients.

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The purpose of this study was to identify the hopes and factors related in maintaining hope in people in their twenties and thirties who are living with leukemia/lymphoma. Hope was defined as“the possibility of feeling for producing the power to live in the future”. Data were collected from semi-structured interviews with four patients, who were informed of their own disease at the hematology outpatient ward in a university hospital. Inductive and qualitative analysis were employed for analyzing data. As a result, five hopes and five related factors in maintaining hope were identified. The five hopes were: (1) staying alive, (2) relief from disease, (3) visualizing future life and dreams, (4) being oneself, and (5) experience with other people's development. The five related factors in maintaining hope were: (1) having desires for the future, (2) barriers against hope, (3) personality characteristics or sense of worth, (4) strategies to overcome barriers against hope, and (5) environmental factors for supporting hope. We think that these results will prove useful when nurses or those who are with patients select a way to interact with patients by making it possible for them to support the patient's hope.

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1. The Japanese higher education system in nursing has developed greatly over the last 15 years. Much research is conducted by university nursing faculty members and graduate students in nursing, but it does not affect in clinical practice.
2. Most nursing research projects were descriptive studies which cannot he applied to the practice of nursing. We need to challenge ourselves to discover the methodologies and strategies for utilization and application.
3. The nurse researcher cannot conduct research continuously, so the research is limited to early stages of development. We need to develop methodologies and strategies to complete the research and develop theories for nursing practice.
4. The clinical situation is changing rapidly. We need to develop various methodologies with new perspectives. We must develop each methodology according to the current nursing situation.

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