Poster Abstract Book PDF

Poster Presentation List
Presentation Date: February

Presentation Time:
No.
5, 2015
Rm 402CD
09:00-12:00
Title of the Abstract
Presenter
Nationality
Page
PA02
Development and psychometric testing of the blood donor satisfaction

scale
Shu-Chen Yang
Taiwan
PA03
Development of a stress appraisal scale on workplace harassment injury

for nurses
Yuki Kawamura
Japan
PA04
Development of a measurement scale for workplace harassment inicted

on nurses
Sakae Mikane
Japan
Osamu Munakata Japan
PA05 Literature review of Japanese nurses' concept of yarigai

PA06
The effects of nurses practice environment on new graduate nurses' reality

Eun-Young Kim
shock
South Korea
PA07
Usefulness of the compassion process to manage human resources in

nursing elds at hospitals
Joo Hyun Kim
South Korea
11
PA08
The current situation of discharge planning nurses in Japan

comparison of the results of two nationwide surveys: 2010 versus 2014
Hikari Tomura
Japan
13
PA09
Psychological empowerment among hospital nurses in Japan:

A preliminary qualitative investigation
Junko Ouchi
Japan
15
PA10
Costs of nursing interventions: Compare with Korea health insurance

system and abc code of united states
Young-Shin Park
South Korea
17
PA11
Identication of realtionship among organizational characteristics and

organizational commitment of nurses in rural area of Nepal
Mineko Namba
Japan
19
PA12
The relationship between social support and nursing performance among

Korean clinical nurses
Mi-Ae You
South Korea
21
Nursing administrators' views of barriers to research utilization and the

PA13 relationship to their educational levels in the northeastern provinces of
Japan
Yoshihito Endo
Japan
23
PA14 Shortening patient's waiting time for abdominal ultrasound examination
Hsueh-Ling Ku
Taiwan
25
PA15
The relationship between nursing staff's quality of working life and

organizational commitment
Jen Sheue Hung
Taiwan
27
PA17
Effect on experienced violence, emotional labor and job stress on

depression of clinical nurses
Yeon Kyung Na
South Korea
29
PA18
Recognition of verbal abuse toward nurses by patients in psychiatric wards

Yuriko Tanabe
in Japan
Japan
31
PA19
Dealing with burnout through bibliotherapy: The effects of reading

selected iinspirational short stories for nurse managers
Warren Kemuel
Marte Pan
Philippines
33
PA20 Survey of actual state on nurse call in Hirosaki University Hospital
Toshiya Inaba
Japan
35
A study on the strategy of the visiting nursing station in the local area in
PA21
Japan
Masaru Isoyama
Japan
37
PA22
Quality of working life and related factors of nurses in the hospitals a cross-sectional research
Ya-Chun Yang
Taiwan
39
PA23
State of educational programs for current clinical nurses and relevant

issues in Japan
Hiromi Uesawa
Japan
41
Taiwan
43
PA24 Assessment and instruction to promote higher thinking in nursing students Huimin Lo
PA25
The "thinking exercises" were effective to improve a stigma against cancer

AI Yamaguchi
in the nursing students
Japan
45
PA27
Analysis of the concept of thedevelopment of educational materialsin

nursing training
Japan
47
Kumiko Iwatani
18th EAST ASIAN FORUM OF NURSING SCHOLARS
No.
Developing a nursing continuing education program focused on the

PA28 process of active listening, for patients with intractable neurological
disease: Features of the education program
Presenter
Nationality
Page
Chizuko Takeuchi
Japan
49
Kanna Okayama
Japan
51
Hiromi Morioka
Japan
53
PA29
Problems of the existing evaluation forms for the basic nursing practicum
and a proposal of the rubric-based evaluation form
PA30
Student information which should be shared by teachers to conduct

effective on-site practice guidance second report
PA31
Examination of effective educational guidance at practical nursing sessions

held at multiple facilities
Yuri Tainaka
Japan
55
PA32
Investigation of the cognition of nursing students at various facilities

regarding lack of teaching consistency
Horie Naoko
Japan
57
PA33
Factors related to the continuation of volunteering for a support service for

persons with early-onset dementia by nursing students in Japan
Yuko Degai
Japan
59
PA34
Meaning and learning of nursing students who participate in volunteerism

of people with young-onset
Junko Masuya
Japan
61
PA35
Factor analysis of nursing students' learning featuring senior students

acting as simulated patients
Sachie Arai
Japan
63
Momoe
Konagaya
Japan
65
Emi Nishida
Japan
67
PA38 A study on the professional identity in basic nursing education
Satomi Tanaka
Japan
69
Contraceptive self-efcacy, attitude toward contraception and practices of

PA40
contraception among Korean nursing students
Dong-Hee Kim
South Korea
71
The effect of an online continuing education program on urinary

PA41 incontinence knowledge and attitudes among community health nurses in
South Korea
Aeyoung So
South Korea
73
Validation of a nursing continuing education program for the care of

PA36 patients with intractable neurological disease, with an emphasis on active
listening: Analysis of self-learning and the active listening scale
PA37
What lies behind educational behavior of preceptors to novice nueses

focusing on educational concept of values of preceptors
PA42
Effect of audiovisual materials in teaching menopause to rst-year nursing

students
Yukiko Ushigoe
Japan
75
PA43
Developing evidence-based nursing concept strategies in pediatric nursing

practicum through action research
Fang-Yi Lin
Taiwan
77
PA44
Self-condence in core nursing skills among Korean undergraduate

nursing students
Dong-Hee Kim
South Korea
79
PA45 Preceptorship programs for newly registered nurses: A systematic review
Ya-Ting Ke
Taiwan
81
A study about the communication skill of nursing students during nursing

PA46
practice for the elderly with dementia
Koko Kaneyama
Japan
83
PA47
A study on students' core competencies of gerontological and long-term

care program based on fuzzy delphi method
Hung-Lan Wu
Taiwan
85
PA48
Development of a values-based person specication for recruitment and

selection of compassionate nursing and midwifery students
Anne Waugh
United
Kingdom
87
PA49
Improving education in nursing skills & techniques required by school

nurses in a junior high school environment
Mika Yuasa
Japan
89
PA50
The effects of English article discussion club on reading behaviors:

A longitudinal survey of undergraduate nursing students in Taiwan
I Lee
Taiwan
91
PA51
A review of the literature on communication issues faced by nursing

students
Makiko Morita
Japan
93
PA52
Male nursing students' perception and managing experiences of role

strain in Taiwan
Cheng-I Yang
Taiwan
95
Hui-Lin Sun
Taiwan
97
Yu-Ling Wu
Taiwan
99
PA53 The reective process of nursing students during the clinical practice
PA54
Effects of video instruction on the skin care learning in long-term care

nurse aides
II
No.
Presenter
Nationality
Page
PA55
Learnings of public health nursing undergraduate students from

community
health nursing diagnosispractice
Kiyoko Kurihara
Japan
101
Rie Tomizawa
Japan
103
Shu-Chen Wang
Taiwan
105
Mei-Chen Tsai
Taiwan
107
Mikiyo Sato
Japan
109
Cheng-I Yang
Taiwan
111
Emiko Yamamoto
Japan
113
Myung-Sun Hyun
South Korea
115
Chiu-Ping Su
Taiwan
117
PA56 Perceptions of teachers in the education of nursing college students

PA57 The effect of mindfulness-based intervention on stress in nursing staff
A study of the relationships between disease self-management and related
PA58
factors in hemodialysis patients
PA59
Educational effectiveness of using the online database of thehealth and

illness narratives DIPEx-Japan (of breast cancer)
PA60
Building the trust relationships with psychiatric patients:

Students' experiences in the psychiatric clinical placement
Medical safety skills of nursing students involved in "skills of taking

PA61 directions", "skills of transmitting directions" ~extraction of the target
behavior for basic nursing education
PA62
Development of the evaluation instrument for achievement of education

objectives
PA63
Port-A multimedia instruction: It's efcacy in nursing knowledge and

condence
PA65
Explored the practice stress and interactive satisfaction with clinical nurses
Hsueh-Ching Wu
among nursing students
Taiwan
119
PA66
Evaluation of " human relationship " curse as interprofessional education

(IPE) for medical technology related university students
Keiko Sekido
Japan
121
Yu-Hsien Hsu
Taiwan
123
Yumi Maenobu
Japan
125
Kazuaki Hirai
Japan
127
Eun Ji Seo
South Korea
129
Restrained the gap between the education and practice: The evaluated
PA67 study for newly graduated nursing college students with the last mile
engagement program in Taiwan
PA68
Effectiveness of reective thinking in small group presentations on clinical

nursing skills by utilizing movie feature of tablet computer
PA69
Development of forensic nursing education in Japan:

A questionnaire survey of forensic nursing universities
Level of core competency recognized by nursing students in Korea

PA70 -focusing on interpersonal&cooperative skills and higher - order thinking
skills
PA71
Effect of adopting reective thinking in post clinical patient summary

presentation after the rst adult nursing clinical practice
Kazue Tamura
Japan
131
PA72
The self-role perception of the clinical nursing teacher in ve-year nursing

college
Pen-Hsin Hou
Taiwan
133
PA73
Current state of education activities in clinical practice guidance nursing

teacher of 3- year nursing school in Japan to address
Kimiko Takahashi
Japan
135
Chih-yin Chien
Taiwan
137
PA74 Evaluation of admission care teaching program for nursing students

PA75
Systematic review: Patient-family caregivers congruence of cancer

symptom perception
Chia Tai Hung
Taiwan
139
PA76
The inuence of end of life educational programs on attitude to death of

undergraduate nursing students: A systematic review
Ting-Ting Mei
Taiwan
141
Yoko Satake
Japan
143
Yi-Chun Yang
Taiwan
145
Young Ran Chae
South Korea
147
Emi Kondo
Japan
149
Chika Matsuda
Japan
151
Chien Hui Lin
Taiwan
153
PA77 Conicts in nursing roles in the emergency department: A concept analysis

PA78
Out of the doldrums a gripping narrative from a HIV-infected patient's

female spouses
PA79
Validity and reliability of Korean version of revised moral distress

scale(KMDS-R) for clinical nurses
PA80
A comparative study of ethical dilemma and coping between Korean

nurses and Japanese nurses
PA81 Meta-analysis of scientic nursing theory

Constructing ethical approaches through nursing practice-when nurse face
PA82
to caring for stillbirth
III
No.
Presenter
Nationality
Page
Yuan-Ching Liu
Taiwan
155
Pei-Pei Chen
Taiwan
157
PA83
A concept analysis: Psychological insulin resistance in adults with type 2

diabetes
PA84
Developing a Q-methodology study to explore nurses' views on moral

distress
PA85
The utilization of information and communication media by hospitalized

children with cancer with a focus on hospital websites
Kenji Takao
Japan
159
PA86
Trends in transition care from adolescents to young adults with chronic

disease in Taiwan
Yo-Ting Jin
Taiwan
161
PA87
Required knowledge and skills of nurses for families whose infants are
transitioning from NICUs to home
Miyuki Nakayama
Japan
163
PA88
Effectiveness of a smoking prevention class for seventh grade junior high

students
Miki Konno
Japan
165
PA89
Lived experiences of mothers of children with autism spectrum disorder:

Basis for enhanced nursing care
Bea-Gracia
Martinez Cruz
Philippines
167
Shingo Ueki
Japan
169
Fumie Shimizu
Japan
171
Ayumi Nakata
Japan
173
Chinatsu Nishida
Japan
175
PA90 Parents' uncertainty when their children have an illness

PA91
Role development of nurses for technology-dependent children attending

mainstream schools in Japan
PA92 Factors of child dental fear

PA93
A qualitative study of requests to society from parents of children receiving

developmental support
PA94
Effects of inkblots therapy on anxiety and post-operative pain among

9-11 year old children for circumcision
Roqsan-Apple
Dolores
Philippines
177
PA96
Effectiveness of Buteyko method in asthma control and quality of life of

school-age children
Zarah Delerro
Libozada
Philippines
179
PA97
Factors associated with health related quality of life of adolescents with

congenital heart disease
Hsiao-Ling Yang
Taiwan
181
PA98
Study into the effectiveness of education through asthma classes for

mothers of children with bronchial asthma
Keiko Hosono
Japan
183
PA99
Relations of PDQ developmental screening with physiological and

environmental characteristics of premature infants at age of six months
Kyung-Sook Bang
South Korea
185
PA100
Validation of the Chinese version of the family hardiness index and the
family resilience scale among families with adolescence
Hsiang-Yun Lan
Taiwan
187
Hisae Tabata
Japan
189
PA101 Concept analysis of "children's independence"

PA102
Oral motor interventions to improve oral feeding performance in preterm

infants: A systematic review
Yu-Wen Wang
Taiwan
191
PA103
The actual situation of the NICU long-term hospitalization child's nursing

in Japan
Maki Shirasaka
Japan
193
Maki Shirasaka
Japan
195
Aya Shimizu
Japan
197
Akemi Hara
Japan
199
Chieko
Numaguchi
Japan
201
Shu-Yi Tseng
Taiwan
203
Chia-Hsuan Lin
Taiwan
205
Tanaka Haruna
Japan
207
PA104 The childcare living survey of the parents of the child who left NICU
PA105
Stationary sound surrounding preterm infants within occupied-closedincubator
PA106 The review of the children in need of medical care at home in Japan
PA108
The thoughts and feelings of siblings living with children with severe motor
and intellectual disabilities
PA109 An experience on helping families learn home parenteral nutrition

PA110
Cross-cultural adaption and validation of Taiwan version of the family

management measure (FAMM)
PA111 Self-conceptions of solitary seniors living at home a concept analysis
IV

Presentation Time:
No.
5, 2015
Rm 402CD
14:00-17:00
The impact of training parents by acceptance and commitment therapy

PB02 (ACT) for managing their children with chronic health problems: A literature
review
The family empowerment of mothers rearing children with severe motor
PB03 and intellectual disabilities: Mothers' perception of service needs for
maintaining their daily living and empowering the family
Presenter
Nationality
Page
Yuen-Yu Chong
Hong Kong
209
Naho Sato
Japan
211
PB04
Validation and psychometric testing of the caregiver burden index (CBI)

for parents of children with allergies
Pei-Ching Liu
Taiwan
213
PB05
Concomitant diseases and environmental risk factors will inuence the

incidence of allergic rhinitis for 6-8 years old in Taipei, Taiwan
Ciao-Lin Ho
Taiwan
215
PB06 The review study of fathers' recognition
Kiyomi Decker
Japan
217
The effectiveness of cabbage leaf application (treatment) on pain

PB07 and hardness in breast engorgement and its effect on the duration of
breastfeeding
Boh-Boi Wong
Singapore
219
Stress, coping style and nursing needs of hospitalized pregnant women for
pre-term labor
Su-Hyun Kim
South Korea
221
Characteristics related to mother-child interaction at one-month postpartum

PB09 assessed by Japanese version of nursing child assessment satellite
training project (JNCAST)
Masako Saito
Japan
223
PB10
Nursing practices for early detection of child abuse risks and perinatal care
for mothers by maternity nurses in Japan
Mitsue Otomo
Japan
225
PB11
Usefulness of a pregnancy-related risk self-assessment scale for pregnant

Japanese females requiring transfer or referral
Kyoko Kanamori
Japan
227
PB12
Factors related to low maternal satisfaction among Japanese rst-time

mothers one month after childbirth: A logistic regression analysis
Emi Mori
Japan
229
PB13
Maternal depression, sleep quality, and mother-infant attachment in the

rst 12 months postpartum
Pao Ju Chen
Taiwan
231
Chikako
Mochizuki
Japan
233
Kaori Kinouchi
Japan
235
PB08
PB14 Current status of oxidative stress during pregnancy and future study issues
PB15
Development of new pelvic oor muscle training support systems for

postnatal women delivered via email on a smartphone
PB16
Qualitative evaluation of perineal support care during the second stage of

labor
Toyoko
Yoshizawa
Japan
237
PB17
Social support and postpartum depression in Taiwanese women:

A longitudinal study
Li chun Lee
Taiwan
239
Miao-Fang Shih
Taiwan
241
PB20 Autonomic nervous activity before and after labor
Hiroe Washio
Japan
243
The related factors for postpartum depression among immigrant women:

PB21
A literature review
Qiong-Ai Jin
Japan
245
The effect of maternal adaptation enhancement program on the

PB22 breastfeeding and caring condence in the primipara who used Sanhujori
facilities in Korea
Ju-Eun Song
South Korea
247
PB23
Literature review for qualitative researches of maternal adaptation among

Korean immigrant women
Ju-Eun Song
South Korea
249
PB24
Self-care agency and associated factors among pregnant Japanese

women with nausea and vomiting of pregnancy
Akiko Iwakuni
Japan
251
MIchiko
Nakashima
Japan
253
Cognitive behavior in relation to the fetuses during the third trimester of

PB19 women who were pregnant with twins after the use of drug or reproductive
technology
PB25 Study on support of the pregnant woman which observed the father
No.
PB26

Prenatal exposure to different smoking environments urine cotinine
analysis of pregnant women in South Taiwan
PB27 Health and QoL of Chinese female students in Japan

PB28 Experiences with and adjustments to infertility: The gender difference
PB29 Sexual and reproductive health among women with spinal disorder
PB30
Intervention methods in sex education programs for adult women:

A literature review
PB31
Effects of advanced on-the-job training for maternal-child care nurses and

midwives in Tigray regional state of Ethiopia
PB32 Effectiveness of stretching exercise on low back pain among postpartum women
PB33
Efcacy of enjoying a quilting against quality of daily life and tendency to

depression in the aged women
PB34 Study of the self-massage method on the lower extremities of healthy women
Presenter
Nationality
Page
Shih-Hui Huang
Taiwan
255
Sanae Saitoh
Japan
257
Liying Ying
China
259
Hiroko Tsujimoto
Japan
261
Shiho Kawata
Japan
263
Kyung-Sook Bang
South Korea
265
Huei-Mein Chen
Taiwan
267
Masayo Ayukawa
Japan
269
Yukiko Ushigoe
Japan
271
PB35
Results of the health education program towards promotion of cervix

cancer screening for the 20 30th generation woman
Izumi Matsuo
Japan
273
PB36
Factors associated with intention to use condoms for reducing human

papillomavirus infection risk among Taiwanese adolescent women
Yu-Ching Tu
Taiwan
275
PB37
The effect of a self-monitoring network using PHS among Japanese

women during pregnancy
Yumiko Sakuma
Japan
277
Miao-Fang Shih
Taiwan
279
Masako Abe
Japan
280
Cheng-Chen
Chou
Taiwan
282
Atsuko
Yoshidome
Japan
284
Kanako Yamada
Japan
286
Qing Guo
China
288
Chia-Wen Lee
Taiwan
290
Ju-Fen Lu
Taiwan
292
PB38 The life experience of an adolescent becoming a mother

Qualitative study: Understanding women's experience in infertile women
PB39
to reach fertile limitation
PB40
Validation of the Chinese version of the Cogstate Computerized Cognitive

Assessment Battery in Taiwanese women with heart failure
PB41 Factors related to HRQoL in endometriosis patients

PB42
Developing the network of sexuality education reaching out from

university
PB43
Study of intervention on women's help-seeking behavior for stress urinary

incontinence
PB44 Social network support and health perception in Taiwanese single mothers
The effectiveness of home telehealth care combining telephone
PB45
consultation in hypertension management among elderly population
PB46
Identifying research directions for optical topography to address

depression among elderly with dementia in Japan
Miwa Yamamoto
Japan
294
PB47
Establishment of a transitional care program for discharged elderly stroke

patients
Pingping Zhang
Japan
296
PB48
Changes in the Euro QoL and depression, and post-operative patient

satisfaction 5 years after total hip arthroplasty
Kimie Fujita
Japan
298
Bea-Gracia
Martinez Cruz
Philippines
300
Hsin-Yi Jennifer
Liu
Taiwan
302
Mana Kanno
Japan
304
Mimi Tse
Hong Kong
306
Shino Morizane
Japan
308
Terumi Kijima
Japan
310
Composure behaviours of advanced beginner nurses and their effects

PB49 on the wellness outcome among selected orthopaedic patients: Basis for
action plans
PB50
The impact of family functioning and self-efcacy on caregiving appraisal

of dementia family caregivers
PB51
Nonpharmacological therapies for behavioral and psychological symptoms

of dementia: A systematic review
PB52 Electronic pain management across a lifespan: A review of the literature

PB53
Initiatives in residents' associations for preventing elderly living alone in

housing complexes from being isolated
PB54
Approaches of nurses to inpatient care of the elderly with dementia at

advanced treatment hospitals
VI
No.
Improvement of the physical activity and quality of life after primary total
PB55 knee arthroplasty: Two-year postoperative evaluation and comparison with
healthy persons
Presenter
Nationality
Page
Kimie Fujita
Japan
312
PB56
Sense of coherence and inner sense of value among elders who

experienced the great east Japan earthquake
Minako
Kobayashi
Japan
314
PB57
International trend in attitudes toward older people among healthcare and

welfare students: A literature review
Mayumi
Sakamoto
Japan
316
PB58
Exploring the impact of advance care planning on Chinese older people in

Hong Kong
Amy Mi Fun NG
Hong Kong
318
PB59
Self-perceived burdens in cancer patients on their spouses when requiring

nursing care in elderly two-person households
Miki Oeki
Japan
320
Yumiko Taketomi
Japan
322
Miki Fukuma
Japan
324
Shu-Fang Chang
Taiwan
326
PB60 Effect of aromatherapy on elderly nursing home residents with dementia

PB61
Relationship between cognitive functions and the propensity for falls in

community-dwelling elderly
PB62 Predictive factors of at risk of malnutrition for pre-frail older adults in Taiwan
PB63
Issues regarding gerontological sleep education for nursing students in

Japan
Rika Saito
Japan
328
PB64
Analysis coping style and related factors of elderly women patients with
stress urinary incontinence in Binzhou
Binbin Yu
China
330
PB65
Factors associated with progress or regress of the consistency of food

substances of residents in welfare facilities for seniors in Japan
Tomoko Nishihira
Japan
332
Tetsuko Takaoka
Japan
334
PB66 Research trends in depression among the elderly in nursing science in Japan
PB67
The useful life skills during the elderly period - by focused group interviews
of the Japanese elderly people
Ruriko Kidachi
Japan
336
PB68
A study on interpersonal intimacy and meaning of life among the senior

veterans in institutions
Chen-Chun Niu
Taiwan
338
PB70
Nursing interventions for decreasing medication error among homedwelling elderly discharge from hospital in China
Jie Li
China
340
PB71
The effectiveness of a life-enhancement program focusing on dining for

residents in welfare facilities for seniors
Miho Takami
Japan
342
Kai-Li Chen
Taiwan
344
PB72 An exploration of feelings of respect among hospitalized elders in Taiwan

PB73 Characteristics of QoL and difculties in daily life of elderly minor stroke patients
PB74 Nonrestorative sleep is associated with increased falls in dementia
Megumi Toriya
Japan
346
Hsiao-Yean Chiu
Taiwan
348
Hui-Ping Cheng
Taiwan
350
PB75
The differences of geriatric syndromes and quality of life in diabetes elders

with different physical activities
PB76
The actual situations of end-of-life care provided to the care receivers with
Tomoko Sugimoto
cancer by the care workers at nursing care insurance facilities
Japan
352
PB77
Future prospects of intergenerational interaction in China based on Japan's

experience
Xiaowei Lu
China
354
PB78
Exploring elements of end-of-life care for the elderly with the aim of
developing quality indicators: English literature review
Nobuko Kawai
Japan
356
PB79
Nurses' experiences with and interests in patients with cognitive

impairment in acute hospitals: Comparison between Thailand and Japan
Chieko Greiner
Japan
358
PB80
The changes of applying the gerotranscendence reminiscence therapy

among institutionalized elder
Chiu-Yueh Hsiao
Taiwan
360
PB81
A study on prevalence of elderly people with edema according to activity at

long-term care hospital and nursing home in Japan
Aya Sato
Japan
362
PB82
Predictors of health behaviors for adults with hypertension worldwide:

Research synthesis
Mayumi Mizutani
Japan
364
PB83
An investigation of the effect of exercise and physical activity in the

treatment of diabetes
Feng-Ching Sun
Taiwan
366
VII
No.
Presenter
Nationality
Page
Kyeha Kim
South Korea
368
Effects of normal saline and essential oil gargling on bacterial colonization

in intubated patients for general anesthesia
Hae-Sook Hong
South Korea
370
PB86 Development of acne reected stress in the last grade of nursing students
Riho Kuwabara
Japan
372
Jun-Hui Ong
Malaysia
374
PB84 Effects of deep breathing with incentive spirometer

PB85
Comparison of physiological responses and metabolic equivalents on

PB87 elliptical training with 12-minute walking test (12mwt) in males with
different categories of body weight
PB88
Factors inuencing adherence to vestibular rehabilitation in patients with

dizziness
Hyun-Jung Lee
South Korea
376
PB89
The effects of the PCA (patient controlled analgesics) educational program

on the post-op pain of the gynecologic laparoscopic surgery patients
Joo Hyun Kim
South Korea
378
Huei-Chen Lin
Taiwan
380
Can exercise training improve the functional impairment in the intermittent

claudication PAOD patients?
Yi-Teen Wang
Taiwan
382
PB93 Smoking cessation counseling and predictors in tobacco control educators
Shiu-Wen Tsai
Taiwan
384
PB94
Designing a healthier lifestyle in a student nurses-nursing teachers

partnership
Satoko Imaizumi
Japan
386
PB95
A decrease in body mass index and its inuence on dermal structure in

Japanese overweight males
Masaru
Matsumoto
Japan
388
PB96
Effectiveness of home-based exercise in patients with heart failure:

A systematic review of randomized controlled trials
Yu-Ying Chou
Taiwan
390
PB97
The current situation and issues of the latest research about secondary
prevention after acute myocardial infarction
Hitomi Nagamine
Japan
391
PB99
Incontinence associated dermatitis in critical care unit a prevalence

survey
Shiao-Pei Wang
Taiwan
393
PB100
Nursing approaches during passive music therapy in the ICU and patients'
responses
Erika Goda
Japan
395
PB101
Postoperative nutrition management focused on oral intake during the

recovery process in esophagectomy
Tomoko Shimoda
Japan
397
Yuko Uesugi
Japan
399
Junpei Haruna
Japan
401
Effects of stationary cycling and elliptical training with same resistance

PB90 load on physiological responses and oxygen consumption in a group of
men with 3 different levels of body weight
PB91
PB102 Review of quality of life of patients with osteonecrosis of femoral head

PB103
Difculties faced by nurses dealing with oncologic emergencies at

emergency centers
PB104
Patient anxiety corresponds with SigA levels over the course of pancreatic
surgery
Nanae Ikeda
Japan
403
PB105
Aggressive medical treatments received by terminal stroke patients in the

adult intensive care unit in the last of life
Pei-Yi Wang
Taiwan
405
PB106
The development of a framework to analyse the nursing process in critical

care nursing
Shinsuke
Hashiuchi
Japan
407
PB107
Nursing support for families facing surrogate decision-making on

withdrawal of active treatment for patients in intensive care units
Masayo Takeuchi
Japan
409
PB110
The role of nursing care in stroke patients' return to work: A systematic

review
Yuki Gotoh
Japan
411
Mayumi Mizutani
Japan
413
Akiko Tomioka
Japan
415
PB111 Nursing support for families of emergency patients in Japan

PB112
Thoughts and experiences of family members in attendance during

cardiopulmonary resuscitation
VIII
6, 2015
Presentation Time: 08:30-11:30
No.
Rm 402CD
The impact of preoperative organic brain damage or postoperative

PC01
complications to the postsurgical recovery process of mental function
Presenter
Nationality
Page
Hiroshi Ono
Japan
417
Yumiko Yatomi
Japan
419
PC02
Characteristics of the content of the work of critical care nurses based on

a time-motion study: Through comparison with neurology nurses
PC03
A systematic review of methods of eye care for adult patients in the

intensive care unit: A meta-analysis
Cai Hua Sim
Singapore
421
PC04
Excretion patterns of urinary melatonin after cardiac surgery in elderly

patients
Hiromi Arita
Japan
423
Yuko Yamamoto
Japan
425
Sz-Ching Lin
Taiwan
427
PC07 Efcacy of compression stockings in the treatment of venous ulcers
Yi-Teen Wang
Taiwan
429
Being a caregiver for patients with end-stage renal disease in Singapore:

PC08
An exploratory qualitative study
Kai-Jun Chan
Singapore
431
PC09
Experiences of patients undergoing haemodialysis in Singapore:

Leting Isabella
Hong
Singapore
432
PC10
Implicit end-of-life needs of patients with chronic respiratory disease and

their families in the home care setting
Yoshiyuki
Takahashi
Japan
433
PC11
Risk factors for foot lesions and related preventive care intervals in
patients undergoing maintenance hemodialysis
Yayoi Takahashi
Japan
434
PC12
Factors associated with self-care behaviors in Chinese chronic heart

failure patients
CAO XI
China
435
Fumiyo
Minamimura
Japan
436
Chinatsu Uetani
Japan
438
Yuka Kanai
Japan
440
Mitsuyo Inoue
Japan
442
Masaharu
Kadono
Japan
444
CHIA-CHIEN Li
Taiwan
446
Chun-Ja Kim
South Korea
447
Hsiu-Yen Huang
Taiwan
448
Yunlu Wang
China
449
Chinatsu
Ishibashi
Japan
450
An education program based on the health belief model for newly

PC05 diagnosed type 2 diabetes patients to promote self-care behaviors in
Japan
PC06
Increasing self-care ability can reduce hospital utilization in COPD

patients: A systematic review
A study on decision making of the disease disclosure or nondisclosure in

PC13 diabetic patients: The relation between internal personal factors, HbA1c,
patients' satisfaction, and diabetes disclosure to friends
PC14
A case study regarding home nursing support provided by visiting nurses

to support the lives of people with chronic heart failure
The structure of nursing care for patients with intractable neurological

PC15 diseasesanalysis of a nurse's interaction with a patient who had
myasthenia gravis
PC16
Quality of life instruments for patients with systemic lupus erythematosus:

A literature review
PC17 Health literacy in male patients newly diagnosed with chronic heart failure
PC18 The challenges of living experience in patients with chronic heart failure
Psychometric evaluation of the self-efcacy for appropriate medication use
PC19
scale-Korean version (SEAMS-K) among adults with type 2 diabetes
PC20
A study of the relationships between symptom burden and functional

status and health-related quality of life in patients with COPD
PC21
To evaluate the efcacy of a physical activity intervention program using a

log sheet for stroke impaired elderly
PC22
Self management in patients with Crohn's disease-a investigation of

expert nurses
PC23
Relationships of lifestyle with physical health and mental health in

Japanese late middle-aged patients on chronic hemodialysis
Mizue Fujii
Japan
452
PC24
Literature review for developing patient education program in prevent

aggravation of chronic virus hepatitis
Ying-Ai Cui
China
454
IX
No.
Presenter
Nationality
Page
PC25 Development and effect of the tool "life story" to promote the communication
Tomoko Hayashi
Japan
456
Diabetic related retinopathy and neuropathy and impacts on falls in

diabetics patients
Pi-Ling Tsai
Taiwan
458
Masako Uchida
Japan
459
PC26
Development of the scale life reorganization for adults on chronic

PC27 hemodialysis in Japan -examination of the effect differences in lifestyle
and medical environment
PC28
End-of-life care preferences in patients with chronic obstructive pulmonary

disease
Ting-Ru Chen
Taiwan
461
PC29
The effect of relaxation-based interventions on health related outcomes of

patients with COPD: A systematic review
Doris Yu
Hong Kong
462
PC30
Nursing care of patients with gastric cancer and cachexia to learn home
parenteral nutrition
Meng-Yuan Liu
Taiwan
464
PC31
The nursing experience of caring a terminal hepatocellular carcinoma

patient with attempted suicide
Hui-Chuan Chang
Taiwan
465
PC32
Factors affecting cognitive function in breast cancer patients receiving

hormonal therapy
Sena Yamamoto
Japan
466
PC33
The introduction of a "caring for couples coping with cancer (4Cs)"

programme to support couples coping with cancer
Qiuping Li
Hong Kong
468
PC34
Characteristics of communication skills of general ward nurses for endstage cancer patients and their families
Saori Yoshioka
Japan
470
PC35 Visitor's needs and nursing support at cancer information section
Kiyomi Kurata
Japan
472
Overview of and issues in nursing care for edema in patients with endPC36
stage cancer in Japan
Sachie Miyake
Japan
474
Misuzu Shimada
Japan
476
Michiko
Kadobayashi
Japan
477
Kaori Murata
Japan
479
Mizue Shiromaru
Japan
481
Tomoki Maeda
Japan
483
PC37 A research on the diverging point of yuragi among cancer survivors

Why do authors publish their owntobyo-ki
? Focus on books written by
PC38
breast cancer patients
PC39
Difculties faced by nurses caring for patients with hematologic

malignancies and their families
PC40
Narratives about chemotherapy in tobyo-ki: From autobiographies written

by women with breast cancer
PC41 The current status of studies on benet nding in Japan

PC42
Nursing experience of caring a small cell lung cancer patient in the

terminal stage
Yu-Ju Chuang
Taiwan
484
PC43
A case report: Nursing care for a single mother with neuroblastoma by

nurse practitioner
Yu-Fan Chen
Taiwan
485
PC44
Nursing care of young woman patient faced with the threat of pancreatic
cancer disease
Shiang-Lan Yan
Taiwan
486
PC45
Lower urinary tract symptoms of prostate cancer patients undergoing

treatments over eight-month follow-up
Hui-Chi Li
Taiwan
487
PC46
Development of a nursing model for supporting a shared decision making

process with a cancer patient
Yuko Kawasaki
Japan
488
Momoe Utsumi
Japan
490
Wei-Jung Chang
Taiwan
492
Yu-Juan Xu
Taiwan
493
PC47 The efcacy of his@home, an ipad application, for in-home palliative care
PC48 Nursing experience of intra-arterial chemotherapy for oral cancer
The effectiveness of perioperative enteral immunonutrition in patients
PC49
undergoing esophageal cancer resection: A systematic review
PC50
The effects of group nutrition education program for postoperative oral

cancer patients
Shu-Ling Tu
Taiwan
494
PC51
A literature review of factors of patient-related barriers to the use of

analgesics in early stage cancer patients
Mariko Koike
Japan
496
PC52
Associations between physical activity and fatigue in head and neck

cancer survivors in Taiwan
Yuan-Yuan Fang
Taiwan
497
No.
Comparing survival rate between surgical resection and non-surgical

PC53 resection for colorectal liver metastasis of cohort study at medical center
in central Taiwan
Presenter
Nationality
Page
Mei-Wen Chen
Taiwan
498
PC54
The effect of therapeutic touch for cancer patients with pain-a systematic
review
Li Ting Chen
Taiwan
499
PC55
Changes in vital signs and level of consciousness as predictors for

end-of-life care in patients with lung and gastrointestinal cancer at home
Yuki Kumagai
Japan
500
PC56 Fear of cancer recurrence in patients with head and neck cancer
Hsin-Yu Hsu
Taiwan
502
The impact of oncology case management on the effectiveness of cancer

PC57
care-the study on urinary tract cancer
Ru-Yi Wang
Taiwan
503
Tomoko Otsuka
Japan
505
Jisho Takashi
Japan
507
Taiwan
509
Ming-Ying Hong
Taiwan
510
PC58
Experiences of relationship with others from women diagnosed with

cervical precancerous lesion
The health care professionals' barriers to using analgesics to relieve

PC59 the chemoradiotherapy-induced oral mucositis of head and neck cancer
patients: A literature review
PC60
The reliability and validity of a short form experience of close relationshipsChia-Chen Hsieh
revised questionnaire in female cancer survivors
PC61 Role transition in oncology case managers: A qualitative study

PC62 Fear of recurrence in gynecological cancer survivors
Yu-Ju Hung
Taiwan
512
Yu-Chien Liao
Taiwan
513
Ching-Chi Huang
Taiwan
515
Naomi Ota
Japan
517
PC66 Care needs and psychological distress in gynecologic cancer survivors
Yu-Fang Chu
Taiwan
519
Body composition and QOL among prostate cancer patients undergoing

PC67
hormone therapy
Junko Takagai
Japan
521
Jia Jing Sun
Taiwan
523
PC63 Concerns among women living with incurable lung cancer: A qualitative study
PC64 The transformation process in nurses caring for dying patients
State of daily living in breast cancer patients immediately after disclosure
PC65
of disease recurrence
PC68
My dream is shattered: The impacts of a permanent colostomy after the

reversal of a protective ileostomy
PC69
Determinants of subjective and objective body image in patients with head

and neck cancer
Shu-Ching Chen
Taiwan
524
PC70
Helath related quality of life as a prognostic marker in men with prostate

cancer
Chiung-Yu Huang
Taiwan
525
PC71 The effects of tai chi exercise increase mental health with hypertension
Huimin Lo
Taiwan
526
PC72
Effectiveness of medication adherence therapy for people with

schizophrenia: A randomised controlled trial
Wai-Tong Chien
Hong Kong
527
PC73
Recognizing abuse against persons with seriously mental and physical

disabilities by staff working in related care facilities
Toshiko
Matsushita
Japan
528
PC74
Visiting home care nurses' view of sexual consciousness in elderly

persons with dementia: Interviews with visiting nurses
Toshiko
Matsushita
Japan
530
PC75 Development of smartphone application for alcohol use disorder management
Hae-Sook Hong
South Korea
532
Applying the interprofessional practice to improving the effectiveness of

PC76
dangerous goods safety inspection in the psychiatric ward
Chun-Ti Yu
Taiwan
533
Families of patients with borderline personality disorder in Japan: Family

PC77 signs/symptoms and classication based on the family environment
intervention model
Yasuyo NIshimoto
Japan
534
So Yayama
Japan
536
PC78
Analysis of pica behaviors by disorder observed in a Japanese psychiatric

hospital
PC79
The characteristics of post-traumatic growth of bereaved spouses in

palliative care units
Yumiko Takedomi
Japan
538
PC80
Relevance of stress coping and social adaptation on outpatients with

anorexia nervosa
Mina Tsukamoto
Japan
540
XI
No.
PC81 Suicide in psychiatric hospital in-patients. A review of the literature
Presenter
Nationality
Page
Chie Tanimoto
Japan
542
PC83
Emotional well-being following religious conversion among women in

northeast Thailand
Suangsuda
Charoenwong
Thailand
544
PC85
The effects of reminiscence group therapy on agitated symptoms and

quality of life in elders with dementia
Fang-Yu Hsu
Taiwan
546
Heeseung Choi
South Korea
547
PC86 Measuring mental health of those living in a rural mountain area

PC87
Development and feasibility testing of web-based parent education

program for Korean parents of adolescents
Heeseung Choi
South Korea
549
PC88
Case study: Impact of group sand-play therapy on self-concept of

adolescents with renal transplant
Sumi Kim
South Korea
551
PC89
Construction of psychiatric nursing clinical practice records applicable

form in Taiwan
Shu-Fang Su
Taiwan
553
PC90
A review of the literature containing thenarrativesof people with

autism spectrum disorder in Japan
Mami Yamamoto
Japan
555
PC91
Dysmenorrhea self-care behaviors patterns in adolescents: A latent class

analysis
Chao-Chih Yu
Taiwan
557
PC92
Effectiveness and experience connotation of art therapy among

rehabilitation patients at the day ward
Shiu-Feng Lu
Taiwan
558
PC93 The role of forensic psychiatric nursing in family support
Akiko Nosaki
Japan
560
The educational and psychological support actual condition to the

PC94 emergency department (ED) nurse corresponding to the suicide attempters
in Japan
Naruto Goto
Japan
561
Setsuko
Shimmitsu
Japan
563
PC95
What facilitates recovery from mental illness? Views of psychiatric nurses

and people living with mental illness in Japan
PC96
The investigation of metabolic syndrome among patients with severe

mental illness
Yi-Hsin Chen
Taiwan
565
PC97
Multidisciplinary approach to promote a practical radiation culture in

Fukushima, Japan
Emiko Konishi
Japan
566
PC98
Developing radiation teaching materials for public health nurses of

Fukushima, Japan
Chie Kawasaki
Japan
568
PC100
Mental health problems and the risk of subsequent internet addiction in

adolescents: Results of a prospective cohort study in Japan
Shunyue Cheng
Japan
570
PC101
Difculties experienced with nursing activities by nurses working in rural

and remote clinics
Tomoko
Sekiyama
Japan
572
PC102
Survey of specied acts of medical assistance to be provided by nurses in

rural and remote area clinics
Shingo Esumi
Japan
574
PC103
Association between religiousity and sexual attitude among prisoners in

Lembaga Pemasyarakatan Kelas A Wirogunan Yogyakarta
Birrul Qodriyyah
Indonesia
576
PC104
Knowledge and attitude of health workers in Yogyakarta to increasing HIV

test scope by using PITC approach
Rizka Ayu
Setyaningrum
Indonesia
577
PC105
Mothers' accepting attitudes towards the care and educational support

provided for their children with disabilities in an underpopulated area
Hibino Naoko
Japan
578
PC106
Community leaders' views of disaster-relief activities as providers of

support in the event of a disaster
Chizuko Noro
Japan
580
PC107
Hand-washing guidance for elderly people in the community to prevent

infection
Yukiko Yamamoto
Japan
582
PC108
Measures that community health nurses perform to secure quality of

business for outsourcing
Yukari Maeno
Japan
584
PC109 Comparison of daytime and nighttime fatigue among shift workers
Ayako Ogata
Japan
586
Mothers' social competence in building social support networks while

PC110
child rearing
Hikaru Honda
Japan
588
XII
No.
Presenter
Nationality
Page
PC111
Long term care nursing competence and its relationship with knowledge,
attitude and practice
Pei-Lun Hsieh
Taiwan
590
PC112
Effects of a family nursing seminar for nurse with differing years of clinical
experience
Fumiko Okamoto
Japan
592
Ayako Okada
Japan
594
Nature of previous attempt to quit smoking and methods that smokers

PC113 preferred to use in any future quit attempts in Japanese men hospitalized
with cardiovascular diseases
6, 2015
Presentation Time: 13:30-16:30
No.
Rm 402CD
PD01 Supporting workers with depression: A literature review

PD02 Types and features of elderlies in the state of self-neglect in Japan
The development of a questionnaire to explore the factors related body
PD03
mass index on adolescents in southern Taiwan
PD04
The effects of health promotion program using forests on mental and

physical health of school-aged children in Korea
PD05
Transdisciplinary collaboration in home health care with a pharmacist as a

team member
Presenter
Nationality
Page
Yukiko Mochizuki
Japan
596
Emiko Kishi
Japan
598
Ya Ping Yang
Taiwan
600
Insook Lee
South Korea
602
Mikiko Sadamura
Japan
604
Thailand
606
PD06 The community capacity for care of persons with chronic illness conditions Charunee Sorakrij
PD07
The development and validation of the self-efcacy questionaire related

low-calories diet and exercise in community populations
Li-Chun Hsaio
Taiwan
608
PD08
Characteristics of dropouts from a biochemical feedback intervention study

for preventing exposure of kindergarten children to second-hand smoke
Harumi Bando
Japan
610
PD09
Effects of the health education program based on the theory of planned

behavior for farmers' exercise behavior change
Susumu Fukita
Japan
612
PD10
The inuence of the social environment related to playing sports for

physical activity and general malaise
Kotomi Yamashita
Japan
614
PD11
Development and evaluation of psychological health promotion program in

children: Prevention of depression
Hyunju Park
South Korea
616
PD12
Characteristics of mothers with a risk of child abuse and negative emotions

towards their children in Japan: A case study
Hiroko Suzuki
Japan
618
PD13
Association between weight self-stigma, body image, media inuence and

intension to weight loss in university students
Kuan Pin Lin
Taiwan
620
PD14
The study of translation of the center for epidemiologic studies depression

(CES-D 20) scale into Indonesian version
Gilang-Dwi
Pratiwi
Indonesia
622
PD15
A study of casual sex intention among adolescentsthe construction on

extended theory of planned behavior
Ying-Hua Tseng
Taiwan
624
HuiWen Huang
Taiwan
626
PD16 Factors associated with being bullied among Taiwanese adolescents

PD17
Characteristics of nursing care for cancer patients undergoing outpatient

chemotherapy by visiting nurses
Yumi Hirahara
Japan
628
PD18
Abuse of individuals with mental retardation by caregivers in Japanese

homes: A literature review
Makiko Morita
Japan
630
Wei-Ping Lee
Taiwan
632
Tomoko
Watanabe
Japan
634
Ariya Sornboon
Thailand
636
Applying structured physical activities to promote obese children of grade

PD19 4-6 for reducing the sedentary behaviors of class breaks: A school-base
approaching
PD20
Characteristics and changes in subjective QoL of caregivers of adult

cerebrovascular disease patients
PD21
Caregiving management for terminal stage patients in community's ways

of life
XIII
No.
Presenter
Nationality
Page
PD22 Perspectives on chronic pain management in community-dwelling older adults
Hyungran Park
South Korea
638
The analysis and assessment of dangerous factors in the visual lifestyle of

children from the view of myopia prevention
Shu-Ching Chiu
Taiwan
640
Lihua Wang
Japan
642
PD23
PD24 A study on the visiting nurses' attitude to the home care patients
PD25
Survey on hospital discharge planning in authorized health insurance

medical institutions in Saitama prefecture, Japan
Mariko Zensho
Japan
644
PD27
The various aspects of hospital-based support system for palliative care:

A eld study
Mariko Zensho
Japan
646
PD29
Changes in the physical health condition of family caregivers caring for the
elderly at home
Torimoto-Sasai
Yasuko
Japan
648
PD30
Development and psychometric evaluation of the institutionalized elders

perceived caring scale
Huei-Lih Hwang
Taiwan
650
PD32
Nurse assistants' perception on the safety issues for the elderly living in
the residential care facilities: A phenomenological study
Panpan Wang
China
652
Chia-Ying Lin
Taiwan
654
Megumi
Nishikawa
Congo
656
Saori Iguchi
Japan
658
PD33 Advance care planning program for institutionalized older people

PD35 Rainstorm and ood disasters in Japan and role of public health nurses
PD36
Case studies of the professional growth of public health nurses who

PD37
Factors associated with the resumption of social activities in elderly people

after an earthquake disaster
Chuhyang Oh
Japan
660
PD39
Learning the states of displaced people's living through eldwork

placement at a health information room in Fukushima
Toshiko Ikeda
Japan
662
PD40
Radiation risk communication and health consultations for local

government staff on long-term evacuation due to disaster impacts
Chiaki Kitamiya
Japan
664
PD41
Verication of a causal model of team empowerment factors and teamwork

function in nursing activities in the acute post-earthquake phase
Kimiko Hayano
Japan
666
PD42
Preparedness for chemical, biological, radiological, nuclear, and explosive

disasters in Japan: A literature review
Yumiko Ogawa
Japan
668
PD43
Characteristics of elderly nuclear disaster evacuees - through until two

years after the six months after the earthquake
Yukari Kamei
Japan
670
PD44
The effects of music interventions for adult patients undergoing

colonoscopy: A systematic review
Shuk yee Ko
China
672
Hsia-Ling Wu
Taiwan
674
Hui-Ling Lai
Taiwan
676
Shu-Jen Chen
Taiwan
678
Yasuko Sugiyama
Japan
680
Bey-Jing Yang
Taiwan
682
Kyung-Sook Lee
South Korea
684
Mahiro Sakai
Japan
686
Rei Ushiro
Japan
688
PD46 Aromatherapy intervention for nurses in work-stress effectiveness

PD47
The effects of music on psychophysiological responses and opioid

dosages in patients undergoing total knee replacement surgery
PD48 Meta-analysis on the effects of therapeutic use of art drawing

PD49
What elementary school students have learned after attending the class
a course on life given by a midwife
PD50
The feasibility and inuence of secondary triage on the patients in an

emergency department
PD51
Perception on patient safety culture and safety nursing activity in hospital

nurses
PD52
Satisfaction with home visit nursing care and relational coordination among
home healthcare professions
PD53
Prevention of falls by promoting collaboration between patients/families

and the medical staff in Japan
PD54
Effect of applying a hot towel against the skin for a short period during bed
bathing -changes in keratin uid volume and skin surface temperature
Inaho Shishido
Japan
690
PD55
Characteristics of assessments performed by nurses for the selection of

the intravenous insertion site for infusion using a short peripheral catheter
Tsuneko
Masamoto
Japan
692
XIV
No.
Presenter
Nationality
Page
PD56
Comparing bacterial contamination of mobile phones of medical staff in

hospital with that in nursing home
Shih-Hui Huang
Taiwan
694
PD58
Certied nurses in infection control address the use of skin disinfection

before subcutaneous injection
Yuko Yoshida
Japan
696
PD59
The study of the relationship among role expectation and quality of care in
Chun-Ju Lin
hospital nursing attendant
Taiwan
698
Akemi Fujita
Japan
700
Comparison between subjective QoL in < 65-year-old and 65-year-old

PD60 cerebrovascular disease patients who were scheduled to transfer from a
convalescent rehabilitation ward to home
PD61
Effects of anesthetic gel on patients receiving the procedure of urethral

catheterization: A systematic review and meta-analysis
Chia-Chi Kuo
Taiwan
702
PD62
Association of cognitive function with falling in the elderly admitted to a

tertiary hospital: Preliminary data
Yuko Tsumoto
Japan
704
PD63
Movement of nursing studies on patients with traumatic brain injury in

Japan from the perspective of advocating rights
Kiyoko Itagaki
Japan
706
PD64
Examination of the inuencing factors on the collaboration culture of the

workplace when accepting foreign care workers in Japan
Kaori Hatanaka
Japan
708
PD66
Effectiveness of an education and multiple risks control intervention for

falls prevention in long-term care facilities
Su-Jung Liao
Taiwan
710
PD67
Effects of a nurse-led fall prevention program in a medical center-a

retrospective cohort study
Shu-Jung Wang
Taiwan
712
PD68 Transfer of critically ill patients to intensive care unit time
Tzu-Tsui Tsao
Taiwan
714
PD69 The use of zolpidem in Taiwan from 2000 to 2012
Jung-Chen
Chang
Taiwan
716
Shao-Hui Shu
Taiwan
718
Singapore
720
Japan
722
PD70
Autonomy in diabetes management in adolescent patients with type 1

diabetes mellitus: A systematic review
PD71
The nurses' mental model in the adoption of an innovative decision support Betty Peck Chui
technology
Khong
PD72
Structural analysis of interpersonal conict between nurses in a medium

size hospital in Japan
PD73
Changes of the chronic heart failure patients by the telenursing intervention

Nobue Ishibashi
model -from the results of a pilot study
Japan
724
PD74
A systematic review on factors associated with health-related quality of life

Florence Wong
in patients with implantable cardioverter debrillator
Hong Kong
726
PD76
Research into bacterial contamination of medical PHS and associated

cleaning methods
Miho Yoshii
Japan
728
PD77
The recent trend of horticultural therapy and consideration of the

therapeutic effects thereof from a health perspective
Ayumi Takakura
Japan
730
PD78
The contents of the training program to prevent the child abuse for the
midwives working in the medical institution
Kyoko Kajihara
Japan
732
PD79
Comparison of nursing students' cleanliness values in Japan and LAOS

using the cleanliness-oriented scale
Tomoko
Yokoyama
Japan
734
PD80
A survey and analysis of the status quo of clinical pain management and
nursing records
Li Liu
China
736
PD81
Stress management programs intended for nurses in Japan and their

intervention effects-review of literature over past 10 years
Mina Tsukamoto
Japan
738
PD82
Signicance of additional inoculation with measles vaccine for nursing

students
Satoko Yokota
Japan
740
Mei-Wen Chen
Taiwan
742
Comparison of the 6th and 7th editions of the American Joint Committee
PD83 on cancer TNM staging system for gastric cancer underwent surgery at
medical center in central Taiwan
XV
Naoko Inoue
No.
Presenter
Nationality
Page
PD84
A validation study of the assessment tool for family/family member time

allocation
Junko Honda
Japan
744
PD85
A systematic review of the effect of exercise in reducing pain in people

with spinal cord injury
Yi-Ya Chang
Taiwan
746
PD86 Literature review on the effects of foot bathing in Japan
Yasuko Kurosawa
Japan
748
PD87 Cultural sensitivity and related factors among nurses
Wan-Ching Ho
Taiwan
750
Bok-Hee Cho
South Korea
752
Suyan Chen
China
754
Japan
756
Thailand
758
PD88
Effects of a app-based uncertainty intervention program for breast cancer

survivors
The effect of different concentrations of normobaric oxygen in reducing

PD89 caspase-3 and caspase-9 expression in a rat-model of focal cerebral
ischaemia
PD90
Physiological and psychological effects of taktil back massage

in Japanese elderly females
Yoshiko Fujita
PD91
Predictors of intention to use HIV testing service among sexually

experienced youth in Thailand
Kulrawee
Wiwattanacheewin
PD92
Finding factors inhibiting e-learning system for nurses living in Niigata

prefecture
Akihiro
Hashimoto
Japan
760
PD93
The nursing practice of end-of-life care by visiting nurses who support the
dying with dignity of their end-of-life elderly patients in home care
Yoko Katayama
Japan
762
Hisayo
Ushinohama
Japan
764
PD94 Factors in midwives' assessments of families

PD95
The meaning of the intraprofessional interactions among nurses in their

workplace
Huei-Ying Lee
Taiwan
766
PD96
Learning through the eld activities of the disaster healthcare summer

school in Finland
Yuka Saito
Japan
768
PD97
The employment situation and support required for breast cancer patients
in Japan receiving chemotherapy
Sanae Asano
Japan
770
Japan
772
Philippines
774
Inuence of digestive enzymes on development of incontinence-associated

PD98 skin lesions: Inner tissue damage and skin barrier impairment caused by
Yuko Mugita
lipases and proteases in rat macerated skin
PD99
Coping mechanisms in relation to the physical and psychosocial effects of

work-related stress among graveyard shift call center agents
Juaymah
Bustonera Leynes
PD100
Indicators for visiting nurses end-of-life elderly patients to determine

whether patients are at the terminal-stage and aggravation-stage
Yoko Katayama
Japan
776
Screening and assessment for intimate partner violence in emergency

PD101 departments: A questionnaire survey for administrators and staff-nurses
in Japan
Kazuaki Hirai
Japan
778
PD103 Nursing practice of skin care for radiodermatitis of breast cancer patients
Yasuyo Fukushi
Japan
780
Chu-Chi Hsiao
Taiwan
782
Pai-En Chiu
Taiwan
784
Philippines
786
PD104
Effects of progressive muscle relaxation training on symptom distress and

anxiety in colorectal cancer patients undergoing chemotherapy
PD105 An exploring study of the nurses' perspectives on evidence-based nursing

PD106
Pliant as a bamboo: Understanding the experience of aeta's in dealing

with illness
XVI
Gian Carlo Sy
Torres
Development and psychometric testing of the blood donor satisfaction scale
Shu-Chen Yang1
1.
Central Taiwan University of Science and Technology
Presenting Authors Email: sjyang@ctust.edu.tw
Purpose
The purpose of this study was to develop and psychometrically test a Blood Donor
Satisfaction Scale (BDSS).
Design
Cross-sectional study design.
Methods
A 31-item BDSS consisting of 5 subscales was developed based on comprehensive literature
and panel reviews. To test the scale, 407 participants were randomly selected from the
database of a blood center in Taichung, Taiwan. Exploratory factor analysis (EFA) and
confirmatory factor analysis (CFA) were used to examine the construct validity of the BDSS.
Internal consistency and test-retest reliability were used to examine the reliability of the
BDSS.
Results
The CFA indicated that the model demonstrated a high level of fitness for the data in the scale
dimensions of tangibility (6 items), reliability (6 items), responsiveness (6 items),
convenience (8 items), and benefit (5 items). The fitness indices were 2 =1741.37 (429
degrees of freedom, P < 0.001), normed fit index = 0.96, non-normed fit index = 0.97,
comparative fit index = 0.97, and root-mean-squared error of approximation = 0.086 (90%
confidence interval: 0.0830.091). The Cronbach and test-retest reliability of the BDSS
were 0.95 and 0.99, respectively.
Conclusions
The BDSS demonstrated satisfactory validity and reliability. The BDSS can be used by blood
centers for assessing blood donor satisfaction.
3-5 Key words
Donors, satisfaction, validity, reliability
Development of a stress appraisal scale on workplace harassment injury for

nurses
Yuki Kawamura1, Sakae Mikane2, Mieko Yamaguchi2, Kazuo Nakajima3

1.
OKAYAMA PREFECTURAL UNIVERSITY, 2. OKAYAMA PREFECTURAL, 3. The RYOBI

Research Institute of the Well-Being for the Elderly
Presenting Authors Email: kawamura@fhw.oka-pu.ac.jp
Purpose
To develop a workplace harassment injury scale for nurses to understand and evaluate their
stress.
Design
A cross-sectional, quantitative correlation verification study design was used.
Methods
We collected data from 231 nurses (valid replies) for data analysis. Forty-two investigation
items were prepared by using past studies as references. The conformity to the hypothesized
high-order (secondry) factor model was examined by confirmatory factor analysis. When the
conformity to the data of this model was not within the statistically acceptable range, some of
the items with correlation coefficients of 0.8 or more were arbitrarily deleted; next, remaining
items with Corrected Item Total Correlations (CITC) of 0.4 or less among all items were
deleted, and the conformity to the data of the factor model was then re-examined.
Results
The conformity to the factor model data consisting of 42 items was low, and inappropriate
solutions were observed in pass coefficients. Items were further deleted in accordance with
the correlation coefficient and the CITC determination criteria, and confirmatory factor
analysis was then performed on the remaining 20 items. The results of this analysis showed
that the factor model conformed to the data.
Conclusions
3
These findings suggested that using this harassment scale maybe useful for evaluating the
development of a support system for nurses.
3-5 Key words
Nurses, harassment injury, scale
Development of a measurement scale for workplace harassment inflicted on

nurses
Sakae Mikane1, Yuki Kawamura1, Mieko Yamaguchi1, Kazuo Nakajima2

1.
Okayama Prefectural University, 2. The RYOBI Research Institute of the Well-Being for the Elderly
Presenting Authors Email: mikane@fhw.oka-pu.ac.jp
Purpose
To develop a measurement scale for harassment inflicted on nurses in the workplace.
Design
A cross-sectional, quantitative correlation verification study design was used.
Methods
We collected data from 269 nurses (valid replies) for data analysis. Forty-two investigation
items were prepared by using past studies as references. The conformity to the hypothesized
high-order (tertiary) factor model was examined by confirmatory factor analysis. When the
conformity to the data of this model was not within the statistically acceptable range, some of
the items with correlation coefficients of 0.8 or more were arbitrarily deleted; next, remaining
items with Corrected Item Total Correlations (CITC) of 0.5 or less among all items were
deleted, and the conformity to the data of the factor model was then re-examined.
Results
The conformity to the factor model data consisting of 42 items was low, and inappropriate
solutions were observed in pass coefficients. Items were further deleted in accordance with
the correlation coefficient and the CITC determination criteria, and confirmatory factor
analysis was then performed on the remaining 21 items. The results of this analysis showed
that the factor model conformed to the data.
Conclusions
n order to examine the mechanism of harassment occurrence in more detail, we need to
approach this issue not only from the perspective of harassment victims but also from that of
harassment perpetrators. The measurement scale developed in this study is expected to

contribute to elucidating the mechanisms underlying harassment occurrence and to function
effectively in developing preventive measures.
3-5 Key words
Harassment, perpetrator, bullying, scale
Literature review of Japanese nurses concept ofYARIGAI
Osamu Munakata1, Osamu Munakata2, Yumi Yokoyama3

1.
Graduate school of Nursing, Jichi Medical University, 2. R.N./Graduate school of Nursing, jichi
Medical University, 3. R.N., M.E.PhD./Graduate school of Nursing, jichi Medical University
Presenting Authors Email: mn1406@jichi.ac.jp
Purpose
Nursing is a profession, the study of which should deepen and develop over the professional's
lifetime. This study focused on nurses' concept of YARIGAI as related to self-learning
and the intention to continue in the nursing profession. In Japan, YARIGAI tend to be
used in similar meaning such as worthwhileness. The purpose of the study was to clarify what
is considered YARIGAI by nurses in Japan.
Design
Literature review.
Methods
162 articles, published between 1982 and 2013, were collected from Ichushi-Web, using the
keywords YARIGAI and nurse, and excluding articles with a focus on turnover
factors, and those targeting the nursing faculty and patients. Foreign articles were sourced
through CINAHL, also using worthwhile, worthwhileness and nurse as
keywords.
Results
Concepts addressed in articles with the keyword YARIGAI were as follows: Job
continuing intention, sense of achievement, self-efficacy, job satisfaction,
motivated, self-esteem, motivation, career development, work life
balance, work engagement, and career anchor. In addition, the subject of the
study was selected using the following viewpoints: final education, work facilities,
department, years of experience. Concepts related to the term YARIGAI were
often analyzed by interviews. Key factors were as follows: others evaluation, salary
and status, career, relationships, self-evaluation, sense of
accomplishment, satisfaction, personal growth. Many of the foreign articles
retrieval included the concept of job satisfaction.
Conclusions
Many concepts were extracted from the literature review regarding Japanese nurse's concepts
of YARIGAI. It could be characteristic of Japan that there were more related concepts
compared with foreign countries. The challenge for the future is to structure these concepts
with a consideration of social and cultural background.
3-5 Key words

Nurse, YARIGAI, related concepts, literature review, Japan
The effects of nurses practice environment on new graduate nurses

reality shock
Eun-Young Kim1, Kyung-Mi Sin1, Jeong-Ok Kwon1

1.
Dong-A University
Presenting Authors Email: eykim@dau.ac.kr
Purpose
The purpose of this study was to identify what factors are affecting new graduate
nurses'reality shock.
Design
Cross-sectional study
Methods
Participants were 216 new graduate nurses serving for less than 1 year at 5 university and 10
general hospitals in Busan, Ulsan and Gyeongnam, A self-reported questionnaire survey made
on them from Nov. 18th to Dec. 25th, 2013. Data were analyzed using t-test, ANOVA and the
hierarchial multiple regression analysis in accordance with the SPSS WIN 21.0 Program.
Results
Average scores for work environment and environmental reality shock were, respectively,
2.630.33 and 2.660.43 points. That regression analysis found that the work environment
explains 4.2% of the reality shock with those nurses' demographic and work characteristics
controlled and that factors like those nurses' residence movement for job (=.205, p=.001),
whether the working unit (=-.126, p=.031) and day off when they want (=-.144, p=.038)
significantly affect their reality shock.
Conclusions
When these factors are considered, reduction in those nurses' reality shock requires improving
their work environment, placing them in a department that they want and allowing them to be
off-duty on a day that they want. These also would greatly help achieve organizational goals
and develop the nurses to be professional.
3-5 Key words
New graduate nurse, nurse practice environment, reality shock
10
Usefulness of the compassion process to manage human resources in

nursing fields at hospitals
Joo-Hyun Kim1, Hyung-Jin Choi1, Hyung-Jun Choi2

1.
Kangwon National University at Chuncheon, 2. Nam Seoul University
Presenting Authors Email: joohkim@kangwon.ac.kr
Purpose
Compassionate act is important factors for staff-nurse friendly organizational culture at
hospital setting. The purpose of this study was to investigate the usefulness of the compassion
process for human resources management at nursing fields in hospitals. Compassion process
consisted of collectively noticing, collectively feeling and collectively responding.
Compassion process can relive personal suffering at work settings. Compassion process have
3 dimensions-personal, organizational culture and institutional.
Design
22 staff nurses and 5 nurse managers were participated from September 2012 to February
2013. Data were collected with in-depth personal interview.
Methods
Collected data were analyzed with content analysis.
Results
Staff nurse felt absence of compassion processes of 3 dimensions(personal, organizational
culture and institutional) when they were in suffering. However nurse managers asserted the
compassion processes of 3 dimensions for staff nurses. Absence of compassionate act in the
nursing field was one of reasons that they quit their job.
Conclusions
The results of this study provided one of the empirical evidences of the importance of
compassion process in organizations. Thus we recommend developing an intervention
11
program to increase compassionate act for reducing nurse's suffering.

3-5 Key words
Content analysis, nurse, organizational culture, compassion
12
The current situation of discharge planning nurses in JapanComparison

of the results of two nationwide surveys2010 versus 2014
Hikari Tomura1, Satoko Nagata2, Junichi Shimizu1, Megumi Shimada1, Shigemi Suzuki3
1.
Tokyo Metropolitan University, Faculty of Health Sciences, Division of Nursing

2.
Sciences, Department of Community Health Nursing, Graduate School of Medicine, University of

Tokyo, 3. The University of Tokyo Hospital
Presenting Authors Email: h-tomura@umin.ac.jp
Purpose
In Japan, reducing hospital length of stay and expanding home care have been promoted as
measures to control rising medical costs caused by the rapidly growing aging population, thus
discharge planning has become increasingly important. This resulted in the rapid rise of the
number of hospitals to allocate discharge planning nurses (DPNs), however, the current
situation of individual DPN is still unknown. The aim of this study was to elucidate the
characteristics and the activities of DPNs by comparing the results from two surveys
conducted in 2010 and 2014.
Design
a cross-sectional study
Methods
A questionnaire was sent to 819 nurses in 2010 and 948 nurses in 2014, respectively, who
were in charge of discharge planning in hospitals with a capacity of over 100 beds. We had
obtained the permission for research cooperation from the directors of the nursing
departments involved in the previous survey.
Results
461 DPNs (56.3%) in 2010 and 479 DPNs (50.5%) in 2014 were analyzed respectively. The
mean years of DPN experience shown in the 2014 survey was 3.0 years, which was slightly
13
longer than 2.4 years in the 2010 survey. Looking at the number of DPNs by years of DPN
experience, 113 DPNs (24.8%) having less than a year of experience in 2010 and 104 DPNs
(21.8%) having between one and two years of experience in 2014 was the largest number
respectively. Besides, while there were 171 DPNs (37.5%) having more than three years of
experience14 years was the longestin 2010, there were 223 DPNs (46.8%) 17 years
was the longestin 2014, which showed higher percentage than in 2010. With regard to
DPNs engagement in self-directed learning, the following activities showed higher
percentage in the 2014 survey compared to the 2010 survey: obtaining information on the
governments medical/welfare system and services, case studies, participating in out-ofhospital training, and participating in DPNs network.
Conclusions
The difference between the surveys in 2010 and in 2014 in terms of DPN experience years
was 0.6 years. Lately in Japan, hospitals are motivated to receive additional fees by
appointing DPNs, so the certain number of DPNs is newly appointed every year. At the same
time, the percentage of experienced DPNs working more than three years is also increasing.
Thus, it is presumed that those nurses appointed as a DPN are building their own careers little
by little. In addition, particular emphasis has been placed on education for DPNs, so
opportunities for their training have been also extended. Presumably, those DPNs actively
participate in training opportunities to make efforts to engage in self-directed learning.
3-5 Key words
Discharge planning nurse, practice activity, nationwide survey
14
Psychological empowerment among hospital nurses in JapanA

preliminary qualitative investigation
Junko Ouchi1
1.
Faculty of Health Sciences, Hokkaido University
Presenting Authors Email: ouchij@hs.hokudai.ac.jp
Purpose
Past research suggests that a sense of empowerment among nurses is significantly associated
with less burnout and higher levels of job satisfaction and work commitment. As such,
empowerment research may offer a promising and worthwhile topic of inquiry since it is
conducive to a healthier and more productive work environment. However, the concept of
empowerment for nursing professions remains elusive, thereby obfuscating its effects in
various contexts (e.g., hospital settings). In particular, intrapersonal or psychological
empowerment (its experiential component) has received less attention than its structural
empowerment (i.e., perceived work environment) in a particular context. The major purpose
of the study was to explore an intrapersonal dimension of psychological empowerment among
hospital nurses in Japan by face-to-face interviews with nurses in Japanese hospitals.
Design
A face-to-face interview was used to solicit qualitative, narrative data from staff nurses at two
Japanese hospitals.
Methods
Semi-structured interviews with 8 staff nurses in two Japanese hospitals, Hospital A and B,
were conducted. Years of nursing experience among the participants ranged from 4 to 26
years, and the length of employment at their current positions was in a range of 2 to 17 years.
Both of these regional hospitals had rehabilitation units. Hospital A focused on rehabilitation
for the fragile elderly, whereas Hospital B focused their treatment more for patients with
impaired consciousness. Interviews were audio-recorded and transcribed verbatim. The
interview data were analyzed by qualitative inductive analysis.
15
Results
The following categories of psychological empowerment were identified: a) impact or
control (feeling of making a significant impact on patients and/or their working
environment), b) confidence or efficacy (belief in ones capability to perform work
activities), c) trust (sense of being trusted by ones superiors or colleagues), d)
personal values (sense that what is required in ones job matches her/his values), and e)
willingness (willingness to try new things in ones job). Some interesting differences
were observed between two hospital settings. For example, nurses from Hospital A nurses
emphasized impact or control and willingness in their stories that their patients with
severely impaired consciousness remarkably recovered after they intervened, whereas those
from Hospital B focused much on trust in the stories on past or current interpersonal
relationships among nurses and doctors in their wards.
Conclusions
This preliminary study revealed relevant dimensions of psychological empowerment among
hospital nurses in Japan. Findings also suggested that some empowerment dimensions are
more salient than other dimensions, depending on work contexts. Further research needs to
examine relationships between particular dimensions and contextual factors leading to healthy
workplace environment.
3-5 Key words
Nurses, psychological empowerment, work environment
16
Costs of nursing interventionsCompare with Korea health insurance

system and ABC code of United States
Young-Sin Park1, Jeong-Eun Park1

1.
Kyungpook National University
Presenting Authors Email: 1646young@naver.com
Purpose
The aim of this study was to compare the costs of nursing interventions performed by nurses
in the nursing unit using Korea health insurance system and ABC codes of United States.
Design
This study was a retrospective study to comparative analysis of Korea health insurance
system and ABC codes of United States.
Methods
The nursing interventions was mapped in three phases: (1) extraction - a narrative data about
nursing interventions extracted from nursing records, (2) The first mapping - mapping
between nursing interventions and Nursing Intervention Classification (NIC), (3) The second
mapping - mapping between nursing interventions and Alternative Billing Codes (ABC), (4)
analysis - the result of mapping data were analyzed with frequency, percentage, mean, and
standard deviation.
Results
There were a number of items that are not acknowledged for fee in both Korea and United
States system. And there were codes for the time of intervention in the ABC codes of United
States.
Conclusions
On the basis of study results, we were able to obtain an objective data of nursing interventions,
and it will provide a framework that can associated with nursing fee.
17
3-5 Key words

Cost, nursing intervention, health insurance system, ABC code
18
Identification of relationship among organizational characteristics and

organizational commitment of nurses in rural area of Nepal
Mineko Namba1, Archana Shrestha Joshi1, Kana Okayama1

1.
Okayama Prefectural University
Presenting Authors Email: archana.ru@gmail.com
Purpose
Generally hospitals in Nepal are overcrowded with a large number of patients having major
health issues. Due to shortage of nurses in rural area, nurses duties are often limited to
technical task. As a result, patients and their family are deprived of other emotional services,
which are usually expected from nurses at hospitals. The objective of this study is to identify
relationships between various organizational characteristics and three distinct components of
organizational commitment of nurses at hospitals in Nepals rural area. By identifying these
relationships, hospitals may take necessary steps for retaining nurses and getting better work
performance from them. Consequently, despite a shortage of nurses in rural area of Nepal,
hospitals can deliver a better healthcare service to patients.
Design
A cross-sectional correlational design was used.
Methods
Under the approval of the Research Ethics Committee of Okayama Prefectural University, a
self-administrated questionnaire was distributed to 150 working nurses in the eastern and
western region of the country. In total, 120 participants completed the questionnaire which
included three sections namely 1) personal characteristics 2) organizational characteristics and
3) organizational commitment. Three components a) affective, b) continuance, and c)
normative commitment were adopted as organizational commitment scales as proposed by
Meyer and Allen in 1991. Two statistical analysis methods namely 1) descriptive analysis and
2) multiple regression analysis were performed to identify significance in relationships.
Results
19
Out of 120 completed questionnaires, 92 were found valid for the analysis. The mean age was
28.78 years. Regarding education, 47 (51.1%) have completed Assistant Nursing Midwifery
course while 40 (43.5%) have undertaken Proficiency level Nursing course. Nursing
experience mean was 7.16.8 in years, and they worked 2.201.1 times per week on night
shifts. The number of beds, where the nurses worked, was 95.99.2 on average. For each
depended variable affective, continuance and normative commitment, multiple regression
analysis was performed by taking personal characteristics and organizational characteristics
as independent variables. Significance level for each test was set at 5% level.
All independent variables were found significantly related to each of the two dependent
variables affective commitment and normative commitment (Adjusted R squared=0.278,
p=0.000 and adjusted R squared=.0.207, p=0.000 respectively). While two of the
organizational characteristics 1) support from boss (=.248, p<0.05) and 2) training program
(=.233, p<0.05) turned out positive and significant with affective commitment, the results
of two other variables 1) salary satisfaction (=-.360, p<0.05) and 2) number of bed (=.333, p<0.05) were negative and significant with normative commitment. However, nursing
experience (=.275, p<0.05) was positive and significant with normative commitment.
Conclusions
Our study revealed that both support from bosses and training program are essential
for strengthening affective commitment of the nurses. Since salary satisfaction was
negative while being significant with normative commitment, it shows obligation to remain in
job for the nurses in rural area of Nepal is not necessarily relevant to their respective salaries
3-5 Key words
Nursing management, organizational commitment, retention
20
The relationship between social support and nursing performance among

Korean clinical nurses
Mi-Ae You1, Hye-Jin Woo2, Jee-Won Park1, Mi-Sook Song1

1.
College of Nursing Ajou University, 2. Ajou university hospital
Presenting Authors Email: dew218@ajou.ac.kr
Purpose
This study was conducted to understand the relationship between social support and nursing
performance among clinical nurses and to provide basic data for developing nursing
interventions for job performance along with recognizing the importance of social support.
Design
A cross-sectional survey design
Methods
Data was collected from 160 clinical nurses working in a university hospital in Gyeonggi
province from 2nd to 8th of September, 2013, and analyzed using SPSS Window 18.0
program. The instruments used for this study were the Social Support Measurement Scale
developed by Jee-Won Park (1985) and modified by Kyong-Hee Kim (2008) and the Nursing
Performance Scale developed by Yoo-Kyoung Ko et al.(2007) based on the Components of
Individual Measurement by Van de Ven & Ferry (1980).
Results
The mean score of social support level of nurses was 3.44 0.48 out of 5. The mean score of
nursing performance level of them was 3.64 0.41 out of 5. Level of nursing performance
showed significant differences according to age, marital status, educational level, total career,
current department career and position while the level of social support showed a significant
difference only in total career. There was a positive correlation between social support and
nursing performance showing a significantly positive correlation between the lower category
of social support and nursing performance. Analysis on the factors influencing on nursing
21
performance has showed that social support had a greater impact on the charge nurses'
performance than the staff nurses.
Conclusions
This study has revealed that there was a significant correlation between social support and
nursing performance among clinical nurses and social support appeared to affect nursing
performance. Thus it is necessary to develop a program to enhance the social support for
clinical nurses.
3-5 Key words
Social support, nursing performance, hospital
22
Nursing administratorsviews of barriers to research utilization and the

relationship to their educational levels in the northeastern provinces of
Japan
Yoshihito Endo1
1.
Iwate Prefectural University
Presenting Authors Email: y-endo@iwate-pu.ac.jp
Purpose
The purpose of this study was to describe the extent to which nursing administrators perceive
various factors as barriers to research utilization in nursing practice. The study also examined
the relationship between their educational levels and their perception of barriers to research
utilization in the Northeastern provinces of Japan.
Design
cross-sectional survey
Methods
A descriptive survey of 96 nurse administrators from the Northeastern provinces of Japan was
conducted in March 2014. Two instruments were used: a self-administered questionnaire that
measured demographics (nurse with a bachelor's, masters, or higher degree) and the
BARRIERS Scale that measures nurse administrators perceptions of the nurses. An
additional item was added to the scale: The research published in a foreign language is not
understandable. Participants were asked to rate each item on the scale of 1 to 4, with 1 = to
no extent, 2 = to a small extent, 3 = to a moderate extent, 4 = to a great extent, and no
opinion.
Ethical consideration: The protocol for this study was approved by the faculty of the Ethics
Review Committee of Iwate Prefectural University, Japan.
Results
23
Twenty-six nurse administrators (26.8%) returned the questionnaire. Fourteen of the 26 (54%)
hospitals employed nurses with bachelors or masters degrees. The average rate of
recipients of bachelor's or masters degrees was 5.4%; the highest rate was 28.9% and
lowest rate was 0%. The respondents rated the following items as the main barriers to
research utilization: The research published in a foreign language is not understandable
(88.5%); The nurse does not feel capable of evaluating the quality of the research
(76.9%); and The research has not been replicated (73.1%). The following item was the
lowest-rated item/barrier: Administration will not allow implementation (3.8%). An
examination of the scales factors revealed that the main barriers to research utilization were
the items appearing under the Communication factor (mean = 2.7). The following item
received the highest number of no opinion responses: The literature reports conflicting
results (34.6%). There was a significant negative correlation (r = -.47, p = .05) between the
rates of recipients of bachelor's or masters degrees and the scores of the Organization factor.
Conclusions
The studys findings reveal key factors and the major barriers to research utilization, which
may be useful for nurses in developing strategies to overcome barriers by increasing the
numbers of nurses with undergraduate and graduate degrees in Japan. The findings are
discussed in relation to the Japanese healthcare context and evidence-based practice. This
work was supported by Grants-in-Aid for Scientific Research.
3-5 Key words
Barriers to research utilization, educational level, EBP
24
Shortening patients waiting time for abdominal ultrasound examination
Hsueh-Ling Ku1
1.
Cathay General Hospital/National Central University
Presenting Authors Email: 201385@cgh.org.tw
Purpose
How to shorten punctual patients waiting time for examinations is an important index of
medical care. At present, 25% of patients are prolonged waiting. The average waiting time is
38 minutes, and there is one complaint per month. To improve the waiting time for receiving
abdominal ultrasounds at the endoscopy room by making the waiting time less than 30
minutes and having zero complaint from patients was the aims of this study.
Design
A prospective study.
Methods
The interventional methods were the on-time appearance of attending physicians, controlling
the number of engaged and unengaged patients, dispatching nurses flexibly during the rush
hour, reminding patients to be punctual on the date of inspection while making appointments,
prioritizing examination for complex patients, and renovating and increasing equipment.
Results
After intervention, only 5% of patients are prolonged waiting, average waiting time is 27.8
minutes, and there is zero complaint per month.
Conclusions
Prolonged waiting time will make patients nervous and anxious, resulting in low patient
satisfaction and revisiting rate. We should stand on the patients perspective and consider
weather the waiting time for examinations is reasonable in our medical service flow.
25
3-5 Key words

Abdominal ultrasound examination, waiting time, medical service flow
26
The relationship between nursing staffs quality of working life and

organizational commitment.
Jen Hung,1, Cheng-Min Chao2

1.
National Taiwan University Hospital Yun-Lin Branch., 2. Department of Industrial Engineering and
Management, National Yunlin University of Science & Technology.
Presenting Authors Email: hsj.h5191@msa.hinet.net
Purpose
(1). To understand nursing staff levels of satisfaction with the quality of their working life. (2).
To explore the relationship between such levels of satisfaction and their adaptability to their
work. (3). To explore basic attributes of the relationship between quality of working life and
adaptability to work through a review of the relevant literature to propose feasible strategies
for improving the quality of nursing staff working life and adaptation to work, for provision
to hospitals for deliberation in their establishment of management systems.
Design
The subjects of this study were 450 nursing staff from the nursing department of a teaching
hospital. Data were collected by questionnaire.
Methods
The study was a cross-sectional descriptive correlational study. The instrument was a
structured questionnaire that we used for data collection. The contents of the questionnaire
included: 1. Data on basic attributes; 2. Quality of life scale; and 3. Adaptability to work
questionnaire. Data collection was undertaken and the statistical software SPSS 18.0 was used
to perform data analysis by descriptive statistics, ANOVA, and Pearson correlation analysis.
Results
Of the respondents, 71.40% were aged between 22 and 30 and 97.38% were graduates of
junior college or higher-level institutions. Most62.14%were single and most again
74.76%lived with their families. They mainly (62.62%) worked 24-hour shifts (three-shift
system). The percentage that worked fixed shifts was 42.14%. As regards leave, 46.90% took
27
leave in accordance with the fixed shift vacation roster, while 26.67% took it irregularly, only
when their workloads allowed.
On the issue of quality of working life, interpersonal relations scored highest, with 3.71,
while work environment and relationship with family scored lowest, with 3.23.
Average scores on the work adaptation scale were between 3.24 and 3.41. Each dimension of
quality of working life and adaptation to work (organizational commitment, pleasure in work,
job satisfaction, job tenure) showed a statistically significant positive relationship (p<0.05).
After adjustment for age and all other interactive effects, it was discovered that each
dimension of adaptation to work was significantly influenced by age, work environment,
work content, salary, and benefits system (p<0.05).
Conclusions
Satisfaction with and adaptability to work among nurse staff are clearly influenced by work
environment, salary, benefits, and work content but there are variations in line with age
differences. These findings support those of the scholarly research.
3-5 Key words
Quality of working life, nursing staff, adaptability to work, adaptability to work
28
Effect on experienced violence, emotional labor and job stress on

depression of clinical Nurses
Yeon-Kyung Na1, Jin-Hee Noh2

1.
Kyungpook national university college of nursing, 2. Kyungpook national university
Presenting Authors Email: yoenkna@knu.ac.kr
Purpose
The purpose of the study is to identify the effect of violence experience, emotional labor and
job stress on depression of clinical nurses and to provide basic data for improving the quality
of patient care.
Design
The research design is a descriptive study to investigate the effect on violence experience,
emotional labor and job stress on depression of clinical nurses.
Methods
This research involved 257 clinical nurses who were working at an acute care hospital with at
least 200 beds in S city and K province. Data were collected from May 23 to June 7 in 2014
and were analyzed using IBS SPSS version 21.0.
Results
There are positive correlations among violence experience, emotional labor, job stress and
depression (<.01). There are also significant co-relationships between depression and
violence experience (=.21, =.001), between depression and emotional labor (=.48,
<.001) and between depression and job stress (=.31, <.001). The emotional labor
significantly influences depression (=.43, <.001).
Conclusions
The results suggest that it is necessary to set up guidelines for clinical nurses to manage
violence, emotional labor and job stress to secure working environment and to improve
quality of care.
29
3-5 Key words

Violence, emotional labor, job stress, depression, clinical nurse
30
Recognition of verbal abuse toward nurses by patients in psychiatric wards

in Japan
Yuriko Tanabe1
1.
Yokohama City University, School of Medicine, Nursing Course, Japan
Presenting Authors Email: yuriko@yokohama-cu.ac.jp
Purpose
The purpose of this study was to describe Japanese nurses experiences of verbal abuse by
patients and the recognition of this abuse in psychiatric wards in Japan.
Design
A qualitative exploratory study.
Methods
Semi-structured, in-depth interviews were conducted with 19 nurses, including 13 nurses and
6 nurse managers working in psychiatric wards from February 2012 to January 2013. The
interviews were recorded and transcribed. Transcripts of data were subjected to content
analysis. The study was approved by the Ethics Review Committee of Iwate Prefectural
University, Japan.
Results
Six main themes emerged: common occurrences, patient factors, mental exhaustion, nurses
lack of awareness of the influence of their behavior, unclear definitions of abuse, and nonreport. Nurses observed that patients used violent language and spoke rudely more often than
they engaged in physical violence against nurses. Nurses also observed that verbal abuse was
a sign to assess the risk of physical violence. Furthermore, patients behavior varied daily
and depended on characters of nurses, thus leading to emotional exhaustion among nurses.
Moreover, some nurses recognized that they did not understand how their own speech and
behavior caused patients to become irritated and use violent language. Thus, some nurses did
not realize the impact of their behavior on patients mental states. Sensitivity regarding
abuse varied among nurses, and the definition of verbal abuse was ambiguous; therefore,
31
nurses were not able to decide with confidence whether to report an occurrence of patients
verbal abuse. In such circumstances, abuse would often not be reported.
Conclusions
New information regarding difficulties experienced by Japanese nurses was revealed.
Frequent exposure to patients verbal abuse could desensitize Japanese nurses to problems
with their mental health and wellness. Furthermore, unclear definitions of abuse prevent
evidence-based improvement through safety management systems. Increased safety
management systems and safety education are needed for nurses to care for patients and
themselves. This work was supported by Grants-in-Aid for Scientific Research.
3-5 Key words
Verbal abuse, psychiatric ward, safety management
32
Dealing with burnout through bibliotherapyThe effects of reading

selected inspirational short stories for nurse managers
Warren Kemuel Pan1

1.
University of Santo Tomas
Presenting Authors Email: warrenkemuelpan@yahoo.com
Purpose
High levels of burnout have been documented among healthcare professionals, especially
nurses; however, most of the studies have focused on those employed in entry level positions
like staff nurses. Yet, burnout has been identified as a major problem for nurse professionals
who hold lower management roles. To address this gap in literature, this study aimed to
evaluate the effectiveness of self-help bibliotherapy manual composed of selected
inspirational stories as an adjunct therapeutic modality for nurse managers experiencing
burnout.
Design
This study utilized a Quasi-experimental Pre-test, Post-test Design.
Methods
Forty-five nurse managers employed in two private tertiary hospitals in Manila who
consented and were found to have been experiencing moderate to severe levels in any of the
three dimensions of burnout took part in this study. Participants were randomly assigned to
either the experimental or comparison group. The experimental group (n=23) did the
bibliotherapy sessions, thirty minutes per session for five consecutive days while the control
group (n=22) was asked to continue with their usual routines. Data were collected using the
Maslach Burnout Inventory Human Service Survey before and after the intervention which
determined the respondents' levels in the three dimensions of burnout namely: emotional
exhaustion, depersonalization and sense of reduced personal accomplishments. The collected
data were treated using descriptive and inferential statistics that included percentage, mean,
standard deviation and paired- and independent t-test.
33
Results
As compared with the baseline data, results revealed that the experimental group has
significantly decreased levels of emotional exhaustion (p= 0.032) and depersonalization (p=
0.046) while an insignificant increased for sense of personal accomplishment dimension
(p=0.06) after the treatment.
Conclusions
The study intervention which was the bibliotherapy manual had shown significant changes on
the emotional exhaustion and depersonalization scores of the experimental group. However, it
failed to yield significant difference on post-test scores of the two groups on the sense of
personal accomplishment component of burnout.
The results indicate that the self-help bibliotherapy manual is effective as an adjunct tool in
bringing about change among nurse managers experiencing burnout; thus, could have
profound implications not only to nurse administrators themselves but also to the institution
and most importantly to the recipient of care, the patients.
3-5 Key words
Burnout, self-help bibliotherapy, inspirational short stories, nurse managers
34
Survey of actual state on nurse call in Hirosaki University Hospital
Toshiya Inaba1, Shinichi Hukushi1, Tomoko Abo1, Yoko Nara1, Hideaki Yamabe2
1.
Hirosaki University School of Medicine Hospital, 2. Hirosaki University School
Presenting Authors Email: 178itk@gmail.com
Purpose
Some researchers reported that intension to reduce the number of nurse call leads to
beforehand nursing care and elevated quality of life of the patients based on their surveys.
Therefore we examined the actual state on nurse call and thoughts of nurses on the number of
nurse call in our hospital.
Design
This survey was conducted for 24 hours of one day and at 14 wards in our hospital. The study
design was approved by the Hirosaki University ethical committee.
Methods
The daily number of nurse call and contents of nurse call were examined at each of 14 wards
and they were compared with the total number of nurse call and contents to clarify the
characteristics of each ward. We also examined the awareness of nurses on nurse call using
questionnaire we made in reference to previous studies.
Results
The subjects were 261 nurses in our hospital. There were some significant differences in each
of wards in number of nurse call and contents except one ward and such differences showed
the characteristics of each ward (surgery, internal medicine, etc ). 72.6% of nurses answered
they tried to reduce the number of nurse call. However, 54.7% of nurses thought reducing the
number of nurse call is not always good and importance of telling necessary nurse call from
unnecessary one. 32.3% of nurses thought to reduce the number of nurse call related drip
infusion. Furthermore, frequent number of nurse call made nurses to feel irritated and hard,
and a small number of nurse call made them relieved, pleasant and sometimes anxious. From
35
this result frequent number of nurse call induces negative feelings and a small number of
nurse call induces not only positive feelings but anxiety.
Conclusions
The number of nurse call and contents of nurse call showed the characteristics of each ward.
Half of nurses in our hospital thought there is necessary nurse call not to be reduced, although
they need reduce the number of nurse call.
3-5 Key words
Nurse call, survey of actual state, the characteristic of each ward, the awareness of nurses
36
A study on the strategy of the visiting nursing station in the local area in
Japan
Masaru Isoyama1
1.
Teikyo University
Presenting Authors Email: isoyama@main.teikyo-u.ac.jp
Purpose
The more important house nursing becomes, the more important the visiting nursing station
(the following shorten VNS) becomes. But, the research of Japan Association of the Visiting
Nursing shows that many VNSs in Japan are in the red, especially, the small and middle
stations. The VNS is different from other medical institutions, because the nurses move to the
users' house and take care there. In the other side, this character limits the area that VNS can
serve their nursing care, and limits the strategies that VNS can use. And the competitive
strategy is dangerous for the VNS, because this strategy may bring mutual destruction with
other VNSs in the local area. With these factors in mind, our study aims to make clear that the
cooperation strategy is useful to strengthen the base of VNS in the local area.
Design
We carried out the questionnaire survey to VNSs in all over Japan, and analyzed the data
statistically.
Methods
In September 2011, we sent out the questionnaires on fax to 3,344 VNSs, and got returns
from 1,015. And we analyzed these data statistically.
Results
1. The important partners of the VNSs are "other VNSs" (30.0%), "the hospital which belongs
to the same corporation" (26.3%), and "the local government" (13.1%).
2. The main contents of the cooperation among the VNSs are "sharing the information about
the users (44.4%)"," joint sponsorship of the seminars (31.6%)", and "sharing the facilities
and the medical machines(7.5%)".
37
3. The main measures to get users are "the introduction from the hospitals which belongs to
other corporations (44.6%)", "the introduction from the hospitals which belongs to the same
corporation (26.3%)", and "the introduction of the existing users (16.0%)".
4. The main reasons of cooperation with others are "to serve better care to users (55.6%)",
"the offer from other VNSs (17.3%)", and "to strengthen the financial base of the VNS
(15.8%)".
5. The main problems when cooperate with partners are "the difficulty of communication
and/or coordination with partners (69.4%)", "not to get the expected outcomes (25.0%)", and
"'free riding' of the partners (4.6%)".
Conclusions
This study makes clear two points.
1. Many VNSs have already carried out the cooperate strategy instead of the competitive
strategy, and they recognize the effectiveness of the cooperate strategy in the local area.
Because, 74.6% VNSs answered that cooperation strengthened the financial bases of the
VNSs.
2. On the other hands, some problems become clear when the VNS carry out cooperate
strategy. The most serious problem is to coordinate and/or communicate with their partners is
difficult to the VNSs. This corresponds with the reason why 79.6% of the visiting nurse
stations which don't cooperate with other institutions. To solve this problem, we suppose that
the VNS should use the social capital to promote the cooperate strategy and to get more users.
(This study was supported, in part, by Grant-in-Aid for Scientific Research(C) (Number:
21590576) from the Ministry of Education, Culture, Sports, Science and Technology of
Japan.)
3-5 Key words
Visiting nursing station, cooperation strategy, local area, partner
38
Quality of working life and related factors of nurses in the hospitalsA cross-sectional research
Ya-Chun Yang1, Shu Yu2

1.
Taoyuan Armed Forces General Hospital, 2. School of Nursing, National Yang-Ming University
Presenting Authors Email: wicky35@gmail.com
Purpose
The purpose of this study was to investigate quality of working life and related factors of
nurses in the hospitals.
Design
A cross-sectional research design.
Methods
Nurses in three hospitals in north of Taiwan were selected by proportional sampling method.
A self-conducted structural questionnaire was used to collect data. Finally, 267 valid
questionnaires were returned.
Results
The results revealed that nurses quality of working life in the hospitals was moderate
(Mean = 3.07, SD = 0.50, rang from 1 to 5). Among eight dimensions, the top three highest
dimensions were interpersonal relationship (Mean = 3.61, SD = 0.58), learning and growth
(Mean = 3.37, SD = 0.60), and institutional system (Mean = 3.29, SD = 0.59). The lowest
three dimensions existed in working hours and workload (Mean = 2.64, SD = 0.60), work and
family life (Mean 2.67, SD = 0.70), and salary and welfare (Mean= 2.86, SD = 0.64). The
influencing factors of quality of working life included gender, years of work, social support,
family structure, and working unit. According to a stepwise multiple regression analysis
showed that five variables including social support, time of delaying from work, years of
work, gender, and working unit were significant predictors of nurses quality of working life
and accounted for 40.7% of variances. Social support was the most important predictor which
accounted for 36.6% of variances.
39
Conclusions
We suggest the government should make reasonable policies in decreasing working hours and
workload, and increasing salary and welfare. In nursing practice and administration, hospitals
should provide nurses more flexibilities in work schedule, give more substantial social
support, and care about nurses. Finally, further study can use the new scale we developed in
exploring quality of working life in nurses.
3-5 Key words
Nurses, in the hospitals, quality of working life
40
State of educational programs for current clinical nurses and relevant

issues in Japan
Hiromi Uesawa1
1.
Jichi Medical University
Presenting Authors Email: dn1401@jichi.ac.jp
Purpose
We focused on the state of educational programs for current clinical nurses, in order to clarify
the educational approaches aimed at providing nursing care required in the emergency field
using sufficient knowledge and practical skills. As a result, we identified the issues that need
to be addressed. To investigate the state of educational programs for current clinical nurses,
and identify the relevant issues
Design
Review articles
Methods
We searched for target articles of the past 10 years using the Web Japan Medical Abstracts
Society, with the keywords nurses and educational program for current nurses.
Results
The refined search identified 10 articles. Concerning the psychiatric field, in a study by
Hanzawa et al. (2010), the level of difficulty in leading a community life among simulated
patients with chronic schizophrenia was evaluated, and the relationship between such
difficulty and personal stigma was examined by nurses, their hospitalization-oriented ideas
associated with a risk of becoming violent among schizophrenic patients were partially
corrected, and the importance of providing educational programs for current nurses in which
they develop interprofessional care management skills was reported. Concerning the design of
educational programs in which young current nurses develop practical nursing skills,
Watanabe et al. (2008) developed a tool for assessing practical nursing skills that comprised 3
factors (143 items), conducted a survey involving new nurses working in university hospitals
41
using the tool, and reported that a correlation exists between the 3 factors, and practical skills
mutually potentiate. Regarding the relationship between self-education skills and the
willingness to undergo education for current nurses, according to Kurabayashi et al. (2004),
these 2 factors were not correlated with each other based on the results of a questionnaire
survey; however, nurses, particularly those in their 2nd year, show a tendency to have poor
self-education skills, and, hence, it is necessary to intervene for such professionals
individually.
Conclusions
It is important to provide well-developed educational programs for clinical nurses, which are
intended for the emergency field.
3-5 Key words

Nursing care in the emergency field, educational programs, review of the articles
42
Assessment and instruction to promote higher thinking in nursing students
Huimin Lo1, Shu-Chuan Chang2, Yu-Chun Tsai1

1.
Department of Nursing , St Mary Nursing and Management Junior College , Yilan,
Taiwan., 2. Associate professor, Department of Nursing, Tzu Chi University , Hualien, Taiwan
Presenting Authors Email: hmlo@smc.edu.tw
Purpose
Objectives: The dearth of data on the role of assessment in college education formed the two
purposes of this study: first, to explore assessment strategies commonly used in nursing
education by analyzing the curriculum documents of three college nursing programs in
Bloom's Taxonomy of learning, and second to unravel issues of instruction and assessment by
categorizing data into teacher- and learner-centered strategies.
Design
Content analysis research technique applied to analyze the curriculum documents of three
college nursing programs in Yilan, Taiwan.
Methods
After obtaining IRB approval and consent to access the curriculum documents of the
programs, data were analyzed using the content analysis research technique. Data on
assessments and instruction were categorized into student-centered and teacher-centered.
Results
Data revealed deficiency in employing learner-centered strategies in the assessment and
instruction of the three programs. There was evidence that educators of the programs focus on
teaching content and examining retention, thus supporting prior notions on teaching to the test
and accusations in earnest on adherence to the traditional and behavioral curriculum
perspectives. Such curricula leave little room for the development of higher order thinking in
learners.
Conclusions
43
Although assessments are believed to be indicators of program and teaching effectiveness,

there is relatively alarming information on the incompatibility between current assessment
practices and demands of the workplace. There is an urgent need for transforming educators'
beliefs, knowledge, and skills on testing, since teaching to pass a test could impede
knowledge transfer and deter the development of learners' higher thinking skills.
3-5 Key words
Thinking in, nursing students, learner-centered
44
The thinking exercises were effective to improve a stigma against cancer in

the nursing students.
Ai Yamaguchi1, Masayo Ayukawa1, Satomi Tanaka1, Yumie Nagata1

1.
Gifu University of Medical Science
Presenting Authors Email: ayamaguchi@u-gifu-ms.ac.jp
Purpose
Nursing students require the study about patients with cancer. However, most of them have
negative images against cancer and have difficulty and distress to deal with it. It is essential
to recognize their worries and support them to act on their own initiative. We hypothesized
that Thinking exercise would change their images into positive one and evaluated the
contents what they learned though the Thinking exercise.
Design
mix
Methods
Ninety nursing students who have completed the lecture of the introduction of adult nursing
before clinical practice were enrolled in this study. After they took a class about the nursing
for cancer patients and watched the DVD of cancer patients, questionnaire survey was
conducted from April to June 2014. The open-ended questionnaire had the items including
"What is an image of cancer? (Q1)" and "What do you feel when you and your family get a
notice about cancer? (Q2, yourself; Q3, your family) The data obtained were analyzed by
using qualitative analysis. Thematic Analysis method was used to categorize the data
hierarchically.
Results
There were 83 valid responses (92%). Answer to Q1 included major 3 categories: association
with death (death, recurrence, metastasis, terminal care), associated with pain (mental,
physical, economic), and anxiety (changing life, avoidance). Answer to Q2 included 3
categories: passive role (receiving treatment), relationship (desire to maintain usual and
45
unchanged relationship), and fear. Answer to Q3 included 5 categories: let my family do

what they want, spend time together, want to do care, want to contact as usual, and thoughts
on my family without concering what they want.
Conclusions
80% of images about cancer was related to death. This results was similar to the previous
research conducted in foreign countries and negative images reminding of death was
recognized as the imprinting of social stigma. A DVD, how to find the best life, used in
this study showed that disturbance and disease are not just understood as disturbance and
disease themselves, but necessary to build up the life story, and they affirm themselves
through those experiences. Recently the importance of benefit findings by practicing
Thinking exercise has been recognized. It is more important to think about cancer and
method of terminal care than to get knowledge about cancer and terminal care. It is essential
to evaluate the contents what the students learn and continue longitudinal study.
3-5 Key words
Nursing students, stigma, thinking exercises
46
Analysis of the concept of theDevelopment of educational materialsin

nursing training
Kumiko Iwatani1, Satomi Yoshida2, Kyoko Kanamori3, Miwa Izuhara4

1.
Kanazawa Medical University, 2. BAIKA Womens University, 3. Seisen

University, 4. NARAGAKUEN University
Presenting Authors Email: k-iwakmk@kanazawa-med.ac.jp
Purpose
Nursing training aims to help students integrate knowledge and expertise acquired from
learning in school, and develop skills required for nurses while considering changes in the
status of subjects in clinical training sessions. To accomplish this, both training instructors
and supervisors are required to be able to develop educational materials based on their
experiences obtained in clinical settings. The present study examined the views of the
development of educational materials related to nursing training in nursing care research,
focusing on its construct.
Design
It employed the method of concept analysis developed by Rodgers.
Methods
The contents were analyzed for antecedents, attributes, consequences. A literature search was
conducted using Ichu-shi Web, Medical Online, CINAHL, MEDLINE, PsycINFO, and
PubMed. Search terms for the Japanese literature were the development of educational
materials and advice in nursing training, and those for the English literature were
teaching material or teaching materialization of phenomena, and clinical teacher
and or clinical instructor. A total of eighteen papers in nursing science related to the
purpose of the study were analyzed.
Results
47
Regarding the attributes of the development of educational materials for nursing training, the
following five categories were extracted: the task of recognizing the experiences of
students as learning materials, helping students provide meanings to their experiences
and events as nursing care, the activity of instructors to teach students select and
restructure effective phenomena , the selection of subjects to be taught and focuses,
and situations to orient students in the appropriate direction of nursing care as viewed by
them. The following seven prerequisites were extracted: ensuring that students are
ready, changes in the situation in clinical settings, setting goals for training,
characteristics of educators, the ability of instructors to interpret educational
materials, teaching skills, and establishment of relationships. As consequences
for students, the enhancement of knowledge structures, definition of the experiences
of students, promotion of education for a large number of students, helping students
express their thoughts and feelings, accomplishment of training goals, and
spontaneous motivation were extracted. Regarding consequences for educators,
teaching = the accomplishment of learning processes, development of effective
learning models, and necessity for instructors to understand their own features when they
develop educational materials were extracted.
Conclusions
The development of educational materials based on experiences obtained from nursing
training helped students reflect on their experiences and findings, reconstruct them, orient
them in the appropriate direction of nursing care as viewed by the students, and provide them
with meanings in the context of nursing care. Further research should be conducted to develop
measures to increase the ability of educators to create educational materials based on findings,
and, therefore, it is necessary to extract knowledge on the methods for creating educational
materials, and assess the abilities of educators.
3-5 Key words
Development of educational materials, nursing training, analysis of the concept, clinical
training
48
Developing a nursing continuing education program focused on the process

of active listening, for patients with intractable neurological disease
Features of the education program
Chizuko Takeuchi1, Mikiko Hara2, Momoe Konagaya3, Mitsuko Ushikubo4, Noriko Sato2
1.
Tokyo Womens Medical University Yachiyo Medical Center, 2. Tokyo Womens Medical
University School of Nursing, 3. Syowa University School of Nursing and Rehabilitation
Sciences, 4. Gunma University Faculty of Medicine School of Health Sciences
Presenting Authors Email: marron@orion.ocn.ne.jp
Purpose
Nurses employ active listening in their daily care of patients with intractable neurological
disease as a part of the patients psychological care. However, it has been reported that
nurses feel uneasiness and ambivalence when listening to patients narratives. Against this
background,We examined features of nurses approaches to listening in order to extract
elements important to the care of patients with intractable neurological disease, with the aim
of developing a continuing education program for active listening-focused care.
Design
The obtained data were analyzed qualitatively using inductive methods.
Methods
Subjects of this study were 12 nurses who listened to patients with intractable neurological
disease. Semi-structured interviews about their way of listening and their associated feelings
and experiences were conducted. An inductive approach was employed for qualitative
analysis of the structure of listening sessions. A continuing education program for the care of
these patients was developed using the factors extracted from the results of analysis. This
study was approved by the ethics committee of our university.
Results
49
Three factors of the education program, breaking through the mental barrier that prevents
nurses from listening to patients, ways of listening and responding that enhance
conversation, and holding listening sessions as a part of intractable disease care, were
extracted. Experience-based learning that encouraged nurses to rethink their feelings
associated with listening appeared to be effective in addressing the first element. The
education program was therefore designed to help nurses review the specific responses from
communication with patients with intractable neurological disease, expand the variety of
ways of listening and responding, and improve nurses perceived significance of listening
sessions. we will use instructional and theoretical lessons as well as practical training . More
specifically, the program includes practical training in basic active listening skills, as well as
training in emotional experience related to listening. It also teaches about the psychological
specifics of patients with intractable neurological diseases. Goals of the Education Program
(1) Be aware of the importance of active listening skills in the psychological care of patients
with intractable neurodegenerative diseases.(2) Be able to reflect ones own emotions and
alleviate anxiety and the lack of self-confidence which result from talking to patients with
intractable neurological diseases.(3) Acquire active listening skills in order to expand and
deepen conversations with patients with intractable neurological diseasesAfter the program
is complete, students on the course will be administered a written questionnaire as well as
participate in follow-up interviews, which will be analyzed qualitatively and quantitatively
(using an active listening scale, cf. Mishima 2004).
Conclusions
This education program needs to be refined by its implementation in nurses who care for
patients with intractable neurological disease
3-5 Key words
Education program, active listening, patients, intractable neurological disease
50
Problems of the existing evaluation forms for the basic nursing practicum
and a proposal of the rubric-based evaluation form
Kanna Okayama1, Ayako Ogi1, Mieko Yamaguchi1, Tetsuya Ogino1

1.
Okayama Prefectural University
Presenting Authors Email: kokayama@fhw.oka-pu.ac.jp
Purpose
Recently, the rubric has been introduced increasingly in the educational evaluation field. This
study aimed to examine whether the existing evaluation forms for the basic nursing practicum
can reliably assess student achievement, and selected learning goals that are not adequately
evaluated with the current forms, and proposed a rubric-based evaluation forms that will
possibly solve this problem.
Design
A quantitative descriptive research design was used.
Methods
Participants were 42 nursing students registered at University A. Using the existing evaluation
forms, all students were requested to self-evaluate their achievement just after the basic
nursing practicum part I in their first year in November 20XX, and also after the basic nursing
practicum part II in their second year in October 20XX+1. Scores of the existing evaluation
forms were on a 4 phases scale (range: 25 points) and a simple tabulation was used. Basic
evaluation form I scores were compared between the first and second years and classified into
improving, unchanging, and declining groups. To examine whether basic evaluation form II
could continuously and progressively assess student learning achievement, items similar to
the large category in basic evaluation form I were extracted from basic evaluation form II, and
the scoring rates for each item were compared between first and second year and classified
into improving, unchanging, and declining groups. Items with second-year scores lower than
first-year scores were selected for learning goals that are not adequately evaluated with the
current forms.
51
The study protocol was approved by the author-affiliated ethical committee. We then
administered the survey in keeping with the approved contents.
Results
Evaluation forms were obtained from 41 students and the valid response rate was 97.6%.
Three of seven items in the existing evaluation forms I and II showed lower scores in second
year. (Understanding patients, Implementing everyday patient life support, Can
express the nursing viewpoint through a daily record, group work, summary meetings, and
reports. ) Thus, it may be difficult for students in their first and second years to adequately
evaluate these 3 items at different times using the existing evaluation forms. Therefore we
selected these 3 items and constructed a rubric-based evaluation form that possibly enables
students to assess these items adequately.
Conclusions
It may be difficult for students in their first and second years to adequately evaluate these 3
items at different times using the existing evaluation forms. Therefore we selected these 3
items and constructed a rubric-based evaluation form that possibly enables students to assess
these items adequately. Further investigations are needed to test and improve the rubric-based
evaluation form that allows students to self-evaluate their learning achievements. The form
may also encourage students to notice what need to be done further. Reconsideration of the
contents of clinical training and the teaching system also appears to be necessary.
3-5 Key words
Rubric, educational evaluation, basic nursing practicum
52
Student information which should be shared by teachers to conduct

effective on-site practice guidanceSecond report
Hiromi Morioka1, Yuri Tainaka2

1.
Senri Kinran University department of nursing, 2. Kio University
Presenting Authors Email: h-morioka@cs.kinran.ac.jp
Purpose
Among educational methods, practical nursing training is an important learning opportunity
to train nurses who can contribute to people's various health requirements in a wide range of
areas including families, facilities and communities. In this study, we report about a survey
of nursing teachers regarding the necessity of information sharing and just what information
regarding nursing students should be shared with other teachers before training starts in order
to conduct effective learning guidance towards achieving practical training objectives.
Design
Qualitative descriptive studies.
Methods
The subjects were 8 university teachers at institutes involved in nursing. As preparation
before the on-site practice, we conducted a written survey regarding the necessity of
information sharing and the subjects they consider necessary or not necessary. Our study was
conducted from November 2012 to January 2013. Analysis was conducted by grouping
similar meaning and contents on the freely written information by those teachers which
should be shared among them, then abstracted them into sub-categories and categories in a
step-by-step manner. For ethical consideration, we explained verbally and in a written form
regarding the purpose of the study and ensured those involved that the data wont be linked
to any individual person, the data will be strictly held and the results will be officially
announced at academic conferences and so on. We had consent from all of those who cooperated in the study.
53
Results
All teachers answered that it is necessary to exchange information and cooperate with other
teachers. There are 6 categories created for information which should be shared: condition
of study achievement, learning attitude, comprehension, ability to
communicate, health condition and condition of everyday life. 9 sub-categories
were created from them. One unnecessary information item personal background was
created. All of the teachers also stated that the current condition of information sharing is not
good enough.
Conclusions
Nursing study is called a virtual science, and the rate of engaging on-site practical training is
big. It largely affects the formation of students identity as professional nurses. It is
commonly believed that if they can obtain the feeling of self-efficacy through practical
training, it will have a good effect on their nursing practice after they graduate. Important
factors to improve the feeling of self-efficacy include the formation of a good supporting
relationship with patients as well as how hospital ward staff and teachers treat students at
training sites. Due to recent changes in social environments surrounded students, we consider
it is important for teachers to understand and assess various experiences students have in
learning and living in order to conduct precise education and tutoring. For that purpose, it is
important to have a close relationship and cooperation among teachers and share necessary
information about students to help understand them while giving adequate consideration to
ethical matters.
3-5 Key words
Nursing education, student, teacher
54
Examination of effective educational guidance at practical nursing sessions

held at multiple facilities
Yuri Tainaka1, Naoko Horie2

1.
Department of Nursing and Medical Care , Faculty of Health Sciences, Kio University, 2. Kio
University
Presenting Authors Email: y.tainaka@kio.ac.jp
Purpose
Analyzing students recognition at practical nursing sessions held at multiple facilities and
examining which guidance is effective.
Design
Exploratory Research
Methods
We conducted a survey of 82 consenting third year students of the Medical Nursing Division
of the School of Health and Science at A University after their participation at practical
nursing sessions. We used a question sheet (10 questions) regarding the sessions. The
responses (one of 5 levels) to the questionnaire were analyzed using SPSS20.0. Approval
was obtained from the Research Ethics Committee at A University.
Results
78 (95.1%) students submitted their answers and 75 (91.5%) were deemed valid. The nursing
sessions were held at 3 facilities. The average age of the students was 20.910.63 (20 to 21
years old). Survey results showed that the phrases, relationship with other members,
relationship with patients, bitter feeling, hospital ward atmosphere, selfgrowth, physical burden, sense of accomplishment, relationship with trainers,
relationship with teachers and recording sheet were most noted in order of higher
average. The results of conducting t-test after separating self-growth into higher and
lower groups showed a significant difference in sense of achievement (p<0.01),
hospital ward atmosphere (p<0.01), relationship with patients (p<0.01) and
55
relationship with trainers (p<0.01). Additionally, multiple regression analysis (stepwise

method), which set self-growth as a dependent variable and other items as independent
variables, those recognized as strongly related to self-growth were sense of
accomplishment (0.55,p<0.01) and relationship with trainers (0.31p
0.01).
Conclusions
Students experience a lot of difficulties when they put themselves in actual nursing practice
sites which is unfamiliar environment to them (Katsuno, 2013). To achieve learning
objectives in difficult conditions, students are required to self-motivate themselves in the area
of effort and overcoming difficulties. In other words, they need to achieve self-growth. From
the results of this study, strongly related to self-growth are a sense of accomplishment and
relationships with trainers. Sense of accomplishment is a satisfactory feeling obtained from
achieving something and is a factor students must develop or find by themselves, and it is an
inner factor. On the other hand, relationships with trainers are considered to be an external
factor. Furthermore, the items with significant differences depending on the scoring cohort
of self-growth, hospital ward atmosphere and relationship with patients are also
study environments for students, being external factors. Effective guidance at practical
nursing sessions held at multiple facilities means promoting students self-growth by
making them feel the satisfaction of achievement. Therefore, students practice
environment, which is an external factor, should rebuild their learning environment, in
particular, stressing the relationship with hospital wards, patients and instructors with clinical
instructors.
3-5 Key words
Practical nursing sessions, effective educational guidance, students, self-growth
56
Investigation of the cognition of nursing students at various facilities

regarding lack of teaching consistency
Horie Naoko1, Yuri Tainaka1

1.
Kio university
Presenting Authors Email: n.horie@kio.ac.jp
Purpose
The purpose of the study was to examine the attitude toward teaching of nursing students who
have received training at various hospitals.
Design
We developed a questionnaire comprising of questions assessed by the Likert scale and a
comments section that evaluated students awareness and demands after their training at
each hospital. We focused on the comments section of the questionnaire.
Methods
Of the 82 nursing students who participated in our study, we examined the comments section
of the questionnaire of 27 students. The survey was conducted after the nursing students had
undergone training at various hospitals. We used inductive coding to analyze responses of
nurses concerning their awareness and demands, which were straightforward thoughts at the
end of their domain training. The study was approved by the Ethics Committee of the Kio
University.
Results
We examined five codes: introspection, mentorship, training records, material environment,
and ethics based on a questionnaire on awareness and demand. Introspection was based on
awareness and mentorship, training record, material environment, and ethic were based on
demand. The ratio of awareness to demand was 1:4. In terms of demand, most nursing
students described inconsistencies in the type of training they received.
Conclusions
57
Previous reports have discussed the lack of teaching consistency in institutions (Tukada,
2003). Inconsistencies in training of nurses may arise because of various factors, including
whether schools have affiliated teaching hospitals; and this issue needs to be addressed.
We propose that students need to make an autonomous decision to address the problem of
inconsistencies in training directly with their professors or academic institution. This many
create a situation of conflict for the student, which may be difficult for young students.
Nevertheless, if nursing students start demanding these changes, institutions and professors
will have to accordingly respond. Conflict is necessary for students to develop as a person
(Washida & Uchida, 2013). The sense of inconsistency is positive for the mental growth of
young students; therefore, it is affirmative that teachers show inconsistency.
Furthermore, although consistency between mentors is irrelevant, consistency within an
individual mentor is required. During their training at various hospitals, nursing students may
experience many types of conflicts with various people. Consistency within an individual
mentor would safeguard nursing students from double bind conflicts. Thus, consistency
within individual teachers is more desirable than consistency between teachers.
3-5 Key words
Inconsistency training, autonomous decision making, double bind, attitude of teachers, mental
growth
58
Factors related to the continuation of volunteering for a support service for

persons with early-onset dementia by nursing students in Japan
Yuko Degai1, Towako Katsuno2, Sugano Yukako2

1.
Miyagi University, 2. Tokyo Metropolitan University
Presenting Authors Email: degayu2058@gmail.com
Purpose
A support service for persons with early-onset dementia has been implemented by volunteers,
including nursing students, in Tokyo. The purpose of this qualitative study was to explore the
factors related to the continuation of volunteering for a support service by nursing students in
Japan.
Design
Qualitetive describtive reserch desigh
Methods
Data were collected with in-depth interviews by the use of a semi-structured interview guide.
All interviews were tape-recorded and then transcribed. The participants consisted of six
students enrolled in a university located in Tokyo.
Results
Four were females and two were males. The length of volunteer work ranged from 11 months
to 28 months. Content analysis revealed seven categories; positive emotional experiences by
the support activity, experience of being entrusted, bonding with people who share the
activity, supportive culture among staff, learning care knowledge and techniques, matching
with ones interest, and accessibility to the activity. Positive emotional experiences
consisted of pleasantness of the activity, enjoying the activity by oneself, and the experience
of being moved by the activity. Experience of being entrusted included having responsible
roles, sense of accomplishment felt by being entrusted, participating in the whole activity,
feeling of responsibility. Bonding with people who share the activity consisted of having
friends who support the continuation, cohesion among staff, and relating with persons with
59
dementia and family caregivers. Supportive culture among staff consisted of availability of
support from other staff (seniors, graduate students, nursing instructors) and availability of
consultation among staff. Accessibility to the activity included physical accessibility and
psychological accessibility.
Conclusions
The results suggest that experiences of positive emotion, having responsible roles and sense
of accomplishment will encourage the nursing students to continue the volunteer work for
persons with early-stage dementia in the community. In addition, it is necessary to provide
them with a supportive environment among staff and to ensure the accessibility of the activity
to facilitate the continuation of this service.
3-5 Key words
Volunteer work, nursing students, dementia
60
Meaning and learning of nursing students who participate in volunteerism

of people with young-onset
Junko Masuya1, Mikiko Aoyama2, Shin Otomo3

1.
Tokyo Metropolitan University Graduate School of Human Health Sciences, 2. Nagoya Isen, 3. Ouji
Coop Hospital
Presenting Authors Email: masuya@tmu.ac.jp
Purpose
The purpose of this qualitative study was to describe meaning and learning of nursing
students who participate in volunteerism of people with young-onset dementia and their
families.
Design
Design used qualitative and descriptive research.
Methods
The investigation was conducted by means of a free description-style questionnaire survey
for 28 nursing students of a four-year university who participate in volunteerism (Yu-Yu star
club). Study period was from 2011 to 2014.
Results
The first time, many of them had negative emotions such as "The confusion for how
involved", but from the second time, positive emotions such as deepening the subject's
understanding and Sense of achievement were increasing. Learning of the activities,
6 category including "devised interventions", "clarification of the goals of as a nurse" and
"recognition of feelings of family" has been extracted. Meaning of the activities, 4 category
including "my place", "emotional support for the family", "enjoy together" has been extracted.
Conclusions
As a result of participating in volunteerism (Yu-Yu star club), nursing students had been able
to have sense of achievement. In addition, they devised and recalls how the involvement of
61
their own, had led to self-growth. Nursing students were aware that volunteerism (Yu-Yu star
club) have a meaning as a place where people with young-onset dementia and their families
and myself can enjoy together.
3-5 Key words
People with young-onset dementia, volunteerism, nursing students
62
Factor analysis of nursing studentslearning featuring senior students

acting as simulated patients
Sachie Arai1, Ryota Kitao1, Akiyo Nakamoto1, Nanae Iked1, Junko Yamanaka1,
Setsuko Takemura1
1.
SENRI KINRAN University Faculty of Nursing
Presenting Authors Email: s-arai@cs.kinran.ac.jp
Purpose
We anticipated new educational effects by introducing Simulated Patient (SP) Practice with
senior students acting as patients. These effects included having students obtain better
cooperative attitude, a requirement in clinical settings, and improvement in willingness of
study. This study examines the factor structure on the learning of nursing students at SP
sessions conducted with their senior students.
Design
The subjects were 92 third year Department of Nursing students. A freely self-written
questionnaire regarding what they learned was used. Exploratory factor analysis was
calculated.
Methods
Survey periodJuly 2014.
Contents The sessions objective was to develop final stage nursing processes by the adult
nursing practice class. Fourth year student volunteers from the same department acted as
patients. In on SP, a 4 or 5 student group conducted cleanliness support. Afterwards,
students reviewed the experience with the senior volunteer students who acted patients.
Question ItemsAmong the 44 codes qualitatively and inductively extracted from the
questionnaire responses following the above practice, 32 were adopted as question items after
discussion among researchers. Measurements were made on a 4 scale, with 4 being I agree
a lot to 1 being I dont agree at all.
Method of Collecting AnswersResearchers distributed anonymous questionnaires to
63
subjects provided a box for them to return completed forms.

Analyzing MethodUsing SPSSVer.19, researchers conducted a promax rotation with major
factor analysis. 5 factors were characterized from scree plot. We confirmed Cronbachs
coefficient alpha.
Ethical ConsiderationsResearch was conducted with the approval of the Ethical Review
Board of the organization the researchers belong to. Research contents and data handling
were explained to subjects verbally and in written form. They were also informed that the
survey had nothing to do with their grades, and it will be considered that returning their
questionnaires means they agreed to cooperate on the survey.
Results
Among 54 responses (58.7% recovery rate), 49 responses were analyzed (90.7% effective
response rate). After eliminating items with factor loading lower than 0.4, the first factor was
interpreted as New recognition toward well-planned nursing practice with basis and
purposes from 7 items mentioned ( =.880). The second factor was Deepened thoughts
toward nursing from 4 items ( =.893), and third was Importance of preparing for
practical nursing care from 5 items ( =.864). The fourth factor was Imaging actual
care scenes from 4 ( =.743) and fifth was Need for care responding to each patient
from 3 ( = .841).
Conclusions
There were 5 items in the factor structure of these nursing students sessions: New
recognition toward well-planned nursing practice with basis and purposes, Deepened
thoughts toward nursing, Importance of preparing for practicing nursing care,
Imaging actual care scenes and Need for care responding to each patient. The
researchers believe the students had an opportunity to experience detailed, actual on-site
patient support and discover issues they have to work through this session with senior
students.
3-5 Key words
Senior students, simulated patient, nursing students, learning, factor analysis
64
Validation of a nursing continuing education program for the care of

patients with intractable neurological disease, with an emphasis on active
listeningAnalysis of self-learning and the active listening scale
Momoe Konagaya1, Mikiko Hara2, Chiduko Takeuchi3, Kimiko Mogami4, Rika Miyamae5
1.
Showa University School of Nursing and Rehabilitation Sciences, 2. Tokyo Womens Medical
University, 3. Tokyo Womens Medical University Yachiyo Medical Center, 4. Health Corch
Japan, 5. Kanto Medical Center EC
Presenting Authors Email: konagaya@nr.showa-u.ac.jp
Purpose
Active listening is considered by nurses to be the basis of everyday psychological care for
patients with intractable neurological diseases. Although nurses generally intended to engage
in active listening with these patients, they face dilemmas about not having enough time to
provide psychological care for patients while dealing with their various other care demands.
Therefore, as part of the ongoing education program for nurses, a series of three monthly
seminars are being performed to promote active listening by nurses as part of the
psychological care of patients. The seminars are targeted at nurses who have more than five
years of experience and are comprised of lectures, practice, problem-based learning, and selfstudy.
The present study aims to evaluate this continuing education program for nurses.
Design
The effectiveness and importance of the seminars were examined through qualitative analysis
of nurses descriptions and quantitative analysis based on questionnaires.
Methods
Seminar participants establish their own objectives and make specific plans for actively
listening to patients, then implement and evaluate these plans. Fourteen participants' general
instructional objectives, behavioral objectives, and feedback after actual practice were
categorized. The effectiveness of the program was evaluated by examining changes in the
65
scores for self-administered active listening scales (ALS) that assess personal attitudes toward
active listening. This study was approved by the ethics committee of Tokyo Womens
Medical University.
Results
The general instructional objective for the listening-focused care of the participants was to
learn skills for listening and assertively responding to patients and for coaching conversations
to help patients to manage their emotions and feelings, reflect on their life, and gain positive
feelings. To achieve this general objective, specific behavioral objectives were analyzed
and eight items were extracted, such as try to make time to engage in active listening, even
briefly and prepare for listening. Participants noted that sitting down next to patients
beds even for a short time with the intention of listening to them helped patients to talk about
their feelings. Participants also learned that preparing for conversation encourages patients to
give further narration.
Nurses self-assessed attitude obtained using the ALS was higher after the third seminar
than before the first seminar (p<0.1).
Conclusions
The results demonstrated that nurses in the program were able to establish their own
objectives for listening-focused care and achieve them by engaging in actual practice. It is
expected that the program will increase nurses awareness of the objectives of listeningfocused care, and will improve their skills to enable them to engage in better active listening.
3-5 Key words
Active listening, psychological care, intractable neurological disease
66
What lies behind educational behavior of preceptors to novice nueses

focusing on educational concept of values of preceptors
Emi Nishida1
1.
Department of Nursing Science, Faculty of Health Science, Naragakuen University
Presenting Authors Email: enishida@naragakuen-u.jp
Purpose
Clarify from what kind of perspective preceptors instruct novice nurses;
Obtain information for figuring out an effective education system by recognizing concept
of values which support preceptors behavior.
Design
A qualitative and inductive study design was adopted based on Modified Grounded Theory
Approach .
Methods
Survey subjects Four preceptors in charge of novice nurses who joined Hospital A in 2013
Period of survey: From November to December in 2013.
Data collecting methodSemi-structured interview survey was conducted. The interview
guide consisted of questions such as expectation for novice nurses, preferred improvement by
their instruction and the ways to relate with novice nurses.
Data analysis methodData was prepared as a verbatim record from recorded interview
contents.Expectation on novice nurses and educational behavior of the selfwas adopted
as the analysis theme.
Results
Background of subjects: All of the subjects were women with the mean age of 34.8. The
mean years of experience as a nurse was 8.8 .
Extracted category and concept: As a result of analysis of data obtained by the interviews,
five categories, 15 sub-categories and 30 concepts were generated.
Story line: Whileexpectations for nursesheld by preceptors included attitudes expected
67
for novices, determination to become a nurse, constructive thinking powerand

assured technique, picture of novice nurses in realitywhich was revealed in the
course of instruction included attitudes not typical of novice nurses, lack of motivation
to become a nurse, inability to improve in spite of repeated instructionsand
perception gap regarding learning. Therefore, perception and action for solution
may lead to performforced learning method. This forcible instruction may form a gap
in relationship with novice nurses making preceptors further feel them ascumbersome
existence.
Conclusions
Preceptors request novice nurses to have knowledge, technique and attitude as a professional.
However, they recognize attitudes of novice nurses asattitudes not typical of novice nurses
includinglack of consideration for othersandlack of responsibilitywhile feeling a gap
between ideal and reality. Preceptors educational concept of valuesare supported by
ideal nurse to be pursuedindividual belief in educationbut they have underlying
sense ofconflict in relation to educationsuch asconsideration for candidate
colleagues, suspicion against predetermined educationand conflict in individual
perception as an ideal instructor.
3-5 Key words
Novice nurses, preceptor, education for novices, concept of values
68
A study on the professional identity in basic nursing education
Satomi Tanaka1, Masayo Ayukawa2, Ai Yamaguti3, Yumie Nagata3

1.
Gifu
Univercity of medical science, 2. Gifu Univercity of Medical
Science, 3. Gifu
Univercity of Medical Science
Presenting Authors Email: stanaka@u-gifu-ms.ac.jp
Purpose
A high turnover rate of new graduate nurses has been a social serious problem and has
provided the Ministry of Health, Labour and Welfare, Japanese Nursing Association, and
teachers of nursing with a sense of crisis. This high rate was considered to have probably been
caused by immature view of a career and work of the nursing students, and we at this time
conducted a questionnaire research on the professional identity as a nurse using professional
identity scales in 346 nursing students to find out how they should be supported in the basic
nursing education.
Design
Quantitative research study
Methods
We at this time conducted a questionnaire research on the professional identity as a nurse
using professional identity scales in 346 nursing students to find out how they should be
supported in the basic nursing education.
The t-test and cross-tabulation to another school year, I went the one-way ANOVA.
I told that person is not identified as ethical considerations, that you respect the free will of
the participants.
Results
In a previous research, the mean score of the professional identity was highest in the first-year
students with a craving to be nurses. However, in the second- and third-year students, the
mean score lowered because of anxiety for the greater amount and higher level of study
content and less satisfaction level of self-performance in practical training at hospitals. In the
69
fourth-year students, the mean score of the professional identity again increased with
increased confidence in their experience and ability.
Conclusions
However, in the research conducted at this time, the mean score of the professional identity in
the first-year students was lowest, and that in the fourth-year students was highest, showing a
different result from the previous research. The difference was considered because the school
curriculum provided during the previous research period has been changed to a new one at the
research at this time. The new curriculum requires more credits and school hours than the old
curriculum (93 credits and 2,895 hours in the old curriculum and 97 credits and over 3,000
hours in the new curriculum); therefore, the first-year students in the research at this time had
an anxiety for the tight schedule and felt a gap between reality and the image they had for
nursing students rather than simply having a longing to be nurses, which resulted in the lowest
mean score of the professional identity.
Therefore, the basic nursing education should be positioned as the first stage of the process
for nursing students to improve their carrier as nurses and to establish their professional
identity, and it is necessary for organizations and people who guide the nursing students to
recognize that the identity needs to be developed from school entry of the students and to
promote their growth as professionals. It is also necessary to support the establishment of both
the adolescent identity and the professional identity of nursing students.
3-5 Key words
Basic nursing education, the professional identity, turnover
70
Contraceptive self-efficacy, attitude toward contraception and practices of

contraception among Korean nursing students
Dong-Hee Kim1, Young-Sil Bae1

1.
Pusan National University
Presenting Authors Email: dongheekim@pusan.ac.kr
Purpose
This study aimed to explore the level of contraceptive self-efficacy, contraceptive knowledge
and practices of contraception among nursing students in South Korea.
Design
This study employed a cross-sectional survey design.
Methods
Sixty-six students were recruited during the month of May 2014. A structured questionnaire
was self-administered. Descriptive statistics was used for data analysis using SPSS/PC Win
18.0 program.
Results
The average age of the students was 21.9 and the range of ages was 21 to 25. The mean scores
of contraceptive self-efficacy and attitude toward contraception were 46.8 (possible range 12
to 60) and 54.1 (possible range 13 to 65) respectively. About 56% of the students have
experienced sexual intercourse. Among students who have experienced sexual intercourse,
only 59.5% of the students had always used some form of contraceptive in the past 6 months,
whereas 8.1% of them had almost never used any form of contraceptive in the same period.
Among students who have experienced sexual intercourse, 86.5% of the students had decided
the method of contraception by themselves, and the most commonly used contraceptives were
condom (59.5%), followed by coitus interruptus (16.2%).
Conclusions
71
Although nursing students had an above medium level of self-efficacy and attitude in
contraception, the rate of contraceptive practices need to be improved.
3-5 Key words
Contraception, self-efficacy, attitude, practice, student
72
The effect of an online continuing education program on urinary

incontinence knowledge and attitudes among community health nurses in
South Korea
Aeyoung So1, Jennie De Gagne2, Hyewon Shin3

1.
Gangneung-Wonju National University, Department of Nursing, 2. Duke University, School of

Nursing, 3. University of North Carolina, School of Nursing, Greensboro
Presenting Authors Email: aeyoung@gwnu.ac.kr
Purpose
Urinary incontinence (UI) is highly prevalent in Korean rural areas, reporting up to 70.9%.
However, there is a lack of awareness and education among older adults and health
professionals, resulting in little attention on a UI self-management training program for
community health nurses. In response to inaccessibility due to geographic isolation and
limited resources, there is a lack of learning opportunities for community health nurses on UI
care training. Therefore, we conducted a study to assess the effect of an online continuing
education course on knowledge and attitudes towards UI care for community health nurses in
South Korea.
Design
A one-group pre- and post-test design was used with 35 community health nurses.
Methods
The urinary incontinence online continuing education program was developed, which
contained 3 modules consisting of 3 hours of recorded video lectures as well as
supplementary materials. The online education program was open and available from May 19,
2014 to June 30, 2014. Yuan and colleagues UI Knowledge Scale (UIKS) and UI Attitude
Scale (UIAS) were used before and after the online education program. A paired t-test and
descriptive statistics were also used.
Results
73
The mean minute of time spent for studying the online continuing education course on UI was
301.3 minutes (SD = 63.02) with a range of 180 to 459 minutes. Statistically significant
differences were found between pre- and post-test mean knowledge and attitudes scores of the
nurse participants (t =-4.435, P<.001; t =-3.707, P =.001, respectively). The mean knowledge
score was 23.3 (SD = 2.62) at baseline. After the continuing education, the mean on
knowledge increased to 25.2 (SD = 1.84). The mean scores on attitudes were 3.0 (SD = 0.31)
in pre-test and 3.2 (SD = 0.28) in post-test.
Conclusions
Our online continuing education course was effective in increasing knowledge and attitudes
toward urinary incontinence management and care. Further research needs to investigate the
effects of online continuing education on nurses self-efficacy for UI nursing interventions
and the improvement of patient UI related outcomes in community level.
3-5 Key words
Urinary incontinence, continuing, education, community health, nurses
74
Effect of audiovisual materials in teaching menopause to first-year nursing

students
Yukiko Ushigoe1, Yuko Tanikawa1

1.
Kansai University of International Studies, School of Health Sciences
Presenting Authors Email: y-ushigoe@kuins.ac.jp
Purpose
It is believed that videotape recorders (VTR) have facilitated the learning of students brought
up in the information age, as such students are able to more readily imagine a patient or
phenomenon due to the motion provided by VTR images, which in turn encourages the desire
to learn. Therefore, we studied the effectiveness of audiovisual teaching materials in
educating nursing students on the characteristics of climacteric women.
Design
The study employed an intervention research design.
Methods
The study subjects were seven first-year nursing students that had not yet specialized (aged 18
0). The data collected in this study was obtained by allowing subjects to freely describe
their knowledge of menopause using the Scale of Menopause Knowledge and a self-report
questionnaire. I was using an image scale the vividness of the image. Data was collected
before and after the educational video was shown, and again three weeks after the session.
Data analysis was conducted by creating a simple tabulation of total scale scores. The free
descriptions were analyzed by totaling the amount of words written before the learning,
immediately after the learning, and three-weeks after the learning using 2010 Text Mining
Studio for Windows . The image scales were analyzed by comparing the images
immediately after the subjects watched the movie and the images three weeks later.
Results
With regards to the analysis targets, we analyzed the data of seven students before the
learning session, and the data of four students three weeks after. (Three students did not
75
participate in the data collection after 3 weeks)

The total score on the Scale of Menopause Knowledge before the learning was 96.
As for the numbers of menopause-related words extracted from the free descriptions, there
were an average of 19 words before the learning, 24 words immediately after, and 59 words
three weeks after. In all three of the data collection times, the description "I feel irritating"
was the most described phrase. Immediately after the video was shown and during the testing
three weeks later, many of physical symptoms such as "I feel dull" and "I get tired easily"
were included in the reports. There were no changes in the image scale between that collected
immediately after the learning and that collected three weeks later.
Conclusions
The study showed that the Scale of Menopause Knowledge highlighted a lower level of
knowledge when compared with the data of a preliminary study. However, subjects tended to
use an increased number of words immediately after the educational session, and the number
of words doubled three weeks after learning. It is suggested that the use of a movie in this
context exerts a constant learning effect.
3-5 Key words
Audiovisual materials, nursing students, the scale of menopause knowledge
76
Developing evidence-based nursing concept strategies in pediatric nursing

practicum through action research
Fang-Yi Lin1, Tzu-Ying Lee1, Hung-Ru Lin1

1.
National Taipei University of Nursing and Health Sciences
Presenting Authors Email: fangyi@ntunhs.edu.tw
Purpose
The aim of this program is to apply evidence-based nursing concepts in nursing practicum.
Through learning about action research, students can:
1. Learn about the skills to read, search, and analyze professional literature.
2. Understand the steps and procedures of evidence-based nursing.
3. Analyze and discuss the content of the learning form and experience sharing with
classmates.
Design
In this study, we used the Action Research methodology to investigate the level of evidencebased nursing concept in students, as well as difficulties faced by teachers during the activity
and possible strategies for improvement.
Methods
The subjects of the learning strategies were 45 students enrolled in the class of a 1st year
pediatric nursing course, at a 2-year Nursing program of a Technical University. During the
clinical practicum, students form groups of seven and took on the pediatric nursing practicum.
The teaching process of the Action Research is as follow:
Analyzing the ability of the learner, literature management, course design, establishing
research goals and key points, referencing literature on evidence-based nursing, determine
research methodology (design of learning form), applying clinical education, data analysis
and explanation, discuss areas of improvements and drafting of research data report.
Results
77
Students can use the "PICO learning sheet" to perform data mining and clinical issue
discussion. It also helps students to understand more about evidence-based nursing through
hands-on literature review and data filtration. The feedback from the students about the
learning activities was mostly positive; students also reflected on how the program stimulated
their thinking and helped to connect research evidence to practice.
Conclusions
The results of this learning program can be a reference to future nursing educators on
incorporating evidence-based nursing concepts into nursing practicum course.
3-5 Key words
Nursing practicum, evidence-based, action research
78
Self-confidence in core nursing skills among Korean undergraduate

nursing students
Dong-Hee Kim1
1.
Pusan National University
Presenting Authors Email: dongheekim@pusan.ac.kr
Purpose
This study was done to examine the level of self-confidence in core nursing skills among
nursing students in South Korea.
Design
This study employed a cross-sectional survey design.
Methods
One hundred eighteen students who finished 4-year nursing school curriculums were recruited
from two universities. A structured questionnaire was self-administered. Self-confidence
levels were assessed using four-point Likert scales (e.g. 1 for not at all to 4 for very much) in
20 clinical skills which suggested by Korean Accreditation Board of Nursing Education; vital
sign, oral medication, intramuscular injection, subcutaneous injection, intradermal injection,
intravenous infusion, blood transfusion, tube feeding, straight catheterization, urinary
catheterization, enema, preoperation care, post operation care, administration care, personal
protective equipment, oxygen saturation & EKG monitoring, administering oxygen by nasal
cannula, suctioning a tracheostomy, tracheostomy care and basic life support &
electrocardiogram monitoring.
Results
The overall mean confidence score in 20 sets was 2.940.42 (range 1.99~3.80). Performing
urinary catheterization was the practice to which the students were the lowest level of selfconfidence to (2.380.63) followed by Performing straight catheterization (2.410.77),
Providing tracheostomy care (2.430.67), Administering enema (2.450.61) and
Suctioning a tracheostomy (2.500.68). Measuring vital sign had the highest mean
79
score (3.750.47); other skills that had high levels were Oral administration (3.630.57),
Administrating a subcutaneous infection after blood glucose test (3.400.46),
Administering oxygen by nasal cannula (3.350.63) and Applying personal protective
equipment (3.330.51).
Conclusions
Nursing educators in schools should more focus on enhancing nursing students skills
related to urinary catheterization, fecal elimination and tracheostomy care before the students
graduate. Moreover, continuing education programs in clinical settings need to consider these
findings as the students become novice nurses.
3-5 Key words

Self-confidence, skill, undergraduate, practice
80
Preceptorship programs for newly registered nursesA systematic review
Ya-Ting Ke1
1.
Chi-Mei Medical Center
Presenting Authors Email: genie.momo@msa.hinet.net
Purpose
The shortage of nursing manpower is a critical concern in global nursing management. The
average turnover rate for nurses has increased over 20% in Taiwan; many hospitals will face
retention and recruitment challenges. Several recent studies have examined the effectiveness
of preceptorship programs in improving the retention rate. However, there are many
differences in program design and execution period among nations; consequently, it is
difficult to compare the outcomes of preceptorship programs with the effectiveness of
intervention approaches.
To examine the outcomes and effectiveness of preceptorship programs for newly registered
nurses through a systematic review.
Design
A systematic review
Methods
The following databases were used: Index of Taiwan Periodical Literature System, Airiti
Library, CINAHL(Cumulative Index to Nursing and Allied Health), Cochrane Library, and
PubMed/MEDLINE. The search criteria included all articles published before January 2014
and experimental and quasi-experimental studies that have adopted preceptorship programs as
an intervention. A total of 291 articles were included. The exclusion criteria included repeated
studies and qualitative research that have not demonstrated the effectiveness of preceptorship
programs as interventions for new nurses. Finally, 13 articles matching the requirements were
collected. The quality of the 13 studies was assessed using a Joanna Briggs Institute
Standardised Critical Appraisal Tools, with scores ranging from 5 to 7.
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Results
The results show that preceptorship programs significantly increased the competence and
nursing quality of new nurses, decreased costs of manpower and turnover rate, and raised the
satisfaction of preceptorship programs. However, less paper address nursing quality, turnover
rates, and the costs of manpower. In addition, several studies investigated professional
socialization, job satisfaction, and patient satisfaction, but findings of these studies have
revealed no consistency in the effectiveness and ineffectiveness of outcomes.
Conclusions
Based on the results of the systematic review, programs that last for at least 3 months
demonstrate favorable outcomes. The outcome of a preceptorship program should be
evaluated when the program exceeds 3 months. Preceptorship programs can significantly
increase the retention rate of nurses; improve nursing quality, competence, adaptation, and job
satisfaction of new nurses; and reduce the costs of manpower.
3-5 Key words
New nurse, preceptorship program, systematic review
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A study about the communication skill of nursing students during nursing

practice for the elderly with dementia.
Koko Kaneyama1
1.
national center for global health and medicine
Presenting Authors Email: kumi-2.1-mt@hi2.enjoy.ne.jp
Purpose
This study aimed to evaluate the communication skill of nursing students before and after the
nursing practice for the elderly (NPE).
Design
cross-sectional study
Methods
From April to July 2013, 142 students in the 4th grade of A university who took the geriatric
nursing practice II were enrolled. The communication skill assessment scale designed by
Ueno (CSAS) was used to evaluate the basic attirbutes and the degree of communication
learning. The self-efficacy scale for the study designed by Taniyama (SES) was used to
measure the relationship between the self-efficacy and skill learning.
The study was conducted before the orientation and at the last day of the practice. Statistical
analysis was performed by t-test for the basic attributes and SCAS. The correlation coefficient
was calculated between CSAS and SES.
This study was carried out anonymously and the obtained data was deleted after the study
analysis. The informed consent was obtained and the students were declared that the results of
the study didnt affect to any school records.
Results
The score of SCAS significantly increased after the practice compared with before the
orientation (non-verbal communication technique t(114) = 11.2, p <.001); understanding of
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self-growth through communication (114) = 10.5, p <.001); understanding self-growth

through communication (114) = 5.7, p <.001; clarification of the client's feelings, t(114) = 7.0,
p <.001 t; "Understanding the view of human nature involved in the communication, t (114 )
= 3.9, p <.001).
The skill of non-verbal communication techniques improved in the students who took the
severe degree of dementia compared with those taking the mild degree of it t1142.2,
p<.05
The scores of SES significantly increased as follows: I would do it better than other students
(t(114)3.2, p<.01); I would reply to the question about the practice (t1142.4, p<.05);
I would be a better student (t(114)2.7,p<0.01); I would perform the study (t(114) 2.4,
p<.05); I would achieve a good result (t(114)4.9,p<.001); My nursing skill would be
excellent compared with the other students(t(114)6.6,p<.001).
There was moderate correlation between CSAS and SES (r0.43,
p<.001).
Nursing students acquired the abilities to listening, empathy to the patients and representation
of patients through the communication with verb and gesture. The consciousness of selfefficacy was improved by the techniques to communicate with patients and development of
reliability. The success of communication with patients improved their own ability and
recognized their self-efficacy.
Conclusions
Through the practical training with the elderly, acquiring the communication skills and
making reliability with patients improved the self-efficacy.
3-5 Key words
Nursing students, nursing practice, elderly with dementia
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A study on studentscore competencies of gerontological and long-term

care program based on Fuzzy Delphi method
Hung-Lan Wu1, Chia-Mei Tsai2, Mei-Rong Chen2

1.
Department of Nursing/ Fooyin University, 2. Program of Gerontological and Long-term Care/Fooyin

University
Presenting Authors Email: ze555@fy.edu.tw
Purpose
The purpose of this study was to develop the indicators of core competencies for graduating
students of gerontological and long-term care program.
Design
A cross- sectional study using Fuzzy Delphi method was applied in 2013.
Methods
Literature review and questionnaire survey were conducted. Data was collected from 14
stakeholders opinion and was analyzed using triangular fuzzy number. The stakeholders
were educational and practical experts in the field of gerontological and long-term care.
Results
The results of analysis were six core competencies and 26 indicators of core competency,
including health care service, management, critical thinking, caring, communication and
cooperation, and ethics. Among all the core competencies, the overall weight of ethics was
highest, while following was communication and cooperation.
Conclusions
The results can serve as practical references for designing curriculum and evaluating learning
outcomes for students in gerontological and long-term care program. The ethical attitude and
the ability of communication and cooperation were very important. Immersion and
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experienced learning might improve the students confidence and abilities for clinical
practice.
3-5 Key words
Fuzzy Delphi method, core competence, gerontological, long-term care, baccalaureate
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Development of a values-based person specification for recruitment and

selection of compassionate nursing and midwifery students
Anne Waugh1
1.
Edinburgh Napier University
Presenting Authors Email: a.waugh@napier.ac.uk
Purpose
The project aim was to develop a person specification for recruitment and selection of
compassionate nursing and midwifery students. UK policy recommends a values-based
approach to this process (Scottish Government Health Directorates, 2010; DoH, 2013); a
person specification would facilitate its transparency and reliability. A literature review and
online search for relevant attributes did not provide enough information to develop such a
person specification and an online survey was therefore designed to identify appropriate skills
and attributes.
Design
After gaining ethical approval from the university, the local healthcare provider classified the
study as service evaluation which did not therefore require further ethical approval. The
online survey asked participants to rate the importance of 23 skills and personal attributes,
many of them values-based, using a five-point Likert scale. The attributes emerged from the
limited sources found, namely two websites and one person specification. Potentially relevant
attributes were collated and the project team then reached a consensus about their inclusion.
Methods
A small pilot study (n=8) was undertaken to test the validity of the survey; no amendments
were required. A convenience sample was used to gain a snapshot of the views of all
registered nurses and midwives employed by the School of Nursing and Midwifery and the
local healthcare provider (n~10,000), and also all preregistration nursing and midwifery
students at the university (n~1,600). A link to the survey was emailed to all preregistration
students and staff in the School; the Executive Director of Nursing cascaded it to all
registrants in the area.
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The percentage of participants who strongly agreed with the personal attribute statements was
used to list the criteria in order of relative importance. The relative importance of the
attributes was compared between non-registered and registered participants, and between
different fields of practice.
Results
Respondents (n=502) represented student and registered midwives and all fields of UK
nursing practice (adult, mental health, child and learning disabilities). The initial response rate
was low and following an email reminder this increased to 3% for registrants and 14% for
students.
There was consensus in the top seven ranked attributes, not only between both students and
registrants but also between the fields of practice. These were honesty and trustworthiness,
effective communication skills, being a good listener, patience and tactfulness, sensitivity and
compassion, the ability to seek and act on guidance and being a good team worker. The
results will be explored in more detail at the session.
Conclusions
Very low response rates are common with online surveys (Sue & Ritter, 2012) and prevent
generalisation of the findings. Nevertheless, participants represented registrants and students
from midwifery and each field of UK nursing practice.
The findings have informed the first evidence-based person specification, contributing to UK
policy expectations of values-based recruitment of preregistration students (Francis Inquiry,
2013; DOH, 2013). The person specification will be shared at the session; it will be evaluated
after the next recruitment cycle. Replication studies would establish its value in other
geographical areas.
3-5 Key words
Recruitment, selection, nursing, values, compassion
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Improving education in nursing skills and techniques required by school

nurses in a junior high school environment.
Mika Yuasa1, Hiromi Kawasaki2, Mika Nishiyama3, Pete D Angelo4, Yoko Honda5,
Kotomi Yamashita2, Satoko Yamasaki2
1.
Hiroshima University Graduate School, 2. Hiroshima University Graduate School, 3. Hiroshima

Bunkyou Womens University, 4. Doi Clinic, 5. Aino University
Presenting Authors Email: m-yuasa@baika.ac.jp
Purpose
There are, in junior high schools, a variety of situations that require specialized nursing
techniques to allow on-site nurses to be better equipped to deal with these situations, e.g.
analysis of injury, interview of student, checking of vital signs, progress observations, etc.
The purpose of this study is to clarify which skill-sets are of particular importance and should
be more fully taught in the nursing technology course at University with a view to adopting a
more focus led approach.
Design
Questionnaire survey.
Methods
In February 2014, 25 school nurses were asked to complete a questionnaire that had been
designed specifically for this purpose. The questionnaire contained 70 items related to the
importance of educational requirements based on the day to day situations likely to be seen by
a school nurse and what they as school nurses expected to encounter. Answers were totaled,
ranked and placed in descending order. Fully informed consent was obtained from all
participants.
Results
A total of 15 participants completed the questionnaire. On checking the data, researchers
found that all 15 participants agreed that the following 7 points were most important in terms
of receiving education, as a student nurse, about the best methods available to improve their
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school nursing skills;

1) Observation of wound measurements. 2) Cleaning of wounds. 3) Protection of the wound
using adhesive gauze or plaster. 4) Measuring pulse rate. 5) Measurement of body
temperature. 6) Confirming precise symptoms and pathology. 7) Final assessment and
recording of injury. Additional, participants placed importance on items such as; assessing
and assisting with bowel movement, retention of good limb position and movement,
knowledge of body mechanics and accurately confirming the symptoms and pathology.
Conclusions
The data collected shows that there are 3 main factors that require particular attention during
the educational process; 1) Assessment technology. 2) Measurement of vital signs. 3)
Treatment of the wound. This information was collected from nurses who are actually
experiencing a variety of situations in the school and is a realistic account of the day to day
nursing technology requirements of nurses. In order to best prepare student nurses it is
essential that the experiences of nurses who come into contact with students and have to deal
with them on a daily basis is taken into account. Results from this survey strongly suggest that
the nursing technology curriculum taught in university at present is insufficient and perhaps
does not fully take into account the actual experiences of school nurses. Researchers conclude
that the curriculum should be reviewed with a view to introducing a more focus led approach
to the teaching of nursing technologies.
3-5 Key words
Nursing education, nursing technology, school infirmary, school nurses, focus led systems
90
The effects of English article discussion club on reading behaviorsA

longitudinal survey of undergraduate nursing students in Taiwan
I Lee1, Yu-Hua Lin1, Hui-Chi Li1, Chia-Chan Kao2

1.
Department of Nursing, I-Shou University, 2. Department of Healthcare Administration, I-Shou

University
Presenting Authors Email: lee106@isu.edu.tw
Purpose
Healthcare specialists recognized that reading professional journals may enhance expertise
and knowledge. However, reading English article is a challenging task for native speakers of
Chinese. The purpose of this study is to explore the effects of English article discussion club
on reading behavior among Taiwanese nursing students.
Design
The study adopted one-group pretest post-test quasi experimental design. We designed the
discussion clubs to improve reading behaviors of undergraduate nursing students. 120
students from southern Taiwan participated in the study. Pretest was conducted when students
started their first semester of the 3rd year of college. Then, teachers guided the discussion
clubs within 3 consecutive semesters. During the period, selected English nursing journal
articles were assigned to students for reading and discussion. Post-test was conducted at the
end of each semester. Finally, the 3rd post-test was conducted at the end of the first semester
of 4th year of college.
Methods
Questionnaires were disseminated to collect research data for the following three scales:
reading capability scale, reading motivation scale and reading attitude scale. Repeated
measures analysis of variance was used to analyze the research data.
Results
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Results showed that significant difference existed among four checkpoints on reading
capability scale (F = 7.093, P =.000) and reading attitude scale (F = 4.537, P =.004). Post hoc
tests using Bonferroni correction revealed that English article discussion club increased
reading capability and reading attitude for subjects over time. However, reading motivation
scores got lowered within this period.
Conclusions
We confirmed that organizing and English article discussion groups will enhance nursing
students' reading behaviors in Taiwan. Further studies are suggested to thoroughly understand
the barriers of English reading, and to develop strategies that may enhance English reading
motivation for native Chinese speaking nursing students.
3-5 Key words
Reading capability, nursing student, English article discussion club, repeated measures
analysis of variance
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A review of the literature on communication issues faced by nursing

students
Makiko Morita1, Tomomi Takano2

1.
Tokyo Metropolitan University, 2. The Japanese Red Cross College of Nursing
Presenting Authors Email: morita-makiko@ed.tmu.ac.jp
Purpose
The final objective of the present study is to create a training program to improve the
communication skills of nursing students in education settings such as clinical practice in
which students face problems with communication skills. The first step was to analyze and
discuss the current state of communication disorders among students in Japan.
Design
A Review of the Literature
Methods
We conducted a search of two databases for the key words communication skills,
nursing education, and students. Of the 171 papers extracted, 30 pieces of literature
that met the adoption criteria were selected for review.
Results
A survey of hospitals revealed the following reasons for difficulties faced in the education of
novice nurses: they have poor responses and are psychologically weak and they
cannot accept correction without protest. These reasons described behavior similar to the
features of communication disorders that appear in patients with developmental disabilities.
Moreover, it was pointed out in the literature that students with high-functioning
developmental disorders such as Asperger syndrome or ADHD may possible be enrolled at
almost all universities in Japan. Based on the above, we predict that programs for those with
developmental disorders may be useful as education methods for students with inadequate
communication abilities, even if they have not been diagnosed with a developmental disorder.
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Conclusions
Support for developmental disorders among university students must involve both
communication elements and job problem-solving abilities with the aim of preparing students
for employment.
3-5 Key words
Nursing student, practical training, communication issues
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Male nursing studentsperception and managing experiences of role strain

in Taiwan
Cheng-I Yang1, Li-Hung Lee2, Hsing-Yi Yu3

1.
HungKuang University, 2. Jen-Teh Junior College of Medicine, Nursing and Management, 3. Chang
Gung University
Presenting Authors Email: arcoyang@mail2000.com.tw
Purpose
The purpose of this study was to understand male nursing students perception of role strain
and how they manage those circumstances in their social and study life.
Design
A qualitative research design was applied in this study.
Methods
Twenty-four male nursing students from three nursing education institutes (one five-year
junior college, one technological university, and one university) from north and central
Taiwan were invited to participate in this study to share their experiences of studying in
nursing. Data were collected by semi-structured interview and all of the interviews were
recorded by digital voice recorder with the participants agreements. All of the interviews
were transcribed verbatim and analyzed by thematic analysis.
Results
Five themes and nine sub-themes were found as follow: (1) The development of
understanding regarding nursing (nursing is professional, a stable job, a job for both sex); (2)
Support and encouragement; (3) Embarrassing moment; (4) Strategies to manage
embarrassing (explaining, controverting, making jokes, proving); (5) Feeling confidence to be
male nurses (mens predominance in nursing, male nurse role model). Findings from this
study revealed that male nursing students may experience some embarrassing circumstances
in their social and studying life because of their role of being male nursing students. They also
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developed strategies to cope with these embarrassing circumstances and make themselves feel
comfortable.
Conclusions
The findings not only enrich the knowledge of male nursing students perception of role
strain and how they manage those circumstances in their social and study life, but also
provide valuable insights for future male nursing students. Nursing educators may need to
take special concerns when supervising male nursing students who perceive role strain and to
apply appropriate strategies to help them to cope with the difficulties.
3-5 Key words
Role strain, male nurse student, sex, experience
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The reflective process of nursing students during the clinical practice
Hui-Lin Sun1, Yen-Hui Wang1, Sheng-Fang Tuen1, Jin-Shu Wang1

1.
Mackay Junior College of Medicine, Nursing and Management
Presenting Authors Email: s068@eip.mkc.edu.tw
Purpose
To explore contents of the reflective process of instruction professionalism of nursing
students during the clinical practice.
Design
The research tool was based on Powells levels of reflectivity to understand the effect of the
clinical practice on their professionalism in nursing. The theoretical basis of the study was
based on Schons work on reflection-in-action.
Methods
For purpose of the study, a convenience sample of volunteer included 15 second-year and 14
fifth-year nursing students from a college of North Taiwan. 505 transcripts of the diary were
analyzed using content analysis.
Results
The results showed there was 310 items. 56.76% nursing students chose to study nursing by
themselves. The highest number of reflection occurs at the second level affective
reflectivity which is to be able to express their feeling in their diaries (57.74% of the
total number). The following one is the third level discriminant reflectivity which is be
able to assess and evaluate the nursing actives. ( 19.35% of the total number). The next
one is the first level of reflectivity which is be able to observe the clinical setting and
describe their experience. ( 15.43% of the total number). Only 8% of the total number of
scores were found at the high levels of reflectivity (3.22% in the fourth level, 2.58% in the
fifth level and 1.61% in the sixth level)
Conclusions
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All of the students were able to reflect on their practice according to Mezirows levels of
reflectivity. There were a deep impact on nursing students in the clinical setting and majority
of them could express their personal emotions, assess their learning and evaluate their
performance in their diaries. However, the findings highlight the need for students to develop
the skills of critical inquiry and problem solving in clinical setting. Tutors could provide
opportunities for case discussions to increase students awareness and abilities on self- value.
3-5 Key words
Nursing student, clinical practice, reflective thinking, professionalism
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Effects of video instruction on the skin care learning in long-term care

nurse aides
Yu-Ling Wu1
1.
Min-Sheng General Hospital
Presenting Authors Email: plasty510@yahoo.com.tw
Purpose
The work schedule of nurse aides often limits their ability to obtain further education and
training on the skin care. Therefore, developing appropriate and effective training programs
for nurse aides is critical to maintaining and improving quality of care in long-term care
facilities .
The aim of this study is to investigate the effects of video instruction on the skin care learning
of nurse aides working in long-term care facilities .
Design
Participants included 96 nurse aides recruited from 5 long-term care facilities in Taoyuan
County, Taiwan. The experimental group received 3 weeks of video instruction . The control
group did not receive this instruction.
Methods
The Skin Care Questionnaire for Nurse Aides in Long-term Care Facilities and the Skin Care
Behavior Checklist were used for assessment before and after the intervention.
Results
Posttest scores for skin care knowledge, attitudes, behavior, and the skin care checklist were
significantly higher than pretest scores for the intervention group. There was no significant
difference between pretest and posttest scores for the control group. A covariance analysis of
pretest scores for the two groups showed that the experimental group earned significantly
higher average scores than their control group peers for skin care knowledge, attitudes,
behavior, and the skin care checklist.
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Conclusions
The video instruction showed significant and positive effects on the skin care learning of
nurse aides in long-term care facilities. This finding suggests the use of video instruction in
the education and training of nurse aides in long-term care facilities in the future.
3-5 Key words
Video instruction, long-term care facilities, nursing aides, skin care, learning effectiveness
100
Learnings of public health nursing undergraduate students from

Community health nursing diagnosispractice
Kiyoko Kurihara1, Yuki Gotoh1, Junko Hatanaka1, Kaoru Ito1

1.
Yokkaichi Nursing and Medical Care University
Presenting Authors Email: kurihara@y-nm.ac.jp
Purpose
In Japan, the designation regulations of the Public Health Nurses, Midwives, and Nursing
School changed greatly in 2011. One of the revised points was a demand for improvement in
students ability to practice, thus, we have made changes to the community health nursing
diagnosis practice (CHNDP) program so that students could clarify the apparent and
unapparent health problems in the community and strengthen the promotion of health for its
residents.
The purpose of this study is to clarify the learning experience of undergraduate students
enrolled in the CHNDP public health nursing course
Design
inductive approach.
Methods
The CHNDP of our school comprised 1 unit (30 hours) of 28 units of public health nurse
education. For effective practice, we developed the CHNDP, which invites the community to
our university to collaborate with students, thus, enabling students to better understand the
thoughts and ideas of people in their community and learn the CHND process. The program
contents were as follows: part I. "collection and assessment of existing data from the
community, such as the percentage of elderly and so on; part II. "interview investigation of
people in the community"; part III. prioritize and discovery of health issues"; part IV.
"formulate the health policy recommendations schedule"; part V. "prepare a manuscript and
materials for presentations"; and part VI. presentation of CHND and health to people in the
community, receiving their comments and advice.
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Descriptions from 50 students after participation in the CHNDP were classified using the
inductive approach.
Results
Group dynamics were incorporated into each part of the practice. Moreover, students were
able to overcome difficulties encountered during practice in a group. In addition, they realized
the importance of collaborating with people in the community and the benefits of public
health nursing abilities from the CHNDP for the promotion of a healthy city.
Conclusions
The development of the CHNDP could be effective for students deeper learning. Further, a
quantitative evaluation index should be developed referring to the students descriptions to
clarify the effectiveness of practice.
3-5 Key words
Community health nursing diagnosis, public health nursing education, undergraduate students,
nursing practice
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Perceptions of teachers in the education of nursing college students
Rie Tomizawa1, Nanae Ikeda1, Sachie Arai1, Junko Yamanaka1

1.
Senri Kinran University
Presenting Authors Email: r-tomizawa@cs.kinran.ac.jp
Purpose
As part of the basic nursing education process, learning through clinical practice is very
important.
Nursing College is constituted by some education and research regions, therefore many
teachers of multiple regions are engaged in education. Teacher education is completed in
accordance with diploma policy. However, how this education is seen by the profession of
nursing is not clear.
This study aims to describe teacher perceptions of nursing students, focusing on educational
relationships that can be used to guide future developments in the education system.
Design
A qualitative study design was used with data collected from 30 academicians at the A
University of Nursing in 2012.
Methods
Teachers belonging to a college were recruited as participants. All participants took part in
this study on the basis of confidentiality and voluntary participation. The decision to answer
the questionnaire was taken as an indication of informed consent. The Research Ethics
Review Board approved the study.
Results
In total, 30 participants responded to a self-administered questionnaire (response rate: 91.0%).
With regard to nurse image that teachers draw, the analysis identified five categories
from 13 subcategories that were assigned the following labels: "friendly nurse who can
provide physical comfort to the patient" ,"a nurse that can cooperate with others by trying to
communicate with intention", "accurately grasping the subject matter, with the ability to
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provide evidence-based care" ,"understand the person of interest fully" and "have the
ambition and pride to do nursing".
With regard to working consciously in lectures and practical training, the analysis
identified six categories from 11 subcategories that were assigned the following labels:
"search for a way of expression that can be understood by students" ,"help that individual
students is going to establish a view on nursing" ,"a combination of lectures, exercises, and
practical training that focuses on the patient", "treat a student as a prospective medical staff",
"notify the need to objectively view the behavior of their own" and "education was thought to
be sufficient to pass the national examination."
Conclusions
Nurses are required to understand students and their need to pass the national examination.
With this reality, teachers are utilizing educational methods that are based on a strong
awareness of standing of basic education as a precursor to clinical work in the profession.
3-5 Key words
Nursing college student, perceptions of nursing student, educational relationship
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The effect of mindfulness-based intervention on stress in nursing staff
Shu-Chen Wang1, Shih-Ming Shih2, Shu-Chuan Chang3

1.
National Taiwan University and Hualien Tzu Chi Hospital Buddhist Tzu Chi Medical
Foundation, 2. Koo Foundation Sun Yat-Sen Cancer Center, 3. Hualien Tzu Chi Hospital Buddhist Tzu
Chi Medical Foundation
Presenting Authors Email: wangsc@tzuchi.com.tw
Purpose
Nursing professionals are high frequent and long time to contact with the patients than other
professionals. It is importance to reduce stress to improvement quality of care and
improvement the problem of nursing shortages. The purpose of this study is to understand the
effects of mindfulness-based stress reduction on nurse stress and the effects of 6 months after
intervention.
Design
Pre and post test control design is conducted. There are 3 groups and 30 nursing staff in each
group. Consented participants is arranged to an experimental group(8 weeks MBSR) , and
humanity class group, and no intervention control group.
Methods
All participants completed Chinese five facet mindfulness questionnaire and nurse stress
questionnaire 5 times at 1st week , 4th week, 8th week, 3rd month, and 6th month. The
participants record the HRV after MBSR.Participants were take part in two focus groups to
discussion their experience of MBSR program and Humamity program. The psychologist is
qualified as an MBSR instructor. The standardized MBSR program was divided into 7weekly
classes of 2 hours in length and plus one 8-hour day of mindfulness. The humanity program
was conducted by volunteers who were service in the hospital and were discussed their
experiences with the participant in the class.
Results
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The sesults shows that MBSR intervention participants had become more mindful and
manage their stress.
Conclusions
These results will be able to help shape the future teaching of MBSR in new nursing staff.
3-5 Key words
Mindfulness-based stress reduction(MBSR), nursing staff, stress, heart rate variability(HRV)
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A study of the relationships between disease self-management and related

factors in hemodialysis patients
Mei Tsai1, Wu-Hang Yang2, Shih-Hua Lin3, Kuan-Chia Lin4

1.
National defenes Medical center/chung shan hospital, 2. Taipei Veterans General Hospital, 3. TriService General Hospital, 4. National Taipei University of Nursing and health Science
Presenting Authors Email: vivi8234@yahoo.com.tw
Purpose
The purpose of this study examined the disease self-management and related factors for
hemodialysis Patients.
Design
A cross-sectional research design with a convenience sampling was used in this study.
Methods
The structured questionnaires includingBasic Properties,Self-Efficacy Scale,
Social Support Scale and Self-Management Scale Hemodialysis Patients were used to
collect data
Results
The results demonstrated that age, family income, comorbid conditions, self-efficacy and
social supports significantly correlated with disease self-management. The hierarchical
regression analysis showed that the family income, self-efficacy and social support were the
major predictors for disease self-management and explained 43 total fol variance of disease
self-management. The patients with higher self- Efficacy had significantly negative
correlation with creatinine values and potassium ions values, but significantly positive
correlation with albumin values. The patients with higher social supports had significantly
negative correlation with creatinine values, but significantly positive correlation with calcium
values.
Conclusions
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The results will be used as the reference to develop effective disease self-management
program for hemodialysis patients to prevent complications and reduce health care costs. The
optimal goal will improve the living quality and extend survival of hemodialysis patients.
3-5 Key words
Hemodialysis, self-efficacy, social support, disease self-management
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Educational effectiveness of using the online database of theHealth and

illness narratives DIPEx-Japan (of breast cancer)
Mikiyo Sato1, Natsumi Morita2, Miyuki Semba3, Mizue Shiromaru4, Noriko Iba5
1.
Department of Nursing, School of Health Sciences, Tokai University, 2. Department of Nursing,
School of Health Sciences, Tokyo University of Technology, 3. Faculty of Nursing and Medical Care,
Keio University, 4. School of Health Sciences, Sapporo Medical University, 5. DIPE-Japan
Presenting Authors Email: mikiyo@is.icc.u-tokai.ac.jp
Purpose
The Database of Individual Experiences of Health and Illness (DIPEx) started in 2001 at the
University of Oxford, UK. It employs qualitative research methodology to collect personal
narratives of illness and medical experiences from approximately fifty patients for a number
of health-related conditions. These narratives are it video-recorded and the researchers edit
these videos and upload them online ([http://healthtalkonline.org/], 2014). This study aims to
clarify learning outcomes among nursing students, who have participated in a course, using
Breast Cancer Narratives (BCN) available on the Japanese version of the website
(http://www.dipex-j.org/), and to investigate the effectiveness of teaching methods employing
the individual narratives of patients themselves.
Design
The study design was retrospective and descriptive.
Methods
This study examined papers written by 149 nursing students concented, out of 159 third-year
students, who had earned credits for one of our courses (Rehabilitation Nursing Theory) in
2012 and 2013. The students were asked to watch the BCN website, and then submitted
reports on their understanding of the website. Thereafter, we analyzed their reports to identify
and highlight contextual elements relating to the physical, emotional, social, and spiritual
distress of the breast cancer patientsThese elements were then coded to generate
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subcategories and categories, while similarities were noted. To ensure validity, the analysis
was performed by four researchers. This study was proved by the Research Ethics Review
Board of the first authors institution.
Results
A total of 626 coded items, 41 subcategories and 12 categories were identified and
highlighted as the characteristics noted by the students concerning the suffering and distress
of breast cancer patients. First of the categories is, distress relating to a variety of
symptoms such as post-operative pain, numbness, lymphedema, and motor impairment was
found to be a characteristic of the physical pain associated with mastectomy. From a
psychological perspective, pain accompanying the loss of femininity and difficulties in
building relationships with partners was found to induce complex feelings of guilt in
connection with anguish over sexual relations with the partner and anxieties if their
relationship would be changed. Moreover, from a social perspective, diversity of distress
experienced in relation to the age at which an illness is contracted was found to correspond
with the fact that breast cancer treatment would impact life stages such as childbirth and
parenthood. Finally, a broad array of learning outcomes were obtained from challenges in
connection with role transition and withdrawal as well as difficulties with continued
employment, regarding the diverse forms of suffering experienced by breast cancer patients
who faced economic challenges.
Conclusions
The students understood the characteristics that breast cancer patients had long-lasting
physical, emotional, and psychological distress after the treatment has ended, and learned that
the aspects of suffering varied due to differences in the developmental challenges caused by
the age at which an illness is contracted. These results suggest that examining BCN on
the online database can help beginner nursing students understand the diversity of breast
cancer experiences and reflect on the necessity of nursing support.
3-5 Key words
Breast cancer, illness narratives, online information, nursing education
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Building the trust relationships with psychiatric patientsStudents

experiences in the psychiatric clinical placement
Cheng-I Yang1, Jung-Ying Tan1, Ling-Chun Chiang1, Li-Hung Lee2

1.
HungKuang University, 2. Jen-Teh Junior College of Medicine, Nursing and Management
Presenting Authors Email: arcoyang@mail2000.com.tw
Purpose
The purpose of this study was to understand student nurses interpretations of their
experiences of building trust relationships with psychiatric patients in clinical placement.
Design
A constructivist grounded theory method was applied in this study.
Methods
Fifteen student nurses (one male) from a technological university in central Taiwan who
finished their psychiatric placement were invited to participate in this study to share their
experiences of building trust relationship with patients in the psychiatric wards when they
first contacted with the patients. The interviews were conducted within three months after
nursing students finished their psychiatric placement. Data were collected by semi-structured
interview and all of the interviews were recorded by digital recorder with the participants
agreement. All of the interviews were transcribed verbatim and analyzed by thematic analysis.
Results
Four themes and ten subthemes were presented as follow: (1) Changing perceptions toward
psychiatric patients (before-after contacting with psychiatric patients); (2) Evaluating the
relationship of rapport with patients (by observing patients reaction, seeking help
automatically, disclosing more); (3) Strategies of rapport building (step by step, finding a
good time, being with) and (4) The influence of trust relationship on the interaction with
patients (approaching deeper, feeling confident to interact with patients). The student nurses
transformed their perceptions toward psychiatric patients from negative to positive which
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much improved when they built their therapeutic relationships and the skills of interaction
with the patients.
Conclusions
The findings of this study not only help the nursing professionals to understand how the
student nurses develop the trust relationship with psychiatric patients in the psychiatric
placement, but also inspire nurse educators to design the related programs for training nursing
students before they first contact with psychiatric patients.
3-5 Key words
Clinical placement, trust relationship, nursing student
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Medical safety skills of nursing students involved in and skills of taking

directions and skills of transmitting directions~Extraction of the target
behavior for basic nursing education~
Emiko Yamamoto1, Tomoko Tanaka1, Hyodo Yoshimi2, Kaori Hatanaka1, Atsuko Nishida3,
Kumiko Yamashita3
1.
Graduate School of Humanities and Social Sciences Okayama University, 2. Graduate School of
Health Sciences Okayama University, 3. National Hospital Organization Okayama Medical Center,
Okayama Nursing and Midwifery School
Presenting Authors Email: yooyamachan@ybb.ne.jp
Purpose
Complex and diverse nursing services are performed while exchanging a lot of information.
Teaching methods have not been established to enhance skills to organize and transmit
perceived information as well as to clearly understand given orders and act appropriately.
There are techniques such as "double checking" and "confirmation with finger pointing and
call" to enhance behaviors for safety. "Skills of taking and transmitting directions" are
especially considered to be especially important. The purpose of this study is to clarify the
specific contents of "Skills of taking and transmitting directions" in order to better educate
nursing students these skills.
Design
Bearer self-administered questionnaire survey method
Methods
The subjects of this study were 216 nursing students at the School of Nursing in Japan, who
have agreed to participate in this study. The study was conducted from February to March,
2014. A questionnaire was used to analyze communication, personality, and incident
prevention behaviors. The questionnaire contained three established scales, which were (1)
-Skills of taking directions and -Skills of transmitting directions, (2) Ten Item Personality
Inventory (TIPIJ). (Oshio et al., 2012), and (3) Incident prevention behavior.
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Results
(1) Skills of taking directions were assessed with following five factors such as "-1 verbal
confirmation , -2 devotion to the instruction received, -3 uncertain
execution, -4 consideration to validity, and -5 appointment". Skills of
transmitting directions were assessed using three factors such as -1 report confirmation",
-2 confirmation and evaluation of the execution process, and -3 level adjustment".
The results of the exploratory factor analysis showed "skills of taking directions" (GFI =.95,
AGFI = .92, CFI = .99, RMSEA = .02), and for "skills of transmitting directions", (GFI = .94,
AGFI = .91, CFI = .98, and RMSEA = .05), better fit between those two aspects was obtained.
Conclusions
For nursing students, better skills of taking directions mean that they can concentrate on
listening to instructions, verbally confirming given instructions, and examining validity of
instructions. Whereas better skills of transmitting directions involve confirming the results
and adjusting instructions to match the level of others while analyzing the execution process.
In personal characteristics, there was a positive correlation between extroversion and devotion
with skills of transmitting directions. It is presumed that how well one learns and interacts
with others constitutes the background for the ability to give accurate directions to others. In
addition, it has become clear that those who have better skills of taking and transmitting
directions are also taking actions to prevent medical accidents.
3-5 Key words
Nursing students, medical safety skills, incident
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Development of the evaluation instrument for achievement of education

objectives
Myung-Sun Hyun1, Jin Park1, Chun-Ja Kim1

1.
Ajou University College of Nursing
Presenting Authors Email: mhyun@ajou.ac.kr
Purpose
The study was conducted to develop the evaluation instrument for achievement of education
objectives among students in the nursing school.
Design
This study is a methodological research that aims to develop and test the validity and
reliability of the evaluation instrument.
Methods
The process included generation of initial items, verification of content validity, selections of
secondary items, preliminary study, and extraction of final items. The participants were 5
graduates 1 to 5 years after agraduation (preliminary study) and 109 graduates one year after
graduation from nursing school in A University, South Korea. Item analysis, criterion validity,
and internal consistency were used to analyze the data. Data collection was conducted from
November, 2013 to August, 2014.
Results
As a result, twenty six items were selected for the final scale. The scores for the scale were
significantly correlated with the nursing competency scale(r=.62, p<.001) and nursing
performance scale(r=.63, p<.001). Cronbachs alpha coefficient for the 26 items was .87.
Conclusions
The findings of this study indicate that evaluation instrument for achievement of nursing
education objectives has a good validity and reliability. The evaluation instrument can be
useful to measure how much the graduates achieve the established education objectives in the
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education fields. Besides, this instrument will provide data and direction for quality
improvement in nursing education program. The study has a limitation of that it is limited to
generalize the instrument developed in the other nursing school, because the instrument was
developed in one nursing school.
* This research was supported by Ajou University Medical Center (No: M-2013-C046000003)
3-5 Key words
Education objective, instrument development, reliability, validity
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Port-A multimedia instructionIts efficacy in nursing knowledge and

confidence
Chiu-Ping Su1, Pao-Yu Chuang1, Huei-Ying Chen1

1.
National Taiwan University Hospital
Presenting Authors Email: sharon1228@gmail.com
Purpose
Port-A catheter is the most commonly used for cancer patients. But limited schooling and
practice situations, not all new nurses have had Port-A care experience. The purpose of this
study was to explore the effects of a multimedia video instruction on enhancing new nurses
knowledge and level of confidence.
Design
This is a quasi-experimental study. The before and after study design used a pre-and post-test
design.
Methods
A total of 151 purposive samples were recruited from received training of new nurses from
one medical center in Taipei. 76 of the subjects were assigned to the experimental group (EG)
and75 subjects to the control group (CG). The control group nurses received a standard of
procedure(S.O.P) by paper document for reading. The experimental group nurses were trained
in addition by using multimedia video instruction except reading S.O.P. Each group randomly
selected 30 nurses for skill post-test. Research tools included a baseline data sheet, knowledge
scale, confidence scale and skill table.
Results
Results demonstrated that knowledge ( EG : 61.7/pre-test,71.8 /post-test; CG:61.8 /pre-test,
71.3 /post-test) of experimental group and control group did not differ. Confidence (EG: 57.4
/pre-test, 77.0 /post-test; CG: 57.8/pre-test, 68.8/post-test) and skill (EG:42.7; CG:35.3) of
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experimental group subjects were better than their control group post-test (p< .05).
Conclusions
Multimedia video instruction could enhance new nurses confidence and skill for Port-A care.
Nurses can follow the time and learning requirement.Much more interactive for easy
understanding the skill of Port-A care and could enhance the learning efficiency.
3-5 Key words
Nursing education, multimedia instruction, Port-A, confidence
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Explored the practice stress and interactive satisfaction with clinical nurses
among nursing students
Hsueh-Ching Wu1
1.
Hsin Sheng Junior college of medical care and management; Department of Nursing, College of
Medicine, National Taiwan University
Presenting Authors Email: whc06082002@yahoo.com.tw
Purpose
The purpose of this study was to explore interacting satisfaction among a group of nursing
students having interaction with nurses and practice stress during their internship experience.
Design
Using a cross-sectional research design.
Methods
The data were collected by using the questionnaires of Clinical Practice Stress Scale and
Interacting Satisfaction Scale. A total of 600 nursing students were approached, of which 530
valid questionnaires were collected, representing a response rate of 88.3%.The questionnaire
included nursing students basic information, internship experience surveys, Internships
Interactive Satisfaction Scale.
Results
The results of this study showed that (1) The highest satisfaction were nursing
professional competence and interpersonal relationships. (2) The lowest satisfaction
was: the attitude of clinical guidance. (3) The lowest three items of interactive
satisfaction were "Nurses care about nursing students feeling", " Nurses can avoid personal
thoughts to judge the performance of nursing students", " Nurses can accept nursing students'
individual differences"(4) Those who first internship, academic average score less than 85,
prefer to nursing, and feel relatively study hard have higher interactive satisfaction.
Conclusions
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These results may help nurses better understand nursing students feeling, and therefore
avoid using personal thinking in judging their performance and be able to give them positive
feedback with reasonable expectations in order to promote the quality of clinical practice.
3-5 Key words
Nursing student, internship experience, practice stress, satisfaction of interactive
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Evaluation of human relationship and curse as interprofessional education

(IPE) for medical technology related university students
Keiko Sekido1, Yuko Yasuhara2

1.
Kobe University Graduate School of Health Sciences, 2. Institute of Health Biosciences, Graduate
School of the University of Tokushima
Presenting Authors Email: sekido@aquamarine.kobe-u.ac.jp
Purpose
The concept of Human Relationship is an important and fundamental element in providing
good quality of health care. Thus, we have been searching for educational methods to
incorporate the concept in the course by employing some ideas, for instance, arranging a
teacher in nursing in the charge of the Human Relationship. We conducted an evaluation
of the "Human Relationship" course attended by first year or second year students majoring
in any one of the three areas of nursing, radiologic sciences and laboratory sciences.
Design
Questionnaire study
Methods
The questionnaire was distributed to the students on the last day of the human relationship
class in 2011. The aim of this research was explained, and the questionnaire was distributed to
the students. The questionnaire was answered anonymously and the submission was their free
choice. Those students who had agreed to cooperate in the research were requested to submit
their completed questionnaires into a submission box. The students were explained the
followings: the cooperation in the research was irrelevant to their academic results in their
courses; the data would be processed in a manner in which any particular student could be not
identified; and the research results would be presented in essay and presentation.
Results
The questionnaire received responses from 57 students majoring in nursing, 29 students
majoring in radiologic sciences, and 14 students majoring in laboratory sciences. The "Human
121
Relationship" course is conducted as a common fundamental course for some curriculum

programmes, and a unit of this course consists of 15 hours of study. The first 30 minutes is
held for lecture, then the students perform role-playing on a theme related to the lecture for
about 20 minutes, and the last 10 minutes are to complete a coursework sheet and submit it.
On every lecture day, the students are to perform role-playing all together. The "Human
Relationship" course groups the students such that each group contains students from each of
the three majors, enabling exchange of opinions across majors. For the question item of
"Found this course interesting", about 40% students of each of the three majors responded
with "I think so", and about 50% students responded with "I somewhat think so". For the
question item of "Helpful for future vocations", no significant difference was observed in
spite of the fact there were more responses of "I somewhat think so" than "I think so" for the
laboratory sciences major.
Conclusions
It was considered that selecting a task common to each major and being able to learn while
touching on a variety of opinions beyond the major lead to high appraisals. It was understood
that the course content must be introduced to the students in an interesting way and must
specifically convey helpfulness to their future vocations.
3-5 Key words
Human relationship, evaluation, interprofessional education
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Restrained the gap between the education and practiceThe evaluated

study for newly graduated nursing college students with the last mile
engagement program in Taiwan
Yu-Hsien Hsu1, Mei-Chun Lin1, Ya-Lin Tang1

1.
Cardinal Tien College of Healthcare and Management
Presenting Authors Email: yuhsien@ctcn.edu.tw
Purpose
Nursing is a practice-oriented professional. The fundamental purpose of nursing education is
to prepare a qualified nurse ready in working with her professional career. However, there is
always an argument regarding to the gaps in between nursing education and practice itself. A
last mile engagement program was introduced to one of the nursing college last year students
in purpose to help the last year students with better adaptations and abilities to cope with their
further clinical works.
The aim of this study was to evaluate the relationships with nursing competency and work
stress from those newly graduated nursing college students with the last mile engagement
program.
Design
The cross-sectional study design with purposive sampling method was applied in this study.
Methods
The questionnaire with Nursing Competency Scale (NCS) and Work Stress Scale (WSS) was
sent enclosed with the consent form to collect the research data by post among all the 112
year 2011 graduated nurse college students who were working in the clinical sectors. The
descriptive and inferential statistics with Chi-square and Mann-Whitney U were applied with
SPSS 18 for analyzing the research data.
A total of 44 questionnaire was sent back to the researchers. The response rate of
questionnaire was 39.29%. There was 11 respondents who participated with this last mile
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engagement program compared with 33 who were non-participants with this program.
Results
The results of this study indicated that all the participants reported that the major and highest
stress was the workload compared with the minor one of work procedure. In the other word,
the newly graduates nurses reported that the workload was the main stress source among the
others. However, there was no statistically significant differences in overall WSS and NCS
among these two group of participants with this engagement course. Thus, the graduated
students who participated with the engagement course was found with the less work stress in
professional knowledge , work procedure, and patients and their families, in contrast
with the higher nursing competency with clinical care , communication and cooperation,
and professional development.
Conclusions
There were limitations and bias with this preliminary study, however, the results of this study
can help and have some insights for the nursing educators to reform and redesign the last mile
engagement program and further study.
3-5 Key words
Newly graduated nurses, nursing competency, work stress, last mile
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Effectiveness of reflective thinking in small group presentations on clinical

nursing skills by utilizing movie feature of tablet computer
Yumi Maenobu1, Kanae Otsubo1, Toshie Takahashi1, Yumi Iwamoto1, Kazue Tamura1,
Masayo Ayukawa1, Chikako Sakoda1, Mayumi Asaka1, Masako Shinkawa1
1.
HBG University
Presenting Authors Email: maeno@hbg.ac.jp
Purpose
The purpose of this study is to examine what nursing students learn reflectively during their
small group presentation on clinical nursing skills by utilizing movie feature of tablet
computer:
Design
Qualitative Research Design
Methods
At the end of adult nursing clinical practice II, fifty-nine junior nursing students in four-year
undergraduate program are assigned to present one clinically encountered nursing skills in a
small group. During preparation of their presentation, students are encouraged to use movie
feature of tablet computer to record their nursing skill performance. The survey was collected
in February 2014 after their presentations. As ethical considerations, all of the procedures is
followed in accordance with HBG University Institutional Review Board.
Descriptive survey answers are analyzed by extracting what students recognized during
question and answer session after group presentations, regarding clinical nursing skills
presented by watching other groups video-recorded skill performances on screen.
Results
45 survey answers were collected. Return rate was 76 percent.
From 43 codes are extracted and three themes emerged from the descriptive survey data: 1.
learning from multiple nursing skill presentations, 2. visual effect on presentations, and 3.
Reflective learning and evaluation on their nursing skill performances.
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Regarding utilization of tablet computer to record their skill performance, students evaluated
that they are able to learn the importance of basic standard skills to prevent infection from
the questions asked by other students.
Also, they stated that they can use what they learned from the presentation to other nursing
clinical practice. They are able to reconfirm clinical nursing skills and to clarify what part
of integrated nursing skills they want to improve on when they go to next clinical practice.
While they are practicing their presentation, by repeatedly recording and watching their
nursing skill performance, they are able to reflect on themselves such as interacting with
patients and their communication skills.
Conclusions
Small group presentations on clinical nursing skills by utilizing movie feature of tablet
computer promoted students' learning interest on adopting nursing skills to the patient needs.
Clinically encountered nursing skills are sometimes very creative based on basic practice
standards. Students are able to reflect on their knowledge by questioning and answering each
other. Thus, reflective thinking in small group presentations on clinical nursing skills by
utilizing movie feature of tablet computer is effective.
3-5 Key words
Reflective thinking, nursing students, tablet computer, small group presentation
126
Development of forensic nursing education in JapanA questionnaire

survey forensic nursing universities
Kazuaki Hirai1, Naruto Goto2, Takayuki Kageyama2

1.
Oita university oof nursing and health science, 2. Oita University oForensic nursingursing and Health
Sciences
Presenting Authors Email: hirai12@gm.oita-nhs.ac.jp
Purpose
Forensic nursing encompasses a body of specialty professions that unique and critical roles to
the health care and judicial system. Forensic nurses treat assault victims, investigate crime
scenes or provide health care in a correctional facility. Forensic nursing(FN) is a new nursing
specialty for crime victims in North America. In Japan, however, only a few specialists has
discussed FN. The aim of this study was to investigate the education program concerning FN
among nursing universities in Japan.
Design
This was a crosssectional study design that used a self-administered questionnaire, developed
specifically for this study.
Methods
Questionnaires were sent to both of maternal nursing and mental health nursing department in
207 nursing universities.Ethical considerations:The following was explained to the
participants regarding ethics:that the results would undergo statistical analysis,but the
individuals would not be identified; that the information obtained was confidential and
confidentiality would not be used for any purposes other than research; and that participation
in the study was voluntary and consent could be retracted at any time. Ethical approval for
this study was obtained from the Ethics Committee of the School of Medicine, Oitauniversity,Oita,Japan.Statistical analysis: SPSS V.20 was used for the statistical analysis.
Results
127
Questionnaires were sent to both of maternal nursing and mental health nursing department in
207 nursing universities. Out of 132 respondents (31.9%), 55 (41.7%) had FN class, although
72 (54.5%) dealt with related matters such as mental health assessment, suicidical idea
assessment, and cooperation with crime victims support centers. of 27 items, between
maternity nursing lecture and psychiatric mental health nursing (p<0.04; MannWhitney U
test).
Conclusions
To develop FN education in Japan, roles of departments such as psychiatric nursing, pediatric
nursing, and maternity nursing should be clarified.
3-5 Key words
Forensic nursing, crime-victims, nursing education, psychiatric and mental health nursing,
maternity nursing
128
Level of core competency recognized by nursing students in Korea focusing on interpersonal & cooperative skills and higher-order thinking
skills
Eun-Ji Seo1, Jee-Won Park1

1.
College of Nursing, Ajou University
Presenting Authors Email: silbia98@ajou.ac.kr
Purpose
College education these days should focus on enhancing competency that helps students
successfully perform their job after graduation. However, studies are insufficient on
competency that nursing students are required to reach during their school life and the level of
competency the students recognize themselves. Therefore, this study will survey the
competency level of nursing students focusing on the college students' core competency
suggested by K-CESA(Korea Collegiate Essential Skills Assessment).
Design
This is a descriptive study that compares the current competency level recognized by nursing
students with their expected competency level by the time of graduation focusing on
Interpersonal&Cooperative Skills and Higher-Order Thinking Skills among core
competencies of college students that K-CESA suggests.
Methods
A self-report survey of a four-point Likert Scale was developed using items evaluating
Interpersonal&Cooperative Skills and Higher-Order Thinking Skills of K-CESA to measure
the recognizing level of current competency and their expected competency by graduation.
The subject was the students in their first to third year of a college of nursing in Korea and
higher score means higher recognition level.
Results
The current recognition level on Interpersonal&Cooperative Skills and Higher-Order
Thinking Skills was 2.340.44 and 2.300.51 while the expected level by graduation was 3.30
129
0.46 and 3.300.50 respectively. The current recognition level by school year on
Interpersonal&Cooperative Skills and Higher-Order Thinking Skills was in the order of the
students in their third, second and first year, and the third year especially recorded a
significantly greater recognition level on Interpersonal&Cooperative Skills than the first year
(F=3.078, p=.048). All three school years thought that their expected recognition level on
Interpersonal&Cooperative Skills (t=-20.911, p<.001;t=20.595, p<.001;t=-15.516, p<.001)
and Higher-Order Thinking Skills (t=-19.121, p<.001;t=-17.319, p<.001;t=-16.551, p<.001)
will be significantly greater than the current recognition level.
Conclusions
The core competency level the nursing students recognize now increased as they advance to
senior year and their expected competency by graduation was found greater than the current
level regardless of the school year. It can be evaluated from the result that the current nursing
curriculum is appropriate for the competency level of each school year.
3-5 Key words
Core competency, nursing students, interpersonal&cooperative skills, higher-order thinking
skills
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Effect of adopting reflective thinking in post clinical patient summary

presentation after the first adult nursing clinical practice
Kazue Tamura1, Yumi Maenobu1, Yumi Iwamoto1, Masayo Ayukawa1, Chikako Sakoda1,
Mayumi Asaka1, Toshie Takahashi1, Kanae Otsubo1
1.
HBG University
Presenting Authors Email: tamura@hbg.ac.jp
Purpose
The purpose of this study is to determine the effectiveness of nursing students learning by
adopting reflective thinking in post-clinical summary presentation after the first adult nursing
clinical practice.
Design
Pre-experimental Design. One-group Pretest Posttest Design
Methods
Data collected periods are from October to November, 2012
The sample consisted of prelicensure (third year) nursing students (n=139) enrolled in
baccalaureate program who registered to take Adult Nursing Clinical Practice I.
Self-evaluation sheet was created from the previous survey done to delineate students
learning items. 39 items are extracted and categorized into eight themes. Eight themes
consisted of 1. Pre-clinical self-studying preparation 2.data collection, 3. Assessment, 4.care
planning, 5. Intervention, 6.ethical considerations, 7. Reflective thinking, and 8. Nursing
summary presentation conference. Each item is self-evaluated seven-point Likert-like scale.
Then, scores are grouped into each theme, each theme average points are calculated and
compared before and after the nursing summary presentation and question & answer session.
As ethical considerations, all of the procedures is followed in accordance with HBG
University Institutional Review Board.
Results
131
The rate of valid response was 89 percent. 124 responses are returned.
The average scores after the nursing summary presentation and question & answer session
were higher than before presentation and question & answer session. Especially, the part of
patient understanding was significantly higher.
Also, reflective thinking and nursing summary presentation conference resulted in relatively
scored higher.
Conclusions
In clinical practice, nursing students tend to concentrate on completing the task in front of
them, not getting aware of what is going around the patient and his/her environment,
especially the first adult nursing clinical practice. At the end of clinical, they are assigned to
summarize their nursing practice and present in small group(5-6 students). This is the time to
objectively reflect themselves and their care. Also, question & answer session, they are able to
dialogue each other and reflect on patient's ethical issures and share the experience among
students. These activities can promote reflective thinking to nursing students.
3-5 Key words
Adult nursing clinical practice, reflective thinking, nursing students
132
The self-role perception of the clinical nursing teacher in five-year nursing

college
Pen-Hsin Hou1, Hui-Lin Sun1

1.
Mackay junior college of medicine, nursing, management
Purpose
The purpose of this study is to guide teachers through the view of the clinical practice, "how
to look at their role" and "actual performances of the attitudes and behaviors" to help them
understand the meaning of their roles. And it may help new teachers quickly grasp the
characters of the role to create win-win situation between teachers and students.
Design
Researchers used a qualitative research design. We selected eight clinical nursing teachers
who had worked from one year to ten years in the five-year nursing college.
Methods
Through one-to-one recordings and semi-structured in-depth interviews, the research
collected verbatim data to summarize and analyze by using qualitative content analysis.
Results
(A) Playing the connective role of the frontier and the follower.
1. A torchbearer of guiding students into clinical setting.
2. An inheritor of the nursing care value.
(B) An assistant of increasing students ability in the clinical practice.
1 A director of demonstration and correction.
2. An integrator of the rich theoretical skills.
(C) A relier of the mind settle.
1. A communicator among patients, students and health care teams.
2. A discoverer of keenly awareness of the changes.
3. A soul companion of consulting and support.
133
4. A warden of love and tolerance.

(D) Equipped with an elasticity of self-adjustment.
1. A bearer who is reviewed in many ways.
2. A learner of the modest adjustment.
3. A role model of self-restraint.
Conclusions
Through this research, clinical nursing teacher can see multi-level perception of their role, as
well as internal and external pressure by anticipation. The clinical practice organizations and
schools are recommended to be compassionate of the complexity of their roles and give
assistance to facilitate their confidence and enhance the role of execution in order to give the
best to lead the students.
3-5 Key words
Self-role perception, clinical nursing teacher, clinical practice
134
Current state of education activities in clinical practice guidance nursing

teacher of 3-year nursing school in Japan to address
Kimiko Takahashi1, Junko Fuse2

1.
Bunri University of Hospitality Faculty of Nursing, 2. Suchool of Nursing,Yamagata University of

Medicine
Presenting Authors Email: kimiko-takahashi@bunri-c.ac.jp
Purpose
Teachers of nursing vocational schools are often required to teach subjects outside of their
lines, as an obstacle of nursing education practices, which is one of the causes of their
anxieties and distresses. Here, we, therefore, aim to elucidate the features of education
practices that teachers of nursing science in 3-year nurse training schools are working on in
the clinical nursing practice , and the cases that required teachers to educate themselves in
order to teach practical training classes.
Design
qualitative research
Methods
We conducted semi-structured interviews to nine nursing teachers. They were asked to speak
about issues of concerns in the teaching of practical trainings in medical front that are outside
of their specialized areas, and cases that required them to make efforts in teaching. In order to
analyze the data, we created a verbatim report to record the perceptions of the teachers as
described, and analyzed the contents of them.
Results
As a result of analysis, in education practices of medical front practical trainings taught by
teachers of three year nurse training schools, there were three categories and twelve subcategories extracted: Relating to students, Relating to training instructors and Relating to
other teachers. Relating to students included: defining the learning goals and training agendas,
understanding students, devising ways of teaching effectively to have students understand the
135
contents of learning, practicing nursing on patients together with students, supporting students
with interpersonal relationships. Relating to training instructors included: clarifying and
adjusting the teaching methods and exchanging information on students and patients. Relating
to other teachers included: exchanging information on students, discussing teaching methods
and being evaluated for teaching.
And in the cases that required self-education in the teaching of medical front practical
trainings, a category of learning agendas in teaching of medical front training was extracted,
and it was sub-categorized into: understanding basic knowledge of the cases that students are
engaged in, reflection, obtaining latest medical and nursing information and brainstorming.
Conclusions
Features of educational practices that nursing teachers are working on in clinical nursing
practice are that, as they are sometimes engaged in teaching in practical training programs that
are outside of their specialized areas, teachers value cooperation with the instructors at the
medical front or with other teachers, and educate themselves to assure the quality of education.
3-5 Key words
3-year nursing school, nursing teacher, clinical practice
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Evaluation of admission care teaching program for nursing students
Chih-Yin Chien1
1.
Department of Nursing, Mackay Junior College of Medicine, Nursing and Management
Purpose
The purpose of this study is to investigate admission care teaching programs for nursing
students in a Junior Nursing College to raise nursing competence in clinical care
Design
A quasi-experimental design.There were 46 student nurses in medical-surgical nursing
practice. 25 students were randomly assigned into the experimental group training with
admission care teaching programs; Control group of 21students training with traditional
teaching process.
Methods
Evaluation of time spend in admission care, self-perception of nursing competence
questionnaire, feedback of nursing preceptors. The statistic methods used in this research are
as follows: inferential statistics and qualitative analysis.
Results
(1) Items of time spendThe implementation of admission care in the experimental group
(mean=47.79.4) was significantly shorter than the control group (mean=7111.7) (2) Selfperception of nursing competence questionnaire were significant difference in "systematic
assessment and data collection and " communication and cooperation with medical team
members "(p=.022). (3) Feedback of nursing preceptors showed that the integration and
fluency of history taking and physical assessment are guiding focus in this teaching program.
Conclusions
137
Care" is a practice-oriented professional, clinical practice through the process, allowing

student nurses develop the necessary expertise. The results of this study provide clinical
nursing teachers in planning clinical teaching strategies.
3-5 Key words
Admission care, clinical competence, nursing preceptor
138
Systematic reviewPatient-family caregivers congruence of cancer

symptom perception
Chia-Tai Hung1, Linda Spence2

1.
Nursing Department / Macky Medical College, 2. College of Nursing /Michigan State University
Presenting Authors Email: hungchia@mmc.edu.tw
Purpose
The aim of this article was to show congruence of symptom perception between cancer
patients and their family caregivers during the last ten years. In the nursing education,
assessing family caregivers' percpetion of patients' symptoms is also improtant to provide
appropriate cancer care.
Design
This is a reivew article.
Methods
The keywords for selecting articles were congruence, cancer, symptoms, family caregivers, as
well as the Mesh words, such as agreement and concordance, neoplasm and oncology. The
articles published in ten years from2003 to 2013 in PubMed, PsysINFO, CINAHL, and
Cochrane, were examined. Factors influencing the congruent symptom perception of cancer
patients-caregiver dyads were also examined.
Results
There were seventeen articles synthesized through a set of searching process. They were
analyzed for the levels of congruence and factors of congruence perception. Among seventeen
articles, caregiver-patient dyads generally have poor to fair congruence, and caregivers often
rate higher scores for patients symptom experiences more seriously than patients do. Poor
congruence of symptom perception has been consistently correlated to caregivers negative
mental health and care experiences. Overall, in these seventeen studies, demographics of both
caregivers and patients did not contribute a consistent effect on congruence of symptom
139
perception. No theoretical frameworks were applied to illustrate congruence of symptom

perception, only Lobchuk and her colleagues tried to find the cue of perceiving other cancer
peoples symptoms. Few longitudinal and experimental studies were designed to identify
the changes of congruence and their impacts on symptom management and the health of
patients and family caregivers.
Conclusions
The systematic process and findings suggested that caregivers congruence of symptom
perception can contribute an understanding of the family care environment to nursing science.
The low congruent level of symptoms perception may indicate that family caregivers were
less likely to provide appropriate symptom management for patients. Applying a theoretical
framework can illustrate congruence of symptom perception between cancer patients and
family caregivers. Clinical health providers can use the exploration of the individual
differences of patients and caregivers on congruent symptom perception to support an
appropriate symptom management for cancer families. It is necessary for further nursing
science to examine the changes of congruence to understand whether cancer survivors having
a great symptom management, and influence the health of both patients and caregivers during
the time of long-term care in cancer families.
3-5 Key words
Congruence, cancer, symptom perception, family caregivers, review
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The influence of end of life educational programs on attitude to death of

undergraduate nursing studentsA systematic review
Ting-Ting Mei1, Meei-Fang Lou1, Bih-Shya Gau1, Mei-Chang Yeh1

1.
Department of Nursing, College of Medicine, National Taiwan University
Presenting Authors Email: d01426007@ntu.edu.tw
Purpose
Nursing students often encounter people nearing death when they take care of dying patients
and feel fear, anxiety, and even withdraw. Most life and death or end of life education only
focuses on knowledge cultivation by using lectures; few are concerned with students
attitude to death through a combination of lectures and clinical experience.This study is to
review the influence on undergraduate nursing students attitude to death by using life and
death education, palliative care education, and end of life relative educational programs, and
to compare and contrast the teaching contents and strategies among programs.
Design
A systematic literature review of the influences on undergraduate nursing students attitude
to death through end of life related courses was conducted by using databases, hand searching,
and search terms.
Methods
The search strategy of this systematic review included the following databases: PsycINFO,
PubMed, Medline, CINAHL[EBSCO], Airiti Library, and hand searching without defined
date. Only English and Chinese articles were included. Inclusion criteria were: (1) subjects
are undergraduate nursing students; (2) programs are related to life and death education, end
of life care, and palliative care; and (3) quantitative studies for evaluating the changes of
nursing students death attitude when facing dying patients or death pre and post programs.
Consolidated Standards of Reporting Trials (CONSORT) and Transparent Reporting of
Evaluations with Nonrandomized Designs (TREND) were employed to evaluate the reporting
quality of articles, and six quantitative studies were finally included.
141
Results
Nursing students attitudes toward dying patients and death could be positively changed by
end of life related programs using lecture teaching, experiential teaching and learning, and
guiding students to develop self-awareness about their feelings about death. These programs
could assist nursing students to face death positively and appropriately deal with their
emotional reaction from death. Students attitudes about death could be changed easily if
they learned from real clinical situations or scenarios besides learning knowledge from
lectures.
Conclusions
According to results, it is recommended that end of life related educational programs should
integrate lectures, clinical practice, and experiential leaning for improving the preparation of
nursing students facing dying patients or death.
3-5 Key words
Undergraduate nursing students, death attitude, education, systematic review
142
Conflicts in nursing roles in the emergency departmentA concept

analysis
Yoko Satake1, Harue Arao2

1.
Nara Medical University, 2. Osaka University
Presenting Authors Email: y-satake@naramed-u.ac.jp
Purpose
In the emergency department, nurses must provide both life-saving treatment and end-of-life
care. Thus, nurses have conflicting roles in the care of living and dying patients in the
emergency department. This study aimed to define the concept of conflicts in nursing roles in
the emergency department.
Design
The Walker and Avant approach was used.
Methods
Textbook and dictionary definitions of the keywords role, conflict, and role conflict were
reviewed in the areas of sociology, psychology, and nursing science. Then, electronic
databases (CINAHL and ICHUSHI) were searched for literature related to conflicts in nursing
roles. In total, 39 studies were analyzed after excluding literature that made no mention of
role conflict. Supervision was provided by an experienced concept analysis researcher.
Results
The defining attributes of conflicts in nursing roles in the emergency department were the
demands and practice of care that contradict or is in conflict with patients, their family, and
the medical team and negative feelings about role performance, which were influenced
by past experience of role conflict, circumstances, individual characters, and
culture.
Recognized antecedents were personal values and beliefs about end-of-life care,
mixed contexts with both life-saving and end-of-life care elements, crises with the
143
patients and their families, and lack of positive role perception of patients and their
family and the medical team towards each other. The consequences of conflicts in nursing
roles in the emergency department were stress and burnout. At the same time,
nurses who intended to renew their job and develop their professional skills dealt with their
conflict effectively, that is, they coped.
Conclusions
According to the concept analysis in this study, conflicts in nursing roles in the emergency
department were defined as negative feelings regarding role performance in nursing practice
for living and dying patients. Future research should develop objective descriptions of the
phenomena associated with conflicts in nursing roles in the emergency department. This may
contribute to positive practices in the management of patients and their families.
This work was supported by a Grant-in-Aid for Young Scientists, No. 26861903.
3-5 Key words
Role conflict, nurse, emergency department, concept analysis
144
Out of the doldrumsA gripping narrative from a HIV-infected patient &

female spouses
Yi-Chun Yang1, Yi-Chien Lee1

1.
Ditmanson Medical Foundation Chia-Yi Christian Hospital
Presenting Authors Email: cych03453@gmail.com
Purpose
In Taiwan, the prevalence of Human Immunodeficiency Virus (HIV) infection is increasing,
and there is a trend towards younger age in these infected patients. Hiv infection is a chronic,
controllable disease with antiretroviral therapy, so continuous treatment and suppression of
viral replication have become much more important in patient care. However, HIV-infected
patients are still discriminated and have a stigma. For themselves, they not only bear disease
burdens, but also suffer from the indescribable complicated contradiction when they informed
their spouses the fact of being infected with HIV. On the other hand, the event will have much
more unimaginable impact on HIV-negative partners. The keynote of this article describes
that one female HIV-negative heterosexual partner is tortured with being betrayed, fear of
being infected, continuing the family line when she had known her spouse got infection with
HIV. Furthermore, this study investigated the fetters of female roles in traditional marriage
and impact of worrying about exposure of HIV infection on family function and role,
especially when supportive systems about physical, mental and spiritual parts lack. It will be
promoted attention and counseling for family members of HIV-infected patients.
Design
Data were collected from April 2012 to May 2014.The interview was proceeding by
participant observational and semi-structural interviews. The duration for interview was
around 30 to 60 minutes, and total six times had been completed.
Methods
The study is a case study and the data coding the original interview records and analyzed.
145
Results
There are several findings in this case study (1) Stereotype and fetters of female roles in
traditional marriage: females only feel angry, disappointed and guilty because they must
comply with their husband in traditional marriage relationship. (2) Empowerment: the
pessimism would pass away sooner if females treated themselves with active attitudes and
couples could support and accept mutually by means of true love when they evaluated
their function in family structure. (3) Maintenance of intimate relationship: this female HIVnegative heterosexual partner no more desires for intimate behavior, i.e., Sex," to hold
marriage relationship together. (4) Establishment of supportive systems: how to express and
vent emotions needs guidance and one injured heart need to be reconstructed. One mental
supportive group with safe and therapeutic function should be organized.
Conclusions
HIV-infected patients stabilized disease severity and returned to normal life via good drug
compliance. They found self-appraisal from inside their heart," which was helpful to
rebuilding the relationships of family and couples. Starting from respect
acceptancegive a chancebetween couples would find the equilibrium of common
lifestyles with each other. It is an important and long-term mission that one continuous and
therapeutic counseling teams belonging to HIV-infected patients and their family members
had been constructed.
3-5 Key words
Human immunodeficiency virus, stigma, female spouses, empowerment, narrative
146
Validity and reliability of Korean version of revised moral distress scale

(KMDS-R) for clinical nurses
Young-Ran Chae1, Su-Jeong Yu2, Eun-Ja Lee3

1.
Department of Nursing, Kangwon National University, 2. Department of Nursing, Sangji

University, 3. Kangwon Medical Center
Presenting Authors Email: yrchae@kangwon.ac.kr
Purpose
To develop and test validity and reliability of the Korean Version of Revised Moral Distress
Scale(KMDS-R) for Clinical Nurses.The Original scale of 21 items developed by Hamric,
Borchers & Epstein (2012) based on Corley et al(2001).
Design
This study is methodological research to verify KMDS-R .
Methods
KMDS-R was articulated through forward-backward translation methods. The participants
were 188 university hospital nurses in Chuncheon, Korea. Internal consistency reliability,
construct validity, and criterion validity were analyzed using SPSS ver 20.0 program.
Results
Internal consistency with Cronbachs for KMDS-R were .91. Five factors were extracted
through factor analysis; Futile care, nursing practice, institutional and contextual factor,
constraints of ethical conduct and physician practice. Variance range of the five factors was
10.3 16.4%. Total variance of KMDS-R was 63%. Criterion validity compared to Yoos
moral distress scale(2003) showed significant correlation(r=.60, p=.001).
Conclusions
KMDS-R was valid and reliable. It is recommended to use when measuring the moral distress
of Korean clinical nurses.
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3-5 Key words

Korean, revised moral distress scale, clinical nurse
148
A comparative study of ethical dilemma and coping between Korean nurses

and Japanese Nurses
Emi Kondo1
1.
Graduate School Of Nursing,Chiba University
Presenting Authors Email: kondoemi1219@chiba-u.jp
Purpose
The purpose of this study is to understand and compare ethical dilemma and coping of the
clinical experiences between Japanese and Korean nurses.
Design
This study is a descriptive competitive review study to analyze the relations between ethical
dilemma and coping that Japanese and Korean clinical nurse experience.
Methods
The subject were 381 nurses from both countries, who have more than 1 year of clinical
experiences in hospitals with more than 400 beds, and the periods of the examination were
from April 1st, 2012 to April 13th, 2012. Two types of survey sheet were prepared for the
examination, one based on the ethical dilemma, the other based on coping. The collected date
had analyzed with frequency, percentage, average, the standard deviation, x-test, ANOVA,
Scheffe test, Pearsons correlation coefficient.
Results
The average point in the ethical dilemma were 0.48 in Korean nurses, 0.31 in Japanese nurses.
Focus into the subcategories, Korea's results were as follow: professional job field, patient
field, coagent field, human life field, whereas patient field, human life field, professional job
field, coagent field in Japan.
The average point of coping of ethical dilemma were 1.24 in Korean nurses, and 1.11 in
Japanese nurses; and active coping type hit high score in both countries.
In regard to general factors, Korean nurses showed significant differences in education level,
whether they had taken the ethical courses during the college or not and after completed a
149
courses or not about ethical dilemma (p<0.05). And in case of coping, significant differences
was understanding of ethical code (p<0.05). On the other hand, Japanese nurses showed
significant differences in age, married, clinical career, present position, religion about ethical
dilemma, whether they had taken the ethical courses at college or not(p<0.05) in case of
coping.
Conclusions
To sum up the results above, active coping was often used in the both countries, however, the
field of the most common ethical dilemma experience was different, thus, the different
solution for each countries is necessary. Korea should focus on disposing more nurses and
enhancement of the quality of the service to deal with ethical dilemma in the field of
professional job. Japan should focus on encouraging coworkers including doctors, nurses, and
stuff across division in the hospital to communicate and to exchange the information of the
clinical principles and need of the patients each other.
3-5 Key words
Ethical dilemma, coping, Japanese and Korean nurses
150
Meta-analysis of scientific nursing theory
Chika Matsuda1, Ayumi Suematsu2, Yukiko Abe1, Akiko Nagata1, Toshie Yamamoto1
1.
Graduate School of Nursing, Chiba University, 2. Chiba University Hospital
Presenting Authors Email: chikamatsu@chiba-u.jp
Purpose
The purpose of this paper is to analyze Scientific Nursing Theory developed first in Japan in
accordance with the evaluation criteria for the nursing theory, and to clarify the characteristics.
Design
Analysis of the nursing theory
Methods
Scientific Nursing Theory by Hiroko Usui was used as the object of analysis. Criteria
for analysis included five items: clarity, simplicity, generality, empirical
precision and derivable consequences based on the Nursing Theorists and Their
Work by Ann Marriner-Tomey, et al. As for the analysis procedure, (1) the Scientific
Nursing Theory was carefully read and analyzed according to the criteria and (2)
characteristics of Scientific Nursing Theory were clarified in comparison with Parses
nursing theory that had already been evaluated with these criteria.
Results
(1) Clarity: Scientific Nursing Theory is consistent from major concepts to subconcepts, and
the theoretical structure is clear. Parses nursing theory does not refer to clarity. (2)
Simplicity: Scientific Nursing Theory is modeled to represent the image of the theory;
however its level of abstraction is high. With Parses nursing theory, the major concepts
are defined in highly abstract and philosophical terms, which have been a source of comfort
and discomfort for nurses. (3) Generality: Scientific Nursing Theory is a logic based on
broad generality; therefore is widely applicable without being limited to a specific field.
Parses nursing theory was selected as a theoretical guide in different settings. (4)
Empirical precision: Scientific Nursing Theory systematizes what is nursing; therefore
151
what kind of qualities lies in each case can be verifiable. Parses nursing theory provides
a meaningful foundation that is helpful for nurses in practice and research. (5) Derivable
consequences: Scientific Nursing Theory is significantly influencing the history of nursing in
Japan as the first nursing theory in Japan in the cultural background of resistance to science or
logic. Parses nursing theory The humanbecoming research and practice methodologies
are generating transformations in care and a renewed sense of professional purpose.
Conclusions
Scientific Nursing Theory scientifically systematizes nursing and its concepts are consistent,
while the level of abstraction is high. It could be a nursing theory applicable to a wide field
with practical training by using the representation image of theory visualized in accordance
with defined concepts.
3-5 Key words
Scientific nursing theory, Parses nursing theory, analysis, characteristic
152
Constructing ethical approaches through nursing practice-when nurse face

to caring for stillbirth
Chien-Hui Lin1
1.
Department of Nursing, Kang-Ning College of Nursing and Doctoral Candidate, School of Nursing,
The National Yang-Ming University
Presenting Authors Email: hui726@knjc.edu.tw
Purpose
The purpose of the qualitative study is to encourage discussion and team reflection on
working as a nurse and to develop the self-knowledge of the participants by group dialogue.
Design
A qualitative approach was used to investigate the nursing experience of stillbirth care in the
nurse group.
Methods
The researchers, as facilitators of the group, conducted 12 sessions for supportive groups
made up of nurses in the delivery room of a university affiliated hospital. The data were
collected through tape-recording of the group interaction and were analyzed in terms of
constant comparison and analysis.
Results
Data were analysed using thematic analysis informed by Grbichs (1999) framework for
theoretical analysis. The findings revealed two categories emerged that described the
construction of the themes and four subcategories. The two themes are relatively informative
and the ethical practice of providing care to stillbirth between the self and the other. The four
subcategories are the inhumane guilt, perception accomplice, farewell between mother and
infant (concerning mother's gaze, baby dress) and farewell between nurse and infant (pray).
Conclusions
153
Nurses who adhere to a DNR order in the delivery room cannot save life as their duty. In the
process of caring for the deceased infant, they feeling guilty is motivated to showed confess,
apologies or repair. As a result, being prone guilt would enhance moral or prosocial behaviors.
On the basis of the findings, the transaction between professional self and providing humanity
palliative care for stillbirth is a new understanding of individual ethical practice in the
delivery room.
3-5 Key words
Qualitative research, stillbirth care, ethical attitudes
154
A concept analysisPsychological insulin resistance in adults with type 2

diabetes
Yuan-Ching Liu1, Ya-Ling Lee1, Fei-Hsiu Hsiao1

1.
Department of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan
Presenting Authors Email: r94426030@ntu.edu.tw
Purpose
Most of patients with type 2 diabetes eventually required insulin treatments to control blood
sugar and reduce the possibility of chronic complications. However, patients generally put off
or repelled these treatments. This phenomenon was called as psychological insulin resistance
in literatures. The purpose of this study was to further understand the phenomenon by using
concept analysis. We hope that the study results will be useful for assisting patients to cope
with relative concerns and improve blood sugar control.
Design
The analytical method used in this study was based on the eight steps of concept analysis
recommended by Avant and Walker (2011).
Methods
Firstly, researchers used electronic data base to search research papers regarding the
definition of psychological insulin resistance. Then the attribute, antecedent, and consequence
of the concept were verified. The model, borderline, and contrary cases were used to explain
and clarify the definitional characteristics of the concept. Finally, measurement tools of the
concept were collected and listed to be empirical referents of the concept.
Results
Based on the concept analysis results, the attributes of psychological insulin resistance in
patients with type 2 diabetes included: (1) Insulin injection was recommended by physicians,
(2) Lack of motivation in insulin injection, (3) Fear of injection, (4) Negative beliefs of
insulin treatments, (5) Fear of side effects, (6) Negative feelings caused by the insulin
155
treatments, (7) Life style restrictions, and so forth. The antecedents of psychological insulin
resistance involved the influence of social environment, lack of knowledge, attitude of
medical care team, perceived threat of disease, and low-efficacy of self control. As a result of
psychological insulin resistance, patients try more active self-care behaviors, and alternative
methods other than insulin to control blood sugar. Related measurement tools of
psychological insulin resistance have been developed for clinical assessment.
Conclusions
It is necessary for clinical health care providers to understand the concept of psychological
insulin resistance comprehensively and to develop effective nursing interventions to assist
patients to make a knowledgeable decision to improve the blood sugar control and reduce the
possibility of chronic complications.
3-5 Key words
Psychological insulin resistance, type 2 diabetes, concept analysis
156
Developing a Q-methodology study to explore nurses & views on moral

distress
Pei-Pei Chen1, Chin-Ling Wang2, Fang-Yu Tsai1, Chiu-Mieh Huang1

1.
National Yang-Ming University, 2. National Yang-Ming University Hospital
Presenting Authors Email: rubby1990@yahoo.com.tw
Purpose
The importance of nursing ethics is continuously emphasized in the process of nursing care.
When there is conflict in the implementation of nursing care, nurses who experience moral
distress easily generate work stress which indirectly influences the development of their
nursing specialties and interferes with the establishment of the nurse-patient relationship. This
highlights the importance of solutions to moral distress. This study adopted Q methodology to
explore the viewpoints of nurses about moral distress and compared descriptions of the types
and contents of moral distress.
Design
Q methodology
Methods
Data were collected in two stages. First, in-depth interviews were conducted to collect nurses
opinions about moral distress. Sentences which best fit the concepts of moral distress were
extracted for the construction of Q statements. Second, nurses were allowed to subjectively
rank these Q statements to obtain relevant descriptions of moral distress using Q-sorts. The
study participants were nurses at a regional teaching hospital in northeast Taiwan. A total of
60 participants were invited to rank 40 moral distress Q statements.
Results
The PQ method was used for data analysis. Five different types of responses were obtained
from the nurses viewpoints. A total of 52 participants were classified, which explained
46.51% of the variance. Five group categories were obtained which were labeled: conflicting
with personal value; compression by working load; curbing autonomy; constraint by
157
organization norm; and self-expectation frustration. Nurses in the conflicting with personal
value group considered non-responses to individual patients wishes most troubling. Nurses
in the compression by working load group thought the influence of overloading on the
quality of nursing care most troubling. Nurses in the curbing autonomy believed the
authorization to perform non-nursing care or failure to perform some healthcare due to
conflicts of opinions from other health team members was most troubling. Nurses in the
constraint by organization norm group thought the impact of organizational inflexibility
on quality of care was most troubling. Nurses in the self-expectation frustration group
were most troubled by time allocation which did not meet their expectations, such as the
impact of overloading on nursing care quality and lack of time for continuing education to
improve their quality of care.
Conclusions
The findings points to the variety of viewpoints of moral distress existing among nursing
staffs encountered in clinical situation. Acknowledging these views can advance the
understanding of nurses experience in moral distress. The five identified categories may be
useful in developing tailor-made distress coping strategies.
3-5 Key words
Moral distress, nurses, Q methodology
158
The utilization of information and communication media by hospitalized

children with cancerWith a focus on hospital websites
Kenji Takao1
1.
Kyoto Prefectural University of Medicine School of Nursing
Presenting Authors Email: takao@koto.kpu-m.ac.jp
Purpose
In Japan, Hosoya (1994) proposed that the diagnosis and prognosis should be explained to
children with cancer aged around 10 or older, with the parents consent. The rate of
hospitals that actively obtained informed consent from parents to discuss cancer with their
children was less than 10% in 1997, but it was reported to have increased to approximately
40% in 2008 (Hori, 2009). However, less than 40% of patients wish for their children to be
informed of a diagnosis of cancer, and so whether or not to explain about the diagnosis and
prognosis to children is dependent on the wishes of their parents. Under these circumstances,
information and communication media such as mobile phones and personal computers
(hereafter, MBs and PCs, respectively) have been widely used by children, and the prevalence
of MB access is 36.1, 51.9, and 97.2% in elementary school, middle school, and high school
students, respectively. The rate of using the Internet is 69.0% in those aged 6-12, and 97.2%
in those aged 13-19, and media literacy among children has been suggested to be high.
Design
Methods
Subjects: Websites of 22 hospitals that had applied to be registered as Childhood Cancer Base
Hospitals and passed the first stage of approval, document screening, based on the Ministry of
Health, Labour and Welfare health director notification "About the development of childhood
cancer hospitals" (September 7th, 2012).
Study period: March - April 2014.
Survey contents: The use of information and communication media such as MBs and PCs in
159
hospitals.
Results
With regard to the use of MBs in hospitals, areas for usage were designated in 17 (77.3%), the
websites provided no information in 3 (13.6%), and usage was strictly prohibited in 2 (9.1%).
The designated areas were amenity halls, family rooms, and areas near public telephones.
Some hospitals prohibited use on hospital wards, and some permitted use in private hospital
rooms. With regard to the use of PCs in hospitals, the websites provided no information in 10
(45.5%), usage was strictly prohibited in 8 (36.4%), a doctor had to be consulted before usage
in 3 (13.6%), and usage was freely permitted in 1 (4.5%).
Conclusions
Although some hospitals have set limitations on the usage of MBs and PCs by children with
cancer, few hospitals prohibit the use of information and communication media. Hospitalized
children with cancer are in an environment where they can obtain information on cancer
without medical professionals or their families explaining their diagnosis to them, and there is
a risk that such information lacks scientific evidence.
3-5 Key words
Children with cancer, information and communication media, hospitalization, childhood
cancer hospitals
160
Trends in transition care from adolescents to young adults with chronic

disease in Taiwan
Yo-Ting Jin1, Wu-Chien Chien1

1.
National Defense Medical Center
Presenting Authors Email: jinyoting@gmail.com
Purpose
To investigate the key factors and barriers of the transition care for the chronic illness
adolescents from minority to adulthood in Taiwan.
Design
T-test and ANOVA are used to do statistical analysis.
Methods
The database of this study is retrieved from the longitudinal national health insurance research
database (LHID) from 1997 to 2008. The objects are 18 years of age, and suffered from heart
disease, asthma, diabetes, epilepsy, cancer, and visiting records existing before and after
adulthood.
Results
Only 4.10% in total 6,099 patients suffered from the five chronic diseases have received
transition care. The result indicates the patients generally have not received transition care
(p=0.00). 95.84% adolescent patients received adult-oriented therapy before the age of 18.
44.25% adolescent patients have never received child-oriented therapy. The transition care
ratios are 12.05% in epilepsy patients, 5% in heart disease patients, 4.2% in diabetes patients,
1.6% in cancer patients, and 0% in asthma patients. The average number of visiting times of
these patients receiving transition cares is 16.58 (S.D. =33.381). And the average number of
visiting times of those not receiving transition care is 30.73 (S.D. =43.977).
Conclusions
161
This study is the first one about transition care in Taiwan. Different culture and medical
policy could lead to different implementation results or draw out new obstacles of transition
care. In Taiwan, the public lack of knowledge of child-oriented healthcare and often only
consider the patients illness conditions regardless of their mental development problems.
Most of chronic illness adolescent patients either never receive child-oriented therapy or
too early to receive adult-oriented therapy.
3-5 Key words
Transition care, adolescent illness, children with special health care needs
162
Required knowledge and skills of nurses for families whose infants are
transitioning from NICUs to home
Miyuki Nakayama1, Ayako Okada2, Atsuko Inoue3, Natsumi Tawa4

1.
Osaka Prefecture University, 2. University of Hyogo, 3. Bell Land General Hospital, 4. Osaka
University Hospital
Presenting Authors Email: miyuki@nursing.osakafu-u.ac.jp
Purpose
Many Japanese NICUs encounter serious problems with long-term hospitalization. In our
previous study, NICU nurses often reported difficulties in nursing practice for families during
infants transitions from the hospital to their homes. The purpose of this study was to clarify
the required knowledge and skills of nurses for families whose infants are transitioning from
NICUs to their homes.
Design
Qualitative research.
Methods
The subjects were 21 nurses who had practical nursing experience for families whose infants
were transitioning from NICUs to homes. We conducted focus group interviews with these
nurses about the required knowledge and skills of nurses in December 2012. Interviews were
conducted in four separate grups, recorded, and transcribed. Content analysis was performed
on the data obtained.
Results
The average years of work experience as a clinical nurse were 13.8; the average years of work
experience as an NICU nurse were 11.7. The mean of actual time spent in focus group
interviews was 54.6 minutes. The required knowledge and skills of nurses were divided into
twelve categories: breastfeeding management and promotion, understanding of social
resources and the social welfare system, practicing childcare suitable for the
characteristics and development of their infants, general child care instruction,
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assessment of families home environments and simulation education, nursing

practice from birth according to their infants illness prognosis and progression,
discharge guidance for patients with mental disorders, reflection on nursing practice,
understanding family system nursing, knowledge of infectious disease,
understanding the risk of hospitalization during the neonatal period, and information
gathering ability and communication skills.
Conclusions
The nurses recognized that the required knowledge and skills of nurses for families
transitioning from NICUs to homes were general childcare activities such as breastfeeding
management and promotion, child care instruction, and knowledge of infectious
disease. Because nursing practice is implemented for infants with special needs in the
NICU, they lack knowledge of general childcare. The required knowledge and skills were
widespread such as assessment of families home environments and simulation education.
These knowledge and skills needed that families were adapted to their daily life in home
setting. Moreover, to improve the quality of nursing practice, nurses need to reflect on their
daily care. Using such broad knowledge and skills, nurses can reduce the difficulties
experienced in their practice.
3-5 Key words
NICU, family, knowledge and skills of nurses
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Effectiveness of a smoking prevention class for seventh grade junior high

students
Miki Konno1, Masayo Tooi2, Tsuyoshi Asari3, Hisae Tabata3, Keiji Mise3, Mitsue Iori4,
Haruko Taniguchi5, Masako Kitada6, Hiromi Dobashi7
1.
Sapporo Medical University, School of Health Sicences, Department of Nursing, 2. Grad student,
Sapporo Medical University, Graduate School, 3. Sapporo Medical University, 4. Hokkaido University
of Science, 5. Yoboiryokenkyujyo, 6. Sapporo Gakuin University, 7. Sapporo Konan Praimary School
Presenting Authors Email: miki@sapmed.ac.jp
Purpose
Smoking prevention education for children is not about one-off classes, and follow-up
observation is necessary. The aim of the present study was to evaluate the effectiveness of a
smoking prevention class over the long term.
Design
A descriptive, quantitative design was utilized in this study.
Methods
A smoking prevention lecture was given to seventh grade students at three junior high schools
in Hokkaido, Japan in 2013. To investigate the effectiveness of the lecture, the students were
asked to complete the same questionnaire before, immediately after, and at 3 months after the
class. The questionnaire was composed of items regarding the students background, such as
the presence of smokers in their family environment, the Kano Test for Social Nicotine
Dependence (KTSND), and how the students rated the teaching material. High KTSND
scores indicated a high level of psychosocial nicotine dependence.
Results
Three hundred and forty valid responses were received before, 328 were received
immediately after, and 330 were received at 3 months after the class. Based on the results of
analysis, very little change was seen in the number of children with a smoker(s) in their
family environment, with 186 (54.7%) before and 183 (55.5 %) at 3 months after the class.
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No significant decline was evident in the median KTSND score, with 9.0 before, immediately
after, and 3 months after the class. Further KTSND analysis revealed that item 7 (tobacco
use releases stress) had significantly changed (1.0 before, 0.0 immediately after, and 0.5 at
3 months after the class; p < .001). A total of 187 students (56.7%) showed their parents a
newsletter that had been provided as follow-up educational material. The KTSND score of
these students (9.0) was significantly lower than that (10.0) of students who did not show
their parents the newsletter.
Conclusions
Our smoking prevention class was not shown to be very effective over the long term. These
results suggest the importance of analyzing students psychosocial nicotine dependence and
improving students awareness over the long term following lectures on smoking prevention.
3-5 Key words
Smoking, smoking prevention education, junior high school students, Kano test for social
nicotine dependence
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Lived experiences of mothers of children with autism spectrum disorder

Basis for enhanced nursing care
Bea-Gracia Cruz1
1.
Our Lady of Lourdes Hospital
Presenting Authors Email: beanightingale@yahoo.com
Purpose
The aim of this study is to determine the lived experiences of mothers of children with autism
spectrum disorder and to increase the public awareness about their condition.
Design
The method used was descriptive study. The target population of the study was the parents of
children with autism spectrum disorder.
Methods
The researcher used purposive sampling in choosing the respondents. A snowball technique
was used to locate the participants through the help of Autism Society of the Philippines (ASP)
Manila Chapter in UP-CAMP, Padre Faura, Manila.
The participants criteria were the following: the participant must be a parent, able to read
and write and absence of cognitive problems.
Results
The researcher discovered that the nursing curriculum has lack of competency in terms of
dealing with ASD. There is a massive need for early screening of children with ASD as
evident by lack of hospitals that will attend to them. As of today, there are only two hospitals
that cater to them namely: Philippine General Hospital and Philippine Childrens Medical
Center. As for the stigma of having ASD, information dissemination, can be of help.
Conclusions
167
Increased knowledge, skills and attitude towards caring of a patient with ASD through
introducing an elective subject (1.5 units) pertaining on introductory concepts with regards to
occupational therapy, speech therapy and some communication techniques can help us give
quality nursing care to children with ASD. With a large need for early intervention of children
with ASD, it is therefore a must for us to put up a strategy to strengthen the early diagnosis of
the said condition.
Further research study is of great importance for discovering the cause of ASD thus leads to
appropriate intervention and possible cure of ASD.
3-5 Key words

Mothers, children, autism spectrum disorder, enhanced nursing care, qualitative
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Parentsuncertainty when their children have an illness
Shingo Ueki1, Kazutomo Ohashi1

1.
Osaka University
Presenting Authors Email: ueki-s@sahs.med.osaka-u.ac.jp
Purpose
When a child becomes ill, the parents may not be able to determine the meaning of the child
s condition and be faced with many uncertainties. The theory of uncertainty of illness
comprises three major themes: antecedents of uncertainty; appraisal of uncertainty; and
coping with uncertainty. The purpose of this study was to review studies identifying the
contents of these themes of uncertainty in parents when their children became ill.
Design
A literature review involving qualitative research.
Methods
This review considered studies that investigated the experiences of parents of children with
any health problem, and incorporated all health care settings, including inpatient, outpatient,
and community. We searched the literature in two electronic databases, MEDLINE and
CINAHL, from 2004 to 2014. The search order was as follows: (1) the keyword used was
uncertainty; (2) thesaurus terms Mothers, Parents, Mother-child relations,
Parent-child relations, or Maternal behavior; (3) we searched the literature based on
(1) and (2). We considered the following studies for inclusion in this review: (1) published in
English; (2) qualitative research; and (3) investigated parents uncertainty when their
children suffered an illness or experienced illness-related events. Qualitative findings were
extracted and categorized on the basis of similarity in meaning.
Results
Six studies were considered relevant to this review out of 535 articles. The study analysis
methods were: 2, grounded theory approach; 2, narrative approach; 1, interpretive approach;
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and 1, content analysis approach. The illnesses included chronic diseases (cancer after relapse,
asthma, peanut allergy) and rare genetic syndromes (Klinefelter, Turner, fragile X, cystic
fibrosis). Parents were also concerned with uncertainty when children received vaccines
(measles, mumps, and rubella) associated with a crisis of confidence in public health.
Antecedents of uncertainty were reported in this literature as individual characteristics (sense
of control, close bonds with children), structure providers including family members, and the
duration. Parents uncertainty fluctuated between hoping for a cure and contemplating death.
Parents adopted the following strategies to cope with uncertainty: considering that the
syndrome does not exist; using their own expertise; seeking information; focusing on the
chance of cure; choosing all offered treatments; trying alternative treatments; reducing
complexity through trust; compromising strategies that embrace ambivalence; and identifying
vulnerable groups.
Conclusions
Uncertainty of parents of children with an illness led to fluctuating their feelings and this was
influenced by variable factors. These parents adopted many behaviors to cope with their
uncertainty. Nurses need to be aware of these findings to support parents with uncertainty.
3-5 Key words
Uncertainty, parents, literature review
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Role development of nurses for technology-dependent children attending

mainstream schools in Japan
Fumie Shimizu1
1.
Department of Human Health Science, Graduate School of Medicine, Kyoto University
Presenting Authors Email: shimizu.fumie.52v@st.kyoto-u.ac.jp
Purpose
The importance of inclusive education, in which all children learn together regardless of
disability, has been demonstrated worldwide. In some countries, there are technologydependent children attending mainstream schools. In Japan, technology-dependent children
have increased. In recent years, nurses were employed by boards of education for providing
nursing care to technology-dependent children in mainstream schools. This study described
the role development of nurses for the technology-dependent children attending Japanese
mainstream schools.
Design
A qualitative research design was used.
Methods
Semi-structured interviews was used with 21 nurses who have taken care of the technologydependent children in mainstream schools for more than two years. Interviews were analyzed
using the modified grounded theory approach. The main interview questions were How do
you take care of the technology-dependent child in a mainstream school? Has the content
of care changed? If yes, how has it changed and why? What do you think your role
is for the technology-dependent child in a mainstream school? Has your role perception
changed? If yes, how and why did your perception change? Through this job, has
your nursing view changed? and If yes, how has it changed and why?
The Medical Ethics Committee of Kyoto University approved this study (Approval No.
E1513) and it conformed to the principles set forth by the Declaration of Helsinki.
Results
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Most nurses (19) worked in elementary schools and two worked in junior high schools when
the interviews were conducted. All nurses had experience working in elementary schools, and
five of them also had experience working in junior high schools. 16 nurses took care of only
one technology-dependent child and 5 nurses took care of two or three technology-dependent
children attending different mainstream schools when the interviews were conducted. In each
mainstream school where nurses worked, there were one or two technology-dependent
children. The technology-dependent children needed multiple nursing care procedures
including suctioning from tracheostomies, the mouth, or nose, intermittent catheterizations,
parenteral nutrition, instillation therapy, stoma care, oxygen inhalation, stool extraction,
colostomy care, intestinal lavage, ventilator therapy, and inhalation.
12 categories and 37 concepts were derived. These categories divided into three stages: 1)
maintaining physical health with puzzlement, 2) maintaining physical and mental health with
learning, 3) supporting the study among children with realizing. Nurses developed roles from
maintaining physical health to supporting the technology-dependent children's study among
children, through building relationships of mutual trust with teachres, parents, and children,
learning how to interact with children, understanding the children and the school community,
and realizing the meaning of supporting the technology-dependent children's study among
other children.
Conclusions
The role development of nurses who provide nursing care to the technology-dependent
children in mainstream schools leads to promote the these childrens participation and
realize the inclusive education in mainstream schools. Nurses need to build a relationship of
mutual trust and learn on the job in order to develop nurses roles.
3-5 Key words
Mainstream school, technology-dependent children, role development, nurse, modified
grounded theory approach
172
Factors of child dental fear
Ayumi Nakata1, Yoko Sato2, Naoko Miyajima2

1.
Sapporo City University, 2. Hokkaido University
Presenting Authors Email: a.nakata@scu.ac.jp
Purpose
Dental fear affects oral health, and factors of dental fear are rooted in childhood. However,
the relationships among the factors of the child dental fear have yet to be determined. This
study aimed to identify these factors and determine the relationships among them.
Design
In this survey, we enrolled 1,036 pairs of primary school children (4th6th grade) with their
legal guardians in the A area of Hokkaido, Japan.
Methods
The children and their guardians completed our questionnaires from May to June 2012.
The questionnaire for children was constructed with attributes for children from the Japanese
version of CFSS-DS (Dental Subscale of Childrens Fear Survey Schedule), the Japanese
version of STAI-C Trait Anxiety (State-Trait Anxiety Inventory for Children), experience of
fear, impression of dentist. The questionnaire for legal guardians was constructed with
attributes for guardians from the Japanese version of DFS (Dental Fear Survey), STAI-JYZ
(State-Trait Anxiety Inventory, form JYZ) and a dental visit experience of the child.
The data were analyzed using Mann-Whitney U testKruskal-Wallis test, chi-squared test, 2way analysis of variance (multiple comparison), and Spearmans rank correlation coefficient
to explore possible factors of the child dental fear. Structural equation modeling was used to
verify the effect of these factors on the total score of child dental fear.
Results
The mean total CFSS-DS score was 26.9 (standard deviation = 10.97, median = 23.0), and
this score was not significantly different between boys and girls. IN 10 year olds, the CFSSDS score was significantly higher than in 11- and 12- year olds. Children who had had
173
experiences of fear (p < 0.01), had never visited a dentist (p < 0.05), or had a negative
impression of dentist (p < 0.01), had a higher CFSS-DS score.
There was a significant correlation between the total CFSS-DS score and the total STAI-C
trait Anxiety score (rs = 0.465, p < 0.01) but not between the total CFSS-DS score and the
total DFS score (rs = 0.107, p < 0.01). Nonetheless, the total DFS score in the high-fear group
(CFSS-DS 33) were significantly higher than those in the low-fear group(CFSS-DS 32;
p < 0.05 ).
The path coefficient to the total CFSS-DS score was 0.43 from trait anxiety, 0.23 from
experience of fear, 0.15 from the total DFS score, 0.13 from age, 0.11 from dental visit
experience (p < 0.05).
Conclusions
We identified 6 factors of the child dental fear: age, experience of fear, dental visit experience,
trait anxiety, impression of dentists, and a guardians dental fear. The path model showed
that trait anxiety has the strongest correlation with the total CFSS-DS score.
3-5 Key words
Factors, child, dental fear
174
A qualitative study of requests to society from parents of children receiving

developmental support
Chinatsu Nishida1
1.
Graduate School of Clinical Education (Doctoral Course), Mukogawa Womens University , Japan /
Baika Womens University
Presenting Authors Email: tc-2003@mocha.ocn.ne.jp
Purpose
Children with developmental disorders, such as those on the autistic spectrum, often have
problems with school attendance or future employment. Therefore, their parents are likely to
have anxiety related to these problems experienced by their children. Although support for
children with developmental disorders is gradually expanding, the problems of school
absenteeism and unemployment indicate that it is difficult at present for children with
developmental disorders to live in society. We herein report the analysis results of our
interviews with parents of children with developmental disorders to clarify their requests
pertaining to society. At present, the term "hattatsushogai (developmental disorder)" is not
used as a unified term because the Japanese word "gai" has the connotation of harm.
Therefore, the study subjects were referred to as "parents of children receiving developmental
support." However, the term "developmental disorder" has been used in narratives and as a
diagnostic designation.
Design
A qualitative study using the semi-structured interview M-GTA (Modified Grounded Theory
Approach).
Methods
We interviewed 7 mothers and 1 father and recorded the interviews after obtaining consent
from the interviewees. The interview contents were conceptualized for each data item and
categories were extracted. Requests to society were extracted and analyzed, including the
contexts of preceding and subsequent remarks. Their children were 3 to 17 years old, and the
175
diagnoses included autism, Down syndrome, intellectual disability, learning disability,

Attention-Deficit/Hyperactivity Disorder, and no diagnosis (developmental delay).
Results
The following 5 categories reflecting requests to society were extracted: "thoughts regarding
school," "reactions of people to child's characteristics," "support for employment," "difference
from physical disability," and "resistance to being perceived as typical of disability."
Conclusions
The study indicated that parents have various feelings ranging from gratitude to
dissatisfaction toward school, and the requests to society were mostly thoughts regarding
school. They also felt that there is insufficient recognition of developmental disorders in
general society because of differences in how developmental disorders and physical
disabilities are accepted. Parents of elementary school children already feel anxiety about
future employment; we need to prioritize support for employment of children receiving
developmental support as a specific support measure in the future. Parents of children
receiving developmental support participate in many study sessions and seminars; however,
they feel resistance to participating in seminars specifically viewing them as involving
"disability;" it is easier for them to accept viewing their childs condition as "one
characteristic." The study elucidated that the ideal society would be one where their childs
specific disability is recognized as "one characteristic," rather than being viewed as
"disability."
3-5 Key words
Parents of children receiving developmental support, requests to society, characteristics of
children, qualitative analysis
176
Effects of inkblots therapy on anxiety and post-operative pain among 9-11

years old children for circumcision
Jenessa Dominguez1, Katrina Ann Domingo1, Marianne Joyce Domingo1, Xedrick Cesar
Duazo1, Roqsan Apple Dolores1
1.
University of Santo Tomas College of Nursing
Presenting Authors Email: jenadominguez94@yahoo.com
Purpose
Various interventions have been utilized to help reduce anxiety among patients who will
undergo surgical or medical procedures. Color inkblots is a form of therapy that utilizes
colors to allow subjects artistic expression paired with verbalization of feelings. The use of
color inkblots as a therapeutic intervention to assess personality and physiologic issues has
been utilized to encourage pre-circumcision children to convey their feelings for the
approaching surgery. Through the use of the therapy, the subjects would be able to verbalize
their feelings prior to the procedure. Thus, the purpose of the study is to determine the
effectiveness of inkblots therapy on decreasing pre-operative anxiety and decreasing postoperative pain among 9-11 year old children for circumcision.
Design
The study utilized a quasi-experimental pre-test post-test design in an urban community with
a total of 30 randomly-assigned participants: 15 in the control group and 15 in the
experimental group.
Methods
The Filipino version of the Modified State-Trait Anxiety Inventory for Children (STAIC),
with a Cronbachs alpha of 0.87, was used to measure the preoperative anxiety while the
Visual Analog Scale (VAS) was used to measure the post-operative pain. Independent and
paired t-tests were used to analyze the gathered data. It has been reviewed and approved by
the Ethics Review Board.
Results
177
The pre-test mean anxiety scores of the control (M=23.6; SD=2.69) and experimental groups
(M=23.8; SD=2.98) revealed that there is no significant difference between the two (t=-0.19;
p=0.85). Concurrently, there was a significantly higher (t= 3.54, p= 0.001) post-test mean
anxiety score in the experimental group (M=19; SD=3.07) compared with the control group
(M=22.8; SD=2.81). From the paired t-test analysis, it showed that the post-test mean anxiety
score was significantly higher than the pre-test mean anxiety score of the experimental group
(t=5.64; p=0.001). Lastly, there was no significant difference (t=1.79; p=0.08) between the
mean post-operative pain scores of the control (M=4.4; SD=2.64) and the experimental
groups (M=2.8; SD=2.24).
Conclusions
The use of inkblots therapy is an effective way to decrease the preoperative anxiety of
children aged 9-11 for circumcision. Inkblots therapy can be used as another way to decrease
the preoperative anxiety of children aside from the provision of health teachings.
3-5 Key words
Color inkblots, inkblots therapy, pre-operative anxiety, post-operative pain, art therapy
178
Effectiveness of Buteyko method in asthma control and quality of life of

school-age children
Zarah Libozada1, Romella Lina1

1.
Presenting Authors Email: zdlibozada@gmail.com
Purpose
Asthma affects not only the physiological status of school-age children but also their over-all
functional capacity. This may eventually impede personality development if not managed
promptly and adequately. This study aimed to determine the effectiveness of Buteyko Method
in improving asthma control and quality of life of school-age children.
Design
This study utilized a quasi-experimental design since not all of the three elements of a true
experiment were attained
Methods
This study utilized a pre-test post test design to measure the changes in asthma control and
quality of life after the administration of Buteyko Method. Fourteen (14) subjects diagnosed
with bronchial asthma, age 7 - 11 years old participated in the study. They were equally
divided into two groups: the control group received no intervention while the experimental
group was asked to attend sessions of Buteyko Method lecture and demonstration. The
experimental group was visited for three (3) consecutive weeks to monitor their progress and
compliance. Moreover, each group was asked to answer ACQ pre- and post-intervention and
PAQLQ before the start of the intervention phase and every week during the follow-up visits.
Results
In comparing the asthma control pre-test and post-test mean scores of the control group, no
significant difference was noted (p=0.177) while the experimental group showed a significant
difference after the administration of Buteyko Method (p=0.002). On the contrary, the quality
of life pre-test and post-test mean scores of the control group showed no significant difference
179
in any week within one month of follow-up (p=0.736, 0.604, 0.689). On the other hand, the
experimental group showed a significant difference on the third visit (p = 0.035) and fourth
visit (p=0.002) but no significant difference on the second visit (p=0.111).
Conclusions
The use of Buteyko Method within 3-4 weeks as an adjunct to conventional management of
asthma helps in improving asthma control and quality of life of school-age children.
3-5 Key words
Buteyko method, asthma, quality of life, asthma control, school-age children
180
Factors associated with health related quality of life of adolescents with

congenital heart disease
Hsiao-Ling Yang1
1.
National Taiwan University, College of Medicine, Department of Nursing
Presenting Authors Email: slyang@ntu.edu.tw
Purpose
This study aimed to explore the Health Related Quality of life (HRQoL) of adolescents with
Congenital Heart Disease (CHD) in Taiwan, and its associated factors, especially focusing on
disease severity, parenting style, and patients knowledge about their heart disease.
Design
Comparative, correlational, cross-sectional research designs
Methods
Research subjects consisted of 162 adolescents with CHD and 578 healthy adolescents. The
research data were collected from adolescents with CHD within the period of July 2010 to
August 2011 at the Department of Pediatric of National Taiwan University Hospital. From
April to May of 2012, data were collected from healthy adolescents studying at junior or
senior high schools located in North, Central, South, and East of Taiwan. Subjects were
requested to answer self-report questionnaires, which included PedsQL TM 4.0 Generic Core
Scale, PedsQLTM 3.0 Cardiac Module, Parental Bonding Instrument, Leuven Knowledge
Questionnaire for Congenital Heart Disease, and demographic form.
Results
The overall generic HRQoL score of adolescents with CHD was lower than that of healthy
adolescents after the demographic data and family background information of both two
groups of subjects were controlled to exclude significantly different variables. Disease
severity was only correlated to physical functioning and overall score of general HRQoL.
After controlling the other variables, paternal care, paternal overprotection, maternal care, and
maternal overprotection were significantly correlated to most domains of HRQoL of
181
adolescents with CHD. The overall score of general HRQoL was positively correlated to
maternal care. No evidence suggesting correlation between disease knowledge of adolescents
with CHD and their HRQoL was found.
Conclusions
Parenting style was found to statistically associate with adolescents HRQoL. Parents should
be given not only knowledge about the disease, but also guidance and instructions about
parenting to their children with CHD.
3-5 Key words
Congenital heart disease, adolescent, parenting style, knowledge, disease severity
182
Study into the effectiveness of education through asthma classes for

mothers of children with bronchial asthma
Keiko Hosono1
1.
Asahikawa University Faculty of Health and Welfare Science Department of health and Nursing
Presenting Authors Email: hosono86@live.asahikawa-u.ac.jp
Purpose
To clarify the effects of education through asthma classes held for the mothers of children
who periodically visit hospitals for treatment of bronchial asthma, and to study the
effectiveness and issues related to such education.
Design
Qualitative Descriptive Study
Methods
Asthma classes were planned and held in 2013 as part of the health education of the mothers
of child patients who regularly visit pediatric allergy outpatient clinics for the treatment of
bronchial asthma. As these planned asthma classes are still in the trial stage, the asthma
classes were planned so that each target participant could attend at least once, and mothers
were encouraged to attend. An attending physician (pediatrician) was requested to teach the
classes, the content of which included characteristics of the illness (bronchial asthma),
medication, the significance of preventative medicine and living environment maintenance. A
semi-structured interview study was undertaken after the classes to evaluate the understanding
of the participating mothers. The study mainly included what the mothers were able to
understand after attending the class, their impressions of the class after participating and their
future requests for the classes. Data obtained from the interview study was analyzed using
qualitative and inductive analysis.
Results
Asthma classes were held twice during 2013, once each in November and December, and
participants were able to choose to attend either class. Five of the eight mothers who were
183
invited to attend the classes actually attended. As a result of attending the classes, the
participants gained an understanding of issues such as the importance of preventing asthma
attacks in severe cases of bronchial asthma, that preventative medicine must be taken
continuously without fail, and the effective period of oral medicines. Impressions were that
the content of the classes was easy to understand, participants were able to ask questions and
they were happy to have participated. Future requests were for the continuation of these
classes in the future.
Conclusions
Through participation in asthma classes, the participants were able to obtain a basic
knowledge of bronchial asthma, and indicated an understanding of the importance of asthma
attack prevention and the significance of preventative medicine. The opportunity to ask
questions to an attending physician was linked to the level of satisfaction of the participants.
These results support suggestions that an increased awareness of the importance of treatment
may lead to more active medication management by the participants. Future issues include
designing PR that communicates the significance of participation in asthma classes,
increasing the number of participants and providing a setting in which participants can
exchange information with each other.
3-5 Key words
Bronchial asthma, asthma class, effect of education
184
Relations of PDQ II developmental screening with physiological and

environmental characteristics of premature infants at age of six months
Kyung-Sook Bang1, Hyunju Kang1

1.
College of Nursing, Seoul National University
Presenting Authors Email: ksbang@snu.ac.kr
Purpose
Due to recent medical advance, the survival rate in children who are born premature is
increasing. According to many studies, premature infants are at risk for developmental
problems. Not neonatal factors such as birth weight, gestational age, and medical
complications but mother-infant interaction is related to development of premature. But little
is known about various physiological and environmental variables for premature babies
development, especially in Korea. The purpose of this study was to monitor the development
of Korean premature infant at six month age, and to explore the relations of the
developmental states of them with their physiological and environmental characteristics.
Design
This is a longitudinal prospective study.
Methods
The participants were 53 mothers of premature infants who were admitted to neonatal
intensive care unit in one university hospital, and whose corrected age were 6months. The
physiological characteristics of infants were investigated with the medical record. The
developmental states of infants were followed-up by home visiting with Korean Prescreening
Developmental Questionnaire (KPDQ II). Also, the environmental characteristics including
Edinburg Postnatal Depression Scale (EPDS), husbands support, social support, and
mother-infant attachment were assessed with mothers self-report questionnaires.
Results
Approximately 43% of the infants belonged to the questionable group in KPDQ II screening.
There were significant difference between normal group and questionable group of KPDQ II
185
depending on gender (2=7.76, p=.005), gestational age (t=2.17, p=.035), and revised NBRS
score (t=-2.42, p=.019). Mother-infant attachment score of questionable group was
significantly lower than that of normal group (t=2.36, p=.024).
Conclusions
These results suggest that mother attachment as well as physiological state of premature
infants is important variable in early development. Therefore, the early monitoring for the
development has to be done in physiologic vulnerable premature groups. Providing proper
nursing support for improving maternal attachment needs to be considered.
This work was supported by National Research Foundation of Korea (NRF-2011-0009987).
3-5 Key words
Premature, development, attachment, physiologic state, environment
186
Validation of the Chinese version of the family hardiness index and the
family resilience scale among families with adolescence
Hsiang-Yun Lan1, Jen-Jiuan Liaw2, Luke Yung3

1.
National defense medical center/, 2. National defense medical center/ nursing school, 3. Hsuan
Chuang University/ Department of Social Welfare
Presenting Authors Email: shinnylan@msn.com
Purpose
Families possess unique and innate qualities, strength, and skills that enable their members to
adapt to lifes transitions and challenges. Adolescence is a transitional period that requires
special attention and protection. During adolescence, the brain undergoes quite substantial
developments, which affect emotional skills as well as physical and mental abilities. Family
plays an important role in helping adolescences adapt to the big changes of their physical
maturity and emotion regulation. This study was designed to examine the reliability and
validity of the Chinese version of the Family Hardiness Index (FHI) and the Family
Resilience Scale (FRS). In addition, this study examined the relationship between the family
function and family resilience in families with adolescence.
Design
The study was a cross-sectional and exploratory design. Data were collected by using the
questionnaires of FHI and FRS. Adolescences from13 to 19 years old were recruited into this
study in eastern Taiwan. Family hardiness and family resilience were measured. Hardiness is
a characteristic that helps families resist stress and cope. The FHI was developed to measure
family function. The FRS was used to examine how family deals with crises and ongoing
stresses.
Methods
The Chinese version of FHI and FRS was developed using domain identification, expert
reviews, and testing for construct validity and instrument stability. After initial item analysis,
the construct validity and reliability of the FHI and FRS were examined. There were totally
275 healthy adolescences enrolled and 270 completed the questionnaires. Written
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questionnaires were administered to the adolescences who agree to attend the study. We used
factor analysis to examine the construct validity of the Chinese version FHI and FRS, and
Cronbachs alpha to calculate the internal consistency of the FHI and FRS.
Results
The results suggest that internal consistency was 0.796 and 0.979 for the FHI and the FRS,
respectively. The exploratory factor analysis of the FHI showed four factors: co-oriented
commitment, confidence, challenge, and control. The KMO is 0.895, and the Bartletts test
of sphere is 2227.98 (p<0.001). There are three factors loaded by the FRS. They are family
belief systems, family organizational patterns, and communication/problem-solving process.
The KMO is 0.969, and the Bartletts test of sphere is 8152.56 (p<0.001).
Conclusions
The preliminary evidence suggests that both the Chinese-version FHI and FRS are valid and
reliable scale. The FHI is able to reliably and validly assess the family function from families
with adolescence in Taiwan, and the FRS can be used to reliably and validly measure the
family resilience. Both instruments can be used as screening tools when family faces some
transitions and challenges. Future research also can use the two measures to evaluate the
effects of clinical interventions developed for the family during crisis.
3-5 Key words
Family hardiness index (FHI), family resilience scale (FRS), validation
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Concept analysis of Childrens independence

Hisae Tabata1, Miki Konno1, Masumi Hasegawa1, Megumi Toriya1
1.
Sapporo Medical University
Presenting Authors Email: hisaet@sapmed.ac.jp
Purpose
This study was carried out to examine the meaning of childrens independence
currently prevalent in Japan, with a wider aim of developing a framework to support children
with congenital heart disease in their independence development process.
Design
Rodgers concept analysis was applied in this study.
Methods
56 papers, all written in Japanese, were selected as samples. They consisted of 23 papers in
nursing science, 30 papers in education and psychology disciplines, one dissertation and two
books. A web search was made on the Japan Medical Abstracts Society website to locate
literature in nursing science addressing the childrens development, using children and
independence as key words; out of 55 papers found, 23 (42%) were available to the
authors. Literature in education and psychology was sourced from the Scholarly and
Academic Information Navigator database service (CiNii), out of 121 papers detected, 30
(25%) were available to the authors. Each paper was examined to identify attributes,
antecedents and consequences of childrens independence, using literature summary
sheets for data organization. The study was supervised by three researchers in nursing
science with specialist knowledge in concept analysis.
Results
1.Three attributes were identified. They were (1) childrens independence is active and has
different levels, (2) there is a cycle in the development of childrens independence, and (3)
interpreting the childs independence from his words and action is not always
straightforward. There were two underlying categories for (1). They were (a) active self-
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recognition and emotions (deriving from such descriptions as a sense of being in the
spotlight, forward-looking, ability to control feelings, and ability to think and
judge by oneself) and (b) proactive behavior (being categorized from such descriptions as
acting at ones pace, ability to express oneself, willingness to challenge,
ability to accommodate the situation and work together, and ability to judge and cope
by oneself).
2.Two antecedents identified were (1) the state the child is in (consisting of such categories as
development, affection, cognition and experience), and (2) the environment the child is in.
The underlying categories for (2) were (a) interaction by surrounding adults to, among others,
understand and respect children and ensure their safety and freedom, (b) values and feelings
of surrounding adults which affected their interaction with children, and (c) the childs
relationship with peers and surrounding adults.
3.Seven consequences were identified. They were (1) to develop a sense of self, selfaffirmation and self-esteem; (2) to improve communication skills and the ability to think; (3)
to gain confidence, satisfaction and a sense of achievement; (4) to have a will to overcome; (5)
to have the ability to cope and adapt; (6) to regard pain and challenges as a positive
experience; and (7) to build a trusting relationship with surrounding adults.
Conclusions
Three attributes, two antecedents and seven consequences were identified from the concept
analysis of childrens independence based on the Rodgers approach. The findings
will be used as useful input in developing a framework to support children with congenital
heart disease in their independence development process.
3-5 Key words
Children, independence, concept analysis
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Oral motor interventions to improve oral feeding performance in preterm

infantsA systematic review
Yu-Wen Wang1, Hsiao-Ying Hung1

1.
Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University
Presenting Authors Email: arfadima@gmail.com
Purpose
Feeding problem is a major complication of preterm infants and might influence infants
growth, neurological development, and the length of hospital stay. A number of strategies had
been investigated to facilitate oral feeding. According to the variations in interventions and
outcome measurements of earlier studies, the effects of oral motor intervention havent been
concluded. The purpose of this study was to evaluate the current evidence for the
effectiveness of oral motor interventions on feeding performance in preterm infants.
Design
A systematic review of clinical control trials and cohort studies.
Methods
This study was carried out according to the Cochrane Handbook for Systematic Reviews.
Electronic search was conducted in PubMed, MEDLINE, and the Cochrane Library between
January 2007 and August 2014. All published randomized controlled trials, quasiexperimental studies, and cohort studies that examined the effectiveness of oral motor
interventions in preterm infants were eligible for this review. The quality of studies was
evaluated by two researchers with the quantitative evaluation criteria of the Critical Appraisal
Skills Programme developed by National Health Service in the U.K..
Results
Twenty-six studies were included in this review. Eligible studies were divided in 7 groups
according to the interventions. There were 12 studies in oral stimulation, 1 in swallow
exercise, 3 in tactile/kinesthetic sensorimotor intervention, 11 in non-nutritive sucking, 3 in
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patterned orocutaneous stimulation, 3 in pacifier-activated-voice system, and 3 in oral support.

The outcomes of feeding performance studied included the transition time of learning-to-feed
period, suck/swallow/breathe patterns, feeding efficiency, physiological responses, age of
successful oral feeding, growth, length of hospital stay, complications, and long-term
development. Consistent results showed that oral stimulation could reduce transition time of
learning-to-feed period, improve sucking power, and enhance feeding efficiency in preterm
infants. Non-nutritive sucking could reduce transition time of learning-to-feed period.
Patterned orocutaneous stimulation could improve sucking ability. However, there was a lack
of evidence related to physiological responses to oral feeding and the outcome of long-term
development.
Conclusions
The current evidence demonstrated that oral stimulation and non-nutritive sucking could
improve the short-term outcome of feeding performance.
3-5 Key words
Oral motor intervention, oral stimulation, oral feeding, feeding performance, premature
infants
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The actual situation of the NICU long-term hospitalization child's nursing

in Japan
Maki Shirasaka1
1.
Department of Clinical Nursing,SHIGA UNIVERSITY OF MEDICAL SCIENCE
Presenting Authors Email: kitamaki@belle.shiga-med.ac.jp
Purpose
In Japan, although the number of birth is decreasing, the number of the high-risk children
hospitalized in NICU (Neonatal Intensive Care Unit) is increasing. Especially, since the rate
of lifesaving went up, children with an advanced disease are increasing in number. The nurse
is taking pains over the care towards a long-term hospitalization child's leaving hospital in
such a situation. The aim of this study is to clarify the actual situation of nursing to the NICU
long-term hospitalization children and their family.
Design
Its the qualitative research.
Methods
Subjects were NICU nurses who have experienced care giving to long-term hospitalization
babies and their family. They were interviewed about their nursing experience by semistructured interview guide. The contents of interview were analyzed inductively. For ethical
condition, we explained to the subjects about contents of this study and got the informed
consents. The research was approved by the ethical committee of Shiga University of Medical
Science.
Results
10 NICU nurses were interviewed. We found several categories of the actual situation of a
NICU long-term hospitalization child's nursing as follows
- Pains is taken over an unstable diagnosed infant's nursing.
- Nursing which values the familys intention.
- Special consideration at the time of conveying a family's intention to a doctor.
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- Efforts to keep a relation with a family.

- Anxious in the family who brings up a serious illness child.
- Efforts to collect the information on the area on which a child lives.
- Nursing which is conscious of multi-occupational description cooperation.
- Nursing which forms a family's bonds, etc.
Conclusions
The NICU nurse always checks and respects a family's feeling. They perform lifesaving of a
diagnosed infant, and the care for aspect stability, and do their best in family formation
support. Furthermore, it is in cooperation with many occupational descriptions to collect the
information on the area after leaving hospital.
This work was supported by JSPS KAKENHI grant Number 26463411.
3-5 Key words
NICU nurse, long-term hospitalization baby, family care
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The childcare living survey of the parents of the child who left NICU
Maki Shirasaka1
1.
Department of Clinical Nursing,SHIGA UNIVERSITY OF MEDICAL SCIENCE
Presenting Authors Email: kitamaki@belle.shiga-med.ac.jp
Purpose
The aim of this study is to clarify actual condition of the parents who bring up the child who
left NICU (Neonatal Intensive Care Unit). In Japan, while the number of decrease, the
number of the newborn infants who enter NICU in JAPAN is increasing. Bringing-up of the
child who left NICU requires consideration, and cooperation between father and mother is
important.
Design
Its the quantitative research method.
Methods
The subjects of this study are parents of post NICU children.
Investigation cooperation was explained to parents from the visitor doctor in attendance. A
questionnaire study was conducted during November, 2012 - November, 2013.The
questionnaire content includes the condition of mind and body, the pleasure of child- rearing,
time spend on child-rearing, etc. Statistical analysis was conducted and chi-squared test was
performed among 2 groups of father and mother. The significance level was made into
5percent. For ethical condition, we explained to the subjects about contents of this study and
got the informed consents. The research was approved by the ethical committee of Shiga
University of Medical Science.
Results
Effective answers were obtained from 150 couples [mother and father], and a total of 300
subjects (recovery rate; 41.5%).Results were as follows. (1) Parents in good condition [mind
and body] were about 50-60 percent.(2) 30-40% feels difficulty for child-rearing, and the
father and mother did not have the significant difference. (3) Compared with the father, the
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mother was in the situation where it cannot have own time. (4) The mother was evaluating the
mental support from father. (5)Many parents were satisfied with NICU and pediatrics visitor
medical treatment and nursing.
Conclusions
Although there was little time which can have the mothers themselves, the mothers were
evaluating the mental support from fathers.
This work was supported by JSPS KAKENHI grant Number 292222, 26463411.
3-5 Key words
Post NICU baby, child care life, parents
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Stationary sound surrounding preterm infants within occupied-closedincubator
Aya Shimizu1, Hiroya Matsuo1

1.
Graduate school of Health Sciences, Kobe University
Presenting Authors Email: ashimizu@penguin.kobe-u.ac.jp
Purpose
Preterm infants in the neonatal intensive care unit are commonly exposed to noise exceeding
the recommended levels, which may result in adverse health effects. Non-invasive respiratory
management has been recently implemented for preterm infants to prevent
pneumomediastinum, and this represents one of the major contributors to this high noise level.
This study was conducted to describe the sound pressure level (SPL) and sound frequency
level (SFL) surrounding preterm infants within closed incubators utilizing the respiratory
mode as well as High Frequency Oscillation (HFO) or nasal Directional Positive Airway
Pressure (nasal-DPAP).
Design
Observational study.
Methods
Preterm infants who participated more than once at an interval of approximately 2 weeks
before the corrected age of 33 weeks, and whose parents provided written informed consent,
were included in this study. Sound was recorded using a High Function Sound Level Meter
(HFSLM) LA-5560K during the dayshift. Our researcher, or the nurse caring for the preterm
infants, placed a covered microphone (for protection against wind) and recorded sounds from
1) beside (outside) the respirator, 2) near the neonates head inside the incubator with
opened windows, and 3) near the neonates head inside the incubator with closed windows.
The HFSLM was located outside the incubator. Based on previous studies, an equivalent
continuous sound level (Leq) >45 dBa and SFL >1 kHz were considered high.
Results
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Eight preterm infants participated in the study a total of 17 times (HFO, n=8; nasal-DPAP,
n=9; total measurement duration = 31 h 23 m). The mean gestational age at birth, corrected
age at birth, and infant body weight at observation were all smaller in the HFO setting than
for n-DPAP (gestational age at birth: 23.251.17 vs. 26.002.92 weeks, P<0.05; corrected age
at observation: 29.381.92 vs. 31.440.73 weeks, P<0.01; infant body weight at observation:
838.00191.74 vs. 1052.78176.97 g, P<0.01). The inside SPL did not correlate with the
corrected age at observation, regardless of the respiratory mode. The mean inside Leq with
closed windows was significantly higher in the nasal-DPAP than in the HFO mode (63.66
3.45 vs. 49.301.69, P<0.001). Additionally, in the nasal-DPAP mode, the inside Leq with
closed windows did not significantly differ from the other values, whereas in the HFO mode,
the inside Leq with closed windows was significantly lower than that beside the respirator
(49.301.69 vs. 54.241.34, P<0.05). The high frequency range in the nasal-DPAP setting
was associated with a higher SPL than in the HFO setting.
Conclusions
The nasal-DPAP mode resulted in higher SFL and SPL compared to the HFO mode. As a
non-invasive respiratory approach has recently been implemented to prevent
pneumomediastinum for preterm infants, nasal-DPAP currently tends to be used after birth for
these infants. The care provider should assess the adverse effects of the sound intensity
produced by the respirator, and measures to decrease the sound level should be taken to assure
that preterm infants are not exposed to exceeding noise.
3-5 Key words
Preterm infant, stationary sound, environment, frequency analysis, developmental care
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The review of the children in need of medical care at home in Japan
Akemi Hara1
1.
Graduate School of Nursing Art and Science,University of Hyogo
Presenting Authors Email: cm13n005@stcnas.u-hyogo.ac.jp
Purpose
The aim of this paper is to describe on childrens living condition which require with
medical and nursing care at home in Japan through literature.
Design
systematic review of literature
Methods
The review was conducted via keyword searches using the Japan Medical Abstracts Society
Online. A total of 90 papers that met the aim of the present study were collected and
analyzed.The articles were published between 1994 and 2014, and the keywords were
homecare, medical care, child(or children), family, and
experience.
Results
Upon the analyzing the papers following categorized into were found support of transition
to home of children in need of medical care; situation of the children in need of medical
care; life of caregivers of children that require medical care; parenting view of
mother to nurture children that requires medical care; the needs and challenges of
children and families that require medical care and nursing practice to the children and
families that require medical care. The 44 articles out of 90 studies were focused on
mothers or families for the research subjects. The only two researches of the children living at
home were founded. The living condition of a child and their family has became known.
However, there are not enough resource to support children and their family's home life. The
report of the child-based care method is not found.
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Conclusions
The findings suggest that it is necessary to examine the comprehensive support system for a
child and their family. More research are required for the child centered care.
3-5 Key words
Homecare, medical care, children, family, nursing
200
The thoughts and feelings of siblings living with children with severe motor
and intellectual disabilities
Chieko Numaguchi1, Kaori Nishigaki2, Rie Wakimizu3, Hiroshi Fujioka4, Naho Sato5,
Keiko Yamaguchi6
1.
Ibaraki Prefectural University of Health Sciences, 2. Tokyo Healthcare University, Faculty of
Healthcare, Division of Nursing, 3. Division of Health Innovation and Nursing, Faculty of Medicine,
University of Tsukuba, 4. Department of Nursing, Faculty o f Health Sciences, Tsukuba International
University, 5. Department of Child and Family Nursing,Graduate School of Nursing, Chiba
University, 6. Clinical nursing section, Faculty of Nursing Sciences, University of Tsukuba
Presenting Authors Email: moric@ipu.ac.jp
Purpose
To shed light on the thoughts, feelings, and experiences of siblings living at home with
children with severe motor and intellectual disabilities (SMID) concerning children with
SMID, themselves, and public support arrangements, and to investigate empowerment of
families with children with SMID from the perspective of siblings.
Design
The study adopted the qualitative descriptive approach.
Methods
Semi-structured interviews were conducted with siblings aged 12 or over of children with
SMID living at home. Interviews were recorded with the consent of the participants, from
which verbatim transcripts were prepared and analyzed. Interviews were conducted between
October 2013 and March 2014.
Results
1)Characteristics of children with SMID.
The children were aged between 4 and 22, and the average age was 13. The main conditions
were encephalopathy, cerebral palsy, and genetic disorders.
2)Attributes of participants.
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The participants consisted of 10 siblings living at home with a child with SMID. They ranged
in age from 12 to 19, and had an average age of 15.4. Three were younger and seven older
than the sibling with SMID.
3)Thoughts and feelings of siblings.
(1)Thoughts and feelings concerning children with SMID.
Regarding children with SMID, the participants considered their siblings to be ordinary
and helpful, and their disabilities to be nothing special. At the same time, however,
they expressed hope that they will recover, a belief that they should provide support
themselves, and anxiety.
(2)Thoughts and feelings concerning selves.
Reflecting on their early childhood, the participants indicated that they experienced some
loneliness. Now they feel pride in having cared for a child with SMID and realize
the positive impact of living with a child with SMID. Concerning their futures, they saw
their own future is with sibling with SMID, but also had thoughts of own life
independent from the sibling with SMID.
(3)Thoughts and feelings concerning public support arrangements.
The participants accepted public support as normal and felt gratitude for support
due, for example, to its role in mitigating the burden on their parents. However, they also
indicated that they feel that public support is unnecessary as their families are able cope
to through their own efforts at present, or that, though they use public support services, they
sense issues at present with them. They also recognized that problems emerge as
children with SMID grow up, such as a lack of facilities and job choices after they finish
school.
Conclusions
The siblings of children with SMID see them as ordinary siblings. In the long term, however,
they also believe that they themselves should support their siblings and see their futures as
being alongside them. The siblings recognize the increased need for public support as children
with SMID grow up, and this study suggests that support is needed to help maintain a balance
of family and public support so that the burden does not fall too heavily on siblings in the
future.
3-5 Key words
Children with severe motor and intellectual disabilities, siblings, feelings, public support,
empowerment
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An experience on helping families learn home parenteral nutrition
Shu-Yi Tseng1, Shu-Ling Tu1

1.
Changhua Christian hospital
Presenting Authors Email: 64109@cch.org.tw
Purpose
Short bowel syndrome (SBS) is a disorder caused by the surgical removal of large part of
intestine due to congenital or acquired factors. The gastric emptying rate increases and
patients with SBS often have diarrhea. The bowel dysfuction results in complications, such
as malabsorption, and full pulse nutrution is required. After patients stay stable, they need to
learn how to perform home parenteral nutrition, which brings pressure to them and their
families. The purpose of this study is to explore the problems and pressure the familiy
members of a patient with SBS faced while learning home parenteral nutrition, and how the
medical team provided resources and assistance.
Design
The subject of this study is a premature baby born at 33 weeks and 5 days on Oct. 8, 2012,
weighing 3208g. Bowel resection was conducted and about 30 cm of jejunum was left due to
meconium peritonitis and congenital jejunal atresia. The case was diagosed as congenital
short bowel syndrome. Observation, interviews and direct care were performed for an holistic
evaluation from Jan.6, 2013 to March 11, 2013 by the researcher. Home parenteral nutrition
education was provided to the family members.
Methods
Intravenous nutrition was provided to this case during hospitalization. While explaining
intravenous nutrition-related issues to the family, it was found that the family had difficulty in
performing home parenteral nutrition due to heavy daily work and financial problems. The
medical team succeeded in inviting the family to be part of the caring plan and provide
medical resources and consultation. The case was discharged for home parenteral nutrition on
March 12, 2013.
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Results
Through telephone interviews and home visits, the subjects father was observed to prepare
and operate pump correctly. The medical wastes were classified and stored properly.
Medications were strored correctly and documented in details. The calorie intake of the case
reached 110kcal / kg / day, enteral nutrition was increasing gradually, and parenteral nutrition
calorie was reduced.
Home parenteral nutrition ended because of catheter occlusion on May 27, 2013. Completely
oral feeding was suggested. Through telephone interviews with the father, the subjects
condition was acceptable. The case was energetic, yet showed developmental delay. The
family was satisfied with the outcome.
Conclusions
Short bowel syndrome is caused by a surgical removal of large part of instestine, resulting in
complications, such as malnutrition and malabsorption. Home parenteral nutrition is
commonly used to provide nutrition. The possible factors affecting the prognosis are age,
underlying diseases, sites and lengh of removal, caregivers age and learning attitude. At
the beginning, the family encountered difficulty in learning home parenteral nutrition. With
the assistance of the medical team, they were able to adjust and help the case to have oral
intake. The case demonstrated development delay, yet no significant difference was noticed.
It is expected that this caring experience contributes to home parenteral nutrition education.
By providing medical resources and consultation, the life quality of patients with SBS will be
improved, and their health will be maintained.
3-5 Key words
Short bowel syndrome, home parenteral nutrition, health education
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Cross-cultural adaption and validation of Taiwan version of the family

management measure (FaMM)
Chia-Hsuan Lin1, Fan-Hao Chou1

1.
KAOHSIUNG MEDICAL UNIVERSITY
Presenting Authors Email: hsuan0100@gmail.com
Purpose
To test the psychometric properties of the cross-cultural adapted Taiwan version of the
Family Management Measure (FaMM).
Design
The research design of this study is a crosssectional questionnaire survey.
Methods
The FaMM measure was translated based on well-established guidelines (Beaton, Bombardier,
Guillemin, & Ferraz, 2000). After translation and back translation, cultural appropriateness
will be examined further. To confirm the semantic, idiomatic, experiential and conceptual
equivalence, the Taiwan version (FaMM-TW) will be reviewed by clinical experts. The
psychometric test will be conducted by internal consistency reliability, test-retest reliability,
content validity, and construct validity.
Results
The FaMM-TW has a good content validity index(CVI). Reliability and validity of FaMMTW has been established.
Conclusions
The Family Management Style Framework(FMSF) is a well-developed theory to understand
how families incorporate condition management into everyday family life. Family
management plays an important role in family and individual functioning. The FaMM is a
conceptually grounded measure that has been used in diverse family and cultural contexts.
However, culture and language varies in different countries and necessitates the adaptation of
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measures to be culturally appropriate. A cultural-appropriate FaMM measure would

contribute to a better understanding of how families in Taiwan respond to a childs chronic
condition. Validated Taiwan Version of the Family Management Measure (FaMM) will
provide a sensitive and reliable tool to assess in families who has a child with chronic
condition in Taiwan.
3-5 Key words
Family management measure, cross-cultural adaption, validity, reliability
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Self-conceptions of solitary seniors living at home A concept analysis
Tanaka Haruna1, Greiner Chieko1

1.
Department of Home Nursing,Fuculty of Nursing Kobe University School of Health Sciences
Presenting Authors Email: haruna@people.kobe-u.ac.jp
Purpose
In a 2010 survey, over 60% of Japanese seniors responded that they hoped to continue living
in their current homes, even if they become physically frail.
The Act on the Protection of Personal Information and the trend towards the nuclear family
led to individualism; this affected interpersonal relations at the local level and raised serious
concerns in relation to the social isolation of seniors living alone. While it is believed that the
self-conceptions of contemporary seniors have been greatly affected by these generational
transitions in social values, very little research related to this topic can be found.
The provision of support that helps facilitate a better quality of life for seniors living at home
in a community environment needs to approach the self-conceptions that shape the
foundations of their thought and behavior. An appropriate approach requires in turn the
development of a Self-conception Scale relating to the Continuation of Home Life for
Solitary Seniors. The development of such a scale first requires a clarification of selfconceptions. Therefore, this study sought to conduct an analysis of these self-conceptions in
order to clarify their component elements for the purpose of conceptual definition.
Design
Clarification of the structure of these concepts was carried out using the concept analysis
approach described by Walker and Avant.
Methods
This technique is a method for defining a concept by identifying textual attributes from the
related scholarly literature, building model and borderline or contrary cases, and identifying
antecedents and consequents.
Articles within the scholarly literature related to self-conceptions of solitary seniors living
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at home were identified using the Ichushi-Web database, as well as others such as PubMed,
CiNii, CINAHL, and ERIC. Additional articles for analysis were identified through manual,
first-hand research. These methods resulted in an explicit definition of concepts.
Results
Antecedents factors included first-hand and repeated experience, relationships with
significant others, relationship with lifestyle and physical condition, and objective
views of self. Attributes included self-regulation, a framework for deciding future
conduct, self-recognition of role and function, sense of belonging, the state of
ones awareness of being elderly, assessment of others, and incorporation and
acceptance of social values. Consequences included the reconstruction of values,
existential value and significance, self-assessment, and role-shifting. Concepts
were defined on the basis of these component elements.
Conclusions
These concepts can be effectively utilized to understand the realities of lifestyle support for
solitary seniors living at home in Japans future super-aging society. They can also be used
for clarifying factors pertaining to the continuation of life at home and improving educational
and research activities. Moreover, they will provide foundational data for the development of
a Self-conception Scale relating to the Continuation of Home Life for Solitary Seniors.
3-5 Key words
A concept analysis, self-conceptions, solitary seniors, walker and avant, solitary seniors
living at home
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The impact of training parents by acceptance and commitment therapy

(ACT) for managing their children with chronic health problemsA
literature review
Chong-Yuen Yu1, Mak-Yim Wah1, Loke Alice Yuen1

1.
The Hong Kong Polytechnic University
Presenting Authors Email: connie.yy.chong@connect.polyu.hk
Purpose
Background:
Many parents experience various levels of psychological difficulties when taking care of
children with chronic health conditions (CHC), yet they did not response effectively to
traditional behavioral therapies as cognitively restructuring distress is practically difficult.
Some parents who exercise with acceptance-based coping were found to be less distress.
Acceptance and Commitment Therapy (ACT) helps to enhance the effectiveness of traditional
behavioral therapies. Reviews demonstrated strong evidence of ACT on psychological
problems among adults, there still remains a paucity of outcome studies that have focused
exclusively on parents with children under CHC.
Purpose:
To examine the changes in well-being of parents and their children from parental participation
in an ACT-based training programmes specifically designed for managing children with
chronic health problems
Design
A literature review
Methods
Selection criteria:
Intervention studies included in the review met the following criteria: (a) the participants must
be parents with children diagnosed with chronic health problems; (b) at least one treatment
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group used ACT intervention for training parents and (c) the report was primarily a treatment
outcome study.
Search methods:
Electronic databases including Medline via Ovid; CINAHL via EBSCO Host; PsycINFO via
ProQuest and Cochrane Central Register of Controlled Trials via Cochrane Library were
searched for articles in English published from 1980 till September 2014. Other strategies
were hand-searching, scanning reference lists of selected studies and citation searching of the
studies.
Results
Eight intervention studies meeting selection criteria were identified. A total of 278 parents
with children aged 2-18 with various CHC were included. CHC of the children involved with
autism, idiopathic pain, sickle cell disease, anorexia nervosa, cancer and cerebral palsy.
Various study designs were adopted, including randomized controlled trials (n=2), pre-post
repeated measure studies (n=5) and case report (n=1).
It was not possible to combine the findings of the identified studies because of different
outcome measures were used.
The six core components of ACT were used in all the studies. A positive impact of parental
psychological well-being was found. The impact included less depression and distress (n=4);
an improvement in parental behaviors (n=2) and a positive effect on childrens physical
health, such as weight gain among children with eating disorder and pain reduction among
children with idiopathic chronic pain receiving pharmacological therapy (n=4). Five out of the
eight studies assessed parental psychological flexibility, a core ACT process mediator, only
one found strong correlation with the parent and child outcomes.
Conclusions
Acceptance and Commitment Therapy (ACT)-based training approaches are a strategy of
effective intervention on parents caring their children with chronic health conditions.
3-5 Key words
Acceptance and commitment therapy, parents, children, chronic health conditions
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The family empowerment of mothers rearing children with severe motor

and intellectual disabilitiesMothersperception of service needs for
maintaining their daily living and empowering the family
Naho Sato1, Rie Wakimizu2, Hiroshi Fujioka3, Chieko Numaguchi4

1.
Chiba University Graduate School of Nursing, 2. University of Tsukuba, 3. Tsukuba International

University, 4. Ibaraki Prefectural University of Health Sciences
Presenting Authors Email: naho.sato@faculty.chiba-u.jp
Purpose
The aim of this research project is to develop the family care model toward the family rearing
children with severe motor and intellectual disabilities (SMID) at home focusing on the
family empowerment. The purpose of present study was to explore the mothers perception
of service needs for maintaining their daily living and enhancing the family empowerment.
Design
A qualitative descriptive design was used to depict the service needs of mothers of children
with SMID living at home.
Methods
Semi-structured interview was conducted with mothers of children with SMID aged from 2 to
18 living at home. Each interview was conducted following participants' consent, and
recorded on audio and transcribed. Data were classified according to the categories of the
services as well as time series; the needs at the early stage of rearing their child with SMID at
home, the current needs, and prospective needs to maintain the family daily living in the
future.
This study was approved by the Ethics Review Board at the University of Tsukuba and the
Review Committee at the institution.
Results
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1. Characteristics of Participants.
The participant consisted of 25 mothers of children with SMID. Mothers were aged between
30 and 53, and all mothers were married. The children with SMID were aged between 4 and
22. The main conditions were cerebral palsy, chromosomal disorder, and encephalopathy.
2. The mothers service needs at the early stage of rearing the children with SMID at home.
Mothers mentioned that they could feel relieved to start rearing their children with SMID if
the service providers proffered the ideas and proposals until the family became empowered to
act on their own initiative. Especially, the needs related to keeping the childs physical
condition were crucial for mother in this period.
3. The current service needs of mothers rearing children with SMID.
Most mothers expressed the need for the visiting nursing service. Mothers hoped for the
visiting nurses to arrange the care contents and visiting time for not only the child but also the
family daily living. They also wished the social welfare system would function more to
coordinate the short stay and the daycare services.
4. The prospective service needs to maintain the family daily living in the future.
Mothers were anxious for establishing the system which could accept a child aged 18 and
over even if they need the medical care. This service need was related to the parents' concerns
about the accumulation of the care burden according to the health declines with aging.
Conclusions
The findings suggested that the mother's service needs had arisen based on the balancing
between the needs of children with SMID and the need of the family as a whole. It also
indicated that mother perceived the service needs from anticipating what the family would
face in the future. It is significant to take the family development tasks into consideration to
provide the service for empowering these family.
3-5 Key words
Children with severe motor and intellectual disabilities, family empowerment, service needs,
mother
212
Validation and psychometric testing of the caregiver burden index (CBI)

for parents of children with allergies
Pei-Ching Liu1, Bih-Shya Gau2

1.
Nursing Department/Mackay Junior College of Medicine, Nursing, and Management, 2. Department

of Nursing/School of Medicine, National Taiwan University
Purpose
This article reports the development and psychometric testing of the Caregiver Burden Index
(CBI) for parents taking care of school-aged children with allergic disorders.
Design
A mixed-methods study.
Methods
This study was conducted in three consecutive phases. First, the item generation phase was
composed of three steps using qualitative and quantitative approaches including in-depth
interviews, content validity, and a focus group. Second, a cross-sectional study was
performed between September 2006 and July 2008 to validate the psychometric properties by
applying the scale on parents of allergic children. Third, this scale was again applied to
another sample of parents with allergic children between November 2013 and April 2014 to
further validate the psychometric properties of this CBI scale.
Results
The final CBI consisted of 19 items with three factors extracted after exploratory factor
analysis. The Eigen values of these three factors was 4.554, 4,475 and 4.344 respectively. The
explained variance by these three was 23.97%, 23.55% and 22.86% with a cumulative
variance of 70.38%. During the second and third phases, slightly difference was found
regarding the factors extracted and scale items attributed to these three factors.
Conclusions
213
The study findings provide evidence suggesting that this scale has sufficient psychometric
properties for use with three separate dimensions underlying the caregiver burden. The
Caregiver Burden Index will serve as a disease-specific instrument that help nurses and
healthcare providers better understand the impact perceived by parents of children with
allergic disorders.
3-5 Key words
Caregiver burden, parents, children, allergic disorders
214
Concomitant diseases and environmental risk factors will influence the

incidence of allergic rhinitis for 6-8 years old in Taipei, Taiwan
Ciao-Lin Ho1, Lu-I Chang2 W.-F. Wu 3
1. School
of Nursing, National Yang-Ming University, 2. School of Nursing, Tzu Chi
University 3Taipei City Hospital, Ren-Ai Branch / West Garden Hospital, Taipei, Taiwan
Presenting Authors Email: g455095013@tmu.edu.tw
Purpose
Prevalence of childhood allergic rhinitis in Taiwan has increased rapidly during the past 30
years. The ISAAC studies investigated several environmental risk factors of childhood
allergic rhinitis across countries all over the world. However, these factors have not yet been
examined in Taiwan. The aim of this study is to identify risk factors for allergic rhinitis in 68-year-old children in Taiwan.
Design
A cross-sectional survey was conducted in 26418 first graders (6-8-year-old) in Taipei with a
respondent rate of 94.6% (24999/26418).
Methods
We used ISAAC questionnaire regarding possible factors related to childhood allergic rhinitis
was completed by their parents or guardians. Multivariate logistic regression was conducted
to exam possible environmental (in early life and current) factors related to allergic rhinitis.
Results
The prevalence of allergic rhinitis (during the last 12 months) was 42.9% (10734/24999)
among 6-8 year-old first graders in Taipei.
Children with atopic dermatitis (OR = 3.39, 95% CI = 3.20-3.58) or asthma (OR = 2.04, 95%
215
CI = 1.93-2.16) are more likely to have symptoms of rhinitis. Compared with girls, boys are
more susceptible to rhinitis (OR = 1.46, 95% CI = 1.39-1.54). Babies who ever used
antibiotics during their first year of life are more likely to have rhinitis (OR = 1.41, 95% CI =
1.31-1.53). Children who ever had bronchiolitis before the age of 2-year-old are more prone
to rhinitis (OR = 2.08, 95% CI = 1.94-2.23). Children who had ever lived with cat (OR = 1.24,
95% CI = 1.04-1.49) or dog (OR = 1.12, 95% CI = 1.03-1.22) at home during their infancy
have a higher chance of occurrence of rhinitis. In addition, children with elder siblings are
less likely to have rhinitis symptoms (OR = 0.61, 95 % CI = 0.57-0.64). On the other hand,
children who have elder siblings may reduce the chance of suffering from allergic rhinitis
(39%OR).
Conclusions
Six-to-eight year-old boys with atopic dematitis or asthma are more likely to have symptoms
of rhinitis. Having bronchiolitis before the age of 2-year-old, ever used antibiotics, and living
with cats and dogs at home during the first year of life are factors related to the occurrence of
rhinitis. Our results can be referenced while implement allergic rhinitis prevention programs
for first graders in an urban city. We propose strategies for children to reduce the risk of
occurrence of allergic rhinitis include: preventing bronchiolitis before two years of age,
avoiding using antibiotics, and rearing cats and dogs at home during the first year of life.
3-5 Key words
Concomitant diseases, environmental risk factors, allergic rhinitis, ISAAC
216
The review study of fathersrecognition
Kiyomi Decker1, Motoe Yamamura1, Akiko Maruyama2

1.
Tokyo Metropolitan University, 2. Kyoritsu Womens University
Presenting Authors Email: kdecker@iuhw.ac.jp
Purpose
In terms of fathers recognition, fathers differ in their consciousness and role behavior as
fathers who have had contact with their children from pregnancy until after birth. This study
qualitatively analyzes research papers in Japan and abroad and the literature in Japan and
investigates differences in fathers recognition during pregnancy, immediately after birth,
and during the period when the child is less than one year of age, and what is demanded as a
father during this period by this process of fathers' recognition while subject to the influence
of ones child and spouse.
Design
The design is the review study for fathers recognition, paternity, and childcare
Methods
I searched the Japan Medical Abstracts Society, CINAHL, and Scopus and the literature and
data in technical books written by psychologists and sociologists with a thesis about domestic
and foreign fatherhood recognition. I conducted searches of documents from 2001 to 2012
with the keywords of "father," "recognition," "consciousness," "parental role," "brooding
behavior," and "childcare satisfaction" in Japan, and "recognition," "consciousness,"
paternity," and childcare, in foreign countries for this study.
Results
A search of the literature in Japan found 198 cases of consciousness, 255 cases of
"recognition," 63 cases of "parental role, 24 cases of brooding behavior and one case
of "childcare satisfaction." A study of the literature revealed few documents concerning
"father" and "childcare action and childcare satisfaction". In overseas literature, there
217
were 68 cases of "recognition," six cases of "consciousness," 41 cases of "paternity," 13 of

"childcare", and no cases of "childcare satisfaction. Finally, I referenced 31 Japanese
documents, 34 English documents, and three technical books.
After analyzing the documents, I classified them into the five categories of, 1) father figure, 2)
child care participation of father, 3) recognition of the couple regarding the relationship of
husband, 4) role of father, and 5) formation of father consciousness.
Conclusions
Biologically, anyone is capable of becoming a father. However, to be a father, I
think they must have awareness as a father as they experience the development process as a
father through the preparatory stage of becoming a father. One factor to raising awareness of
being a father is the wifes pregnancy along with the husbands participation in childrearing, such as actively helping with housework and childcare, and satisfaction in the marital
relationship, which is shown to have a strong effect.
When we look at the period from 2001 to 2012, we see that studies of fathers have increased
every year. I found that the father has a major existential value in a family system that
changes as the times change.
3-5 Key words
Father, recognition, consciousness, paternity, childcare
218
The effectiveness of cabbage leaf application (treatment) on pain and

hardness in breast engorgement and its effect on the duration of
breastfeeding.
Wong Boh Boi1, Hagney Gail2, Hong-Gu He 3, Koh Serina3, Chong Yap Seng4
1.
Thomson Medical Centre, 2. Perth University, 3. Yong Loo Lin School of Medicine (NUS)
ALCNS, 4. Yong Loo Lin School of Medicine (NUS)
Presenting Authors Email: bbwong@thomsonmedical.com
Purpose
The overall objective was to examine the effectiveness of cabbage leaf treatment on pain and
hardness of the engorged breasts of post-partum women and its influence on the duration of
breastfeeding in women with breast engorgement.
Design
This systematic review focused on studies that evaluated the effectiveness of cabbage leaf
treatment on breast engorgement in reducing pain, hardness and increasing the duration of
breastfeeding.
It only included studies that provided data on cabbage leaf treatment for breast engorgement.
It excluded cabbage leaf extract creams, as the evidence on its effectiveness is unclear in the
treatment of engorged breasts.
Methods
The systematic review covered studies in English language from inception of the relevant
databases to 2012. The databases searched included: CINAHL, MEDLINE, SCOPUS,
EMBASE, Web of Science, Science Direct. The search for unpublished studies included:
Google Scholar, Mednar, Proquest. Studies were assessed by two independent reviewers for
methodological validity using standardised critical appraisal tools from the Joanna Briggs
Institute.
Results
219
Four studies were included in this review: one RCT and two quasi-randomised studies and
one quasi-experimental study. Overall results showed that cabbage leaf treatment used on
women with breast engorgement did reduce pain, the hardness of the engorged breasts and
increased the duration of breast feeding.
Conclusions
The current available evidence suggests that cabbage leaf treatment helps reduce pain in
breast engorgement and lengthens breastfeeding duration, although some studies have also
reported that cabbage leaf treatment is not effective. There is insufficient evidence to suggest
the generalized use of cabbage leaf in protocols for the treatment of breast engorgement.
3-5 Key words
Breast engorgement, pain, hardness, treatment, outcome
220
Stress, coping style and nursing needs of hospitalized pregnant women for
pre-term labor
Su-Hyun Kim1 Cho Chung, Hyang-In2
1. Doctors course student

2. Associate Professor, College of Nursing, Chonnam National University, Gwangju,
Korea
Presenting Authors Email: ksh136112@gmail.com
Purpose
This study was conducted to assess stress, coping style, and nursing needs of hospitalized
pregnant women for pre-term labor.
Design
This is a descriptive study.
Methods
Data were collected from 125 pregnant women aged between 20 and 40 years and diagnosed
to have pre-term labor by an OBGY hospital located in G-city during the period from 10th of
May to 10th of August, 2012. Data were analyzed by frequency, percentage, t-test, ANOVA,
and Scheffe test using SPSS PC+ 18.0 for Windows. The reliability of the instruments was
calculated by the Chronbachs alpha.
Results
The stress of the women was an average of 2.13 out of 4 points, the level of coping style was
an average of 2.65, and the nursing needs was an average of 2.83 out of 4 points. The level of
stress was significantly different based on the job, length of stay in the hospital, type of
hospital and history of admission at OB department. The level of coping style was
significantly different according to age and monthly income. The level of nursing needs was
significantly different according to type of hospital. There were significant positive
221
correlations between stress and nursing needs and between coping style and nursing needs.
There was no significant correlation between stress and coping style.
Conclusions
The result of the study showed the importance of nursing intervention dealing with stress,
coping style and nursing needs. Nurses need to provide interventions to reduce the stress, to
strengthen the coping style, and to satisfy the nursing needs of pregnant women hospitalized
for preterm labor.
3-5 Key words
Stress, coping, nursing needs, preterm labor
222
Characteristics related to mother-child interaction at one-month

postpartum assessed by Japanese version of nursing child assessment
satellite training project (JNCAST)
Masako Saito1, Yoshiko Nagao2, Yuko Takayama2, Yumi Kondo3, Mari Suenaga4,
Hayami Hayashida5, Kiyoko Hayashi6, Emiko Kawauchi7, Sayaka Tsuchiya7, Emiko Suzui8,
Kazutomo Ohashi7
1.
Osaka unversity , Hyogo Unversity of Health Science, 2. International University of Health Science
and Welfare, 3. Kobe Adventist Hospital, 4. Hyogo College of Medicine Hospital, 5. Kinki Central
Hospital, 6. Meiwa Hospital, 7. Osaka University, 8. Hyogo University of Medical Science
Presenting Authors Email: m-saito@huhs.ac.jp
Purpose
Recently, there have been significant changes in the social environment in Japan, including a
declining birthrate. Many young women, therefore, have few opportunities to interact with
babies, resulting in a tendency to be anxious about child rearing during the first one month
following childbirth. In Japan, there have been few studies on the mother-child relationship
using an objective evaluation. In the United States, Nursing Child Assessment Satellite
Training (NCAST) was developed to objectively assess interactions between infants and
parents, and several interventions effective in relieving the anxiety of child rearing were
developed according to studies using the NCAST program.
The purposes of this study were to assess mother-child interaction at one-month postpartum in
Japan, to clarify the relationship between background variables and scores on the Japanese
version (JNCAST), and to compare these scores with those in the United States database.
Design
Methods
Subjects were pairs of mothers and children at one-month postpartum, and mothers were
primiparae and experienced a full-term delivery. Playing environment and feeding
environment with mothers and children were recorded by a video camera in a private room at
223
a one-month postpartum checkup. The recordings and evaluation methods were performed in
accordance with NCAST. The Ethical Board of Health Sciences, Osaka University, approved
the study.
Results
Subjects were 79 pairs of mothers and children (52 pairs in playing environment, 27 pairs in
feeding environment). Total scores were 57.3 7.0 and 63.9 7.9, scores of mothers were
42.3 4.5 and 44.2 5.7, and scores of children were 14.9 4.0 and 19.6 2.9, in playing
environment and feeding environment, respectively. Total scores in each environment were
significantly higher than those in the database of the United States (49.7 10.6 and 59.9 8.8,
p=0.007 and p=0.035, Mann-Whitney U test). In playing environment, fathers ages were
negatively correlated with total scores (rs=-0.376, p=0.007, Spearmans rank coefficient
correlation). In feeding environment, both parents ages were negatively correlated with
scores of children (rs=-0.401, p=0.038 in mothers and rs=-0.417, p=0.034, Spearmans rank
coefficient correlation). Moreover, subjects with a history of infertility treatment showed
significantly lower total scores in feeding environment than those without it (60.2 7.6 and
66.0 7.5, p=0.049, Mann-Whitney U test).
Conclusions
Mother-child interaction was correlated with parents age and history of infertility treatment.
Older aged mothers and mothers with older aged partners were previously reported to have
high levels of mother-child interaction, while the results of the present study were contrary to
the previous findings. Scores of mother-child interaction were different between Japan and the
United States.
3-5 Key words
Mother-child interaction, one-month postpartum, nursing child assessment satellite training
(NCAST)
224
Nursing practices for early detection of child abuse risks and perinatal care
for mothers by maternity nurses in Japan.
Mitsue Otomo1, Hiroko Suzuki1, Emiko Saito1

1.
graduate school of human health sciences ,Tokyo metropolitan university
Presenting Authors Email: otomo-mitsue@ed.tmu.ac.jp
Purpose
It is essential that prediction and prevention of child abuse occur during the period in which
hospitals are involved with mothers, from pregnancy through the post-partum phase.
Maternity nurses have many opportunities to observe child abuse risk factors and to reduce
risks through maternal care. Therefore, they have an important role in the early detection of
risk factors and prevention of child maltreatment. However, studies of the details of
preventive maternity nursing practices are lacking.
The aim of the study was to identify nursing practices such as screening in the population,
identification of mothers with abuse risk factors, and coordination of multidisciplinary
collaboration for the prevention of child maltreatment.
Design
A qualitative descriptive design.
Methods
Data were collected via semi-structured interviews from June to Aug 2014. I interviewed six
maternity nurses (1 nurse, 5 midwives) at 5 hospitals in Japan. Data were categorized by
examining differences in meaning. The study was conducted after approval by the university
research ethics committee.
Results
Interviews demonstrated that nursing practices involved careful consideration to identify child
abuse risk factors. Results were classified into individual care and ob-servation through
interdisciplinary collaboration. Practices for individual care included Relationships built on
trust,Being alert for potential risks, Assessment of the needs level of support, and
225
Provide support for post-discharge childcare. Practices central for collaborations were
Team work among nurses, Conveying information for consistent support from many
professions, and Information sharing between interdisciplinary team members.
Conclusions
Results of this study highlight the importance of increasing nursing skills for individual care
and interdisciplinary collaboration for child abuse prevention. A work environment conducive
to the promotion of child abuse prevention is a critical need.
3-5 Key words
Prevention of child maltreatment, maternity nurses, nursing practices
226
Usefulness of a pregnancy-related risk self-assessment scale for pregnant

Japanese females requiring transfer or referral
Kyoko Kanamori1, Misae Okamoto2, Hiromi Ueno2, Tokiko Hanafusa2, Kumiko Iwatani3,
Miwa Izuhara4
1.
SEISEN UNIVERSITY, 2. Otsu Red Cross Hospital Japanese Red Cross Society, 3. Kanazawa
Medical University, 4. Naragakuen University
Presenting Authors Email: kanamo-k@seisen.ac.jp
Purpose
In 2004, a research group developed a pregnancy risk self-assessment scale (Score). It
aims to help pregnant females assess their pregnancy and choose a place for childbirth based
on information from the early stage, share responsibilities with a hospital according to the
function, and efficiently collaborate with its staff. This study examined differences in the
attributes of pregnant females, risk scores, and outcomes of childbirth. The subjects were
classified into a group of females requiring transfer or referral to another health care
institution (Group A) and control group (Group B) which chose the center from the former as
a delivery place.
Design
A cross-sectional, observational study was conducted, including a retrospective survey
following childbirth.
Methods
The subjects were 178 females who gave birth between January and May 2013. Anonymous,
self-completed questionnaire forms were distributed to the subjects on the third day following
childbirth or later, and collected prior to their discharge. Analysis items included the age,
whether or not they gave birth for the first time, mean score on the Score scale,
proportions of pregnant females in each risk group, and outcomes of childbirth. Pearsons
2 and Mann-Whitney U tests were conducted, using SPSS Ver.21 as an analysis tool. The
study was conducted with the approval of the ethics committee of Seisen University
(September 2012, No.12).
227
Results
The response rate was 79.8%, and valid responses were collected from 142 females. Pregnant
females in Groups A and B accounted for 24.6 and 75.4% of the total, respectively (n=107).
The mean age of the females was 32.6 4.7 years old, and 45.8% of them gave birth for the
first time (n=65). There were larger numbers of pregnant females who gave birth for the first
time in Group A (p<0.05) and the high-risk group (p<0.05), and the mean score received by
those in Group A was higher (p<0.01). There were no significant differences in the age and
outcomes of childbirth.
Conclusions
When pregnant females required to be transferred or referred to a high-order health care
institution, the Score was useful to some extent.
In 18Th EAFONS, the contents of the pregnancy risk self-assessment scale which is
developing and spreading in Japan are introduced concretely.
3-5 Key words
Pregnancy risk score, delivery conclusion, perinatal period management, medical care
cooperation
228
Factors related to low maternal satisfaction among Japanese first-time

mothers one month after childbirthA logistic regression analysis
Emi Mori1, Kunie Maehara1, Miyako Tsuchiya1, Hiroko Iwata1, Tomoko Maekawa2, Yoshimi
Mochizuki2, Harumi Ozawa1, Akiko Morita2, Kyoko Aoki1, Akiko Sakajo1, Koji Tamakoshi3
1.
Graduate School of Nursing, Chiba University, 2. Former Graduate School of Nursing, Chiba
University, 3. Graduate School of Medicine, Nagoya University
Presenting Authors Email: mori@faculty.chiba-u.jp
Purpose
To determine the factors related to low maternal satisfaction among Japanese first-time
mothers one month after childbirth.
Design
A prospective cohort study.
Methods
Mothers who delivered live singleton infants from May 2012 to March 2013 at 13 hospitals in
Japan were recruited for a prospective cohort study. For the present study, we used data on
1517 primiparas who completed the questionnaires both at the early postpartum period and at
one month after childbirth. The questionnaires included the Postpartum Maternal Role
Satisfaction Scale (PMRSS), the Postpartum Maternal Role Confidence Scale (PMRCS), the
Postnatal Accumulated Fatigue Scale (PAFS), and questions assessing demographic and
background characteristics. Research nurses at each hospital obtained vital records data. Data
were analyzed using stepwise logistic regression. The two-category outcome variable gauged
whether a mother scored low on maternal satisfaction (PMRSS score < 28). Institutional and
medical ethics committees approved this study before the start of the research.
Results
In total, 24.2% of first-time mothers scored low on maternal satisfaction one month after
childbirth. Feeling that changing to a baby-centered lifestyle was difficult, dissatisfaction with
229
appraisal support such as affirmative feedback on efforts, dissatisfaction with the birth
experience, scoring higher on the PAFS, and scoring lower on the PMRCS increased the odds
of low maternal satisfaction at one month after childbirth. Maternal age, marital status,
pregnancy after infertility treatment, pregnancy-related complications, mode of delivery, and
feeding method were not significantly related to low maternal satisfaction at one month after
childbirth.
Conclusions
Maternal satisfaction at one month after childbirth was negatively influenced by the
difficulties in changing to a baby-centered lifestyle. Additional anticipatory guidance about
parenting life postpartum should be provided to primiparas during the pregnancy period.
Nurses should assess womens perceptions of discrepancy between reality and expectations
in parenting life and provide support for the transition to becoming a mother. Dissatisfaction
with the birth experience, but not the mode of delivery, also increased the odds of low
maternal satisfaction. It is important to pay attention to womens perceptions of the birth
experience. Severe fatigue was negatively related to maternal satisfaction. Nurses should
facilitate access to supportive resources for mothers to prevent accumulation of fatigue during
the postpartum period. Maternal confidence and appraisal support were associated with
maternal satisfaction. Providing care with an understanding of these factors could promote
maternal role attainment at one month after childbirth.
3-5 Key words
Primiparous, mothers, satisfaction, postpartum
230
Maternal depression, sleep quality, and mother-infant attachment in the

first 12 months postpartum.
Pao Chen1
1.
Hsin Sheng Junior College of Medical Care and Management
Presenting Authors Email: shock650203@gmail.com
Purpose
Women are at increased risk of maternal depression and poor sleep quality during postpartum,
which may impact the mother-infant bonding in the first 12 months, and then influences the
infant future development. This study examined the relationships among maternal depression,
maternal sleep quality, and mother-infant attachment during the first 12 months postpartum
period.
Design
A prospective descriptive longitudinal correlation survey design was used to examine
maternal depression, sleep quality, and mother-infant attachment during the first 12 months
postpartum period (the 3rd day, 1st month, 6th month and the 12th month after delivery). The
target population was women giving birth in Taipei County during the study period. There
were total 102 healthy women, aged 2040 years old who gave birth during the study period.
Methods
Written questionnaires were delivered to the participants who agree to attend this study at the
time when they were recruited, and at the 3rd day, 1st month, 6th month and the 12th month
after delivery. The Edinburgh Postnatal Depression Scale (EPDS) was used to screen
maternal depression, and the Pittsburgh Sleep Quality Index (PSQI) was used to assess the
maternal sleep quality and disturbances during the postnatal period. Mother-infant attachment
was assessed by using the Mother-Infant Attachment Scale (MIAS).
Results
Overall, 12.2% of women reported depressive symptoms during the first 12 months
postpartum in Taipei. The prevalence of maternal depression was 16.7%, 10%, 10.4% and
231
10.6%, respectively at the 3rd day, 1st month, 6th month and the 12th month postpartum.
GEE showed sleep quality (B=.410, p.001) and the MIAS scores (B=-.089, p.001) was a
consistently strong predictor of maternal depression across the first 12 months postpartum.
The poor maternal sleep quality and mother-infant attachment was associated with higher
maternal depression scores. However, there was no relationship between the MIAS and PSQI
scores.
Conclusions
Poor sleep quality during the early postpartum period is associated with poor mental health
throughout the first 12 months postpartum. In addition, women who are depressed during
postpartum fail to bond well with their baby. Therefore, early intervention to promote
maternal mental health should be developed including an instrument to screen depression and
the intervention to relieve the mothers depression symptoms. The study findings and
suggestions for future research can help developing clinical interventions to alleviate maternal
depression and improve maternal sleep quality and mother-infant attachment during
postpartum period.
3-5 Key words
Postpartum depression (PPD), mother-infant attachment, sleep quality
232
Current status of oxidative stress during pregnancy and future study issues
Chikako Mochizuki1, Kumiko Adachi2, Mariko Shibata3, Tomoko Ono3, Yoshimi Mochizuki3
1.
Teikyo University Graduate Course of Midwifely, 2. Metropolitan University Sivision of Nursing

Sciences, 3. Teikyo University Graduate Course of Midwifery
Presenting Authors Email: mchikako@med.teikyo-u.ac.jp
Purpose
Exposure to stress is known to trigger biological responses in the human body, inducing
oxidative stress. Oxidative stress is defined as a shift in the balance between pro-oxidative
and anti-oxidative reactions in the body in favor of the former. It has been shown that
pregnancy-induced oxidative stress causes an imbalance in the redox status of living tissues,
which can damage the liver, kidneys, lungs, vascular walls, skin, muscles, and other tissues,
thereby producing harmful effects in the body. To improve medical care and ensure a healthy
course of pregnancy, it is necessary to focus on oxidative stress as an indicator to objectively
evaluate health and identify the future issues relevant to the stress. This can be achieved by
organizing currently available data on the actual condition of oxidative stress and
investigating findings related to oxidative stress during the perinatal period. Thus, this study
aimed to review past studies on the relationship between pregnancy and oxidative stress,
which have been published in Japan and overseas, and identify the future study issues.
Design
Using theMEDLINE and Igaku Chuo Zasshi (Japana Centra Revuo Medicina)
databases, we conducted a literature search with the keywords oxidative stress and
pregnancy.
Methods
From a total of 261 English and 61 Japanese articles that were matched, we excluded those
with titles concerning the fetus, newborn babies, in-vitro fertilization, adolescent pregnancy,
and the puerperal period. Among the remaining articles, we reviewed those published over a
period of 10 years between 2004 and 2014.
233
Results
The literature review identified the following factors influencing oxidative stress during the
perinatal period: i) nutrients such as folic acid, vitamins, and fatty acids, and lifestyle habits
such as smoking and exercise, ii) pregnancy complications such as hypertension and diabetes,
iii) abnormal delivery such as premature birth, and iv) psychological stress. While many of
the studies on oxidative stress during the perinatal period discussed factors contributing to
pregnancy complications or abnormal delivery, few included discussions based on the
viewpoint of preventive medicine to ensure a normal course of pregnancy. During pregnancy,
midwives are expected to offer guidance on healthy lifestyle habits that can help prevent
pregnancy complications and any abnormalities. However, we found that the actual condition
of oxidative stress, which can provide the evidence for reviewing lifestyle habits, has not been
elucidated sufficiently.
Conclusions
In future studies on oxidative stress during the perinatal period, it is important to further
clarify the relationship between lifestyle habits and oxidative stress with the aim of providing
preventive care to help maintain or improve health during pregnancy. This work was
supported by JSPS KAKENHI Grant Numbers(25463525)
3-5 Key words
Oxidative stress, pregnant women, pregnancy, adult females
234
Development of new pelvic floor muscle training support systems for

postnatal women delivered via email on a smartphone
Kaori KInouchi1, Kazutomo Ohashi1

1.
Osaka University graduated school of Medicine
Presenting Authors Email: kinouchi@sahs.med.osaka-u.ac.jp
Purpose
The International Continence Society defines urinary incontinence as a complaint of any
involuntary loss of urine. Our previous study found that approximately 20% of Japanese
women have urinary incontinence after childbirth, and most cases were of stress or mixed
urinary incontinence. Systematic reviews have identified pelvic floor muscle training as the
first choice for the effective treatment of stress and mixed urinary incontinence. However,
pelvic floor muscle training must be continued for a certain period of time (minimum 8 weeks)
with active support from professionals to ensure adherence. We previously developed a pelvic
floor muscle training support system that delivers supportive information to postnatal women
using the email function of a mobile phone; however, mobile phones have limited data
handling capacity. Todays smartphones are better equipped to transmit and process larger
amounts of data, and therefore, we developed a system that can be used with smartphones.
Design
Development of a new pelvic floor muscle training support system for postnatal women
delivered via email on a smartphone
Methods
The system automatically sends an email daily for 8 weeks. Subjects receive the email and
perform pelvic floor muscle training. They then access a URL provided in the email and
report the number of times pelvic floor muscle training was performed the previous day. This
structure allows bidirectional communication between researchers and subjects. Subjects first
transmit a blank email for registration with the system, and a reply containing a URL is
transmitted back. The subjects click on the URL and are directed to a website that prompts
them for a user ID and password. At this point, registration is complete. Every day for the
235
next 8 weeks, an email is sent to each participant with a URL that directs them to the webpage.
There, the subjects use radio buttons and pull-down menus to input data on background
characteristics, the presence and type of urinary incontinence, and their impression of using
the system. We log into the data management system to monitor the enrolled subjects, send
emails, and download the accumulated data. The system uses Secure Sockets Layer security
coding.
Results
In our testing process, mobile phones were not able to handle the large amount of data in the
system, but with the use of smartphones, we were able to collect all investigational data on
the system. A researcher can obtain necessary data from the system without the need for a
patient questionnaire or interview, while the subjects can easily participate in the study using
a familiar tool. Subjects had to bear the cost of communication when using mobile phones,
but the use of smartphones carries no additional cost.
Conclusions
Here we developed a smartphone system that provides added functionality in terms of data
transmission to a smartphone and does not place an additional economic burden on subjects.
3-5 Key words
Pelvic floor muscle training, postnatal women, smartphone, email
236
Qualitative evaluation of perineal support care during the second stage of

labor
Toyoko Yoshizawa1, Maki Hojo2, Yasuka Nakamura1, Takeshi Okuyama3, Fumi Atogami1,
Mami Tanaka2, Sachie Shindo4
1.
Tohoku University Graduate School of Medicine, 2. Graduate School of Biomedical Engineering
Tohoku University, 3. Graduate school of Engineering Tohoku University, 4. Graduate School of

Nursing Tkoto Tachibana University
Presenting Authors Email: toyoko@nursing.med.tohoku.ac.jp
Purpose
Japanese midwives provide birthing women perineal support during the second stage of labor.
The Japanese hands-on technique involves highly skilled perineal support that prevents
perineal tearing. To become a midwife, Japanese midwifery students must assist midwives
with 10 deliveries at the hospital. However, the number of vaginal deliveries is decreasing due
to declining birth rates and increasing maternal ages. Therefore, midwifery students do not
have enough chances to attend deliveries and master the skills needed to practice midwifery,
particularly in terms of perineal support. Accordingly, we developed an ingenious delivery
simulator as a learning tool to supplement students lack of experience and help them master
these skills.To develop this delivery simulator, we quantitatively assessed the skills related to
perineal support care that expert midwives perform by examining the pressure applied by the
fingers and palm during perineal support actions.
Design
Observation study
Methods
We developed a system that can measure the pressure within an extensive area. A multiple
flexible pressure sensor with conductive ink was used to measure the pressure of the fingers
and palm during the second stage of labor. The motion was simultaneously recorded with a
video camera to investigate the correlation between hand pressure and motion. The delivery
action was reproduced in a defined sequence using a phantom pelvis and fetus to practice
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delivery. The simulation was set up for a 3-minute period. We configured tree contractions
and tow interval to simulate delivery and set the situation of the appearance of the fetal head
at the first contraction. At the second and third contractions, we simulated crowning. To
control the fetal motion in this delivery simulation, the same research assistants pushed the
fetus from the pelvis. Subjects included 11 students and 17 midwives with 320 years of
experience. The characteristics of the experts motions were extracted from the pressure
sensor and video results. This study was approved by the Ethics Committee of Tohoku
University School of Medicine.
Results
Comparative analysis of the mean palm pressure provided for perineal support showed that
the palm pressure of the right hand used in the Japanese hands-on technique for preventing
perineal tears did not differ significantly between the midwife group and the student group. In
addition, correlation coefficient analysis of the pressure profiles of both hands revealed a
strong positive correlation of 23.1% and 51.7% in the student and midwife groups,
respectively. The experts were more likely than the students to press on the fetal head and the
mothers perineum simultaneously using both hands.
Conclusions
The Japanese hands-on technique provided by Japanese midwives does not simply consist of
hand placement on the perineum but also includes adding and controlling pressure. This work
was supported by Grant-in-Aid for Scientific Research (KAKENHI) Number
2124904/22659407.
3-5 Key words
Perineal support, Japanese hands-on technique, midwife, simulate delivery, hand pressure
238
Social support and postpartum depression in Taiwanese womenA

longitudinal study
Li-Chun Lee1
1.
Department of Nursing, I-Shou University
Presenting Authors Email: grace@isu.edu.tw
Purpose
Postpartum depression (PPD) is the common issue with regard to the mental health of the
postpartum women. However, there are rare studies according to factors of the postpartum
depression and their variations in the postpartum period. This study aimed to understand the
trend and relationship among maternal social support and depression in postpartum.
Design
A prospective longitudinal survey was undertaken to explore women depression variations in
the first, second, and sixth month postpartum.
Methods
This study utilized the Social Support Scale and the Edinburgh Postnatal Depression Scale
(EPDS) to measure respectively the level of social support and maternal depression after the
postpartum period in 282 postpartum women in Kaohsiung, Taiwan, from May, 2011 to
December 2012.
Results
When the EPDS cut-off was set at 9-10, there are 39 (13.8%), 60 (22.1%), and 50 (18.1%)
postpartum women whose scores were larger than 10 in the first, third, and sixth month
postpartum, respectively. The prevalence rate of the PPD was the highest in the third month
postpartum but the lowest in the first month postpartum. Low social support was a significant
predictive factor of the PPD within six months postpartum. In addition, the preferred sex of
the baby was another important predictive factor in the first and third month postpartum.
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Eventually, the age and multipara were two important predictive factors in the third month
postpartum.
Conclusions
According to our findings, we believe the mental health of postpartum women should be
taken more care of, especially those postpartum women in the third month or who are lack of
sufficient social support. Practical nurses have to assess whether the postpartum women
obtain sufficient social support. EPDS is a reliable and valid scale which can simply and
quickly screen PPD. For the community nursing, the cut-off score can be set at 9 - 10 to
identify PPD. We suggest a health management policy to assess PPD for maternal postpartum
women in the third month using the EPDS.
3-5 Key words
Depression, social support, postpartum women, longitudinal study
240
Cognitive behavior in relation to the fetuses during the third trimester of

women who were pregnant with twins after the use of drug or reproductive
technology
Miao-Fang Shih1
1.
Chang Gung University Of Science and Technology
Presenting Authors Email: mfshih@gw.cgust.edu.tw
Purpose
This qualitative study explored the cognitive behavior in relation to the fetuses during the
third trimester of women who were pregnant with twins after the use of drug and reproductive
technology.
Design
The observer-as-participant field method was used in this study, and a narrative form of
process recording was applied to record data.
Methods
The researcher, as a nurse, offered nursing services to the cases during prenatal care. Five
cases were studied, and the researcher communicated with the cases during the 20th
gestational week. and communicated with every case 7 to 10 times for an average of 8.2 times.
Results
In this study, 513 pages of process recording data were collected. After quantifying the
qualitative data,1,094 behavioral units were recorded. Cognitive behavior was classified into
3 parts: orient behavior, comparative behavior, and appraisal behavior. We determined that
orient behavior emerged most frequently at 67.37%, followed by appraisal behavior at
16.91%, and comparative behavior yielded the lowest percentage of 15.72%.
The cognitive behavior in relation to the fetuses of the pregnant women in this study
comprised 2 parts: body aspect and social characteristic aspect of the fetuses. The body aspect
contains body structure, body function and physical conditions. The social characteristic
aspect contains temperament, gender and ranking. The cognitive behavior of the twin
241
pregnant women emerged most frequently at the body aspect of the fetuses (83.46%), and
exhibited the least focus on the social characteristic aspect of the fetuses (16.54%).
Conclusions
The cognitive behavior of the twin pregnant women emerged most frequently at the body
aspect of the fetuses. Nurses must understand the meaning of the behaviors exhibited by
women pregnant with twins to communicate effectively, accept messages appropriately, and
offer suitable nursing care.
3-5 Key words
Cognitive behavior, the third trimester, reproductive technology
242
Autonomic nervous activity before and after labor
Hiroe Washio1, Daisuke Takeshita1, Susumu Sakata1

1.
Kio University
Presenting Authors Email: h.washio@kio.ac.jp
Purpose
Autonomic nervous activity (ANA) influences heart rate variability (HRV), of which the
parameters reveal cardiac autonomic balance. The aim of this study was to compare ANA
before/after labor in women with the 1st childbirth and in women with the 2nd-4th childbirth,
using power spectral analysis of HRV.
Design
This study was conducted in accordance with the revised version of the Helsinki declaration
and was approved by the Kio University Ethical Committee. HRV was evaluated 0-20 days
before and after labor in 29 healthy women (the 1st childbirth, 13; the 2nd-4th childbirth, 16).
Methods
Subjects were advised to breathe at the rate of 19 breaths per minute using a metronome.
HRV was measured in the resting state by a Pulse Analyzer Plus (TAS9, YKC Co., Japan).
Fast Fourier transform was used to calculate low frequency (LF) components that reflect
ANA and high frequency (HF) components that reflect parasympathetic nervous activity
(PNA). Moreover, the ratio of LF/HF (an index of sympathetic nervous activity), total power
(TP, an index of regulatory potency in autonomic nervous system) and physical stress index
(PSI) were obtained.
Results
There was no difference between heart rate or LF/HF ratio before and after labor. Likewise,
there was no difference between heart rate or LF/HF ratio of women with the 1st childbirth
and of women with the 2nd-4th childbirth. However, HF and TP after labor were significantly
higher in women with the 2nd-4th childbirth than in women with the 1st childbirth. To the
contrary, PSI after labor was significantly lower in women with the 2nd-4th childbirth than in
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women with the 1st childbirth. In addition, TP was higher and PSI was lower after labor in
women with the 2nd-4th childbirth, as compared with the prenatal levels.
Conclusions
Women with the 2nd-4th childbirth showed higher PNA and lower PSI after labor, suggesting
a relatively relaxed state. In contrast to this, women with the 1st childbirth showed lower
PNA and higher PSI after labor, suggesting a relatively high level of stress.
3-5 Key words
Heart rate variability, autonomic nervous activity, labor, stress
244
The related factors for postpartum depression among immigrant women

A literature review
Qiong-Ai Jin1, Emi Mori2, Akiko Sakajo2

1.
Chiba University, Graduate School of Nursing, 2. Graduate school of Nursing, Chiba University
Presenting Authors Email: jpa1988@chiba-u.jp
Purpose
Postpartum depression (PPD) is conceived as a serious issue that can affect new mothers after
childbirth, their infants, and family relationships. This literature review aims to make the
related factors clear for postpartum depression among immigrant women.
Design
A literature review.
Methods
The MEDLINE, CINHAL, and Cochrane Library databases were searched in English, while
the Japan Medical Abstracts Society database was searched in English and Japanese for
literature review. Papers were included for this review if they satisfied the following criterion:
1) the subject of research were immigrant women who gave birth in an area that is not their
mother country, 2) the related factors of PPD were presented, 3) the prevalence of PPD was
defined, 4) quantitative methodology was used, 5) and the paper was published in English or
Japanese as an original article between January, 1990 and August, 2014.
Results
Following the databases search results, a total of 219 citations were identified; however, only
7 articles were found as meeting the inclusion criteria and were thus selected for the final
review. Five studies were conducted in Western countries and the others were carried out in
Asian countries. Most of these studies were targeting Asian women as a participants. The
prevalence of PPD among immigrant women ranged from 7.6% to 53%. Each study
expressed related factors prevalent within many of the selected coinciding studies in regard to
245
PPD among immigrant women. These related factors within the seven studies were as follows:
a lack of social support (Lucy M et al., 2003; Small R et al., 2003; Chen TL et al., 2012), a
stressful life event (Yoshida K et al., 1996; Bjerke SE et al., 2008), antenatal depression
history (Lucy M et al., 2003; Small R et al., 2003; Zelkowitz P et al., 2008), a poor
relationship with the mothers partner (Small R et al., 2003; Bjerke SE et al., 2008;
Zelkowitz P et al., 2008), cultural practices (Chen TL et al., 2012), and being an immigrant
mother (Choi SY et al., 2012).
Conclusions
The finding of this review indicated that the prevalence of PPD among immigrant women
varies considerably, and that the related factors identified among immigrant women for PPD
are mostly similar to those found previously for the general population. However, two cultural
factors for PPD are presented as potential characteristic issues: adherence to cultural practices
and in being an immigrant mother. Thus, it cannot yet be concluded that being an immigrant
mother is a related factor for PPD. Additional studies with detailed cultural background data
are required in order to find unknown factors of PPD among immigrant women. Studies
focused specifically on cultural differences and the correlations to postpartum depression in
immigrant mothers are needed.
3-5 Key words
Postpartum depression, immigrant women, literature review
246
The effect of maternal adaptation enhancement program on the

breastfeeding and caring confidence in the primipara who used Sanhujori
facilities in Korea
Ju-Eun Song1, Hyun-Ju Chae2, Jung-Mi Ko3

1.
Ajou university, College of Nursing, 2. Joongbu University, Department of Nursing, 3. Cheongju

University, Department of Nursing
Presenting Authors Email: songje@ajou.ac.kr
Purpose
The purpose of this study was to identify the effects of maternal adaptation enhancement
program on the breastfeeding and caring confidence in the primipara who used Sanhujori
facilities, i.e. postpartum care center in Korea.
Design
A non-equivalent control group non-synchronized design was used.
Methods
A total of 57 women who used one of two Sanhujori facilities located in Suwon city of South
Korea participated in the study. The 37 women in the control group were recruited from
December, 2013 to January, 2014, whereas the 30 women in the experimental group were
selected from February to March, 2014 in the two Sanhujori facilities. Maternal adaptation
enhancement program was provided to the women and her husband in the experimental group,
which were consisted of 2 times of group based supportive childcare education for the couple
and several times of individual consults and education for the first time mother. While the
women in the control group received routine education only. Data were collected by a selfadministered questionnaire in the four measurements time, which were the admission day to
Sanhujori facilities (T1), the discharge day from Sanhujori facilities (T2), the 4 to 6 weeks
postpartum (T3), and the 12 to 14 weeks postpartum (T4). Collected data were analyzed using
the IBM SPSS 20.0 program with descriptive statistics, independent t-test, ANCOVA, and
x2- test.
247
Results
The experimental group showed higher breastfeeding score at T3 (F=7.97, p=.006) and T4
(F=14.31, p=<.001) than control group when controlling the difference of T1 breastfeeding
score between two groups and the percentages of the positive breastfeeding score change
from T2 to T3 and from T3 to T4 were much more than those of the control group (x2=6.89,
p=0.032, x2=8.72, p=.013, respectively). In addition, the score of caring confidence in the
experimental group was higher than that of control group at T4 (t= -3.01, p=.004) and the
mean difference from T3 to T4 in the experimental group was significantly lower than that of
the control group (t=-2.65, p=.010).
Conclusions
From these results, it is noticed that women in the control group experienced more significant
decreases in the caring confidence and breastfeeding at T4 than women in the experimental
group and maternal adaptation enhancement program is an effective intervention to alleviate
the difficulty of breastfeeding and increase the caring confidence of the primipara who used
Sanhujori facilities in Korea. Therefore, as one of the effective methods for facilitating a
becoming a mother of the primipara, the maternal adaptation enhancement program
developed in this study should be applied to the primipara, especially in the Sanhujori
facilities.
3-5 Key words
Becoming a mother, maternal adaptation, breastfeeding rate, primipara, Sanhujori facilities
248
Literature review for qualitative researches of maternal adaptation among

Korean immigrant women
Ju-Eun Song1, Eun-Ha No1, Moon-Sook Yoo1, Jin-Hee Park1

1.
Ajou university, College of Nursing
Presenting Authors Email: songje@ajou.ac.kr
Purpose
The purpose of this study was to analyze the qualitative researches of maternal adaptation
among Korean immigrant women.
Design
The study design was a literature review to identify the current status of qualitative researches
focused on the maternal adaptaion of Korean immrgrant women.
Methods
Thirteen qualitative researches among the thirty-five articles published from 2006 to 2014
were selected for literature review and analyzed by the narative analysis method.
Results
Thirteen qualitative researches regarding maternal adaptaion of Korean immigrant women
have been published since 2009. The publication types were journals (9 articles, 69.2%) and
master's thesis and doctoral dissertations (each 2 articles, 15.4%). The majors of authors were
nursing (46.7%) and social welfare (20.0%). The major issues of studies were classified into
three, which were the experience of childbearing (7 articles, 53.8%), the experience of
maternal adaptation (4 articles, 30.8%), and the experience of pregnancy & childbirth (2
articles, 15.4%). Methodologies of qualitative researches were phenomenological study (8
articles, 61.5%), case study (2 articles, 15.4%), and grounded theory approach (2 articles,
15.4%). Only one article adapted the theoretical framework. Countries of immigrant women's
were China (9 articles, 25.0%), Vietnam (8 articles, 22.2%), and Philippine (7 articles, 19.4%).
The places of data collection of all studies were multicultural centers (100%). Methods of
data collection were interview (100%), audio/video record (20.8%), observation (8.3%), field
249
note (8.3%), self-reported diary (8.3%), and questionnaires (8.3%). The major theme of the
experience in child rearing were 'isolation from the maternal role due to cultural differences',
'ignorance of a parental role', 'having practical problems and facing difficulties of child
rearing due to cultural gap'. In regard to the maternal adaptation, the major theme were
'identify as a new boarder people', 'a clumsy foreigner's life with nostalgia', 'crisis in the crisis',
'unprepared for motherhood', 'becoming aware of Korean maternal instinct: thirst for
education supporting' and 'influenced by the conflict from being different & lack of support
system'. In case of pregnancy & childbirth experience, the major theme were 'becoming a
person who gained no respect one's spouse', 'left out in a place where access to medical
information and health care provider were blocked', 'endured time of loneliness and isolation
from in-laws and people around', 'accepted the new child-centered family relationship',
'running in to double troubles in a strange environment', 'relying but becoming lonely and
difficulties', 'partially changing and applying traditional culture of pregnancy and childbirth',
'gaining the joy of life beyond loneliness', and 'suffering less thanks to the expansion of
supporting resources'.
Conclusions
The results of this study show that the acculturation make negative effects on the multiple
barriers in maternal adaptation such as communication difficulties, loneliness, ignorance, lack
of information, and blocked supporting from the resources. Therefore, The focus of the
nursing interventions for Korean immgrant women should be focused on the improvement of
the acculturation process.
3-5 Key words
Immigrant women, maternal adaptation, acculturation, qualitative researches, literature review
250
Self-care agency and associated factors among pregnant Japanese women

with nausea and vomiting of pregnancy
Akiko Iwakuni1
1.
University of Hyogo Graduate Course of Nursing Art and Science
Presenting Authors Email: akiko.iwakuni@gmail.com
Purpose
Women lead her life due to abilities to initiate and perform practice of activities on their own
and for themselves (self-care) (Orem, 2001). After nausea and vomiting (NVP) be
accompanied by, new self-care requisites might have emerged to maintain women and also
her fetus life, health, and well-being. Although self-care agencies of pregnant women and
associated factors have been reported previously, these among pregnant women, particularly
with NVP, remain unknown.
The purpose of this study was to determine self-care agency and its associated factors among
pregnant Japanese women with NVP.
Design
A correlational, cross-sectional design
Methods
The study participants were pregnant Japanese women with NVP in their first 11 week of
gestation, with no history of treatment for complications, threatened abortion, or hyperemesis
gravidarum. According to earlier studies of associated factors to NVP and self-care agency in
pregnant women, the following data were collected; 1) The Index of Nausea, Vomiting, and
Retching (INVR), 2) The 35 item Exercise of Self-Care Agency (ESCA), 3) Profile of Mood
States (POMS), 4) The 8-Items Short-Form Health Survey (SF8), 5) Social Support of
Pregnant Women Profiles, 6) Demographic data. Data were analyzed using SPSS statistical
software for Windows version 22.0. Statistical analyses included descriptive statistics and
multiple regression analysis. The study was approved by the Research Ethics Committee of
the University of Hyogo.
251
Results
Data was collected from a total of 46 women (average age, 33.41 4.70 years) at a mean
gestational week of 8.98 1.69 weeks (range, 611). The mean INVR score was 7.26 3.55
points (range, 319). Of these 46 women, 29 (63.0%) reported mild NVP, with 16 (34.8%)
and 1 (2.2%) reporting moderate and severe symptoms, respectively. Further, 23 (50.0%)
were educated at or above the university level, 19 (41.3%) were primigravida, and the
majority (n = 28, 60.9%) were employed.
The mean ESCA score was 86.9 14.6 points (range, 56124). The mean score was 32.5
5.05 (range, 2044) for Factor 1 (Self-concept), 28.4 6.46 (range, 1544) for Factor 2
(Initiative and Self-responsibility), 13.4 2.47 (range, 819) for Factor 3 (Knowledge and
Information Seeking), and 12.5 3.7 (range, 622) for Factor 4 (Passivity). Using a stepwise
method, two variables, the POMS categories of vigor and non-pregnant weight, were selected
for a regression equation to explain the variance in the total ESCA score. These two variables
explained 26.7% of the variance in the total ESCA score (R2 = 0.267, p = 0.001; POMS vigor,
= 0.410; non-pregnant weight, = 0.311).
Conclusions
Two variables, POMS categories of vigor and non-pregnant weight, explained 26.7% of the
variance in the total ESCA score, indicating that the degree of NVP does not necessarily
affect the total ESCA score.
3-5 Key words
Self-care, pregnant Japanese women, nausea and vomiting of pregnancy
252
Study on support of the pregnant woman which observed the father
Michiko Nakashima1
1.
Asahi University Department of Nursing School of Health Sciences
Presenting Authors Email: kapusaisin2005@yahoo.co.jp
Purpose
For many women delivering a child and for their families, pregnancy and delivery are
delightful events, but at the same time, they are also stressful events because they require
changes in lifestyle. It is desirable to obtain high amounts of support during stressful periods,
but there are reports that in the family of orientation of pregnant women, it is difficult for
fathers to be recognized by their daughters as being supportive. purpose of this study To
clarify the structures of paternal awareness regarding support for daughters in the pregnancy
period.
Design
Qualitative descriptive research The interview method
Methods
We explained the purpose of the study to pregnant women who had been undergoing prenatal
checkups at the department of gynecology on an outpatient basis and obtained written consent
to conduct interviews with their fathers. The fathers were contacted by their daughters, and
for those who replied, we confirmed their consent in writing and decided the interview date.
The details of the interviews were recorded using an IC recorder upon gaining permission
from each subject. After making word-for-word transcripts, the data were discarded.
Results
We conducted interviews with seven fathers. Furthermore, we extracted the following 6
categories of factors consisting of awareness regarding support: formation of affection with
daughter, recognition of role as a father, rules of the parental couple, system
patterns in the family of orientation, considerations for the family to which the daughter
was married into, and birth and succession of family members. It was found that the
253
structure of the awareness of fathers regarding support for their daughters in the pregnancy
period is based on their affection for their daughters, leading to the development of roles that
the fathers wish to express and fulfill for their daughters and an awareness of the delight and
significance of the birth and succession of family members, and these developments are
expressed to their daughters in the form of considerations for the family to which the daughter
has married into, the rules of the parental couple for how to treat their daughter, and the
system patterns in the family of orientation.
Conclusions
In Japan, it is said that pregnant women recognize support mainly from their biological
mothers and from their husbands, but the awareness of biological fathers regarding support is
also strong in the pregnancy period, although it becomes weaker after the delivery because the
biological mothers take over such roles of support.
The following four premises for forming awareness regarding support were perceived: (1)
parent-child affection that developed during the childs growth process, (2) the fathers
role in the family of orientation and communication within the family and between the parents,
(3) the setting of rules for providing support (complying with interfamilial borders), and (4)
paternal values that were passed down over generations.
It will be necessary in Japan for all family members to collectively support pregnant women
during the perinatal period. It remains a challenge for the future to develop new systems, not
only for utilizing social resources, but also for providing support from families.
3-5 Key words
Pregnant women, daughters, support, father
254
Prenatal exposure to different smoking environmentsUrine cotinine

analysis of pregnant women in south Taiwan
Shih-Hui Huang1, Ken-Pen Weng2

1.
Department of Public Health,College of Heal Science , Kaohsiung Medical University,
Kaohsiung, 2. Department of Pediatrics and Medical Education and Research, Kaohsiung Veterans
General Hospital
Presenting Authors Email: sc042@fy.edu.tw
Purpose
The purpose of this study is to evaluate the correlation between cotinine levels of different
prenatal smoking exposures and birth outcome.
Design
This is a cross-sectional study.
Methods
This study was conducted in the department of Obstetrics, Fooyin University Hospital from
2008 June to 2009 September. Two hundred and ninety three pregnant women were enrolled.
Questionnaires including the smoking exposure were done. Urine was collected for
measurement of cotinine in three subgroups: smoking(n=22), non-smoking &
ETS(Environmental tobacco smoke exposure)(n=121), non-smoking & non-ETS (n=150).
The correlation of urine cotinine levels and birth outcome was analyzed.
Results
The prevalence rates of maternal smoking, paternal smoking, and smoking in other family
were 7.5%, 60.4%, and 41.3% respectively. There was a significant difference among three
subgroups (smoking, non-smoking & ETS, non-smoking & non-ETS) in terms of maternal
age (24.23.7 yrs, 26.83.8 yrs, 28.04.6 yrs, p=0.0004), urine cotinine level (853.59
1202.75g/g, 197.03540.01g/g, 185.15396.25g/g, p<0.0001). There was a borderline
255
significant difference among three subgroups in terms of birth weight (3087.3 348.4 g,
3141.8387.7 g, 3238.3375.7 g, p=0.05).
Conclusions
Our results shows that smoking exposure of pregnant women might adversely affect fetal
development. Thus, reduction of prenatal environment exposure to smoking would
particularly result in substantial health benefits for newborns.
3-5 Key words
Pregnant women, smoking, cotinine
256
Health and QOL of Chinese female students in Japan
Sanae Saitoh1, Xiaodong Cardenas2, Hiroko Tsujimoto1, Yuko Kuroda3, Michiko Machiura4,
Kimiyo Suehara4
1.
Department of Nursing, Baika Womens University, 2. Department of Nursing, Osaka Medical

College, 3. Department of Nursing, Tokushima Bunri University, 4. School of Nursing, Osaka
Prefecture University
Presenting Authors Email: s-saitoh@baika.ac.jp
Purpose
To clarify the relationship between the health and QOL of Chinese female students in Japan,
and use it as basic information to improve nursing support for these students.
Design
A quantitative, exploratory, and cross-sectional study
Methods
We recruited study subjects from among Chinese female students belonging to graduate
schools, universities, or preparatory educational institutions for entering university (Japanese
language schools) in the Kinki region. An anonymous self-completed questionnaire was
administered to 229 students from institutions that consented to cooperate in our study, and
the completed questionnaires were collected by mail or using a placement method. The
questionnaire inquired about the subjects basic attributes, as well as their knowledge of and
behaviors regarding womens health, and involved the WHO/QOL-26. For ethical
considerations, the study was approved by the ethical review board of BAIKA Women's
University.
Results
A total of 153 completed questionnaires were collected (response rate: 66.8%). Of these
questionnaires, 96 with responses for all items of the WHO/QOL-26 were analyzed (effective
response rate: 62.8%).
The subjects scored an average of 5.82.0 points on a 10-point scale for their knowledge of
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menses, and 10.94.2 points on a 25-point scale for their knowledge of sexually transmitted
diseases (STD). These 2 scores showed a positive correlation with each other. Concerning
their knowledge of potential infection due to sex, among the 12 diseases that the STD scale
asked about, HIV/AIDS, gonorrhea, and syphilis were recognized by more than 70% of the
subjects; however, the other 8 diseases were recognized by only 10 to 50%. Also, 50% or less
of the subjects provided correct answers for 16 of the 25 items on the STD scale. These items
inquired about trends in the number of HIV-infected individuals in Japan, the modes of
transmission, likelihood of being infected with HIV among women, methods of preventing
HIV infection, appearance of AIDS symptoms, interaction between AIDS and other STD,
appropriate timing of testing, curability of AIDS, HIV testing, and its treatment. Regarding
consulting medical centers, 33.3% of the subjects had a history of consulting gynecologists in
China, and 13.5% consulted such professionals in Japan.
The subjects showed an average WHO/QOL-26 score of 3.30.3 points. The average scores
were: 3.30.4, 3.40.5, 3.30.4, and 3.30.4 points for the physical domain, psychological
domain, social relationships, and environmental domain, respectively. The knowledge of
menses or STD was not correlated with any QOL score. Also, the QOL score did not
significantly differ between subjects keeping and not keeping records of their menses, as well
as between subjects with and without menses-related concerns.
Conclusions
Chinese female students in Japan have poor knowledge of womens health (e.g., menses and
STD), and do not actively consult medical centers. Some of our subjects had physical
concerns, such as with menses. The WHO/QOL-26 scores for the physical domain and social
relationships showed a tendency to be lower among the subjects than Japanese women aged
20 to 30 years. It is necessary to meet the health-related needs of Chinese female students in
Japan.
3-5 Key words
Chinese, studying abroad, womens health, knowledge, QOL
258
Experiences with and adjustments to infertilityThe gender difference
Liying Ying1, Lai-Har WU1, Alice Yuen Loke1

1.
School of Nursing, The Hong Kong Polytechnic University
Presenting Authors Email: liying.ying@connect.polyu.hk
Purpose
To identify gender differences among couples regarding their experiences with and
adjustments to infertility.
Design
Literature review.
Methods
A systematic search was conducted in the following databases: PubMed, PsycInfo, CINAHL,
Scopus, Web of Science, and the CAJ (China Academic Journal) Full-text Database. The key
search terms used were infertile AND partnership OR marital OR relation* OR
psycho* OR stress* OR distress* OR anxiety OR depress* OR mental health OR emotion*
OR disorder* OR sexual*OR physical* OR identity OR self-esteem OR stigma OR shame
OR coping OR support AND gender. The studies included in this review were those
published in either English or Chinese from the January 2000 to April 2014. Couples
respond to infertility were examined from the perspective of gender.
Results
A total of 31 articles were identified and included in this review. The impact or adjustment of
infertility can be classified into five domains on the basis of the biopsychosocial theory
including: existential stressors, physical stressors, emotional stressors, interpersonal stressors,
and the moderators of stress. Overall, infertile women reported more negative experiences
with infertility than men in most of the domains, including lower levels of identity, selfesteem, and physical health; and higher levels of depression, stress, anxiety, stigma, and
shame. Infertile couples experienced stress in their married life, although there were no
259
gender differences in the areas of marital adjustment, marital satisfaction, and sexual
satisfaction. Females were likely to perceive themselves as being less confident than their
partners in coping with infertility. For both men and women, partner support was found to be
negatively related to stress due to infertility.
Conclusions
This review indicated that gender differences in the experience with infertility exist in many
realms, while both men and women were subject to a stressful married life. Partner support
was an important element of coping with infertility. Therefore, a supportive intervention,
focusing on the enhancement of partnership among infertile couples needs to be conducted to
help them cope with infertility.
3-5 Key words
Coping, couple, gender difference, infertility, stressors
260
Sexual and reproductive health among women with spinal disorder
Hiroko Tsujimoto1, Sanae Saitoh1, Sakiko Riki2

1.
BAIKA Womens University, 2. BUKKYO University
Presenting Authors Email: h-tsujimoto@baika.ac.jp
Purpose
In order for women, including those with disorders, to lead an active life while maintaining
their QOL, it is important to maintain both physical and sexual health. The present study
aimed to clarify the issues regarding nursing care that is provided to support the sexuality of
adult women living at home who are wheelchair-dependent due to spinal injury.
Design
A qualitative, descriptive study using a narrative approach that investigated the sexual and
reproductive health of adult women with spinal disorder
Methods
We contacted a facility from which we thought we could recruit subjects. The study subject
was one adult woman with spinal disorder who lived at home and was able to move in a
wheelchair.
We interviewed her using an interview guide for approximately one hour per trial, while
focusing on her statements.
Verbatim transcripts of her statements were made, after which they underwent content
analysis. The obtained data were encoded according to common meanings among them, data
with similar codes were classified into subcategories, and similar subcategories into
categories. To ensure the validity of our analyses, the researchers had group discussions until
they reached agreement.
For ethical considerations, we made adjustments to our schedules at the subjects request in
order not to hinder her daily life, and interviews were held at the place that she designated,
where her privacy was protected. This study was approved by the ethical review board of
BAIKA Women's University.
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Results
We interviewed the subject 6 times, and the total time was 7 hours and 4 minutes.
She was in her 30s, and had a 3-year-old daughter. She had lived a wheelchair-dependent life
for approximately 8 years.
Content analysis of the subjects statements extracted the following 9 categories: disease
acceptance, disorder acceptance, adherence, sexuality, reproductive
health, changes in lifestyle, social support, prospects, and hope. The
category of sexuality included the subcategories of [menses], [marital relationship], and
[particular wheelchair-related ideas], and the category of "reproductive health" included the
subcategories of the [history of pregnancy], [desire to have a child], [delivery], and
[gynecological examination].
Conclusions
On the basis of the subjects statements, we clarified that she had searched for necessary
information by herself because of insufficient information provided by healthcare workers and,
through trial and error, accepted and adapted to her own disabilities and herself undergoing
changes.
Concerning changes in the way the subject perceived sex, because it is a sensitive topic, we
did not obtain many statements during the interviews, each of which lasted approximately an
hour. However, the subjects accounts regarding her husband increased in frequency with
each interview.
Since the subjects first medical examination, nursing professionals have been involved with
her experiences, such as her acceptance of her own disorder, and living at home. This
suggests that it is necessary to start providing women with appropriate health and nursing
support while respecting their sexuality and discretion during the early phase of each of their
lifes turning points.
3-5 Key words
Sexuality, reproductive health, narrative, women, spinal injury
262
Intervention methods in sex education programs for adult womenA

literature review
Shiho Kawata1, Emiko Saito2

1.
shiga university of medical science, 2. Tokyo Metroporitan University
Presenting Authors Email: sk0612@belle.shiga-med.ac.jp
Purpose
To describe intervention methods for sex education programs aimed at Japanese adult women
through a literature review.
Design
A literature review
Methods
PubMed, Cumulative Index to Nursing and Allied Health Literature and the Japan Medical
Abstracts Society were searched to identify articles with abstracts and post-pubescent subjects
published between 2004 and 2014. The keywords used were sex education or sexual
education or reproductive health education plus program. The extracted research
comprised 152 papers in English and 59 papers in Japanese; of these, only articles including
detailed descriptions of the program contents and methods of implementation were selected
leaving a total of 15 papers (12 in English and three in Japanese) for the final analysis.
Results
Intervention methods included initial lectures combined with group discussions, e-mails,
online materials and practical instruction. In seven articles, the program contents took
regional culture or societal norms into consideration. Media used in lectures and during
ongoing intervention included pictures or pamphlets. Ongoing intervention also included emails or the websites and not only was information given out, but consultations were also
offered. In nine articles, ongoing intervention was implemented at a frequency of once a
month over a duration of >6 months.
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Conclusions
Intervention methods need to take subjects cultural background into account. Furthermore,
efforts should be made to create materials that are easy to understand by using visual aids.
Combining lectures with other methods is expected to increase educational effectiveness.
Specifically in Japan, it is worth considering ongoing intervention using e-mail since most
women own a cell phone.
3-5 Key words
Sex education, program, intervention methods
264
Effects of advanced on-the-job training for maternal-child care nurses and

midwives in Tigray regional state of Ethiopia
Kyung-Sook Bang1, Insook Lee1, Sun-Mi Chae1

1.
Seoul National University, College of Nursing
Presenting Authors Email: ksbang@snu.ac.kr
Purpose
The level of maternal-child health (MCH) is still very poor in developing countries, especially
in sub-Saharan Africa region. The purpose of this study was to identify effects of advanced
on-the-job training program for nurses and midwives working at public health centers in
Tigray regional state of Ethiopia.
Design
One-group pretest-posttest design was used.
Methods
Ten nurses and ten midwives from 5 health centers in the target region participated in the 5day advanced training sessions. Topics of education for the nurses were family planning,
antenatal care, postnatal care, child health care and immunization. For midwives, topics of
family planning, delivery care, newborn care, basic emergency and obstetric care, and safe
abortion were provided. Knowledge level was measured before and after each session of the
topic. Data were collected in March and April of 2014, and analyzed using paired t-test.
Results
For nurses, knowledge on family planning (t=-6.69, p<.001), antenatal care (t=-10.05,
p<.001), postnatal care (t=-8.37, p<.001), child health care (t=-13.65, p<.001) and
immunization (t=-10.21, p<.001) were significantly increased after the training. Total percent
of correct answers for nurses were changed from 54.6% to 95.4%. For midwives, family
planning (t=-17.77, p<.001), delivery care (t=-16.97, p<.001), newborn care (t=-12.08,
p<.001), basic emergency and obstetric care (t=-8.98, p<.001), and safe abortion (t=-7.43,
265
p<.001) were also significantly increased. Total percent of correct answers for midwives were
changed from 58.4% to 93.8%.
Conclusions
The findings of this study imply that the advanced on-the-job training for MCH nurses and
midwives was effective to develop capacity of the healthcare professionals in Tigray, Ethiopia.
3-5 Key words
Midwife, maternity, newborn, on-the-job training, Ethiopia
266
Effectiveness of stretching exercise on low back pain among postpartum

women
Huei-Mein Chen1, Shu-Fen Wang2

1.
Chung Hwa University of Medical Technology, Department of Nursing, Tainan, Taiwan, 2. Holy
promise postpartum nursing home, Department of Nursing, Tainan, Taiwan
Presenting Authors Email: hueimein@mail.hwai.edu.tw
Purpose
The purpose of this study was to evaluate the effectiveness of stretching exercise on low back
pain among postpartum women.
Design
This used a quasi-experimental design.
Methods
The participants were recruited from postpartum nursing centers in the Tainan area, Taiwan.
The patients were randomly divided into an experimental group and a control group. The
experimental group (n=50) followed a stretching exercise, whereas the control group (n=50)
was directed to perform standard postpartum treatment for 50 minutes per time, three times a
week. The participants were followed for 4 weeks. The tools used in this study include
individual case information, the Visual Analogue Scale for Pain (VASP) and The Short-Form
McGill Pain Questionnaire (SF-MPQ). SPSS18.0 software was used for analysis and testing,
and statistic calculation methods, such as percentage, chi-square test, and repeated measure
ANOVA, was used.
Results
During 2weeks and 4weeks follow-up, the results demonstrated the differences between the
states of VASP and SF-MPQ in postpartum women in the experimental group and those in the
control group (F=10.974, p=0.01; F=8.179, p=0.005 and F=1.642, p=0.203; F=14.346,
p<0.001, respectively).
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Conclusions
This study demonstrates that applying stretching exercise has positive effects on low back
pain in postpartum women. These results can be used by nurse practitioners as a reference for
the care of postpartum women.
3-5 Key words
Stretching exercise, low back pain, postpartum women
268
Efficacy of enjoying a quilting against quality of daily life and tendency to

depression in the aged women
Masayo Ayukawa1, Shunyue Cheng1, Satomi Tanaka1, Ai Yamaguchi1, Yumie Nagata1

1.
GIFU UNIVERSITY OF MEDICAL SCIENCE
Presenting Authors Email: sarya217@gmail.com
Purpose
A leisure activity gives elderly person a positive effect on the mental health. It is reported
that enjoying creative handicrafts such as the quilting as a hobby becomes one of the effective
means that it raises will-being. However, the quantitative study between quilt and body and
body health has not been reported. This study aimed to evaluate what kind of influence
enjoying quilt had about quality of daily life and tendency to depression .
Design
Methods
180 people who was a member of association of handicrafts spread in Japan and conducted a
quilt school were enrolled. The data was collected using self-administrated questionnaires that
had questions including the subjects basic attribute, the first hobby, related information and
purpose of the quilting, effects such as a sense of fulfillment to be provided by quilting, a
dejection standard of GDS(Geriatric Depression Scale), which was sent with the association
magazine for from April, 2014 to August. Categorical data was summarized by using simple
tabulation. Continuous data was analyzed by t test. Multiple regression analysis was
performed to evaluate the relationship between questionnaire items and GDS. All statistical
analyses used statistics software SPSS Version 20. This study was approved by the ethical
committee of University A and was performed under the written informed consent.
Results
Questionnaire forms were collected in 150 people (83.3%) and the number of effective
answer was 124 (82.6%). The mean age was 60.710 years old and 37.1% were elderly
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people 65 years or older. Experience in quilt was more than 10 years in 91.1% and a quilt
was performed every day in 52.4%. In 70% the subject belonged to another school. Item
about Life was answered to be satisfied and almost satisfied in 94.4%. Item
effect of a quilt was become fun in 84.7%, meet more friends in 36.3% and
prevent dementia in 21.8%. T The scoring average of the GDS standard was significantly
high in the following groups: satisfied with life, subjectively healthy, having many friends,
economically comfortable, more than 10 year of experience in a quilt, quilting every day,
belonging to a quilt school, a sense of fulfillment after completed a quilting work, a quilting
makes life enjoyable. Multiple regression analysis showed that the groups satisfied with
life and subjectively healthy had significantly low score in GDS.
Conclusions
This study demonstrated that 90% of aged women who enjoys a quilt was satisfied with life
and had low score in GDS. There were several reports that making a quilt is challenging and
requires concentration, which puts negative thinking out of their mind and has a relaxation
effect. Quilting with friends increases resilience in conjunction with friendship and feeling of
assistance. Furthermore, making a quilt gave them sense of fulfillment and make life
enjoyable, resulting in improvement of quality of life. A quilting, creative hobby, is effective
to improve quality of daily life and prevent dejection in aged women.
3-5 Key words
Quilt, aged women, well-being, depression, daily living
270
Study of the self-massage method on the lower extremities of healthy

women
Yukiko Ushigoe1, Ayako Kajimura1, Shigeki Tatsukawa1, Mai Takagaki1

1.
Kansai University of International Studies, School of Health Sciences
Presenting Authors Email: y-ushigoe@kuins.ac.jp
Purpose
Finger pressure and massage are said to relieve pain, promote parasympathetic activity and
result in improved sleep. Until now, a relaxation effect has been suggested in reports of foot
massage by others.
The purpose of this study was to clarify the effect that Self-Massage has on autonomic
nervous activity and the feeling of relaxation in healthy women.
Design
This study was pretest-posttest design.
Methods
The study subjects were five healthy women in the luteal (hyperthermic) phase (age: 18 0
years). The data collection period was from December 2013 to January 2014. The
experimental environment was set to 2225 room temperature with 5060% humidity
rate. All of the subjects wore T-shirts and shorts.
The experimental procedure was as follows: the way of Self-Massage was to massage rub the
soleus muscle lightly, based on the anatomy, and promote blood circulation to relax the
muscles of the lower extremities. There were three conditions in which 10-minute, 20-minute
and 30-minute massages were carried out on different days.
After the subjects entered the experimental room, they were given a 10-minute habituation
period on the bed. Then, their autonomic balances were measured by the relaxation scale (RE
scale) and pulse analyzer (TAS9). After that, a massage was carried out in a sitting position.
Immediately after the massage, evaluations were carried out after 5 minutes, 10 minutes and
15 minutes.
271
The results were analysed by Kruskal Wallis test (p0.05) with software SPSS Ver 21.0.
Results
A trend towards a mood increase (RE scale) was observed in all the four items as the massage
time increased to 10 minutes, 20 minutes and 30 minutes. There was no significant difference
between before and after of the massage. A trend of high frequency (HF) component increase,
which is a parasympathetic activity index, was observed up to 15 minutes after each of the 10minute, 20-minute and 30-minute massages There was no significant difference between
before and after of the massage. The ratio between high frequency components and low
frequency components, which is a sympathetic activity index (LF / HF: low frequency / high
frequency), increased 10 to 15 minutes after the 30-minute massage; however, it decreased in
the case of 10-minute and 20-minute massages. There was no significant difference between
before and after of the massage.
Conclusions
A trend towards an increase of the feeling of relaxation was observed in all durations
(massage periods); however, there were no significant differences. Trends towards an increase
in the parasympathetic activity index were observed in all durations; however, there were no
significant differences.
This suggests that relaxation effects can be obtained regardless of the massage duration.
3-5 Key words
Self-massage, relaxation, autonomic nervous activity
272
Results of the health education program towards promotion of cervix

cancer screening for the 2030th generation woman
Izumi Matsuo1, Yoshiko Nishizawa2

1.
aomori university of health and welfare, 2. Hirosaki University Graduate School
Presenting Authors Email: i_matsuo@auhw.ac.jp
Purpose
In Japan, cervix cancer screening consultation rates in the 2030th generation woman
remain at low levels. To promote participation in uterine cervix cancer screening, we will
conduct a health education program combining individual recommendations with a health
education lesson by medical professionals, and clarify its effects.
Design
This is a hypothesis-testing, interventional study using a health education program.
Methods
The 220 female subjects living in Region A of the Tohoku area of Japan were assigned to
either an intervention group or a control group using participant register numbers. Both
groups attended a health education lesson, with the objective of providing knowledge about
uterine cervix cancer, which discussed topics such as the characteristics of uterine cervix
cancer, how to attend a gynecological consultation, details of cancer screenings, the current
low consultation rates, and the importance of voluntary consultation behavior. In addition, to
encourage a positive attitude towards consultation, a demonstration of how to plan a
consultation was given. Next, in the intervention group only, we had subjects make postcards
recommending a consultation, and made individual recommendations by posting these cards
individually before the planned consultation dates. To measure the effects of this health
education program, we performed longitudinal surveillance of basic characteristics,
knowledge about uterine cervix cancer, changes in health locus of control (HLC) and actual
attendance of consultations, using a self-completed answer sheet, at three time points: before
and after the health class, and 3 months after.
273
Results
The 142 subjects who gave valid responses (average age 27.09.4 years) had increased
knowledge of uterine cervix cancer after attending the health lesson. Their willingness to
attend screenings had also increased. The 53 subjects wo gave valid responses 3 months after
(average age 29.08.2 years) had a consultation rate of 42.3% in subjects aged 20 to 29(a
whole consultation rate 32.1%), which was higher than the consultation rate for Region A
(14.9% in 2009) and the national consultation rate (23.7% in 2010). Although there was no
significant difference, the consultation rate was higher in the intervention group (27 subjects,
37.0%) than in the control group (26 subjects, 26.9%). The HLC score for medical
professionals 3 months after the health lesson was also significantly higher in the intervention
group.
Conclusions
The results suggested that this health education program was effective in promoting
consultation behavior with respect to uterine cervix cancer screening. In the future, it will be
necessary to adapt education methods, in collaboration with local education institutions and
medical institutions, as with cancer prevention strategies in other countries, and consider the
timing and methodology of longitudinal surveillance so that results can be generalized.
3-5 Key words
Uterine cervix cancer screening, health education program, health locus of control, screening
consultation behavior
274
Factors associated with intention to use condoms for reducing human

papillomavirus infection risk among Taiwanese adolescent women
Yu-Ching Tu1, Yi-Jung Lin2, Hsiu-Hung Wang3, Te-Fu Chan4

1.
Chung Hwa University of Medical Technology, 2. Department of Nursing, Shu-Zen College of
Medicine and Management, 3. College of Nursing, Kaohsiung Medical University, 4. School of

Medicine, Kaohsiung Medical University
Presenting Authors Email: pochacco2293@yahoo.com.tw
Purpose
Human papillomavirus (HPV) is a frequent cause of sexually transmitted infection worldwide,
and has a key role in the etiology of cervical cancer. Since the successful development of the
HPV vaccine, it has become an effective method of protection against vaccine-specific types
of HPV-related disease. Young people are the most vulnerable age group for acquiring HPV
infection, but in Taiwan little is known about such knowledge in this particular age group.
This study investigated Taiwanese adolescent womens knowledge of HPV and factors
associated with intention to use condoms for reducing HPV-related diseases among
adolescent women.
Design
A descriptive cross-sectional design was used
Methods
A convenience sample of 512 adolescent women aged 15 to 17 years living in Southern
Taiwan was recruited in this study. Data were collected using a self-administered
questionnaire and analyzed with descriptive statistics, t-test or ANOVA, and multiple
regression analysis.
Results
Only 26.6 % of the participants were aware of HPV. The percentage of correct answers for
knowledge about HPV was 35.4%. The majority of participants were unvaccinated against
HPV-related disease (98%). Attitude (r = 0.56, p < .01), subjective norm (r = 0.59, p < .01),
275
perceived behavioral control (r = 0.56, p < .01), and HPV knowledge (r = 0.15, p < .01) were
significantly positively correlated with intention of condom use for HPV prevention. Factors
associated with intention to use condoms for HPV prevention were: discussed sexual issues,
attitude, subjective norm, perceived behavioral control, and HPV knowledge. These variables
accounted for 55.8% variance in scores for intention to use condoms for HPV prevention.
Conclusions
The participants of this study had limited HPV-related knowledge and extremely low rates of
HPV vaccination among Taiwanese adolescent women. Poor understanding and
misconceptions of HPV prevention could further undermine their health. It is, therefore,
necessary to implement supplementary approaches to promote adolescent womens sexual
health in the regions with low rates of HPV vaccination.
3-5 Key words
Women health, sexually transmitted infection, cervical cancer, HPV prevention, HPV vaccine
276
The effect of a self-monitoring network using PHS among Japanese women

during pregnancy
Yumiko Sakuma1, Sadayo Ishida2, Akiyo Sasaki-Otomaru2, Yoshiko Mochizuki3,

Ayako Usui1, Chifumi Sato4
1.
Faculty of Nursing, Kameda College of Health Sciences, 2. Nursing Course, School of Medicine,
Yokohama City University, 3. Tokai University College of Nursing and Medical Technology, 4. Otsuka
Medical Clinic
Presenting Authors Email: yumahs@kameda.ac.jp
Purpose
The purpose of this study was to examine the effect of a self-monitoring network using PHS
(Personal Handy-phone System) among Japanese women during pregnancy.
Design
This study was conducted under the design of a prospective randomized trial. A convenient
sample of healthy pregnant women who had normal singleton pregnancy were recruited in
two clinics between 2012 December and 2014 September.
Methods
We assigned the participants randomly to the self-monitoring group, the telephone counseling
group and the usual care group. The participants in the self-monitoring group were
encouraged to continue monitoring blood pressure and weight by e-mail using PHS every day.
Each week data were returned to the respective participants with comments by a public health
nurse. Additionally, those in the self-monitoring group and the telephone counseling group
were arrowed to receive telephone counseling using PHS by a midwife about distress or the
life in general during pregnancy. The implementation status of the self-care behavior scale
and the Profile of Mood State (POMS) were used at baseline, 26th week and 36th week of
gestation.
Results
277
The pregnant women who gave birth by September, 2014 were included in the analysis.
Eighteen pregnant women were assigned randomly to the self-monitoring group (n=8), the
telephone counseling group (n=3) and the usual care group (control group: n=7). The
implementation status of a self-care behavior subscale scores; diet improved
significantly at 36th week of gestation in the telephone counseling group (p=0.050).
Furthermore, among the pregnant women who were working full-time, the implementation
statuses of the self-care behavior subscale score; daily activities (the 36weekth p=0.032)
and Anger-Hostility in POMS (the 26weekth p=0.038) have improved in the self
monitoring group as compared to the control group.
Conclusions
The self-monitoring network using PHS may improve the selfcare behavior and levels of
mental mood in working pregnant women.
3-5 Key words
Pregnant women, self-monitoring, self-care behavior
278
The life experience of an adolescent becoming a mother
Miao-Fang Shih1, Hsiang Yen1

1.
Chang Gung University Of Science and Technology
Presenting Authors Email: mfshih@gw.cgust.edu.tw
Purpose
This qualitative study explored the life experience of an adolescent becoming a mother.
Design
The observer-as-participant field method was used in this study, and a narrative form of
process recording was applied to record data. The data was analyzed by content analysis.
Methods
The researcher, as a nurse, offered nursing services to the cases during prenatal care from the
case first time to the OPD to the first postpartum check. The research period lasted 8 months.
Results
Five major themes emerged in this study:(1) She suddenly finds out that she is pregnant. (2)
Everyone from her family opposes to her pregnancy.(3) She doesn't care about others'
viewpoints upon her. (4) She suffers lots of social pressure. (5) She enjoys to be herself.
Conclusions
Its not easy for an adolescent becoming a mother. She needs more caring and support.
Nurses must understand what they want and what they need, then provide them suitable
intervention.
3-5 Key words
Life experience, adolescent, becoming a mother
279
Qualitative studyUnderstanding womens experience in infertile women

to reach fertile limitation
Masako Abe1
1.
Nagano College of Nursing
Presenting Authors Email: masakoA@nagano-nurs.ac.jp
Purpose
Despite infertility treat, there are some cases that women cannot have a baby because of their
age. In such cases, it is important for them to decide when they terminate the treatment. Their
experiences in the process of fertility treatment and its termination are not well understood.
Design
We employed a qualitative design based on a content analysis approach to collect and analyze
the perspectives of 20 sterile married women without childbirth experiences.After participant
selection, we conducted semi-structured interviews, and collected data from these.
Methods
Qualitative analysis based on grounded theory.This study was approved by the Committee on
Research Ethics of the universities to which we belong and conducted after obtaining
informed consent from the study subjects upon explaining the ethical considerations in the
study.
Results
Results of the analysis by the grounded theory approach revealed that infertile women had felt
the [increase of accountability to oneself] by deviation from the ideal and the reality that
children cannot be made even after the treatment process and will age bestow a child that has
been assumed to treatment initially.Therefore, woman had been procrastinating the decision
to stop the treatment in order to reduce the psychological conflict.On the other hand, after she
had a counseling session with a nurse to explore her own feelings, their negative emotions
have subsided, and this was a chance to expand their vision.
280
Conclusions
This result suggested that assisted reproductive technology nurses require the recognition of
promotional role for making the advance for womens life-span development in nursing
counseling.
3-5 Key words
Infertility, woman, decision-making, reproductive technology
281
Validation of the Chinese version of the CogState computerized cognitive

assessment battery in Taiwanese women with heart failure
Cheng-Chen Chou1, Susan J. Pressler2, Bruno Giordani3

1.
Department of Nursing,College of Medicine, National Cheng Kung University, 2. University of
Michigan School of Nursing, 3. University of Michigan School of Medicine, Neuropsychology Section,

Department of Psychiatry and Department of Neurology
Presenting Authors Email: chenchou@mail.ncku.edu.tw
Purpose
To evaluate the validity of the Chinese version of the CogState battery, a computerized
neuropsychological test battery among women with heart failure (HF) in Taiwan.
Design
A cross-sectional descriptive study. A convenience sample consisted of 76 women with HF
and 64 healthy women from one medical center in Northern Taiwan.
Methods
Participants completed the Chinese version of the CogState battery and the Montreal
Cognitive Assessment (MoCA). Construct validity of the Chinese version of the battery was
evaluated by exploratory factor analysis and known-group comparisons. Convergent validity
of the CogState tasks was examined by Pearson correlation coefficients.
Results
Principal components factor analysis with promax rotation showed two factors reflecting the
speed and memory dimensions of the tests. Scores for CogState battery tasks showed
significant differences between the HF and healthy control groups. The convergent validity of
the CogState significantly associated with MoCA in the HF group (P< 0.05).
Conclusions
The Chinese CogState Computerized Cognitive Assessment Battery has satisfactory validity.
It has potential use with HF patients for both research and practice.
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3-5 Key words

Women, heart failure, CogState computerized cognitive assessment battery
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Factors related to HRQOL in endometriosis patients
Yasuko Tabuchi1, Aki Nakagawa2, Atsuko Yoshidome3, Yuki Kumagai2

1.
Saga University Department of NUrsing Faculty of Medicine, 2. Saga University, 3. Kagoshima

University
Presenting Authors Email: ytabuchi@cc.saga-u.ac.jp
Purpose
Endometriosis has been shown to significantly reduce female patients quality of life (QOL).
However, there are few reports that evaluate QOL in endometriosis patients quantitatively.
This paper aims to examine endometriosis patients QOL during their menstrual periods and
the relationship between the patients health-related quality of life (HRQOL) and
concomitant menstruation symptoms.
Design
questionnaire investigation
Methods
Objects were 1,308 women who had received an endometriosis diagnosis and were registered
with the Japan Endometriosis Association. The representative distributed self-administered
questionnaires to the participants via mail. The questionnaire was completed anonymously,
and the return of the questionnaire was considered to imply consent to participate. The
questionnaire item topics included attributes, menstrual state, concomitant menstruation
symptoms, and HRQOL (The SF-8 Health Survey acute form was used to investigate the
Health Related QOL). SPSS statistics software was used to analyze the data. The research was
conducted subsequent to ethical evaluation, performed by the affiliated university.
Results
Three hundred thirty copies of the questionnaire were returned (response rate: 25.2%), and
154 patients who stated that they were experiencing menstruation during the study period
were selected as subjects. The average age of the subjects as 39.5 years (age range: 2453
years). QOL was lower in endometriosis patients with stronger concomitant menstruation
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symptoms. Concomitant menstruation symptoms affecting patients physical component

summary and mental component summary scores were revealed via multiple regression
analysis. Of the nine concomitant menstruation symptoms reported, including lower
abdominal and back pain, multicollinearity was found in one. As a result, the related item was
excluded and the remaining eight items were used as independent variables in stepwise
multiple regression analysis. The items that affected physical component summary scores
were painkillers do not work, lower abdominal and back pain continues, had pain that
continued after menstruation, there is a lot of menstrual blood, and there is pain
deep in the anus. The adjusted R-square was .472. The items that affected mental
component summary scores were lower abdominal and back pain continues, had pain that
continued after menstruation and painkillers do not work. The adjusted R-square
was .234.
Conclusions
Results indicated that endometriosis patients with stronger concomitant menstruation
symptoms experienced lower HRQOL. The symptoms that affected the physical component
summary scores included intensity of menstrual pain, long-term pain, amount of menstrual
blood, and anal pain. The symptoms that affected the mental component summary scores
included long-term pain, and intensity of menstrual pain. Symptom management is crucial to
the improvement of HRQOL in endometriosis patients.
3-5 Key words
Endometriosis, concomitant menstruation symptoms, HRQOL
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Developing the network of sexuality educationReaching out from

university
Kanako Yamada1, Minako Saho2, Miho Furuyama2, Chie Kou2

1.
Osaka Prifecture University, 2. Osaka Prefecture University
Presenting Authors Email: yamadak@nursing.osakafu-u.ac.jp
Purpose
Our university is expanding through sexuality education activities on a visiting basis,
targeting high school students in Osaka Prefecture, educational activities aimed at local
communities, and the development of teaching materials for sexuality education. The
objectives of the education project were: to develop a feeling of loving oneself, and to
learn thinking and behavior with feelings for the preciousness of life.
Design
We report on this approach.
Methods
The Osaka Prefecture University sexuality education project began its activities about 10
years ago, and delivers lectures to about 17 high schools each year.
Results
1.In 2013, class unit workshops and full lectures were carried out for a total of 4069 students.
The themes of the lectures were: a. Prevention of dating violence; b. Precautions against
AIDS/sexually transmitted infections; etc. At the workshops, other than university teaching
staff, there was cooperation from many undergraduate students, graduate students, nurses,
midwives, public health nurses, etc. 2. Other than the delivery lectures, twice a year, within
the university, the Sexuality Education Research Conference is held, and lectures, etc.
are conducted in line with the theme of the conference. 3. In the development of teaching
materials, taking a hint from traditional Japanese card games, we produced sexuality
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education teaching materials (Dating Etiquette Cards) that could be approached by anyone as
though it were a game. They could discuss sex by the cards. 4. Our university coordinates
with educational institutions, and provides support up until the plans for the local
communities to become independent in expanding their sexuality education activities are
implemented.
Conclusions
Through these activities, the numbers of students, clinical nurses, and practitioners who
participate in sexuality education activities have grown. Also, the card game has been
developed that any Japanese person is able to experience, and by using it as sexuality
education teaching materials, there is no undue tension, and sex education can be approached
in a pleasant way. We aim to go beyond the university, and through a direction of
coordination and activation with the local communities, while involving people who
understand our sexuality education objectives, will play a coordination role so that the
respective practitioners can be active in their local communities.
3-5 Key words
Sexuality education, high school students, network
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Study of intervention on womens help-seeking behavior for stress urinary

incontinence
Qing Guo1, Yan Ma1

1.
Tai Shan Medical University
Presenting Authors Email: 884235gq@163.com
Purpose
To investigate the effect of health education intervention on womens knowledge, health
beliefs and help-seeking behavior of stress urinary incontinence(SUI).
Design
A randomized controlled trial.
Methods
Using purpose sampling methods,80 SUI women who were screened with Chinese Short
Form of International Consultation on Incontinence questionnaire(ICIQ-SF) aged over 20
years from two communities in Taian were enrolled and randomly divided into two groups.
Intervention group(40 cases) undergo a four-week health education program (health lectures,
health education manual, establish a telephone follow-up), control group(40 cases) without
any intervention. The stress urinary incontinence knowledge and health beliefs of the two
groups were collected respectively by the Chinese version of health beliefs scales and SUI
knowledge questionnaire before and after the intervention. After the intervention, collect the
number of women who sought for help within six months. T test and 2 test were used for
statistical analysis.
Results
In terms of population sociology, disease conditions, knowledge of SUI and severity of
SUI ,there were no significant differences between the two groups (P > 0.05); After the
intervention, the score of stress urinary incontinence knowledge, perceived susceptibility and
seriousness about diseaseperceived benefits of taking action and cues to action in the
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intervention group was significantly higher(P<0.01), while the score of perceived barriers to
taking action was significantly lower after the intervention(P<0.05); There were no
significantly difference in scores of stress urinary incontinence knowledge and health beliefs
in the control group (P> 0.05). Compared to the control group, the score of stress urinary
incontinence knowledge, perceived susceptibility and seriousness about diseaseperceived
benefits of taking action and cues to action in the intervention group was significantly higher,
while the score of perceived barriers to taking action was significantly lower after the
intervention (P<0.01). After the intervention, the women in the intervention group who sought
help was more than the control group(P<0.01).
Conclusions
Health education intervention can improve womens knowledge level of stress urinary
incontinence, enhance womens health beliefs and promote womens help-seeking
behavior for stress urinary incontinence.
3-5 Key words
Stress urinary incontinence, health belief model, help-seeking behavior, influencing factors,
health education
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Social network support and health perception in Taiwanese single mothers
Chia-Wen Lee1
1.
Mackay Medical College/ Department of Nursing
Presenting Authors Email: cxl276@mmc.edu.tw
Purpose
According to available statistics in 2010, 9.78% of all families were headed by single-parent
families, and mother-headed families were 56.68%. Findings from past research support that
social support influences health problems and consequences through the influence,
engagement and participation, regulation of contact, and access to resources provided by
members of the social network. Low levels of social network support may be risk factors for
physical and psychological health problems. The negative physical and psychological health
consequences may influence the interaction between single mothers and their children. Thus,
a single-mother family is more vulnerable not only in social and economic status than a twoparent family but also in health status. The purpose of this study was to investigate social
network support and health perception of single mothers in Taiwan.
Design
A cross-sectional design was used to answer the research questions.
Methods
Ninety-one single mothers were participated. Four instruments were used to collect data: the
Demographic Questionnaire, The MOS Social Support Survey, CES-D, The Rand 36-item
Health Survey 1.0: General Health Perception subscale.
Results
The age of participants ranged from 18 to 58 years (M = 41.6, SD = 6.69), and 50.2% of
participants were divorced. Of total participants, the majority (87.6 %) reported a high school
education background or less. The majority of the single mothers (n = 75, 82.4%) had two or
less than two children. The mean length of having been a single mother was 79.12 months or
6.6 years (SD = 54.84 months, range = 10 - 228 months). After controlling the demographic
290
variables, social network support was negatively correlated to depressive symptoms (r = -.38,
p < .001) and to perceived general health were positively correlated (r = .46, p < .001). The
correlation analyses respectively showed the expected directions in those two dependent
variables, the strength of the relationship between variables was moderate relationships.
Conclusions
Although social network support is associated with single mothers health perceptions, the
researcher suggests that the social network support is not the only influential factor in single
mothers health outcomes. The level of satisfaction with social support may be a more
influential factor in single mothers health outcomes. Thus, social network support is a
multiple dimensional aspect, which needs to be measured by different point of view to
understand how social network support may affect health status.
3-5 Key words
Social network support, health perception, single mothers
291
The effectiveness of home telehealth care combining telephone consultation

in hypertension management among elderly population.
Ju-Fen Lu1, Ching-Min Chen2, Mei-Ju Chi3

1.
Department of Nursing, Jen-Te Junior College of Medicine, Nursing and Management, 2. Department
of Nursing, National Cheng Kung University, 3. School of Gerontology Health Management, College
of Nursing, Taipei Medical University
Presenting Authors Email: jufen407@yahoo.com.tw
Purpose
Hypertension is one of the most common chronic disease in elderly population and an
important risk factor for cardiovascular disease and stroke. Home Telehealth Care (HTC) is
an innovative care mode and has been applied in home care services in many developed
countries . It is believed that HTC can be effective in control of hypertension and can assist
hypertensive patients monitor medical conditions, improve drug adherence and achieve
disease self- management in daily life. The purpose of this study is to explore the
effectiveness of HTC combining telephone consultation in hypertension management among
elderly population in Taiwan.
Design
The prospective quasi-experimental research design
Methods
The study was applied and participants were recruited from the 12 District Health Centers in
Taipei City who had been case managed for their hypertension for 3 months during August
2012 to April 2013. A total of 116 hypertensive elderly were randomly assigned to receive the
HTC plus five telephone consultation sessions for 2 months (HTC- telephone; n=41), only
home telehealth care (HTC; n=38), or usual care (UC; n=37). Data were collected through a
structured interview and brief physical exam, and retrieved frequency of clients uploading
from Taipei City governments central server at baseline, 3 months and 6 months follow up.
Repeated measures analysis of variance were used to analyze the studys hypothesis.
292
Results
The hypertensive knowledge mean score improved for all groups (F=8.53, p <0.01F=5.13,
p <0.05; F=6.03, p <0.01) during 3 and 6 months. Compared to the UC group, HTCtelephone group had better hypertensive knowledge and self-efficacy mean score (F= 3.83,
p=0.007; F=7.62, p=0.000) at 6 months follow up. SBP and DBP were maintained in the
HTC- telephone group; on the other hand, the HTC group had significant increased mean
systolic and diastolic blood pressure (F=5.43, p<0.01; F=4.33, p<0.05), and the UC group
experienced mean increased diastolic blood pressure (F=4.27, p <0.05) at 6 months. In blood
pressure self- monitoring frequency, both HTC-telephone group and HTC groups had a
significant increased (F=4.33, p<0.05; F=5.64, p <0.01) at 6 months, and a higher frequency
was noticed in HTC- telephone group (F=3.52, p=0.065).
Conclusions
This study found that HTC combining telephone consultation could help hypertensive elderly
to maintain their BP level and self-monitoring behaviors and to improve patients
hypertensive knowledge and self-efficacy. Tailored strategy to enhance patients disease
knowledge and self-efficacy is needed in order to improve their disease self-management. We
hoped that such results can be referenced for government in the further development of home
telehealth care.
3-5 Key words
Home telehealth care, telephone consultation, hypertension management
293
Identifying research directions for optical topography to address

depression among elderly with dementia in Japan
Miwa Yamamoto1, Shigeru Sakuraba2, Jun Shimizu2, Yuki Murase2, Noriko Adachi1,
Yoko Miyoshi1
1.
Tottori University, 2. Kyoto Koka Womens University
Presenting Authors Email: tokiwa27@hotmail.com
Purpose
Development of optical topography, a non-invasive tool used to analyze cerebral
hemodynamics using near-infrared spectroscopy (NIRS), has made it possible to view the
working brain like never before. Optical topography reveals brain activity by measuring
different absorption spectra of oxygenated and deoxygenated hemoglobin in the near infrared
region, providing multiple opportunities to explore the mysteries of the human brain. After
positioning the easy-to-use probes on the head of the subject, the ETG-4000 (Hitachi Medical
System) generates images that depict changes in hemoglobin concentrations of the brain.
Minimal restraint allows for subject comfort in an environment controlled by the operator in
Japan. In May 2013, optical topography was examined specifically at 10 facilities as an
advanced medical technology of the Ministry of Health. Depression is difficult to diagnose,
especially in elderly individuals with observed symptoms of dementia, but brain activity as
revealed by optical topography can more readily reveal depression as a disease. Therefore, we
aimed to identify research directions for the use of optical topography to examine depression
among elderly with dementia in Japan.
Design
We have used text date mining for analyses by anonymous articles.
Methods
A literature search was conducted in Ichushi, the Japanese medical literature database
provided by the NPO Japan Medical Abstracts Society. This database comprises
approximately 5000 journal titles and 6,300,000 articles, the latter of which are linked to a
thesaurus for indexing and retrieval. The search term optical topography identified 275
294
articles published within the last 5 years. Of these, 54 were original research articles with
abstracts containing the keywords dementia and elderly and included 5 original
research articles published between 2009 and 2013. These articles were analyzed using text
mining software (Trend Search, FUJITSU) to map related terms and analyze relational line
size and distance in order to determine relational strength.
Results
Of the 275 articles published between 2009 and 2013, we found only 5 eligible articles,
suggesting that research in this field is currently insufficient. Mapping yielded the two
wedges of education and diagnoses. Education was associated with
Alzheimers, rehabilitation, neurologic examination, Met hemoglobin,
cognitive inspection, brain contexts, image diagnosis, short-term memory,
oxyhemoglobin, cerebral circulation, near infrared spectroscopy,
notifications, sense of balance, and examinations. In addition, Diagnoses
was associated with pilot project, depression, discrimination, longitudinal
study, medical treatment, psychiatry, pharmacotherapy, dementia,
scale, bipolar disorder, prognosis, and availability.
Conclusions
We conclude that mapping research should be conducted to analyze education and diagnoses,
the two wedges identified by this study. 1. Education, and 2. Diagnoses. 1.
education means the result of these text Data clarified an effect of the learning therapy
using the light topography. Therefore, these mean, we aimed to evaluate two fields of research
directions in Optical Topography for depression focusing on the elderly with dementia in
Japan.
These are education and diagnoses about optical topography for depression focusing on the
elderly with dementia in Japan. We have ability of approach reading to education and
diagnoses by Optical Topography for depression focusing on the elderly with dementia in
Japan.
3-5 Key words
Research directions, optical topography, depression, dementia
295
Establishment of a transitional care program for discharged elderly stroke

patients
Pingping Zhang1
1.
Saitama Prefectural University
Presenting Authors Email: cho-heihei@spu.ac.jp
Purpose
The present study aimed to establish a transitional care program for discharged elderly stroke
patients.
Design
This was a qualitative study that explored the transitional care situation of discharged elderly
stroke patients through interviews with nurses and nurse managers working on internal
medicine hospital wards in China. We also conducted a literature review of relevant studies in
China and Japan to elucidate how knowledge and experience in transitional care support for
discharged patients gained in Japan could address current and future needs in China.
Methods
During May and July 2013, five nurses working on the same internal medicine hospital ward
in A city were interviewed individually, and six nurse managers from six hospitals in B city
were interviewed as part of a group. Interviews were composed of questions aimed to clarify
the transitional care situation of discharged elderly stroke patients, such as current status and
needs, as well as hopes for future improvement. In addition, 32 Chinese and 18 Japanese
studies of transitional care for discharged elderly stroke patients were analyzed. This study
was approved by the Ethics Committee of Saitama Prefectural University, Japan.
Results
In China, discharge instructions were provided consistently, but support for discharged
elderly stroke patients was generally poor. In Japan, not only were discharge instructions
provided from the time of admission until discharge, but discharge support was also
performed through active coordination between nurses and other medical staff or facilities. In
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particular, individualized interventions based on patient-centered nursing, such as teaching

patients with dominant hand disorder how to self-inject insulin, or assessing the needs of
patients living at home, were performed after discharge. Based on these results, we
determined that an intervention program for discharged elderly stroke patients should be
established to provide good transitional care. This program should include the following: 1) a
necessary information sheet to support transitional care; 2) an assessment sheet of transitional
care intervention for discharged patients through discharge coordination; and 3) an evaluation
sheet for transitional care for discharged patients. Before putting this intervention program
into practice, nurses must be appropriately educated and trained.
Conclusions
With the rapid aging of society, providing a consistent transitional care model capable of
coordinating hospital-, community-, and home-based care for elderly patients is important on
a global scale. Japan has become the first country in the world with an aged society, and
discharge coordination should therefore operate optimally. This program can provide
reference for transitional care research and practice, and can also suggest policy directions
that may be possible for the elderly care system in China.
This study was funded by a JSPS KAKENHI Grant-in-Aid for Scientific Research in Japan
(number 24660045).
3-5 Key words
Transitional care, program establishment, discharged elderly stroke patients
297
Changes in the Euro-Qol and depression, and post-operative patient

satisfaction 5 years after total hip arthroplasty
Kimie Fujita1, 2
1.
Department of health scienses, Kyushu university, 2.
Presenting Authors Email: fujitak@hs.med.kyushu-u.ac.jp
Purpose
Total hip arthroplasty (THA) is a widely accepted orthopedic surgical procedure performed to
relieve pain and improve physical functions. However, research on long-term quality of life
among THA patient is limited. The purposes of this study were to 1) examine changes in the
Euro-QOL (EQ5D) and depression in patients before THA and five years after THA and 2)
assess post-operative satisfaction and anxiety evaluated by self-administered questionnaire.
Design
This study is a longitudinal, quantitative, and descriptive study.
Methods
Consecutive patients going through primary THA at Saga University Hospital, Japan,
between July 2003 and November 2006 were eligible for the study. The preoperative
questionnaires included baseline demographic variables. Surgical procedure, diagnosis and
post-surgical complications requiring treatment were obtained from the medical record. The
study was approved by the ethics committee of Saga University. The EQ5D and depression
subscale of Arthritis Impact Measurement ScaleAIMS2 were administered at the preoperative period and post-operative at five years. Participants were also asked to rate the
original 10 items regarding post-operative satisfaction, such as no pain of daily life and
working. Higher scores indicate better satisfaction. In addition, 3 items about anxiety
regarding postoperative dislocation and loosening were asked for these participants. Higher
scores indicate stronger anxiety. Responses of these items were based on a 4-point Likert
scale.
Results
298
During the study period, 1004 preoperative patients agreed to participate. Of these, 236
participants did not return their questionnaires or were too many missing data after THA, and
100 participants were excluded from analysis because of operation of the other hip within five
years after THA. Sixty-hundred and sixty-eight participants completed both pre- and postTHA surveys. The valid-response rate was 66.5%. The improvement in the mean scores for
the EQ5D and depression scales between the pre-operative and post-operative periods were
highly significant (p<0.001). The most of the postoperative satisfaction items showed high
mean scores. However, the enjoy exercise item had a low mean satisfaction score. In
addition, mean score of the anxiety of postoperative loosening was higher than that of
dislocation loosening.
Conclusions
Quality of life in participants who underwent surgery sustained improvement five years after
THA, and the postoperative satisfaction remained high. However, participants reported much
less satisfaction for exercise, and they were more concerned about loosening than dislocation.
In order to assess long-term QOL in THA participants, health professionals need to pay
attention to changes in patients concern over time.
3-5 Key words
Hip arthroplasty, EQ5D, depression, satisfaction, anxiety
299
Composure behaviours of advanced beginner nurses and their effects on

the wellness outcome among selected orthopaedic patientsBasis for action
plans
Bea-Gracia Cruz1
1.
Our Lady of Lourdes Hospital
Presenting Authors Email: beanightingale@yahoo.com
Purpose
The study determined the effects of the COMPOSURE behaviours of advanced beginner
nurses on the wellness outcome among selected orthopaedic patients.
Design
The researcher used quasi-experimental 2-group pretest posttest design. Patients from two
medical centers in Quezon City were recruited. Data was collected using the questionnaires of
Dr. Carmelita C. Divinagracias Theory of COMPOSURE Behaviours that was modified
accordingly.
Methods
There were 12 nurses that rendered the COMPOSURE behaviours and there were 25 patients
in each group for a total of 50 as respondents. The data were statistically treated using the
frequency distribution, percentages, Pearson r and chi square test, t-test, and ANOVA.
Results
The age of the patients were mostly 60 64 years old, male and Catholics. They have
normal vital signs, experience pain on a scale of 1 2 out of 10, and have above normal
level of red blood cells. Their white blood cells, eosinophils, monocytes, platelet counts,
MCV, MCH, and MCHC are mostly on a normal level. Most of them have below normal
level of lymphocytes, haemoglobin, and hematocrit.
COMPOSURE behaviours of nurses: they manifest good interpersonal and communication
300
skills in dealing with patients, able to extract significant information to aid in planning and
delivery of effective nursing care. They always allow some moment of silence, tell patient
what he can do, what he is suppose to do, and how to do it, call the patient by his/her
preferred name, provide options before making decisions, evaluate and document the patient
s response to the intervention, observe their breathing, ask if the patient is feeling relaxed,
encourage expression of feelings, focus on verbal and nonverbal behaviour. They often
establish the purpose of the interaction, display interest to the patient, create an environment
of trust and rapport, encourage patient to evaluate his action and to feel comfortable in the
nurse-patient relationship, clarify the message through the use of question and provide
continuous feedback.
Before the COMPOSURE behaviours of nurses: the patients feel bone pain on the affected
area when they perform physical activities, know that fruits and vegetables should always be
part of their daily diet, know how to relax at the end of the day, and they leave to God what
they cannot take or change.
After the COMPOSURE behaviours of nurses: the patients exercise every day, feel rested
when they wake up in the morning, know exercise is good for their bones, love and take care
of their selves, do not care about others especially if it do not affect them and their values
guide their daily life, and leave to God what they cannot take or change.
Conclusions
There is a significant relationship between the demographic profile and physiologic wellness
outcome of patients specifically their RBC and MCHC.
There is a significant relationship between the age and biobehavioral wellness outcome of
patients before and after the COMPOSURE behaviours of nurses.
There is a significant difference in the physiologic wellness outcome, specifically the red
blood cells, and the religion of patients before and after the COMPOSURE behaviours of
nurses.
3-5 Key words
Effects, orthopedic patients, patient wellness outcome, advanced beginner nurses, composure
behaviors
301
The impact of family functioning and self-efficacy on caregiving appraisal

of dementia family caregivers.
Hsin-Yi Liu1, Lian-Hua Huang1

1.
National Taiwan University
Presenting Authors Email: liu6105@gmail.com
Purpose
The aim of this study was to explore the impact of family functioning and caregiving selfefficacy on caregiving appraisal of family caregivers with dementia and examine the factors
influencing caregiving appraisal.
Design
This study adopted a cross-sectional correlational design. Purposive sampling was used to
recruit 100 dyads of demented patients and family caregivers from two outpatient
neurological clinics of hospitals in northern Taiwan.
Methods
Participant data were gathered through individual interviews with a structured questionnaire
which includes demographic characteristics for both caregivers and care receivers, family
functioning scale, the revised scale for caregiving self-efficacy, and caregiver reaction
assessment scale. Data were analyzed with the SPSS 19.0 software.
Results
Female, spouse, and caring for male demented patientscaregivers reported significantly
more health burden of care and disrupted schedule than male, children and caring for female
demented patients caregivers. The severity of negative caregiving appraisal on the family
caregiver was in the order: disrupted schedule, health problems, lack of family support, and
financial problems. Positive self-esteem caregiving appraisal significantly positive correlated
with caregiving self-efficacy and negative correlated with negative caregiving appraisal.
Negative caregiving appraisal significantly negative correlated with activities of daily living
of demented patients, family functioning, caregiving self-efficacy, and self-esteem caregiving
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appraisal. Caregivers reported that better premorbid relationship with patients and selfefficacy-obtaining respite predicted 24.5% of variance in greater self-esteem from the
caregiving role. Caregivers' declining health and self- efficacy-obtaining respite predicted
35.5% of variance in disrupted schedule of negative caregiving appraisal. Male patients and
caregivers' declining health can explain 31.9% variance in health burden because of
caregiving task. Family functioning was the main predictor of lack of family support; it
explained 41.5% of variance. Caregiver perceived economic status and switch jobs predicted
30.2% variance in negative financial problems.
Conclusions
Caring for family members with dementia could be a long-term burden task and resulting in
physical and emotional distress. Health care professionals should assist family caregivers in
keeping a more positive attitude, empowering their family functioning, and enhancing their
caregiving self-efficacy to continue caring relatives with dementia.
3-5 Key words
Family functioning, self-efficacy, caregiving appraisal, dementia
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Nonpharmacological therapies for behavioral and psychological symptoms

of dementiaA systematic review
Mana Kanno1, Akiyo Sasaki1, Yuka Kanoya1

1.
Yokohama city university
Presenting Authors Email: mkanno@yokohama-cu.ac.jp
Purpose
Nonpharmacological therapies are the first choice for behavioral and psychological symptoms
of dementia (BPSD). New therapies for BPSD that do not involve medication use are
developed constantly, and the variety of nonpharmacological therapies has increased.
However, the types of therapies and their effects have not been summarized. The aim of this
study is to review the types and effects of nonpharmacological therapies for BPSD.
Design
A systematic review.
Methods
We searched PubMed and CINAHL Plus for English literature published from January 1,
2004 to August 19, 2014. Articles that examined the effects of nonpharmacological therapies
for BPSD, and investigated aspects of interventions including non-drug therapy for
individuals with BPSD, were reviewed.
Results
Seventy-five studies were identified during the database search and 7 were selected based on
our study criteria. Five articles examined the effects of therapies and 2 explored interventions
for BPSD in medical records retrospectively. Effects were examined for 5
nonpharmacological therapies: cognitive stimulation treatment, in which participants
experiment with paper/pencil exercises; multisensory environmental intervention involving a
room with an aroma diffuser, light stimulation, fan (for breezes), projector (for visual
stimulation), music, and vibration; advancing caregiver training, which identifies potential
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modifiable triggers of problem behaviors and provides management strategies for caregivers;
collaborative care involving weekly meetings with a support team, web-based management
systems for scheduling patient contact, and voluntary group sessions (including exercise
classes) for patients with dementia and their caregivers; and psychotherapeutic day hospital
treatment including music therapy, movement therapy, psychodynamic therapy, and
sociotherapy at psychiatric day hospitals. With the exception of multisensory environmental
intervention, all therapies showed significant improvements in indications of BPSD. Finally,
studies that investigated medical records retrospectively identified safety-focused care,
resident education, behavior-focused care, and supportive/comfort therapies as
nonpharmacological therapies.
Conclusions
This review identified 9 nonpharmacological therapies: cognitive stimulation treatment,
environmental intervention, caregiver training, collaborative care, psychotherapeutic
treatment, safety-focused care, resident education, behavior-focused care, and
supportive/comfort therapies. Cognitive stimulation treatment, caregiver training,
collaborative care, and psychotherapeutic treatment were found to be significantly effective in
the treatment of BPSD.
3-5 Key words
Behavioral and psychological symptoms of dementia (BPSD), nonpharmacological therapy,
effect
305
Electronic pain management across a lifespanA review of the literature
Shuk-Kwan Tang1, Mimi MY Tse1, Sau-Fong Leung1

1.
The Hong Kong Polytechnic University
Presenting Authors Email: 13903576r@connect.polyu.hk
Purpose
To review electronic pain management in different age groups.
Design
This was a review of the relevant literature found using the following databases: The
CINAHL, Cochrane Library, Journals@Ovid, Medline, and Science Direct.
Methods
Studies published from 2009 to 2014 were included in the search. The following three sets of
keywords were used to conduct the search:
Set 1: electronic pain management AND paediatrics
Set 2: electronic pain management AND adults
Set 3: electronic pain management AND elderly
Results
In the CINAHL database, the three sets of keywords generated up to 125 articles. Twenty
articles could be retrieved from the Cochrane Library from the second set of keywords and
none from the first and third sets of keywords. No articles were retrieved from
Journals@Ovid when all three sets of keywords were used. In Medline, the three sets of
keywords generated 482 to 772 articles. When using Science Direct, the studies retrieved
from all sets of keywords varied from 1648 to 6583.
The articles that were retrieved on electronic pain management in pediatrics focused on the
use of electronic medical records to document pain scores. One study investigated the use of
immersive virtual reality analgesia during physical therapy for pediatric burns. Most of the
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articles were literature reviews, for example, on the use complementary and alternative
medical interventions to manage procedure-related pain, non-pharmacological pediatric pain
management in emergency departments, and psychological therapies for managing chronic
pain in children and adolescents.
The articles on electronic pain management involving adults focus different disease
conditions and types of patients, for example, adult patients who suffer from pain, agitation,
and delirium, and those who experience chronic orofacial pain, neck pain, chronic low back
pain, and mandibular fractures. The use of computerized clinical records and the development
of an electronic database for acute pain service outcomes were analyzed in some of the
research articles. However, no studies were found on electronic pain management in adults.
A few articles were found from The CINAHL. They included work on using electronic
primary care records to identify neuropathic pain patients and systematic reviews on primary
care and care for older persons. No articles could be retrieved from Cochrane Library and
Journals@Ovid. Most of the articles from Medline and Science Direct did not focus on
electronic pain management to benefit older adults and enhance care delivery. Instead, studies
were found on different pain management methods, including the effect of oral analgesics on
acute and chronic pain management and anesthetic techniques and postoperative pain
management.
Conclusions
Only a few articles focused on the use of electronic pain management in different age groups.
The studies revealed that pain can be controlled using adequate and proper pain management
methods. Using electronic devices can help to enhance pain management in all age groups.
With a more educated aging population and the wide use of electronic platforms such as
Facebook and Twitter, more people will be able to benefit from adopting technology to
manage pain.
3-5 Key words
Electronic pain management, pediatrics, adults, older adults
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Initiatives in residentsassociations for preventing elderly living alone in

housing complexes from being isolated
Shino Morizane1, Hiroko Tanaka2

1.
Department of Nursing, Teikyo University of Science
, 2. Division of Nursing, Faculty of
Healthcare,Tokyo Healthcare University
Presenting Authors Email: shino-morizane@ntu.ac.jp
Purpose
The purpose is to build relationships between elderly living alone in housing complexes and
residents, clarify initiatives in residents associations for preventing the elderly from being
isolated, and obtain suggestions for nursing.
Design
A qualitative, inductive research
Methods
Approved by the ethical committee of our university, three leaders of the residents
associations in each housing complex in Kanto area, agreed to answer semi-structured
questionnaires from March through June2014. The contents of the interviews were coded into
various categories for the data analyses.
Results
Principal initiatives in residents associations at housing complexes were divided into the 6
categories of a campaign by residents associations to encourage courteous interaction,
the creation of community space within the housing complex, regular monitoring
activities, support for each difficulty, connections to medical institutions and the
Community General Support Center, and popularizing end-of-life notes.
The everyday difficulties encountered by elderly living alone are cleaning and laundry,
repairing and cleaning the bath, heating water, making meals, shopping, taking out the trash,
not having anyone to accompany them to doctors appointments, the inability to pick up
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medications, and procedures at city hall. Support for each difficulty included support
from residents association officials, support from commissioned welfare volunteers, and
support from fellow residents with whom a comfortable relationship exists. The latter is a
relationship among residents that is built through the creation of community space within
the housing complex.
The residents association initiatives for preventing elderly living alone from being isolated
and dying a solitary death include regular monitoring activities such as regular visits by
commissioned welfare volunteers, regular visits by residents association officials, and
home-help services from the Council of Social Welfare. In all instances, visits are made to the
home of the elderly living alone to directly confirm whether the individual is in good health,
as well as to check whether he or she has any problems in daily life. Aside from regular visits,
other ways of knowing the status of elderly living alone are failure to answer the phone and
newspapers collecting in the newspaper box. Should both occur, the decision is made to enter
the home, and if the elderly individuals health is poor, the residents association responds
by utilizing connections to medical institutions and the Community General Support
Center.
End-of-life notes drawn up by residents associations are handed out to housing complex
residents either for free or a low price in an attempt to popularize end-of-life notes so
that elderly living alone can approach their death in their own way.
Conclusions
To make connections to medical institutions and the Community General Support Center,
residents association officials have built relationships with commissioned welfare
volunteers and the Community General Support Center. This suggests that when a residents
association official or commissioned welfare volunteer reports on the poor health of an elderly
individual living alone, there is a need for nursing professionals from the Community General
Support Center to immediately visit the home and respond accordingly.
3-5 Key words
Elderly living alone, housing complexes and residents, residentsassociations, community
general support center
309
Approaches of nurses to inpatient care of the elderly with dementia at

advanced treatment hospitals
Terumi Kijima1, Yumiko Takahashi2

1.
Dept.of Nursing, School of Health Sciences SAPPORO MEDICAL UNIVERSITY, 2. SAPPORO

MEDICAL UNIVERSITY
Presenting Authors Email: yterumi@sapmed.ac.jp
Purpose
The purpose of this study was to examine how nurses working at advanced treatment
hospitals tried to provide quality inpatient care to the elderly with dementia. The outcome
would be used as input for a project to develop a nursing model to ensure comfort and safety
of such patients undergoing treatment and procedures in highly advanced clinical settings.
Design
A qualitative approach was used.
Methods
Semi-structured interviews were conducted with six proficient nurses with nursing experience
ranging from seven to 30 years. Narratives relating the care of the elderly with dementia were
extracted and grouped by analogy of meaning to increase the level of abstraction. The study
was approved by the Ethical Committee of Sapporo Medial University.
Results
Eight categories were extracted. The subjects thought it important to provide an
environment where patients can relax and the family is welcome to stay because many
elderly patients with dementia perceived hospital as a hostile place. They also recognized the
need to support physically and emotionally drained families and to increase their
understanding of dementia especially when dementia was diagnosed after admission. Care
was taken to avoid negative expressions to prevent patients from becoming confused and
feeling unhappy. Nurses reiterated a fundamental nursing principle of knowing patients as
a person in an effort to let them lead their own life with minimal restrictions. However,
310
to prevent accidents such as drains being pulled out by patients, nurses felt they had to use
a restraint or alternative means such as keeping a watchful eye. When an elderly patient
with dementia was admitted, nurses immediately thought about the risk of delirium. They
tried to provide nursing care with a focus on preventing delirium induced by treatment
by, for example, improving the patients wakefulness-sleep cycle. When a difficult situation
arose, nurses sought to liaise with the nursing team or other professionals. They mainly
relied on support from the nursing team, but also asked for a psychiatrists help when the
patient became confused or from the community support team for discharge planning.
Discharge planning for the elderly with dementia is usually a difficult task. The subjects
would keep the importance of discharge planning in mind from an early stage of
hospitalization, providing information on community services appropriate to the patients
lifestyle and learning about discharge planning themselves.
Conclusions
The subjects were successful in the areas of improving communication and creating a
reassuring environment. However it was not possible for them to stretch nursing care beyond
prevention of confusion in the clinical setting; priority was given to prevention of accidents
and delirium in advanced treatment hospitals. It is important for dementia patients to
maintain function and independence, but nursing care provided by the subjects did not cover
this area despite their wishes. The study suggests that, in order to achieve the desired level of
inpatient care and a smooth transition to care at home, multi-disciplinary collaborative
intervention to prevent functional impairment of patients is essential from an early stage of
hospitalization.
3-5 Key words
The elderly with dementia, nurse, advanced treatment hospital
311
Improvement of the physical activity and quality of life after primary total
knee arthroplastyTwo-year postoperative evaluation and comparison
with healthy persons
Yuriko Myoji1, Kimie Fujita2, Shuya Ide3, Satomi Tomosada4, Yasuko Tabuchi1
1.
Department of Nursing, Saga University, 2. Department of Health Sciences Faculty of Medical
Sciences Kyushu University, 3. Saga University Orthopedic Surgery, 4. Fujiyamato Spa Hospital
Presenting Authors Email: myoji@cc.saga-u.ac.jp
Purpose
The purpose of this study was to determine objective changes in the physical activity and
quality of life (QOL) of patients before, and 6 and 24 months after undergoing total knee
arthroplasty (TKA). Furthermore, we compared the physical activity and QOL of the patients
24 months after TKA with that of healthy persons.
Design
This was a longitudinal study.
Methods
Twenty-seven participants were selected among patients who were indicated to undergo
primary TKA and patients who had undergone primary TKA 6 or 24 months prior. Physical
activities within 1 week were measured using a small pedometer with an accelerometer
(Lifecorder EX, Kenz, Japan) to determine the number of steps walked and the intensity of
physical activity (<3 and
3 metabolic equivalents [METs] h/week). The QOL was assessed
by conducting a self-reported questionnaire survey using the Short-Form 8-item (SF-8)
questionnaire and Oxford knee score (OKS).
Ethical considerations: The participants were informed that (1) study participation was
voluntary, (2) study participation would not affect their treatment, and (3) only aggregated
data would be presented. Written informed consent was obtained from all the participants.
The study was approved by the ethics committee of Saga University of Medicine.
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Results
This study included 3 men and 24 women, aged 73.6 6.3 years (mean SD). The mean
number of steps walked and the intensity of physical activity 3 METs differed significantly
between before, and 6 and 24 months after TKA (p < 0.001). The number of steps walked
before TKA was 3461 steps/day; 6 months after TKA, 4914 steps/day; and 24 months after
TKA, 5133 steps/day. The intensity of physical activity 3 METs was 2.5, 5.9, and 6.9
h/week, respectively. Among the healthy persons (age- and sex-matched with the TKA
patients), the number of steps walked was 5948 steps/day, and the intensity of physical
activity 3 METs was 8.1 h/week. No significant difference was observed between the TKA
patients who had undergone TKA 24 months prior and the healthy persons. The preoperative
SF-8 scores (Physical Component Summary [PCS] score, 38.2 points; Mental Component
Summary [MCS] score, 49.3 points) greatly improved 24 months after TKA (PCS score, 45.3
points; MCS score, 52.6 points).
The total OKS improved 6 and 24 months after TKA compared with that before TKA.
However, of the patients, 44.4% had moderate to extreme difficulty in kneeling down and
getting up afterwards or they could not do it, and 29.6% answered the same for walking down
the stairs.
Conclusions
The physical activity and QOL of the patients improved 6 and 24 months after TKA, and the
patients had a relatively good recovery compared with healthy persons. However, at 24
months after TKA, patients still had difficulty in kneeling down and getting up afterwards and
walking down the stairs.
3-5 Key words
Total knee arthroplasty, physical activity, quality of life
313
Sense of coherence and inner sense of value among elders who experienced
the great east Japan earthquake
Minako Kobayashi1, Fujimi Arai1, Kiyoko Futaesaku2, Shunichi Daito3, Kaoru Kumasaka4
1.
Kameda College of Health Sciences, 2. Junshin Gakuen University, 3. University of Human Arts and
Sciences, 4. University of Tsukuba University Hospital nursing department (Previously)
Presenting Authors Email: m-kobayashi@kameda.ac.jp
Purpose
The purpose of this study was to investigate sense of coherence (SOC) as an index of coping
stress and remaining healthy among elders who experienced the 2011 Great East Japan
Earthquake and tsunami. Factors causing high SOC were also considered, focusing on inner
sense of value among elders with high SOC scores. The results will be used to construct
mental and physical health-promotion programs from the perspective of salutogenesis among
elders in devastated areas.
Design
Qualitative descriptive research design
Methods
1) Subjects: Thirty-two public nursing insurance day service users who lived in the devastated
area before the earthquake (mean age = 85.4, SD = 6.6). 2) SOC: Thirty-two subjects were
asked to complete an SOC-13 questionnaire, and were divided into high and low groups by a
median split on SOC general scores; the high-SOC group was then chosen for interviews. 3)
Interview: We conducted semi-structured interviews asking How have you overcome
difficulties and dealt with stress in your life so far? and so forth. 4) Analysis: We extracted
parts related to inner sense of value or belief from the contents of conversations, and then
conducted a qualitative inductive analysis on the factors related to maintaining high SOC. 5)
Ethical considerations: We obtained approval from the Ethical Review Boards of authoraffiliated institutes and cooperating facilities.
Results
314
The median and SD of SOC scores among all subjects were 68.0 and 10.1 respectively. The
mean and SD of the high- and low-SOC groups were 73.4 and 4.4, and 56.3 and 7.7,
respectively. We interviewed five women in the high-SOC group who were capable of
conversation, and extracted six categories as follows: consistent experience of overcoming
difficulties, realization of connection with ancestors and descendants, feeling of
thankfulness to others, awe, revelation from supernatural phenomena,
optimistic thoughts.
Conclusions
Elders who experienced the earthquake with high SOC scores tended to have customs of
religious services for their ancestors and believe in the assistive and connected nature of their
ancestors and family. Some recognized natural light or dreams as messages from ancestors
informing dangers. It can be inferred that their successful experiences of consistently
overcoming and surviving difficulties facilitated optimistic thinking and enhanced their SOC.
3-5 Key words
Sence of CoherenceSOC, east Japan earthquake, disaster, elder
315
International trend in attitudes toward older people among healthcare and

welfare studentsA literature review
Mayumi Sakamoto1, Chieko Greiner1, Nahoko Okamoto2, Tomoko Oishi3

1.
Kobe University Graduate School of Health sciences, 2. The Japanese Red Cross College of
Nursing, 3. Kanagawa University of Human services
Presenting Authors Email: m-sakamoto@silver.kobe-u.ac.jp
Purpose
The number of people who are
80 years old will nearly quadruple to 395 million by 2050.
With such drastic changes in the composition of the global population due to the ageing
phenomenon, further healthcare challenges and needs are created, such as the increased risk
of chronic diseases, people with disabilities, patients with dementia, and long-term nursing
care. Therefore, attitudes toward older people among healthcare and welfare students who
will be responsible for their care in the future are important to understand in order to improve
the quality of that care. The objectives of this study are as follows: 1) to review the
international trend in attitudes toward older people among healthcare and welfare students;
and 2) to provide a direction for effective future studies of elderly care.
Design
A literature review
Methods
A literature review was conducted using Ichushi (Japana Centra Revuo Medicine), CiNii,
Google scholar, PubMed, PsycINFO, ERIC, and PsycARTICLES. Studies included in this
review are those that specifically described the trend in attitudes toward older people among
healthcare and welfare students. The major outcomes of interest were attitudes,
image, and perception. Exclusion criteria were: a) studies on elder abuse; and b)
studies published prior to 2000.
Results
316
We identified 185 studies, 46 of which met the selection criteria. Of these 46 studies, 21
involved healthcare and welfare students.
1. International trend in attitudes toward older people among healthcare and welfare students
such as nursing students.
Studentsattitudes and awareness toward older people indicate a positive trend from the time
of enrollment in university.
Variables that affect nursing studentsattitudes and awareness toward older people include
the students age, gender, level of education, past experience working with elderly people,
experience living with elderly people, income, and social background.
Even when a positive trend is observed from the time educational programs are begun, a
further positive effect is observed after intervention in the programs.
2. Trend in nursing studentspreferences for clinical nursing fields involving older people.
Although the general field of clinical elderly care is not popular in Westernized countries in
North America, South America, Oceania, the Middle East, and Asia, opposite results were
revealed in some non-Westernized Middle Eastern countries.
Conclusions
International comparative studies on attitudes toward older people among healthcare and
welfare students were rarely found, as the majority of the literature reported on studies
conducted within a single country. In addition, data on cultural and social backgrounds that
are known to influence a persons attitude were not thoroughly collected. Ageing poses a
worldwide challenge. It is important to recognize the trend of ones own country from the
perspective of maintaining adequate numbers of healthcare and welfare providers who will
become responsible for elderly care in the future, as well as improving the quality of care.
These results suggest the necessity of studies that illuminate such characteristics and
challenges from international comparison.
This research was supported by a Grant-in-Aid for Scientific Research (B) (No. 24406037).
3-5 Key words
Attitudes toward older people, students, elderly care, healthcare
317
Exploring the impact of advance care planning on Chinese older people in

Hong Kong
Amy NG1, Yue-Lai Chan1

1.
The Nethersole School of Nursing, The Chinese University of Hong Kong
Presenting Authors Email: amyng@cuhk.edu.hk
Purpose
To address clients wish on treatment choices is well encouraged in nowadays health care
service. The end-of-life care is also reinforced to respect clients own will in their latter part
of life. Older people with vulnerable physical state are the main target population to review
their end-of-life care. There are many Advance care planning (ACP) for older people to
facilitate them voice out their needs and address their preference in the end-of-life care.
However, there is little known on the impact on ACP on older people particular in Hong
Kong Chinese perspective. The aim of this study is to understand the experience and explore
the impacts of advance care planning in Chinese older people in Hong Kong.
Design
An exploratory qualitative study design will be used in this study.
Methods
This study will consider participants who were age 60 or above. As the study will conduct an
interview, participants with cognitive impairment will be excluded in this study. The
participants who finished an ACP programme for chronic illness older people will be
recruited in this study. In this study, the sampling number will be targeted at six initially and
the information will be reviewed for any new information is noted from the participants.
After the older people finished the ACP programme, appropriate participants will be recruited
for this study. The investigator will explain the purpose, nature and procedure of the study to
the participants with the information sheet provided to them. Then, an informed written
consent will be signed. A face to face semi-structured interview will be conducted by the
investigator to the participants. An interview guide that is written in open-ended questions
318
will be used in the interview process which reflects the research objectives. The interview will
be last for about one hour in the out-patient clinic or at participants home. The whole
process of the interview will be audio-taped. After that, the interview content will be record in
the transcribed verbatim. Besides, the investigator will write the field notes including a
reflective journal immediately after each interview.
The content will be identified for different meanings and being coded. Content analysis used
for analysis content of narrative data to identify prominent themes and patterns among the
themes In this study, the framework of Graneheim, & Lundman, (2003) will be used as the
method of content analysis to manage the coding system and analysis of information.
Results
The preliminary result on being identified code were related to psychological aspect and
knowledge aspect of informant. Some identified code included relief, preserved dignity and
known treatment choices.
Conclusions
ACP for older people provided them an opportunity to express their concerns and their
preference in end-of-life care. This study explores the impact of ACP on Hong Kong Chinese
older people. The information reflects what the older people feels and experience in the ACP
process.
3-5 Key words
Advance care planning, advance directives, older people
319
Self-perceived burdens in cancer patients on their spouses when requiring

nursing care in elderly two-person households
Miki Oeki1, Michiko Saiga2, Hiroshi Hagino2

1.
Hiroshima University, 2. Tottori University
Presenting Authors Email: ooeki@hiroshima-u.ac.jp
Purpose
As a society, Japan is aging to a degree that no country has ever experienced previously. In
2012, the proportion of elderly individuals in the Japanese population was 24.1%, and it is
predicted that by 2060, 1 of every 2.5 people will be over the age of 65, and 1 of every 4 will
be over the age of 75. In recent years, the number of households consisting solely of elderly
married couples has increased, resulting in more elder-to-elder nursing care, in which both the
caregiver and care recipient are elderly. This has the potential to increase the burden on the
caregiver. In such situations, the care recipient's self-perceived burden (SPB), his or her
perception of the burden placed on the caregiver, may be higher, which can negatively impact
the care recipient's quality of life and mental health. The present study was conducted to
investigate SPB in cancer patients who require nursing care by their spouses in elderly twoperson households.
Design
Quantitative descriptive research design.
Methods
The subjects consisted of 79 cancer patients over 65 years of age living in households
consisting only of married couples who required nursing care from their spouses. The subjects
were given anonymous self-administered questionnaires that were returned by mail. The
questionnaires included items on the following: (i) an SPB scale (SPBS); (ii) background
factors: age, sex of the care recipient, sex of the caregiver, approximate age of the caregiver,
and presence or absence of secondary caregivers; and (iii) physical condition: site of primary
cancer, performance status, severity of fatigue, pain and nausea, and duration of disease. The
320
survey was conducted in July to December 2009. For statistical analysis, the Mann-Whitney
test was used, and Spearman's rank correlation coefficients were calculated
Results
The mean age of the study subjects was 72.9 5.1 years. The subjects consisted of 59 men
and 20 women. Significant differences observed based on the sex of the care recipient (p =
0.043) and the presence or absence of a secondary caregiver (p = 0.037). Performance status
( = 0.345; p = 0.032) and fatigue ( = 0.233; p = 0.039) were significantly correlated with
higher SPBS.
Conclusions
The care recipient's SPB tended to be higher when the caregiver is female, when there are no
secondary caregivers, when the care-receivers general condition is poor, or severe fatigue is
present.
3-5 Key words
Self-perceived burden, cancer patient, spouse, home care
321
Effect of aromatherapy on elderly nursing home residents with dementia
Yasuko Tabuchi1, Yuriko Myoji1, KImie Fujita2, Yumiko Taketomi1

1.
Saga University Department of NUrsing Faculty of Medicine, 2. Kyushu Univercity
Presenting Authors Email: ytabuchi@cc.saga-u.ac.jp
Purpose
Recently, complementary and alternative medicine approaches for dementia treatment have
gained significance. The purpose of this study was to determine the effect of aromatherapy on
the elderly with dementia
Design
Interventional study
Methods
Twenty-three elderly nursing home residents with dementia were selected for this study. The
participants received a hand massage for 20 minutes with lavender oil for relaxation, and
aromatherapy was performed at night. Aromatherapy (duration: 8 hours, from 20:00 to 4:00)
was performed once a week for 2 weeks. Lavender oil was used for aromatherapy. Lavender
is a medicinal plant reported to be effective for treating inflammation, depression, stress, and
mild anxiety. We evaluated the effect of aromatherapy by using the amylase monitoring
method (NIPRO, Japan) to measure salivary amylase (sAMY) levels, the Japanese version of
the Dementia Quality of Life Instrument (JDQOL), and interviews. Informed consent was
obtained prior to testing for sAMY activity. Ethical considerations were addressed by
explaining the research to the family members representing the participants and obtaining
their written consent. Informed consent was also obtained from the participants prior to
performing the hand massage and aromatherapy.
Results
The mean age of the participants (1 man and 22 women) was 89.1 years (SD, 7.7; range, 66
104 years), and their mean score on the Mini Mental State Examination (MMSE) was 17.4
(SD, 4.1; range, 926). Data for 22 elderly people who had saliva extracted were analyzed,
322
and 1 participant was not able to provide a saliva sample. After the hand massage, there was a
significant decrease in the sAMY value from 183.3 KIU/L (SD, 142.8 KIU/L) to 84.6 KIU/L
(SD, 95.5 KIU/L; P < 0.05). The JDQOL scores of 14 participants were analyzed. Six
participants who declined the MMSE and 3 participants with an MMSE score < 13 points
were excluded from the analysis. The participants (n = 14) showed significant improvement
in 5 subscales of the JDQOL (Self Esteem, Positive Feelings, Negative Feelings, Feeling of
Belonging, and Sense of Aesthetics) after aromatherapy (P < 0.05). Furthermore, they
reported that they found the massage very comfortable and were willing to receive a massage
again.
Conclusions
In conclusion, we found aromatherapy to be an efficacious form of complementary and
alternative medicine for the elderly population with dementia living in a nursing home. The
evaluation method for assessing the effect of aromatherapy at night needs further
investigation.
3-5 Key words
Aromatherapy, elderly, dementia, saliva amylase level, Japanese version of the dementia
quality of life instrument (JDQOL)
323
Relationship between cognitive functions and the propensity for falls in

community-dwelling elderly
Miki Fukuma1, Kuninori Shiwaku1

1.
Shimane University
Presenting Authors Email: mk8592@med.shimane-u.ac.jp
Purpose
The objective was to clarify the relationship between cognitive functions and the propensity
of falls in the elderly above the age of 65 for identifying the factors associated with falls.
Design
The study was a risk factor evaluation study.
Methods
The subjects were 85 elderly individuals who had not received a diagnosis of dementia.
Among them, 26 were males (29.9%). The mean age of the subjects was 82.3 5.5 years. In
2009, a survey was conducted on the physical activity, basic attributes, social participation,
housing conditions, Mini-Mental State Examination (MMSE), and Geriatric Depression Scale
(GDS). The analysis was performed using multiple regression analysis to identify relevant
factors associated with falls.
Results
Falls occurred in 35 individuals (40.2%) in the past year and tipping anxiety affected 61
individuals (70.1%). A total of 39 elderly individuals did not participate in outings (44.8%),
42 were able to rise from a chair (48.3%), 33 exercised more than twice a week (37.9%), 39
were able to visit friends (44.8%), 45 attended to daily chores in the house (51.7%), and 51
individuals spent both day and night in the same room (58.6%). The average MMSE point of
the elderly was 24.4 2.9, and their average GDS point was 5.5 3.1. The propensity of falls
was associated with reduce outings and GDS. As for MMSE, a correlation between age and
grip power was observed.
The results of multiple regression analysis showed that falls were associated with the
324
frequency of outings ( = 0.26, p = 0.013) and ability to rise from a chair ( = 0249, p =
0.018). However, falls were independent of GDS and MMSE.
Conclusions
Falls were related to the difficulty of rising from a chair and reduced outings. Therefore, these
data suggest that the participation in social activities and prevention of muscle weakness are
important. Because the elderly with dementia were not included, falls appeared to be
independent of the differences in cognitive function. However, because it is likely that the
propensity of falls in the elderly with dementia is high, there is a need to clarify the factors
related to falls in the elderly with dementia.
3-5 Key words
Elderly, fall, dementia, cognitive function
325
Predictive factors of at risk of malnutrition for pre-frail older adults in

Taiwan
Shu-Fang Chang1
1.
National Taipei University of Nursing and Health Sciences
Presenting Authors Email: linda@ntunhs.edu.tw
Purpose
To investigate the predictors of nutrition status, focusing pre-frail older people in Taiwan. The
World Health Organization has actively developed prevention programs to address geriatric
frailty. However, few studies have investigated the predictors of nutrition status, focusing on
pre-frail older adults.
Design
A cross-sectional research design.
Methods
The study was executed The inclusion criteria comprised age 65 years, living independently
at home, and exhibiting neither mental impairment nor acute disease. This study used the mini
nutritional assessment to access nutrition status of older people.
Results
Data were collected from a sample of 152 participants, who were primarily men, lived alone,
and had a level of education lower than elementary school. Single-item comparisons of mini
nutritional assessment showed that the pre-frail group had a higher prevalence of weight
loss >1 kg/3 mo or unknown, > 3 drugs/d, impaired mobility, feel
malnourished or uncertain of nutritional status, and considers health status worse
compared with peers than did the robust participates. The results of the multiple linear
regression analysis of the association between variables and nutrition status indicated that prefrailty and BMI were independent predictive factors of at risk malnutrition.
Conclusions
326
This study was a pioneering examination of nutrition status in pre-frail older adults. The
results showed that nutritional assessment can be employed to assess community-dwelling
pre-frail older adults. In particular, pre-frailty and BMI were key factors that affected nutrition
status in older adults.
Community nurses must understand the risk factors related with nutrition status in pre-frail
older adults and endeavour to improve the nutritional status of pre-frail older people.
Consequently, pre-frail older adults experience improved confidence in maintaining their
health and a decreased incidence of frailty and malnutrition.
3-5 Key words
Pre-frailty, nutrition assessment, older people, community nursing
327
Issues regarding gerontological sleep education for nursing students in

Japan
Rika Saito1
1.
Japan Health Care College
Presenting Authors Email: saitouLicca@gmail.com
Purpose
Epidemiological studies have shown that approximately 30% of elderly people have insomnia.
In Japan, which is known as the ultra-aging society, gerontological sleep education for
nursing students has considerable implications. This study aimed to clarify the structure of
contents and educational issues regarding sleep in gerontological nursing textbooks for
students.
Design
Literature review.
Methods
Major gerontological nursing textbooks in Japan were used to collect articles using the search
terms insomnia, sleep disorder, and nursing for sleep disorders.
Results
The subjects for analysis were four publishers textbooks, all of which mentioned the
following three points: a basic knowledge of sleep, the characteristics of sleep that are
influenced by aging, and sleep care for elderly people. Among them, focusing on sleep care
for elderly people, only one of the four publishers gave a detailed description of daytime
sleepiness using questionnaires. No textbook had an educational care plan for elderly people
regarding the characteristics of sleep influenced by aging. One textbook made reference to a
case of delirium as a case of sleep disorder.
Conclusions
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These results suggest that there is a need to be cautious when using standard textbooks that
are not necessarily based on the latest knowledge, i.e., these textbooks were sufficient to give
students a basic knowledge of sleep and the characteristics of sleep for elderly people. On the
other hand, there was no coverage of issues concerning gerontological sleep education such as
assessment, care plans, and case studies. It is considered that editors without specific
knowledge of sleep medicine are not equipped to determine the content of the text. Therefore,
the professors in charge of educating nursing students should give more attention to the
management of gerontological sleep education.
3-5 Key words
Elderly, insomnia, sleep disorder, education for students
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Analysis coping style and related factors of elderly women patients with
stress urinary incontinence in Binzhou
Binbin Yu1, Weihua Liu2

1.
Binzhou Medical University Hospital, 2. Taian Medical University
Presenting Authors Email: yubinbin824@163.com
Purpose
The positive coping style of elderly women with Stress Urinary IcontinenceSUIpromotes
the mental health and improves the life quality. The aimed of this study was to survey the
coping style and its related factors of elderly women with SUI and provide the scientiic basis
to further adopt positive coping style and to promote their quality of life.
Design
A cross-sectional design with a survey.
Methods
The study adapoted the convenience sample to selected 520 cases of elderly women patients
with SUI as the research object to questionnaire survey between January 2014 and May 2014
from four large community in Bin'zhou, the questionnaire consists of medical coping
questionnaire, stress urinary incontinence cognitive subscale and the sociology of population
data.
Results
Avoidance and yield scores were higher than the norm in 520 cases of elderly women patients
with SUI (P0.05); Age, marital status, education level and stress urinary incontinence
cognitive level is the important influencing factors of Medical coping style in elderly women
patients with SUI.
Conclusions
Different age, marital status, different education level and different SUI cognitive level in
elderly female patients with stress urinary incontinence coping styles vary. Therefore, clinical
330
and community health work in the medical personnel should be comprehensive

analysis,considering the complesity of the factors of coping style in the patients with and
influence, to guide their positive coping style.
3-5 Key words
Stress urinary incontinence, coping style, related factors
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Factors associated with progress or regress of the consistency of food

substances of residents in welfare facilities for seniors in Japan
Tomoko Nishihira1, Reiko Sakashita1, Koji Sugimoto2, Hiroyuki Kusumoto3, Miho Fujiwara1,
Michiko Morimoto1, Kazuhiro Watanabe4, Miho Watanabe4, Misao Hamada5
1.
University of Hyogo, 2. Social Welfare Corporation Welgarden Ikouen, 3. Special Nursing Home for
the aged Altenheim, 4. Watanabe Dental Clinic, 5. Social Welfare Corporation Lavita
Presenting Authors Email: lin18811025@gmail.com
Purpose
The ingestion of food substances which require mastication promotes salivary secretion and
oral function, which is suggested to lead to a lower incidence of aspiration pneumonia
(Sakashita et al., 2014). A life enhancement program focusing on dining has started in three
welfare facilities for seniors in Japan. After three months intervention, oral hygiene, tongue
function, water intake, and vitality improved significantly (Nishihira et al., 2014). The
purpose of this study is to reveal the factors which would promote residents to ingest regular
foods and which would make their foods softer and finer.
Design
A quasi-experimental study.
Methods
The subjects were 210 residents (45 males and 165 females, average age is 86.18.1 years old)
who participated in the intervention for three months. The levels of consistency of food
substances were classified as 1) regular food, 2) soft-solid food, 3) chopped food, 4) paste
food or 5) gastric-tube feeding. Subjects were classified into a progressive group whose food
consistency became more chewable, a static group whose food consistency did not change, or
a regressive group whose food consistency become more softer and finer. The health status
data (medical history, frequency of fever, and Body Mass Index), nutritional intakes, ADL,
oral function and oral condition were compared among the three groups before as well as after
intervention. ANOVA was used to test the group differences. For prior and subsequent
intervention analysis, paired t-test was used for parametric data and Wilcoxon signed-rank
332
test was used for nonparametric data. This study was done with the approval of the ethics
committee, College of Nursing Art and Science, University of Hyogo. Only residents who
gave written informed consent were enrolled in this study. If the resident found it difficult to
judge whether or not to participate, the informed consent was obtained from his/her family.
Results
Subjects were classified into 18 progressive, 168 static, and 24 regressive cases. Among 168
static cases, 37 cases who could have regular food before and after the investigation were
excluded for the further analysis. Comparing the three groups, the progressive group had
more caloric intake (1349.9171.6Kcal) than the static group(1125.8530.8Kcal) and the
regressive group (1111.8278.6Kcal) significantly (p=0.005). By before and after analysis, it
was founded that the progressive group had more appetite (p=0.01) and water (p=0.07),
improve their tongue function (p=0.04) and the autonomy of their excretion(p=0.01). The
regressive group had less caloric intake (p=0.02), reduced BMI (p=0.002) and suffered more
frequent choking (p=0.005).
Conclusions
These results suggest the factors associate with progress or regress of the consistency of food
substances would be different. This study also indicates that foods, the consistency of which
require mastication have a positive influence on health. This study was supported in part by
KAKENHI (24390511, to R.S.) from Japan Society for Promotion of Science.
3-5 Key words
Diet modification, mastication, the elderly, life enhancement
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Research trends in depression among the elderly in nursing science in

Japan
Tetsuko Takaoka1, Ruriko Kidachi1

1.
Hirosaki University Graduate School of Health Scienses
Presenting Authors Email: tetsumo8@do-bunkyodai.ac.jp
Purpose
This study aims to identify trends in nursing science research in Japan focusing on depression
among the elderly, and investigates issues that remain to be addressed.
Design
Literature review
Methods
Using the Ichushi Web database Ver. 5 (domestic literature search service on the internet
provided by the Japan Merical Abstracts Society), we searched for original articles published
from 2002 to February, 2013, using the keywords, the elderly, depression, and
nursing inputting and between these terms. We analyzed the retrieved articles with
the Matrix Method of Judith (2012). Topics included focus of the research, study
target, and depression related scale.
Results
The retrieved articles numbered 518 and we selected 151 articles, excluding those that did not
fit the objectives. Research targets were elderly people living in the community (84),
elderly residents in institutions (22), and hospitalized elderly patients (4). The
Focus of the research included Depression as an index of intervention effects (38),
Depression as an index to understand the conditions of the elderly (35), and
Understanding of depression of the elderly (14). Depression as an index of
intervention effects included Effect of efforts to maintain health, Depression as an
index to understand the conditions of the elderly including Influence on the autonomic
nervous system of the elderly, and Understanding depression in the elderly including
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Depression incidence rates of elderly requiring nursing care at home. The scales used in
these studies were, the 15 item Geriatric Depression Scale -Short Version (GDS-15) in 40
studies, the Center for Epidemiologic Studies Depression Scale (CES-D) in 16, and the SelfRating Depression Scale (SDS) in 9.
Conclusions
It was reported that hospitalized elderly patients showed a high incidence of depression
related disorders (The Japan Geriatrics Society, 2011), and that depressed states are an
indicator of a poor prognosis for the illness (Igarashi, 2013). Only few studies focused on
hospitalized elderly patients. Although it is reported that depression in old age shows different
symptoms from those of depression in adolescence and in the prime of life (Takahashi, 2009),
there were few studies that focused on depression but many which used only depression as an
indicative criteria. From these reasons, it appears that there is a necessity to conduct research
focusing on hospitalized elderly patients and that explores the actual living and other relevant
conditions of these patients to determine factors associated with depression. The reliability
and validity of GDS-15 (Yatomi, 1994) and SDS (Niino, 1988) were verified when used for
the elderly here. However, one study reported that CES-Dcannot measure a single
formation, depression, from a cross-cultural viewpoint, and here it was suggested that scores
excluding positive feelings should be used when CES-D is adapted for elderly Japanese
(Yatomi et al., 1993). It may be concluded that it is appropriate to use GDS and SDS when
evaluating depression in the elderly as in the studies here.
3-5 Key words
The elderly, depression, nursing
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The useful life skills during the elderly period-by focused group interviews
of the Japanese elderly people-
Ruriko Kidachi1, Yu Kitajima2, Nobuko Inoue3, Saki Yanagiya4, Yayoi Hikage5

1.
Hirosaki University Graduate School of Health Scienses, 2. Hirosaki University Graduate School of
Halth Scienses, 3. Ajigasawa Local Elderly Care Management Center, 4. Seikyo Sakura Hospital,
Aomori, 5. Department of Home Economics Education, Faculty of Education, Hirosaki University
Presenting Authors Email: kidachi@cc.hirosaki-u.ac.jp
Purpose
The purpose of this study is to clarify the useful life skills and knowledge held by elderly
people.
Design
Qualitative and inductive research methodology
Methods
This study was conducted using a qualitative and inductive research methodology. Twentyone people agreed to become informants among elderly people who participated in an elderly
person circle activity in a part of Aomori Prefecture, Japan. We separated informants into four
groups to perform focused group interview. Informants were asked about the life skills and
knowledge considered necessary for life of the advanced age period and how those skills and
knowledge are acquired. We carried out the investigation in August 2013, with each group
interview in a separate room, lasting about one hour, and recorded using an IC recorder. The
researchers participated in each group as a facilitator. We translated all four recorded scenes
into text, interpreted the smallest contexts and named them, and used these to determine the
categories.
Results
The age of the informants was from 64 to 90 years, with the average at 81.25.8 years old, the
man were only one person. Eighteen subcategories and four categories were created from 204
labels. These categories were: help with the family from childhood (including six
336
subcategories regarding life skills learned through farming naturally and life skills
learned from working on the mountain from childhood), housework role division of
labor from childhood (including four subcategories such as life skills by the babysitter
whose brother was left early and life skills taught by ones mother since childhood,
through cooking), life skills to learn at school (include four subcategories such as
life skills learned through sewing at school and life skills learned through technical
work at school), and wisdom obtained by learning modeled throughout life (such as
life skills learned from the experience of old age and life skills developed from
childhood experiences).
Conclusions
The life skills and the wisdom that elderly people received were primarily from childhood;
however, they remained useful in life, and these suggested possible additions to the practice
of care prevention. Because they are often accepted positively, traditions transmitted by an
elderly person to the next generation will be important. However, these findings have limited
generalizability outside of the cases of the elderly people living in areas mainly composed of
primary industries besides, and elderly women.
3-5 Key words
Life skill, elderly people, care prevention
337
A study on interpersonal intimacy and meaning of life among the senior

veterans in institutions
Chen-Chun Niu 1, Chia-Chan Kao 2

1.
Chung Hwa University of Medical Technology, 2. I-Shou University
Presenting Authors Email: janejune7@gmail.com
Purpose
This study investigated personal characteristics that influence interpersonal intimacy and the
meaning of life, as well as the relationship between interpersonal intimacy and the meaning of
life among senior veterans lived in veterans' homes.
Design
Cross-sectional design was used.
Methods
A cross-sectional design was used, and 120 senior veterans were convenience sampled from
three veterans' homes located in Southern Taiwan. Three structured questionnaires were used
in this study: personal characteristics questionnaire, interpersonal intimacy scale and purpose
of life test.
Results
(a) The interpersonal intimacy was influenced by the way senior veterans was funded,
residential institution, religion, and relationships in contact with family and friends. Education
level and self-perceived health status were positively correlated with interpersonal intimacy,
whereas the period of residence was negatively correlated with interpersonal intimacy.(b) The
meaning of life was influenced by relationships in contact with family and friends. The
education level and self-perceived health status of senior veterans had a significant positive
correlation with the meaning of life; the period of residence was negatively correlated with
the meaning of life.(c) A significant positive correlation existed between interpersonal
intimacy, the four domains of interpersonal intimacy and the meaning of life among senior
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veterans.
Conclusions
The results provided information regarding the relationship between interpersonal intimacy
and the meaning of life among senior veterans in institutions. The findings could be used as a
reference for professionals and management involved in the care of senior veterans in
institutions to enable senior veterans to confront old age in a positive manner.
3-5 Key words
Senior veterans, interpersonal intimacy, meaning of life, veterans' homes
339
Nursing interventions for decreasing medication error among homedwelling elderly discharge from hospital in China
Jie Li1, Tian Xiong2, Jiaqi Xu3

1.
School of Nursing, Tongji Medical College, Huazhong University of Science and
Technology, 2. Nursing department, Tongji hospital, Huazhong University of Science and

Technology, 3. School of Nursing, Tongji Medical College, Huazhong University of Science and
Techonology
Presenting Authors Email: cherrygo10@163.com
Purpose
There is a high prevalence of medication error in Chinese elderly. Few studies have so far
identified what nursing intervention could reduce medication error for Chinese elderly
effectively. The aim of the present study was to explore the benefits of using medication box
and medication information card in reducing medication error among home-dwelling elderly
after hospital discharge.
Design
This semi-experiment study was conducted in Hubei Province, China, from March 2014 to
July 2014. A total of 300 elderly aged
60 with cardiovascular disease discharge from two
general hospitals were willing to participate in the study.
Methods
The participants were divided into an intervention group (N=150) and a control group (N=150)
according to the sequence of the discharge date. The elderly in control group received routine
health care service, including take medication from hospital and obtain oral instruction for
medication use. Participants in intervention group used the medication box and medication
information card to administrate the medication. Demographic characteristics were gathered
before discharge. Two weeks later, participants of both groups were followed and interviewed
by using a self report questionnaire. Prevalence of medication error was measured both
groups using seven close-ended questions. Outcomes were compared using a chi-square test.
340
Results
A total of 289 participants were recruited. 150 elderly received usual care in hospital, and 11
Elderly in control group withdrew from study. There was no evidence of a difference in
demographic characteristics. The chi-square analysis showed there is significantly higher
prevalence of medication error in the control group compared with intervention group (44.0%
versus 9.4%, respectively; p0.05).
Conclusions
Our finding suggested that medication box and medication information card used in this study
can decrease the prevalence of medication error for home-dwelling elderly effectively. Using
medication box and medication information card could be a feasible intervention for homedwelling elderly before discharge from hospital in China.
3-5 Key words

Medication error, medication box, medication information card, home-dwelling elderly,
China
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The effectiveness of a life-enhancement program focusing on dining for

residents in welfare facilities for seniors
Miho Takami1, Reiko Sakashita1, Satoko Takebayashi1, Tomoko Nishihira1, Takuichi Sato2,
Misao Hamada4
1.
College of Nursing Art & Science , University of Hyogo,
2.
Tohoku University Graduate School of
Dentisry, 3. Social Welfare Corporation Lavita
Presenting Authors Email: miho_takami@cnas.u-hyogo.ac.jp
Purpose
The objective of this study was to clarify the characteristics of elderly people who showed
changes after undergoing an intervention program.
Design
This study had a quasi-experimental design. A life-enhancement program focusing on dining
for residents in welfare facilities for the elderly was conducted over a 2-month period. In this
report, we focus on changes in activity that explicitly showed the characteristics of the
participants. A seminar for facility staff members and interventional follow-up was conducted
in this program to standardize the intent and method of the intervention. This study was
approved by the Research Ethics Committee of the affiliated institution, and was conducted
after obtaining consent from the participants and understanding from the facility managers.
Methods
This intervention program comprised the following: an oral examination and an assessment of
meal modifications; establishment and implementation of individual care for the purpose of
improving meal intake; and seminars to increase the willingness to eat. The programs
effects were verified by examining any changes observed in the participants, specifically by
assessing their physical traits (general condition, oral condition, activity, and presence or
absence of fever) both before and after the intervention. Effects were validated with the paired
t-test and the Wilcoxon signed-rank test using SPSS version 17 statistical software.
Results
342
The subjects comprised 125 elderly people (34 men, 91 women; mean age, 83.9 years; mean
nursing care level, 4.1) who were residing in geriatric health services facilities. Changes
observed in the study participants through this intervention program were general condition
(weight gain: p<0.05; increases in fluid intake, appetite, and walking distance: p<0.001), and
increase in total vitality index (VI) score (p<0.05). The common features of the 29
participants who had greater than average increases in their total VI score were as follows: 1)
improvement in movements and posture during meals; 2) increase in fluid intake; 3) decrease
in frequency of developing a fever during intervention; 4) reduction of residual food in the
mouth; 5) extension of waking hours during the day; and 6) expansion in excretory actions.
Conclusions
This intervention program is intended to increase the quality of life of elderly people who
require nursing care through the act of enjoyment of eating, and is composed of both oral
care to promote the act of eating and supportive care to create a suitable meal intake
environment. The results of this study verified the effects on vitality, and, in particular,
showed an extension in daytime waking hours and an expansion in excretory acts. These
findings indicate that this intervention is not simply a support program that aids in meal
activities, but also that may help elderly people who receive nursing care regain their
everyday lives. We believe that in the future, it will be important to analyze the characteristics
of participants who do not show clear changes and further refine this program.
3-5 Key words
Life-enhancement, elderly, nursing care, eating, quality of life
343
An exploration of feelings of respect among hospitalized elders in Taiwan
Kai-Li Chen1, *Ching-Huey Chen2

1.
Institute of Allied Health Sciences/ National Cheng Kung University, Taiwan; Department of
Nursing/ Tajen University, Taiwan. * 2Institute of Allied Health Sciences/ Department of Nursing,
National Cheng Kung University, Taiwan.
Presenting Authors Email: tajen2005@yahoo.com.tw
Purpose
Aim to explore the feelings of respect of the elderly in Taiwan during hospitalization.
Design
This a qualitative study and face to face interview with semi-structure questionnaire.
Methods
This is a qualitative study and face to face interview were conducted to collect data from the
Geriatric ward in medical center at southern Taiwan. Semi-structure questionnaire were used
to collect data. Inclusion Criteria is hospitalized elders, 65 years old and above and being able
to communicate with researchers. Cognition expression difficulty and unstable health
conditions were excluded. Content analysis was used for data analysis.
Results
To the end of August 2014, a total of 16 cases, preliminary results showed that during the
hospitalization, the description for feelings of respect included: "called (the medical staff) to
come", "smiles", "polite", "good-natured", "dedicated service ","talk to me or have a chat"," a
friend-like atmosphere "," thoughtful mind could not say "," professional (able to handle
discomfort) ".
Conclusions
The hospitalized elders reported different appearances of respect in their conditions which
reflexed our particular cultural background. It is worthy to notices that the feelings of respect
of the elders are not consistence with the principle of autonomy as mentioned in Western
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bioethics. How to practice the spirit of autonomy in our medical environment may need
further investigate.
3-5 Key words
Elderly, feelings of respect, autonomy
345
Characteristics of QOL and difficulties in daily life of elderly minor stroke

patients
Megumi Toriya1, Masumi Hasegawa1

1.
Sapporo Medical University
Presenting Authors Email: toriya@sapmed.ac.jp
Purpose
In recent years the number of elderly minor stroke patients in Japan has increased. However,
there are no reports describing how such patients live their daily lives at home after the
discharge. This study aims to identify actual or typical conditions of the QOL and the
difficulties such patients may experience in daily life after the discharge, and also to
investigate possible support measures.
Design
We used a convergent mixed methods design to collect quantitative and qualitative data of the
same timeframes based on the mixed methods research by Creswll et al.
Methods
The participants were elderly patients at and above 65 years of age diagnosed with minor
strokes who had been hospitalized for treatment. Using the Short Form-8 (SF-8) and Frenchay
Activities Index (FAI), the illness period from the occurrence of the stroke, the diagnosis, and
demographic data were included in the quantitative data. For the qualitative data, a semistructured interview was conducted about the difficulties in daily life after the discharge. To
analyze the relationship between the illness period and the SF-8 scores, we used t-tests by
dividing the illness period into two. Difficulties in daily life were analyzed by an inductive
qualitative approach. Further, for reference, the quantitative analysis was integrated with the
qualitative analysis.
Results
The number of participants was 41, 26 males (63.4%) and 15 females (36.6%) with the mean
age 75.36.3. The diagnosed diseases were cerebral infarction (34, 82.9%), cerebral
346
hemorrhage (6, 14.6%), and transient ischemic attack (1, 2.4%). The numbers of participants
whose illness periods were less than three years and three years or longer were 12 (29.3%)
and 29 (70.7%), respectively, and the mean value was six years and eight months. The mean
value of the FAI scores was 20.27.0. The t-test on the relationship between the illness period
and SF-8 scores yielded significant differences in four items. The scores for participants with
illness periods of less than three years were lower than for participants with illnesses of three
or longer years in general health, mental health, role emotion, and physical component
summaryPCS. This suggests an influence on difficulties in activity of daily livingADL
and emotional states among the difficulties in daily life. From the interviews, difficulties in
ADL included mobility difficulties, difficulties in communication, and
deterioration of perception. The influence of emotional aspects included lack of selfconfidence, always thinking about the illness, worries about recurrence, and
inability to fill the gap between the present state and the healthy past . These difficulties
in daily life were reported mostly by participants with illness periods of less than three years.
Conclusions
Both the physical and emotional QOLs were poor for three years after the occurrence of the
illness, but there appeared to be improvements more than three years past the occurrence of
the illness. Specifically in the period of less than three years, participants showed difficulties
in ADL and worries about recurrence even if symptoms were milder. Therefore, it is
suggested that patients in this period need interventions to improve difficulties in ADL and
health care management.
3-5 Key words
Minor stroke, mixed methods, QOL
347
Nonrestorative sleep is associated with increased falls in dementia
Hsiao-Yean Chiu1, Pin-Yuan Chen2

1.
Graduate Institute of Nursing, College of Nursing, Taipei Medical University, 2. Department of

Neurosurgery/ Chang Gung Memorial Hospital
Presenting Authors Email: hychiu0315@tmu.edu.tw
Purpose
To examine the prevalence of falls and insomnia symptoms, and the relationship between
specific insomnia symptoms and the risk of falls in elderly individuals with dementia.
Design
This was a cross-sectional study, using the population-based 2009 National Health Interview
Survey.
Methods
A total of 109 dementia respondents with aging older than 65 years were included. The
insomnia symptoms including difficulty in initialing sleep (DIS), difficulty in maintaining
sleep (DMS), early morning awaking (EMA), and nonrestorative sleep (NRS) were assessed
by 4 questions. The occurrence of falls was assessed by one question that Have you ever
experienced falls in the preceding year? A multivariate logistic regression model was used
to examine the relationship between specific insomnia symptoms and falls adjusting for
potential confounders.
Results
Twenty-seven point five percent of respondents with dementia experienced the occurrence of
falls in the preceding year. The prevalence rate of DIS, DMS, EMA, and NRS were 2.8%,
0.9%, 1.8%, and 20.2%, respectively. NRS was significantly associated with increased risk of
falls in comparison with those without insomnia complaints after adjusted for potential
confounders (adjusted odds ratio = 13.58, 95% confidence interval = 2.07 to 88.95).
Conclusions
348
Approximately one third elderly individuals with dementia had the experience of falls. NRS is
the most common insomnia complaints in dementia elderly. NRS is a risk factor of falls in
elderly individuals with dementia after accounting for a range of covariates.
3-5 Key words
Dementia, elderly, falls, insomnia symptoms
349
The differences of geriatric syndromes and quality of life in diabetes elders

with different physical activities
Hui-Ping Cheng1, Sang-I Lin1, Chong-Shan Wang2, *Ching-Huey Chen1

1.
Institute of Allied health Science, College of Medicine, National Cheng- Kung University, 2. Alian
Health Clinic
Presenting Authors Email: a0921216661@gmail.com
Purpose
Determining differences of quality of life and geriatric syndromes between diabetes elders
who are physical activity active versus those are inactive.
Design
This is a cross-sectional correctional study.
Methods
Subjects Subjects were recruited via poster and physician referrals from a township in
southern Taiwan. Inclusion criteria is 60 years old and above with diabetes, exclude blind,
bedridden, cognition expression difficulty and unstable health conditions.
Activity level classificationThe International Physical Activity Questionnaire (IPAQ) was
used to divid subjects into high activity and low activity groups based on WHO
recommendations for the elder.
Other measures includesLife satisfaction with WHOQOL-BREF assessment, Barthel
Index(BI) and Instrumental Activities of Daily Living (IADL) to assess their activities of
daily living for physical limitations of geriatric syndromes, the Mini-Mental Status
Examination (MMSE) to assess the situation of dementia, the Geriatric Depression Scale
short form (GDS-SF)to assess depression, the International Consultation on Incontinence
Questionnaire (ICIQ) used to measure urinary incontinence, the Malnutrition Universal
Screening Tool (MUST) used to measure nutritional status, and the number of falls and the
severity of injury.
Physical function test includesTime Up and Go, functional fitness to understand gait, and
physical function status.
350
Statistical methodsMann-Whitney U test and chi-square to analysis the difference between

two groups.
Results
From the end of May 2014 to the end of August, a total of 41 cases (Continued to recruit
subjects). Currently most of the subjects showed well controlled in their blood sugar, HbA1c
Mean(SD)=7.2 (0.8). There were no significant difference in demographic variables and
HbA1c between two groups.
Quality of life also showed not significant difference. In physical function, low activity group
in the physical fitness was generally poorer than the high activity group, but there was no
statistically significant difference. In the geriatric syndromes, there was only falls statistically
significant difference between the two groups (p= .04). The study displayed the inactive
group (low- activity) had a higher incidence of falls than active group (high- activity) in
diabetic elders.
Conclusions
The falls is one of the factors that affect mortality in diabetic elders. Diabetes elder of high
physical activity group who happen to fall significantly lower than low physical activity
group.
3-5 Key words
Physical activity, geriatric syndromes, quality of life, elder, diabetes mellitus
351
The actual situations of end-of-life care provided to the care receivers with
cancer by the care workers at nursing care insurance facilities
Tomoko Sugimoto1
1.
Chiba Prefectural University of Health Sciences
Presenting Authors Email: tomoko.sugimoto@cpuhs.ac.jp
Purpose
The study aimed to clarify the reality of end-of-life care given to the care receivers with
cancer by the care workers at nursing care insurance facilities.
Design
Descriptive study
Methods
From December 2012 through September 2013, we worked at 2 nursing care insurance
facilities situated in Kanto area which we could receive the permission of and the cooperation
to our study by the administrators and conducted a semi-structured interview for 10 care
staffers who had experiences of care-giving to the care receivers with cancer.
In the present study, we mainly asked the questions on 6 items such as at the time of
terminal stage of the care receivers with cancer. We recorded the interview with the
consent of the subjects, which were recorded in writing word for word. Based on these, and
in accordance with the study objective, we extracted the narratives related to the actual
situations at the end-of-life care of the care receivers with cancer, and put together the similar
contents for categorization.
To the subjects, we explained the objective and method of the study both verbally and in
writing, and obtained their consent of cooperation for the study in writing.
Results
The subjects were 3 males and 7 females, whose mean working period as professional was 8.5
years.
In the interview, the care workers in the nursing care insurance facilities in Japan thought that
352
the end-of-life care that care workers performed originally existed as well as the endof-life care that nurses played a central role in. Also, due to the difference of specialty
between medical care and nursing care or because of the situation of staff deployment, care
workers felt limitations in the end-of-life care provided by the care-giving professionals,
and felt burdens for practice of the end-of-life care mentally because they could not
confirm the reactions by the care receivers.
Conclusions
As the category to reveal the reality of the end-of-life care for the care receivers with cancer,
recognizing the nursing profession as the center job in the end-of-life care was
mentioned, while the other categories such as providing the end-of-life care which may be
the way only they can implement, etc. were also extracted. Thus it was found that, in the
nursing care insurance facilities in Japan, the roles of the nursing profession and the caregiving profession are divided according to their respective specialties in implementing the
end-of-life care.
Ogiso et al. (2010) pointed outthe limit of restricted manpower as the issue in caring the
aged that was perceived by the care-giving professionals. In the study, the category of
feeling limitation in the end-of-life care provided by the care-giving professionals was
found, but its contents were similar to the report made by Ogiso et al. (2010). Thus it was
suggested that the care workers regard the current staff deployment as a problem, and they
grope about collaboration of the end-of-life care with nurses. Additionally, it was revealed
that its necessary to examine the reduction of the mental burden on care workers at nursing
care insurance facilities.
3-5 Key words
End-of-life care, care workers, nursing care insurance facilities
353
Future prospects of intergenerational interaction in China based on Japan

s experience
Xiaowei Lu1, Xiaowei Lu2, Harumi Yamamoto2, Rieko Aoki2, Hitomi Nagamine2,
Minako Kobayashi3, Kumiko Morita2
1.
Graduate School of Health Care Sciences,Community Health Promotion Nuring, 2. Tokyo Medical
and Dental University Graduate School of Health Care Sciences, 3. Kemda College of Health Sciences
Presenting Authors Email: ns140003@tmd.ac.jp
Purpose
The aim of this study is (1) to describe the effect of intergenerational interaction on the
improvement of the quality of life (QOL) between the elderly and children in China, and (2)
to examine what is considered to be useful in Chinese intergenerational interaction based on
the analysis of super-aging effect to the intergenerational interaction in Japan.
Design
The literature review is conducted to describe the effect of the intergenerational interaction
between elderly and children in Japan and China, and then explore methods of mental health
promotion.
Methods
1. Literature articles are selected from the databases: Ichushi-Web, CiNii, Pubmed, Medline,
WangFang, CNKI, and Wenku.baidu. The literature review criteria include: written in English,
Japanese, Chinese, and published from 2009 to September 2014. Search keywords are
combined with elderly, empty nest elderly, children, QOL, mental
health, community, and intergenerational interaction. Twenty-two articles are
selected for the thematic analysis. Furthermore, newspaper articles about the interaction of the
Chinese elderly and children are summarized.
2. A subject by Chinese intergenerational interaction, and examined what is considered to
be useful in China among the intergenerational interaction in Japan.
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Results
1.The Chinese current situation.
1) It is found that majority of Chinese children do not play outside in holidays. They would
rather stay at home, which is called the "Otaku Children". It has become a social problem in
China. Some factors may contribute to the issue, such as spread of Internet games, lack of
activities and places to play, homework overload, and overprotective of parents for safety
reasons.
2) In addition, with the increasing proportions of nuclear and older-adult families, elderly
people are at the risk of isolation and loneliness, leading to an increase in the risk of
depression and stress. The majority of elderly have moderate to high levels of loneliness, and
the level of loneliness is significantly different due to the age, marital status, income, and
educational levels.
3) According to the newspaper, it has been reported to be effective for the elderly and
children to play old games.
2. The Japanese current situation.
Japan becomes a super-aging society, and the intergenerational activity is performed to help
elderly people improve their QOL. It is beneficial for the elderly: realizing the value of life,
improving the QOL, preventing elders isolation, improving depression. For the children,
enhancing social skills, increasing the generation inherited, and promoting mutual
understanding.
3. Elderly people and children play and study together after school by intergenerational
interaction in Japan. Hence, the relationship between the two generations could be
strengthened, which also reduces the safety concerns for children.
Based on the investigation results, it is possible that the method of intergenerational
interaction of Japan is useful in China.
Conclusions
The intergenerational interaction in China does not spread as much as in Japan. However, it is
a practical suggestion for China to welcome the super-aging society, and to incorporate
intergenerational problems faced by China based on the Japanese experience
3-5 Key words
Elderly people, intergenrational interaction, children, QOL, mental health
355
Exploring elements of end-of-life care for the elderly with the aim of
developing quality indicatorsEnglish literature review
Nobuko Kawai1, Harue Masaki2, Keiko Matsumoto3, Yasue Hayashi2, Sayuri Sakai4,
Kazuko Endo5, Megumi Teshima2, Hiroko Nagae2
1.
Kobe City College of Nursing, 2. Chiba University, 3. Kawasaki University of Medical

Welfare, 4. Niigata University, 5. Yamagata Prefectural University of Health Sciences
Presenting Authors Email: nkawai@tr.kobe-ccn.ac.jp
Purpose
The purpose of this study was to review and explore the elements of end-of-life care for
elderly with the aim of developing quality indicators.
Design
Literature review.
Methods
First, we searched CINAHL for English articles published between 1982 and 2013 using
keywords as followselderly AND(end-of-life) OR (palliative)AND(measure or
measures or measurement) OR (indicator or indicators) OR (scale or scales), or elderly
AND(end-of-life) OR(palliative)ANDquality. After excluding editorials, abstracts,
commentaries, simple descriptions of disease, tools for research, and dissertations, 149
English articles remained for analysis. The end-of-life care situations for the elderly were
categorized, and elements of care were arranged according to the situations.
Results
The following three elements were generated: [physical conditions of the elderly], [intentions
of the elderly], and [environments of care].
The contents of [physical conditions of the elderly] were as followselderly with cancer;
elderly with chronic disease; elderly in end stage chronic disease; elderly with
frailty; elderly with malnutrition; elderly repeating falls; elderly with
356
symptoms; anddying elderly. The literature showed that comprehensive physical

assessments are required and that predicting the trajectory of physical conditions is difficult
but important, and also discussed assessments and approaches for frailty.
The contents of [intentions of the elderly] were as follows: elderly has not expressed
his/her intentions; sharing intentions of the elderly; the situation changing after the
elderly makes decisions;the elderly is in end-of-life care;the elderly requires urgent
hospitalization; andthe decisions made do not fit the intentions of the elderly. The
literature mainly described situations in which most of the elderly face the decision on DNR
or ACP just before dying, and noted that the intentions of care may change according to the
situation or time.
The contents in [environment of care] were as followsfacilities or wards do not focus on
end-of-life care;staff do not have enough knowledge about end-of-life care;staff do
not have enough knowledge about the elderly;staff experience emotional difficulties
when involved in end-of-life care for the elderly;and difficulties providing the elderly
with the desirable level of care due to organizational issues within care faculties. The
literature mainly showed the organizational difficulties in providing end-of-life care for the
elderly, and only a few articles made suggestions for organizational change.
Conclusions
This study clarified when and how end-of-life care for the elderly should be provided by
exploring elements on situation-based, and arranging care according to the situation. This
information is helpful because end-of-life care for the elderly must be provided on a case-bycase basis. This research also showed that elements of care reflect not only physical condition,
but also the care environment and the process of creating care goals with elderlys intention.
These elements are useful for developing holistic quality indicators of end-of-life care for the
elderly.
3-5 Key words
Elderly, end-of-life care, literature review
357
Nursesexperiences with and interests in patients with cognitive

impairment in acute hospitalsComparison between Thailand and Japan
Chieko Greiner1, Supreeda Monkong2, Motoko Kita3, Tomoko Oishi4, Tokiko Isowa5,
Hiroshi Higashiura6
1.
Graduate School of Health Sciences, Kobe University, 2. Mahidol University, 3. The Jikei University
School of Nursing, 4. Kanagawa University of Human Services, 5. Mie University, 6. The Japanese Red
Cross College of Nursing
Presenting Authors Email: greiner@harbor.kobe-u.ac.jp
Purpose
The percent of elderly people in the Japanese population exceeded 25% in 2013. This is the
highest in the world and is expected to continue rising. However, a low birthrate and
longevity are not specific to advanced countries such as Japan: compared to the rest of the
world, Asia is rapidly aging. Along with the aging of the population, the numbers of elderly
patients and patients with dementia receiving treatment in acute hospitals are increasing, and
so establishing appropriate care for patients with dementia is important. The purpose of this
study was to compare experiences with and interests regarding patients with cognitive
impairment (PWCI) among nurses working at acute hospitals between Thailand, which is the
most rapidly aging among ASEAN nations, and the super aging society of Japan.
Design
A cross-sectional comparative research design was conducted.
Methods
Participants were 200 nurses working at two acute hospitals in Bangkok and 362 nurses
working at thirteen acute hospitals in Tokyo having 300 or more beds. Self-description
questionnaires are used to collect data and nurses working in maternity sections and pediatric
sections were excluded. This research was conducted after approval from the first presenter
s Institutional Review Board.
358
Results
Among participants, 200 (100%) in Thailand and 344 (95.0%) in Japan were women. Mean
age was 35.06.8 in Thailand and 35.18.3 in Japan. Mean nursing experience was 12.16.5
in Thailand and 11.48.2 in Japan. Nurses obtained their licenses through universities (136:
68.0%) or junior colleges (64: 32.0%) in Thailand and through universities (92: 25.4%),
junior colleges (42: 11.6%), or training schools (208: 57.5%) in Japan. Nurses who took
lectures or practical lessons on dementia as part of their basic education totaled 50 (50.0%) in
Thailand and 213 (58.8%) in Japan. Nurses who took care of any PWCI during their clinical
practice were 131 (65.5%) in Thailand and 204 (56.4%) in Japan. Nurses who had first-hand
experience caring for PWCI were 87 (43.5%) in Thailand and 131 (36.2%) in Japan. T tests
were conducted to compare experiences and interests between Thailand and Japan. Nurses in
Japan had experienced more difficulty providing nursing care to PWCI (p=.00), but were
more interested in such care (p=.00). Also, nurses in Japan wanted more to take a course on
nursing care for PWCI (p=.00), but nurses in Thailand were more interested in obtaining a
clinical nurse specialist or certified nurse license to care for elderly people or people with
dementia (p=.00).
Conclusions
Despite the percentage of elderly people being much higher in Japan, a smaller percentage
took care of PWCI during clinical practice, relative to Thailand. Students in Japan should be
provided with more opportunities to take care of PWCI. Although nurses in Japan experience
more difficulty, they have more interest in providing care to PWCI than nurses in Thailand.
As a Japanese government strategy, PWCI lecture programs for nurses would be effective and
should be provided as much as possible. This research was supported by a Grant-in-Aid for
Scientific Research (B) (No. 24406037).
3-5 Key words
Acute hospital, cognitive impairment, dementia, Japan, Thailand
359
The changes of applying the gerotranscendence reminiscence therapy

among institutionalized elder
Chiu-Yueh Hsiao1, Shu-Hui Yeh2

1.
Department and Institute of Nursing, Tzu Hui Institute of Technology, 2. College of Nursing, Central
Taiwan University of Science and Technology & Chang Bing Show Chwan Memorial Hospital
Presenting Authors Email: anita16.hsiao@msa.hinet.net
Purpose
This study examined the changes of applying gerotranscendence reminiscence therapy for
older residents in long-term care facilities.
Design
The study used the qualitative study design to understand changes during the process of the
gerotranscendence reminiscence intervention.
Methods
Subjects were recruited from eight community-based long-term care facilities (LTCFs) in
Taipei, Taiwan were research settings in this study. Totally, one hundred- twenty residents
from LTCFs who met the following criteria were research subjects in this study: (1) 65years
old or over; (2) intact cognitive function and able to communicate verbally in Mandarin or
Taiwanese; (3) Small Portable Mental Status Questionnaire (SPMSQ) assessment result was
equal or higher than score 8. Elders were excluded if they had a mental illness diagnosis.
Purposive sampling to select the potential subjects from elder care institutions in Taipei city.
Forty-one elderly residents received reminiscence intervention applying gerotranscendence
concept once a week for eight weeks and each time lasting 60 minutes. Gerotranscendence
reminiscence therapy contained the following stages: warmiing up, needs assessment, ,
activities according to residents needs, and process outcomes evaluation. At the begining of
the study, all of the participants were interviewed by the researcher individually. I contacted
these elderly and established a trustworthy relationship with them. After the agreement was
made and the consent form was filled out, an interview in depth was conducted according to
the themes. All interviews were audio-taped and transcribed verbatim, content analysis was
360
used for data analysis with inductive, seeking understanding of individuals perceptions.
When a number of coded contexts were considered to have common elements, they were
merged to form categories and presented as results.
Results
Results of this study revealed that subjects who received gerotranscendence reminiscence
therapy revealed the positive attributes from subjects reviewing their past life , five main
categories were summarized: the creation of an unique life, harmonious affection is the core
value of human life, faithful belief can be as the source of strong support, the appreciation of
nature beauty is joyful, and the eternal life is the goal to pursue.
Conclusions
In summary, the findings imply that participation in gerotranscendence reminiscence activities
is a positive and worthwhile experience for older institutionalized persons. We suggested that
the application gerotranscendence reminiscence therapy in long-term care facilities is a
necessary treatment for residents to gain a positive feeling of life.
3-5 Key words
Gerotranscendence reminiscence therapy, long-term care facilities, meaning of life
361
A study on prevalence of elderly people with edema according to activity at

long-term care hospital and nursing home in Japan
Aya Sato1, Yumiko Fujimoto1, Saldy Yusuf1, Sayumi Tsuchiya1, Misako Dai2,
Junko Sugama3
1.
Division of Health Sciences, Graduate School of Medical Science, Kanazawa
University, 2. Department of Clinical Nursing, School of Health Sciences, College of Medical,

Pharmaceutical and Health Sciences, Kanazawa University, 3. Wellness Promotion Science Center,
College of Medical, Pharmaceutical and Health Sciences, Kanazawa University
Presenting Authors Email: ayasato66930@gmail.com
Purpose
Elderly people has a high tendency to develop edema due to age-related factor. However,
there are no clear in elderly people with edema and the widespread of edema could not be
determined.
This purpose is to determine the prevalence of elderly people with edema, the anatomical sites
and the degree of edema according to activity.
Design
This is a cross sectional study.
Subject is 65 years or older people who are hospitalized in a long-term hospital and a special
nursing home. Exclusion criteria are 1.the patients and the family members of the patients
disagreed in the participation of this study, 2. people who are not suitable for this study due to
severe conditions based on the opinion of a physician or nurse.
Methods
We investigated edema in 55 anatomical sites in whole body in 232 out of 370 patients, which
is the inclusion criteria group. We evaluated the degree of edema by the modified Fukazawa
method. No investigation was done to the exclusion criteria group, which is a total of 138 out
of 370 patients. The degree of edema was assessed by a WOC nurse.
The descriptive statistics about the prevalence of edema and degree of edema at the observed
362
sites according to activity. The activity was classified in three group as ambulatory, chair
bound and bed bound. We decided with edema in grade 1 or more.
Results
There were 224 participants with edema. The prevalence of edema was 96.6%. There were 13
participants in group A elderly who were ambulatory. Total of 103 sites of edema were
observed in group A. The three most common sites for edema were lower legs (23, 22.3%),
ankles (23, 22.3%) and dorsum of foots (13, 12.6%). There was not edema in the
trunk.Degree of edema was grade 1; 47.6%, grade 2; 41.7%, and grade 3; 10.7% in group A.
There were 48 participants in group B elderly who were chair bound. Total of 434 sites of
edema were observed in group B. The three most common sites for edema were ankles (110,
25.3%) lower legs (72, 16.6%), and dorsum of foots (62, 14.3%). Degree of edema was grade
1; 60.1%, grade 2; 27.6%, and grade 3; 12.2% in group B.
There were 163 participants in group C elderly who were bed bound. Total of 1561 sites of
edema were observed in group C. The most common sites for edema were ankle (276, 17.7%),
lower legs (209, 13.4%), dorsum of foots (207, 13.3%) and forearm (138, 8.8%). Degree of
edema was grade 1; 74.7%, grade 2; 20.8%, grade 3;4.2%, and non-pitting edema;0.3% in
group C.
Conclusions
The prevalence of edema was high.The prevalence of edema of lower limbs was high with all
activity, but appeared to upper limbs and the trunk when it became in bed bound group. When
activity increased the grade of edema, there were many ratios of grade 2.
3-5 Key words
Edema, elderly, prevalence, activity
363
Predictors of health behaviors for adults with hypertension worldwide

Research synthesis
Mayumi Mizutani1, Junko Tashiro2

1.
Doctoral Program, St. Luke's International University, 2. St. Lukes International University
Presenting Authors Email: 12DN010u5Q-ts@slcn.ac.jp
Purpose
The purpose of this literature review was twofold: to explore both health behaviors and the
predictors of health behaviors in adults with hypertension around the world in order to
develop a framework to guide a further study about predictors of health behaviors for adults
with hypertension in Indonesia, which is experiencing globalization, nutrition and health
transitions.
Design
Literature review.
Methods
This literature review was guided by Coopers process of research synthesis. Literature
search was conducted using key wordshypertens* in title and combined withhealth
behavior in subject terms. The literature was searched using the databases: CINAHL,
MEDLINE, PsycINFO, SocINDEX and hand search. Inclusion criteria covered four
major areas: 1) Topical (explore health behaviors and the predictors for hypertension
prevention and health promotion); 2) Population (participant group includes adults of any
nationality. Studies were excluded if the main population was elderly, pregnant women, or
people had mental health problems); 3) Methodological (study used a quantitative
methodology in English or Indonesian); 4) Temporal (published between 2004 and 2014).
The following information of each study was organized into a synthesis matrix: design, author,
publication year, country, participant, predictors, and behavioral outcomes. Information about
behavioral outcomes and predictors were extracted and assessed.
364
Results
Thirty-five publications met the inclusion criteria. Thirty studies were conducted in highincome countries, while five studies were conducted in middle-income countries. Health
behaviors were referred to variously as: self-care behaviors, adherence, compliance, lifestyle
behaviors, health promoting behaviors, and health behaviors. Health behaviors included:
eating behavior (consumption of low-salt diet, low-fat diet, fruits and vegetable), physical
activity, non-smoking, alcohol abstinence, stress control, and regular blood pressure check,
doctor visits, and medication adherence. Personal, social, and environmental predictors were
derived. Personal predictors included: self-efficacy, beliefs about hypertension, knowledge,
personal characteristics and personal barriers. Social predictors included: social support,
support from health professionals and social barriers. Environmental predictors were
environmental barriers.
A model of health behaviors and the predictors of adults with hypertension worldwide was
derived from a synthesis of the findings. Health behaviors were predicted by personal
predictors such as self-efficacy, beliefs about hypertension, and knowledge of hypertension
and its management. The personal predictors were reinforced by demographic characteristics,
social support, and support from health professionals. However, the health behaviors were not
likely to occur if personal barriers, social barriers or environmental barriers had a more
powerful influence.
Conclusions
Predictors of health behaviors for adults with hypertension were personal, social, and
environmental factors. Adults with hypertension need to be supported with these personal,
social, and environmental factors to promote their health. Most of the studies from the
literature review involved high-income countries. There were very few studies on health
behaviors and the predictors for people with hypertension in Indonesia. Motivators for health
behaviors were different for Eastern and Western cultures. Therefore, it is necessary to
explore predictors of health behaviors for people with hypertension in Indonesia.
3-5 Key words
Adult, health behavior, hypertension
365
An investigation of the effect of exercise and physical activity in the

treatment of diabetes
Feng-Ching Sun1, Lune-I Li2, Chi-Chin Tseng3

1.
Kaohsiung Municipal Min-Sheng Hospital. College of Nursing, Kaohsiung Medical
University, 2. Health Center Nangang, Taipei, 3. National Pingtung University of Science and
Technology
Presenting Authors Email: sfcmail333@yahoo.com
Purpose
According to the annual report by Bureau of Health Promotion, diabetes has been the fifth
major cause of death in Taiwan form 2002. ADA has been declared that combining diet,
exercise, and medical care can help us to control body weight, and to keep blood glucose,
blood pressure, HDL cholesterol and triglycerides on target as well. However, benefits from
structured exercise or physical activity were still limited. The main purposes of this study it to
examine the relationship between different types of exercise programs and the status of
diabetes mellitus control, furthermore, to provide the recommendation of physical activity for
patients with type 2 DM.
Design
A quasi-experimental design
Methods
A quasi-experimental design was used in this study, 60 subjects were randomly assigned into
three groups, which were the control group, exercise-group (the structured exercise was
consisted in three times/week, 30 min/time, heart rate >130 beat/min, while the intensity was
set as moderated to vigorous) and Physical activity-group (any kind of physical activity have
to accumulate at least 150min/week, while the intensity was moderate level), and the
intervention was lasted for 12 weeks. ANCOVA was used to estimate relationships among
subjects physical activity, physiological measures, and blood biochemical parameters on
the post-test.
366
Results
The results indicated that two types of intervention improved the effect of treatment on
diabetes, several parameters included body weight, waist, fasting glucose and glycosylated
hemoglobin were decreased significantly.
Conclusions
Compared with the baseline measurement recommended amount of reference .
The physical activity can be integrated with other factors to improve the diabetic care.
We suggest that health providers should present an appropriate daily physical activity or a
structured exercise program to their patients in the treatment of diabetes. Moreover, since
people dont have enough time to involved in structured exercise, we recommended that
cutting the grass, cleaning home and other daily chores, even such as shopping, should be
arranged into must-to-do list for patients in the diabetes treatment.
3-5 Key words
Diabetes treatment, structured exercise, physical activity
367
Effects of deep breathing with incentive spirometer
Kyeha Kim1, Daehwang Moon2

1.
Chosun university, 2. Chonsun university
Presenting Authors Email: kyehakim@hanmail.net
Purpose
The purpose of this study was to examine the effects of deep breathing with incentive
spirometer on pulmonary function and O2 saturation by time process in Korean patients with
rib fracture.
Design
The design of this study is one-group time series study.
Methods
The participants were 25 patients with rib fracture admitted to a hospital in G city, Korea.
Deep breathing with incentive spirometer was educated and performed to participants. Data
were collected from June to October, 2013. Pulmonary function (forced vital capacity, peak
expiratory, forced expiratory volume in one second, FEV1/FVC %) and O2 saturation were
measured by using Micro spirometer and pulse oximeter at admission one day, 2 day, 3day,
4day, 5day, and 6day. The collected data was analyzed by SPSS (Statistical Package for the
Social Science) 21.0 version program with descriptive statistics, and repeated measure
ANOVA.
Results
The result of this study is follows: There were significant differences in the level of forced
vital capacity, peak expiratory, forced expiratory volume in one second, and FEV1/FVC %
and O2 saturation by time process. The level of forced vital capacity, peak expiratory, forced
expiratory volume in one second, and FEV1/FVC % after applying deep breathing with
incentive spirometer were increased as time went on. The level of O2 saturation also showed
the same results.
368
Conclusions
Based in this study, it appears that deep breathing with incentive spirometer is the effective
method for the improvement of pulmonary function and O2 saturation in patients with rib
fracture. Also, the effects of the improvement of pulmonary function and O2 saturation
increase over time. Therefore, patients with rib fracture should be suggested the continuous
deep breathing with incentive spirometer.
3-5 Key words
Deep breathing, pulmonary function, incentive spirometer, O2 saturation
369
Effects of normal saline and essential oil gargling on bacterial colonization

in intubated patients for general anesthesia
Sang-Jin Ko1
1.
Presenting Authors Email: llrall@hanmail.net
Purpose
The purpose of this study was to compare and analyze the effects of gargling using normal
saline or essential oil on oral bacterial colonization of the subjects who did trans-oral
endotracheal intubation for general anesthesia.
Design
A repeated measure, non-equivalent control group pretest-posttest design used in this study.
Methods
The subjects of the study is a total of 58 people, that is the gargling group with normal saline
(n=19), the gargling group with essential oil (n=20) and the control group (n=19). Data were
collected from university hospitals in Korea, province for August 13-31, 2012. The collected
data were analyzed with 2 -test, t-test, ANOVA and Scheff test by utilizing SPSS 19.0.
Results
Although statistically significant differences among the three groups have not appeared in the
change of aerobic bacterial colony before and after experiments, aerobic bacterial colony of
the gargling group with normal saline (71.58143.39) and that with essential oil (6.95332.07)
have less increased compared to control group (145.42385.01). The change of anaerobic
bacterial colony before and after experiments, the control group (167.58483.58) and the
gargling group with essential oil l(169.70291.60) has increased, while the gargling group
with normal saline (-42331.09) has reduced, but significant differences have not appeared.
Conclusions
370
These findings are indicated that oral gargling with normal saline is effective in reducing
anaerobic bacterial colonization.
3-5 Key words
Saline solution, essential oils, bacteria, intubation
371
Development of acne reflected stress in the last grade of nursing students
Riho Kuwabara1, Masayo Ayukawa2, Ai Yamaguchi2, Yumie Nagata2, Satomi Tanaka2

1.
National Center for Global Health and Medicinen, 2. GIFU UNIVERSITY OF MEDICAL SCIENCE
Presenting Authors Email: ex24.kr47@i.softbank.jp
Purpose
This study aimed to elucidate the relationship between acne and stress in the forth grade of
nursing students facing to stress of student life.
Design
Experimental study
Methods
1Thirty nursing students in the forth grade of A university were informed about the study
and enrolled in this study.Experimental investigations date was June 2013.
2Thirty subjects were answered to the questionnaires about stress by STAI(State-Trait
Anxiety Inventory) and skin condition, followed by the number of staphylococcus aureus
were counted by using the culture stump (DD checker) growing staphylococcus aureus. The
stump was pressed in 3 seconds on the face where pimples came out most frequently. In
control group, the stamp was opened in the air in 3 seconds. All the stamps settled upside
down and were incubated in 37 degrees for 48 hours. The number of colony showing york
egg reaction were counted.
3Ethical considerations.
Questionnaire forms were filled out anonymously. Questionnaire forms and culture stamps
were marked to connect each other. All the obtained data were only used for this study.
Study methods about culture stamp were explained before this study. Replies to
questionnaires were considered to agreement to this study.
Results
1Questionnaire forms and culture stamps were obtained from all the students. 16 students
were under practical training.
372
2As a frequent answer, four in male and 13 in female replied that State Anxiety levels were
3. Trait Anxiety level 3 was 4 in male and 12 in female. 23 students (77%) felt rough skin
during practical training.
3Culture grew staphylococcus in 3 male (50%) and 4 female (17%). Culture in male grew
staphylococcus relatively higher than that in female (p=0.12, Fischer exact test).
4Stress receiving from practical training was temporary and considered to be conditional
anxiety. Therefore, in 16 students under the training, conditional anxiety had correlation with
growth of staphylococcus species (r=0.123).
Conclusions
I can be considered the following as reasons why correlation of Staphylococcus aureus and
the stress was close to uncorrelated.
* The detection was carried out of Staphylococcus aureus in this study, but there is a close
relationship between acne and because acne bacteria, the number of Staphylococcus aureus,
the correlation coefficient between the Stressed is close to 0.
* In this study, because it was stamped only for one point in the subject, it is not possible to
give exact figures.
* That they were not able number of subjects is small, to obtain accurate data is increased.
Challenges of the next study is the following three points
1. Increase of the number of subjects.
2. I count the number of all of the acne.
3. I examine the relationship of stress and acne bacteria.
3-5 Key words
Nursing students, acne, stress
373
Comparison of physiological responses and metabolic equivalents on

elliptical training with 12-minute walking test (12MWT) in males with
different categories of body weight
Jun-Hui Ong1, Shih-Yun Lin2, Huei-Chen Lin1, Ching-Hsia Hung1

1.
Department of Physical Therapy, National Cheng Kung University; Taiwan, 2. Department of
Biomedical Engineering, National Cheng Kung University, Taiwan. Cloud Service Technology Center,
Industrial Technology Research Institute South Campus, Taiwan, 3. Institute of Allied Health Sciences,
National Cheng Kung University; Taiwan. Department of Physical Therapy, Shu-Zen Junior College
of Medicine and Management, Taiwan. * Institute of Allied Health Sciences/ Department of Physical
Therapy, National Cheng Kung University; Taiwan.
Presenting Authors Email: junhui5252@yahoo.com
Purpose
Usage of elliptical training has increased dramatically in health-fitness settings nowadays. It
activated large amounts of muscle group. 12-minute walking test (12MWT) had been proven
to be more appropriate to determine the oxygen uptake and endurance, because the duration
takes longer during the test. This study compares the physiological responses and metabolic
equivalents on the elliptical training with a 12-minute walking test in males with different
categories of body weights.
Design
Quasi-experimental design with same subjects and time-series
Methods
Twenty male subjects (age=35.952.67 years; body mass index= 27.13 5.26 kg/m; mean
SD) were divided into three groups based on body weights. Group 1: below 79 kilograms
(average 71.92 4.63), group 2: 80-99 kilograms (average 83.66 5.52), and group 3: above
100 kilograms (average 116.003.39). They were randomly assigned to perform either
elliptical training or 12MWT. Elliptical training comprised of three consecutive 5-minutes
stages at the intensities of 50 watts, 100 watts and 150 watts (with 50 revolution/minutes
during each stages). In 12MWT, subjects were instructed to walk as far as possible in the
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designed pathway for 12 minutes. Breath-by-breath data were collected throughout both tasks
by using the pulmonary gas exchange system (K4b2 system). Borgs scale was used to
measure the rate of perceived exertion (RPE) before and after each task. The studies were
conducted between May to September, 2014. Kruskal-Wallis test was performed to compare
between groups. A value of P < 0.05 was considered statistically significant.
Results
Maximal heart rate (MHR), oxygen uptake (VO2) and RPE are commonly used in prescribing
exercise. Thus, the results obtained in the current study help to refine the exercise
prescription. There was marked differences (P <0.05) found in the oxygen consumption per
kilogram (VO2/Kg) and metabolic equivalent unit (METs) during elliptical training and
12MWT in males with different body weights. However, no significant differences (p>0.05)
were found in the tidal volume (VT), VO2, carbon dioxide production (VCO2), heart rate
(HR) and RPE between groups in both tasks. There was distinct differences (p = 0.046) found
between group1 (below 79 kg, 1307.08191.15 meters), group 2(80-99 kg, 1306.73
62.30meters) and group 3 (above100kg, 1251.0052.61meters) for the walking distance
achieved during 12 MWT. However, no significant difference was found in among the subject
s subjective perception on shortness of breath (SOB) and/or soreness of muscle after elliptical
training and also 12MWT. But, above 60% of the subjects complained muscle soreness as the
main problem in limiting them during elliptical training while 65% of the subjects claimed to
be equal in SOB and/or soreness of muscle in 12MWT.
Conclusions
This study indicates that 12MWT produced similar physiological responses and METs value
as compared to elliptical training. Due to the low impact in nature, elliptical training may have
a gradual benefit especially toward obese people as well as those with orthopedic limitation.
Factors that affect the 12MWTs performance include lack of self-motivation, poor
endurance, respiratory function and cardiovascular fitness. Future research should include
both male and female subjects besides investigating the long-term physiological responses
and changes in the METs of elliptical training.
3-5 Key words
Elliptical training, 12-minute walking test, physiological responses
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Factors influencing adherence to vestibular rehabilitation in patients with

dizziness
Hyun-Jung Lee1, Smi-Choi Kwon2

1.
College of Nursing, Seoul National University, Seoul, Korea, 2. College of Nursing, Research
Institute of Nursing Science Seoul National University
Presenting Authors Email: leehj04@snu.ac.kr
Purpose
This study investigated the level of adherence to vestibular rehabilitation exercise program
(VREP) and evaluated how health belief model (HBM) variables, are related with adherence
to VREP in patients with dizziness.
Design
Tthis study design is descriptive survey research
Methods
The data were collected from 150 individuals, who agreed to participate in the study between
December, 2012 and May, 2013. Adherence to VREP, severity of dizziness, health belief
variables (health belief scale) and self-efficacy (self-efficacy scale) were measured.
Results
The result of this study showed poor adherence to VREP. The mean adherence score to VREP
was 2.111.05(1-5). In multivariate analysis, severity of dizziness (P<.001), taking sedative
medication (P<.001), high self-efficacy (P<.001), high perceived seriousness (P=.019) &
benefit (P=.036) were independent predicting factors explaining 57.7% of adherence to VREP.
Conclusions
Adherence to VREP was poor among these patients. To improve the patients adherence to
VREP, strategies to increase perceived seriousness, benefit or self-efficacy and to decrease
barriers are urgently needed.
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3-5 Key words

Dizziness, adherence, rehabilitation, self-efficacy
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The effects of the PCA (Patient Controlled Analgesics) educational

program on the post-op pain of the gynecologic laparoscopic surgery
patients
Joo-Hyun Kim1, Mi-Sook Hwang2

1.
Kangwon National University, 2. Kangwon National University Hospital
Presenting Authors Email: joohkim@kangwon.ac.kr
Purpose
The goal of the use of PCA (patient controlled analgesics) is to reduce post-op pain that
patients suffer after surgery. However, a lot of patients tend to misuse the PCA and to
complain about the side effects due to its overdoses. Therefore, it has been required that they
be provided with a new PCA educational program to control post-op pain effectively with
minimal side effects and without overdoses. Accordingly, the purpose of this study was to
identify the effects of the new PCA educational program on post-op pain that patients suffer
from gynecologic laparoscopic surgery.
Design
The research was designed for the nonequivalent control group before and after a test design.
Methods
The subjects of this study were 54 in all and were divided into two groups (an experimental
group and a control group). The new PCA educational program for patients who had
gynecologic laparoscopic surgery was executed before the operation. The program consisted
of a brochure for PCA use and a practicum with an actual PCA instrument. Data were
collected out of questionnaires and observations. The data were analyzed on the basis of
frequency, percentage, mean, standard deviation, X2and t-test.
Results
The complaints by the experimental group about pain were significantly less than those of the
control group in both post-op 24 hours and post-op 48 hours. The experimental group pressed
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the PCA button much less frequently than the control group in post-op 24 hours. However,
there were no significant differences in side effects between the two groups.
Conclusions
The results of this study show that the new PCA educational program was effective for
controlling both post-op pain and overdoses of analgesics. Based on these findings, this new
PCA educational program is considered to be useful in the clinical nursing field and helpful
for patients who use PCA.
3-5 Key words
Patient controlled analgesics, surgery, pain
379
Effects of stationary cycling and elliptical training with same resistance

load on physiological responses and oxygen consumption in a group of men
with 3 different levels of body weight
Huei-Chen Lin1, Shih-Yun Lin2, Jun-Hui Ong3, *Ching-Hsia Hung

1.
Institute of Allied Health Sciences, National Cheng Kung University; Taiwan. Department of
Physical Therapy, Shu-Zen Junior College of Medicine and Management, Taiwan., 2. Department of
Biomedical Engineering, National Cheng Kung University, Taiwan. Cloud Service Technology Center,
Industrial Technology Research Institute South Campus, Taiwan, 3. Department of Physical Therapy,
National Cheng Kung University; Taiwan, * Institute of Allied Health Sciences/ Department of
Physical Therapy, National Cheng Kung University; Taiwan.
Presenting Authors Email: hclin1101@gmail.com
Purpose
Training modes may be known to influence the physiological responses and the oxygen
consumption. Therefore, this study compares responses between two different modes of
exercise with the same resistance (stationary cycling vs. elliptical training) among a group of
men associating with three different levels of body weights.
Design
One-group time-series study in quasi-experimental design.
Methods
Twenty subjects (20 men; average age, 35.952.67 years; average body mass index, 27.13
5.26) were prospectively enrolled between Apr 1, 2014 and Aug 30, 2014. They were
separated into three groups based on their body weights, with group 1: below than 79
kilograms (average 71.92 4.63), group 2: 80-99 kilograms (average 83.66 5.52), and group
3: more than 100 kilograms (average 116.003.39). Pulmonary gas exchange system (K4b2
system) was used as the objective measure to continuously monitor the breath-by-breath gas
exchange during stationary cycling and elliptical training. The same resistance load patterns
(tension levelL4 50 watts, L10 100 watts, L13 150 watts50 rpm) were separated
in three groups and each level lasted for five minutes that were performed in this study. The
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subjective measures used Borgs index to check the subjects for the shortness of breath
between pre- and post- exercise training. The Kruskal-Wallis test was used to test the null
hypothesis among groups. For the three separate groups of body weights, three patterns of
resistance load training were made, two types of training modes were taken, and the
pulmonary gas exchange system was discriminated between the exercise performance and the
perceived exertion group (Kruskal-Wallis, P <0.05).
Results
There was significant difference in the physiological responses and the oxygen consumption
between stationary cycling and elliptical training groups. Pulmonary gas exchange system
measured shows significantly in minute volume (VE, liters), oxygen uptake (VO2, ml/min )
and carbon dioxide production (VCO2, ml/min) among the three levels of body weight in
these training mode groups ( P <0.05). In the stationary cycling group, the oxygen pulse
(VO2/HR, ml/beat) was pronounced higher than the elliptical training group from L10 to L13
(P <0.05). There was a marked difference in the elliptical training groups VO2 per Kg
(VO2/Kg, ml/min/Kg) and metabolic equivalent unit (METs, O2/kg/min) from L10 to L13 in
the same intensity training (P <0.05). There was no distinct difference with subjective
measures using Borgs Index in both of the groups (P >0.05), but both groups achieved the
same classification of exercise intensity from level 6 to 7.
Conclusions
The elliptical training objective measurement showed to be more effective than the stationary
cycling under the same subjective Borgs Index. Both the stationary cycling and elliptical
training have the potential to be performed in the home with minimal assistance from others,
and this can provide consistent practice environments that allow a high number of repetitions.
3-5 Key words
Stationary cycling, elliptical training, physiological responses, oxygen consumption, body
weight
381
Can exercise training improve the functional impairment in the

intermittent claudication PAOD patients?
Yi-Teen Wang1, Hsiao-Chiao Wang2, Yung-Hui Tang3, Yi-Fang Lee2

1.
Taichung Hospital, Ministry of Health and Welfare, 2. School of Nursing, China Medical
University, 3. Kaohsiung Veterans General Hospital
Presenting Authors Email: yiteen.w@gmail.com
Purpose
Peripheral arterial occlusive disease (PAOD) patients with intermittent claudication always
result in a sedentary lifestyle and low quality of life. Traditional therapy with percutaneous
transluminal angioplasty (PTA) or artery bypass were indicated for patients with ischemic
wounds or rest pain. How to improve ambulatory function for those PAOD patients who were
not at risk for unhealed wound is a big issue for clinical healthcare personnel. Some studies
suggest exercise training might increase collateral blood flow in extremities.
Design
According to the guideline of American College of Sports Medicine, the Fountaine Scheme
classified four stages of peripheral arterial occlusive disease. Patients with Fountaine stage II
PAOD (intermittent claudication) were eligible to received exercise rehabilitation program.
Those who were exercise intolerance and dementia were excluded from this study. The aim of
this prospective study is to determine if exercise program was effective in improving
ambulatory disability in patients with PAOD.
Methods
There were totally 52 Fountaine stage II PAOD patients were enrolled in the study. 32 of the
52 intermittent claudication patients were randomized to an exercise group and 20 to a nonexercise group. The exercise program consisted of three months of leg swing for 50 times
twice a day. Patients were instructed to swing the affected leg across the body to the right.
Then, swing the leg to the left.
Results
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At the end of this study, all patients performed a walk test at a treadmill speed of 2 mph for 5
minutes. The exercise group increased the distance by an average of 72% compared with the
control group (P<0.01). The time period from starting walking to maximal claudication pain
increased by 46% in the experimental group compared to 12% in the control group.
Conclusions
Most of the PAOD patients were affected by intermittent claudication. Physical training in
patient with PAOD may attribute to oxygen supply to the extremities by increasing collateral
circulation. In this study, three-month of exercise rehabilitation significantly improved
ambulatory ability in Fountaine stage II PAOD patients. The function gain means the
intermittent claudication patients increase the chance to have better performance of activity of
daily living by easy exercise rehabilitation training.
3-5 Key words

Peripheral arterial occlusive disease, intermittent claudication, percutaneous transluminal
angioplasty, artery bypass
383
Smoking cessation counseling and predictors in tobacco control educators
Shiu-Wen Tsai1, Yeur-Hur Lai2, Shu-Ching Chen3

1.
Department of Nursing, Hsin Sheng Junior College of Medical Care and management, 2. School of
Nursing, College of Medicine, National Taiwan University, 3. Department of Nursing, Chang Gung
University of Science and Technology
Presenting Authors Email: thwen715@hotmail.com
Purpose
Smoking cessation is considered to be an important issue on cancer prevention, and tobacco
control educators play the principle role. The purposes of this study were to (1) assess the
level of smoking cessation counseling, and (2) identify factors associated with smoking
cessation counseling in tobacco control educators.
Design
A cross-sectional, descriptive correlation design.
Methods
A structured questionnaires was conducted to survey attitude, perceived barriers, and smoking
cessation counseling. The data analysis was conducted with descriptive statistics, Spearman
correlation, and multiple regression. All calculations were made using SPSS for Windows,
version 20.0 (Chicago, IL, USA).
Results
The smoking cessation counseling was predicted by attitude toward barriers of smoking
cessation, the frequency of providing smoking cessation last month, and attitude toward
smoking cessation as a part of work, and account for 26.0% of the variance.
Conclusions
The results suggested that advanced smoking cessation program are recommended to improve
attitude toward smoking cessation and skilled of smoking cessation.
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3-5 Key words

Smoking cessation, smoking cessation counseling, tobacco control educator
385
Designing a healthier lifestyle in a student nurses-nursing teachers

partnership
Satoko Imaizumi1, Mari Mitsugi1, Naomi Morota1, Setsuko Yamamoto1, Emiko Endo1
1.
Musashino University
Presenting Authors Email: satokoimaizumi2011@gmail.com
Purpose
It is important for student nurses as young adults to acquire knowledge, means, and wisdom
to gain a healthier lifestyle for themselves, their families, and their clients to serve. This study
was the first attempt in our university to seek for how the healthier lifestyle could be designed.
The aim was to identify what changes would occur within the participants in a healthierlifestyle-program in terms of awareness and actions.
Design
Margaret Newmans theory of health as expanding consciousness in a wholeness paradigm
was used, and a qualitative design was chosen. Newman claims that when a person recognizes
ones own pattern, a new insight and a potential action would reveal. For it, a process of
dialogueis needed in a group. It means that each person tells about own lifestyle to others
and listens to others, and then considers reflectively what is healthier and how each
lifestyle could be revised.
Methods
The program consisted of 4 sessions and the topics werelifestyle & health,dietary &
defecation,exercise & worm body temperature, andrelationships & mental
attitude. Each included a mini lecture, experience learning, and dialogue in the group. The
participants were 19 senior students and 5 teachers. Data was the transcriptions of IC recorded
dialogue and the journals all participants described about acquired new knowledge, reflection
on own lifestyle, and potential actions after each session. The changes manifested in the
participantsawareness and actions about own lifestyle was extracted and they were viewed
from Newmans theoretical perspective. An approval was obtained from Nursing Research
386
Ethical Board in Musashino University. Each participant provided a written informed consent.
Results
The participants realized the following things through dialogue
The practice of dietary, defecation, exercise, etc. is not discrete in the human lifestyle. All
are closely connected as a whole.
How to keep better mental attitude and relationships is a key factor to keep the healthier
lifestyle, and they give vitality to the whole lifestyle. The attitude ofA pinch is a chance t
is helpful to keep a better mental attitude and promotes the lifestyle healthier.
Most diseases are signs as distortions of prolonged, irregular practices as the lifestyle. The
problem is not a disease as a part but it is related to the whole person including the lifestyle.
Each of our lifestyle reflects each of our familys lifestyle, and vice versa. Each needs to
design the healthier lifestyle not only for each of us but also for each of our family.
With a bit of conscious devices, the whole as a person is restored. Listening to the body,
using wisdom and living consciously is related to the healthier lifestyle, and it reaches each
family and each client to serve.
Conclusions
Dialogically, the participants reflected their own lifestyle and found the potential actions.
Finally, their consciousness expanded to design their healthier lifestyle by themselves.
Dialogue was an important element for designing the healthier lifestyle.
3-5 Key words
Margaret Newmans theory, dialogue, healthier lifestyle, awareness and actions, a student
nurses-nursing teachers partnership
387
A decrease in body mass index and its influence on dermal structure in

Japanese overweight males
Masaru Matsumoto1, Kazuhiro Ogai2, Takeo Minematsu3, Gojiro Nakagami3, Miku Aoki4,
Misako Dai1, Junko Sugama2, Hiromi Sanada3
1.
Department of Clinical Nursing, School of Health Sciences, College of Medical, Pharmaceutical and
Health Sciences, Kanazawa University, 2. Wellness Promotion Science Center, College of Medical,
Pharmaceutical and Health Sciences, Kanazawa University, 3. Department of Gerontological Nursing

and Wound Care Management, Graduate School of Medicine, The University of Tokyo, 4. Department
of Clinical Nursing, Graduate Course of Nursing Science, Division of Health Sciences, Graduate
School of Medical, Pharmaceutical and Health Sciences, Kanazawa University
Presenting Authors Email: maaaasaru@yahoo.co.jp
Purpose
Obese people have a poorly organized dermal collagen structure because of the degradation of
collagen fibers. This is caused by an increase in oxidative stress levels associated with the
hypertrophy of subcutaneous adipose cells. Moreover, we detected an increase in oxidative
stress levels and a decrease in dermal echogenicity in Japanese overweight males. However, it
is unknown whether these skin changes associated with an increase in body mass index (BMI)
are reversible or not. The purpose of this study is to clarify the influence of BMI decrease on
dermal structure in Japanese overweight males.
Design
This is a longitudinal, observational study.
Methods
Japanese male volunteers aged between 20 and 64 years and with a body mass index (BMI) of
25 and <30 were recruited. Data collection was performed on the skin of both the abdomen
and thigh at the time of baseline and about 1 year later from the time of baseline. Participants
who experienced weight loss of more than 3% from the baseline value were targeted for
analysis. To evaluate dermal structure, we measured dermal echogenicity and thickness. To
measure the echogenicity of upper and lower dermis, the 20-MHz Dermascan C ultrasound
388
scanner was used. To measure the dermal thickness, the 18-MHz Mylab five ultrasound
scanner was used. This study was approved by the Ethics Committee of the Kanazawa
University School of Medicine.
Results
Five Japanese overweight males aged 2761 years (median: 28) were targeted for analysis.
The median decrease in BMI was 1.7 (range 1.15.9) kg/m2. The echogenicity of the upper
dermis was increased in 2 participants (40%) on the abdomen and in 3 participants (60%) on
the thigh. The echogenicity of lower dermis was increased in 3 participants (60%) on
abdomen and in 5 participants (100%) on the thigh. The dermal thickness was decreased in 2
participants (40%) on the abdomen and in 5 participants (100%) on the thigh.
Conclusions
The change in dermal structure with increases in BMI may be reversible by a reduction in
BMI. However, in future, it is necessary to investigate a greater number of participants.
3-5 Key words
Dermal structure, echogenicity, weight loss, Japanese overweight males, body mass index
389
Effectiveness of home-based exercise in patients with heart failure A

systematic review of randomized controlled trials
Yu-Ying Chou1
1.
Purpose
to investigate the effectiveness of home-based exercise interventions for heart failure patients.
Design
Systematically review
Methods
Randomized controlled trials in MEDLINE, PUBMED, CINAHL, EMBASE, and CEPS were
reviewed using the keywords including Home-based exercise, exercise, and heart failure.
Types of outcome were not restricted. The Jadad scale appraised the quality of identified
studies.
Results
Nine studies met the inclusion criteria.
There were significant improvement in participants physical capacity, depression mood,
and quality of life.
Conclusions
Home-based exercise program (walking combined resistance training; three times per week;
duration 12 weeks; supervised with telephone or home visit) provided safety and effectiveness
in heart failure patients.
3-5 Key words
Home-based exercise, physical capacity, mood, quality of life, heart failure
390
The current situation and issues of the latest research about secondary
prevention after acute myocardial infarction.
Hitomi Nagamine1, Harumi Yamamoto1, Rieko Aoki1, Xiaowei Lu1, Kumiko Morita1
1.
Tokyo Medical and Dental University Graduate School of Health Care Sciences, Community Health
Promotion Nursing
Presenting Authors Email: ns140002@tmd.ac.jp
Purpose
The purpose of this study was to discuss the current situation about secondary prevention
after acute myocardial infarction and the future subject by literature review.
Design
Literature review was used
Methods
Literature review articles were searched from the following databases : Ichushi-Web, CiNii ,
PubMed, CINAHL. The literature review criteria included : written in English or Japanese ,
and published from 2009 to September, 2014.
Search keywords were combined,myocardial infarction,recurrence prevention,
secondary prevention,education,regional alliances clinical pathway,
comprehensive cardiac rehabilitation, andnursing.
From 14 Japanese articles and 78 articles which were written in English, 17 articles were
selected. The selection criterion was following.
1)The study which demonstrate that instruction after discharge is important, and reveal the
presence of the education system.
2)Intervention study which use secondary prevention programs after discharge including
comprehensive cardiac rehabilitation programs.
Results
1)According to the research (Sanderson, 2009) on the patients memory of the contents of
discharge instruction after acute myocardial infarction (AMI), the directions of medication
391
from doctor were memorized well. But instructions about lifestyle were easy to be forgotten.
So the recommended instruction about proper lifestyles should be educated after discharge.
2)For the secondary prevention regarding AMI, the revision of the medical organization was
pushed forward in various countries. In Japan (Harada, 2011), the construction and promotion
of the regional alliances clinical pathway was advanced, in order to encourage the sequential
treatment from the time of discharge and the comprehensive cardiac rehabilitation. In Sweden
(Sjstrm-Strand, 2012), patients were suggested to enter the rehabilitation programs at the
health promotion center (PHCC). But both of them, the participation rate and the diffusion
rate werent well.
3)In four articles (Yan 2014, Mok 2013, Intarakamhang 2013, Bellman 2009) among 17
extracted literature, for AMI patients after discharge, follow-up intervention studies were
carried out. Three cases among these studies consisted of face-to-face instruction and
telephone consultations. And one study showed that an intervention study using a lifestylerelated disease education class. That was called Heart School. In all studies, handbooks which
developed from the national handbook (e.g. AHA) were used. Despite of some differences
(e.g. methods of intervention, effects on the variables), these studies demonstrated that
physiological data were improved. Furthermore, improvements of dietary habits, physical
activity, smoking behavior, and adherence to medication were proved. And also it effected on
improvements of QOL, illness perception, depression, self-efficacy, and self-regulation.
4)And there were other useful methods that useed an online chat or a home-based
rehabilitation.
Conclusions
For reduction of the medical expenses, the improvement of patients QOL, and the extension
of health expectancy, the importance of secondary prevention is increasing. In several
countries, those programs are viewed as important. And also the effects are already
demonstrated. But in Japan, these programs havent been popular among patients yet. So the
enhance of the implementation is important issue.
It is suggested that the method by which validity was shown is applicable in order to improve
the diffusion rate.
3-5 Key words
Myocardial infarction, secondary prevention, discharge, patient education, comprehensive
cardiac rehabilitation
392
Incontinence associated dermatitis in critical care unitA prevalence

survey
Shiao-Pei Wang1
1.
Presenting Authors Email: shiaopei@ntuh.gov.tw
Purpose
Incontinence is a common problem for critical care patients because of disease condition,
medication administration, diet formula or bed confined. Either stool or urinary incontinence,
inappropriate treatment will cause IAD around skin exposure area, such as buttocks, perineum,
and inner thighs. However, few studies survey IAD prevalence and related factors for critical
illness patients. So the purpose of this study was to investigate the IAD prevalence in critical
illness patients and the related factors in one teaching hospital affiliated to a medical
university in Taiwan.
Design
A survey study design. IAD prevalence was surveyed in eight ICUs in 10th every month,
since July to November, 2012. The eight ICUs included medical, surgical and emergency
ICUs.
Methods
One or two seeds staffs of each ICU were selected, and training and consensus discussion
before study. Data collection included patient demographic characteristics, stool pattern
assessment via Bristol stool chart, IAD assessment using Perineal Assessment Tool.
Results
704 patients were recruited in this analysis, 61.93% were male, mean age 66.53 (SD 17.37)
years. A total of 191 patients occurred IAD, prevalence rate was 27.48%. The IAD patients
were more female (89, 46.60% vs. 102, 53.40%), older age (72.09 14.83 vs. 64.31 17.85),
lower albumin and hemoglobin level (2.71 0.53 and 9.94 1.52 vs. 2.90 0.65 and 10.61
393
1.93), higher PAT score (8.79 2.18 vs. 5.50 3.05), more loose and frequent stool
compared with patients without IAD (p <.000). The correlation between IAD and Pressure
ulcer events were tested and presented significant relationship (2 = 90.71, p = .000).
Conclusions
IAD prevalence is high in Critical care units. The risk factors are female gender, old age, low
albumin and hemoglobin level, high PAT score and frequent loose stool. The occurrence of
IAD and pressure ulcer has significant correlation.
3-5 Key words
Incontinence associated dermatitis, critical care, intensive care unit, parineal assessment tool,
bristol stool chart
394
Nursing approaches during passive music therapy in the ICU and patients
responses
Erika Goda1, Mizue Shiromaru2, Migiwa Nakada2

1.
Sapporo Medical University Graduate school of Health Sciences, 2. Department of Nursing, School
of Health Sciences, Sapporo Medical University
Presenting Authors Email: mamechan8200@yahoo.co.jp
Purpose
In ICU patients in a life-threatening condition, mental tension and stress may increase,
occasionally leading to critical situations. To avoid this, passive music therapy is performed
in some cases. During this therapy, music is played, regardless of its genre, as an external
stimulus. In previous studies conducted outside Japan, passive music therapy performed as
part of psychiatric or perioperative nursing was shown to alleviate patientsmental tension
or anxiety. However, its effects on ICU patients have not yet been fully examined. Therefore,
this study aimed to clarify the details of nursing approaches during passive music therapy in
the ICU and patientsresponses from a nursing viewpoint.
Design
A qualitative and descriptive study.
Methods
In July 2014, semi-structured interviews were conducted with 2 nurses working in an ICU
performing passive music therapy of a hospital located in A Prefecture, Hokkaido, focusing
on their approaches during such therapy and patients responses to it. The collected narrative
data were classified based on their semantic contents and categorized based on semantic
similarities. Analysis was performed with research collaborators to ensure its validity.
Results
The subjects had been working as nurses for 4 and 17 years, respectively, and as ICU nurses
for 4 and 9 years, respectively. On analysis of the data obtained through interviews, the
395
following 3 categories were extracted as nursing approaches during passive music therapy
performed in the ICUconfirming patients and their families responses the
nurses confirmed patients and their familiesattitudes toward playing music;respecting
patients personalitythey collected information regarding patientsfavorite music
genres to accommodate their tastes; andtaking appropriate actions in each situation
they considered each individual situation in order to take appropriate actions, such as
refraining from playing music in critical cases or during hospital rounds. As patients
responses perceived by the nurses, the following 3 categories were extractedpositive
changes due to musicsuch as a patient with consciousness disturbance who smiled when
listening to his favorite music;unpleasantness of music: such as a patient who
complained of the negative effect of music when he suffered from headaches; andunclear
responses: some patients did not show positive or negative responses to music.
Conclusions
Analysis revealed that the nurses adopted individualized and flexible approaches during
passive music therapy for ICU patients, such as respecting their personality and tastes and
discontinuing the therapy in consideration of each situation within the ICU. Furthermore,
observing positive changes in patients due to music, the nurses realized the therapeutic effect
of passive music therapy in the ICU. While they perceived some patientsresponses to music
therapy as positive, they recognized that it might also cause unpleasant feelings on some
occasions.
3-5 Key words
ICU, passive music therapy, nursing approaches, patientsresponses
396
Postoperative nutrition management focused on oral intake during the

recovery process in esophagectomy
Tomoko Shimoda1
1.
Faculty of Health Sciences, HOKKAIDO University
Presenting Authors Email: tshimoda@hs.hokudai.ac.jp
Purpose
Patients with esophageal cancer who undergo esophagectomy and lymph node dissection are
at risk for recurrent laryngeal nerve paralysis and dysphagia, which can result in nutritional
deficiency. Little is reported in the dysphagia rehabilitation literature on this issue,
presumably because patients usually spontaneously recover within a few months. We
retrospectively studied two post-esophagectomy diets to determine whether there was a
connection between meal content and rates of postoperative complications.
Design
Comparative descriptive design
Methods
Fifty-eight patients who had undergo esophagectomy consumed a diet consisting of thickener
(n = 30) or gruel (n = 28). The postoperative body mass index (BMI), level of nutritional
adequacy, length of postoperative hospital stay, and incidence of aspiration pneumonia of the
two groups were compared. Physical properties of deglutition diets were measured with a
rheometer (Compac-100 II, Sun Scientific Co., Ltd. Japan). This research was approved by
the Ethical Review Board of the Translational Research and Clinical Trial Center, Hokkaido
University Hospital.
Results
There were no significant differences in the postoperative BMI, level of nutrient adequacy,
and average length of postoperative hospital stay between both the groups. The physical
properties, i.e., hardness, agreeability, and adherability, of the diets were 14654363 N/m2,
3761229 J/m3, and 0.700.77 J/m3 in the gruel group and 1273217 N/m2, 0.21118
397
J/m3, and 0.00010.96 J/m3 in the thickener group, respectively. The gruel group had a
higher incidence of aspiration pneumonia with its attendant complications than the thickener
group.
Conclusions
Dysphagia rehabilitation after esophagectomy includes the management of the postoperative
diet. When nurses provide gruel, patients are more likely to choke on it and aspirate. Patients
also lacked the enjoyment of their diet. When nurses adequately supplemented the diet with
thickener, the risk of aspiration was decreased. When the likelihood of dysphagia and onset of
aspiration pneumonia are suggested by dysphagia screening, these factors must be taken into
careful consideration for oral intake. These predictive factors could be very useful for
dysphagia screening to help forecast the successful resumption of oral intake in patients. In
the future, these factors need to be explored.
3-5 Key words
Postoperative, nutrition, oral intake, diet physical properties
398
Review of quality of life of patients with osteonecrosis of femoral head
Yuko Uesugi1, Takashi Sakai2, Takaaki Fujishiro3, Shinya Hayashi3, Shingo Hashimoto3,
Nobuhiko Sugano4
1.
Kobe University Graduate School of Health Sciences, 2. Department of Orthopaedic, Osaka
University Graduate School of Medicine, 3. Department of Orthopaedic Surgery, Kobe University

Graduate School of Medicine, 4. Department of Orthopaedic Medical Engineering, Osaka University
Graduate School of Medicine
Presenting Authors Email: uesugi@kobe-u.ac.jp
Purpose
Causes of osteonecrosis of femoral head (ONFH) are classified into steroid-related, alcohol
related and idiopathic. Patients are generally in their 30s and 40s, with many roles in
their lives, so considering their quality of life is important.
The aim of this review is to provide an overview of current knowledge of such patients
QOL.
Design
The literature review
Methods
The keywordsOsteonecrosis of femoral headandquality of life were used to search
Japanese references, within Japan Medical Abstracts Societys website (Igaku Chuo Zasshi).
The search returned 14 references (from the entire database up to 24 July 2014),
Commentaries and case studies were then excluded. The result was 5 relevant references.
For references in English, the keywordsOsteonecrosis of femoral headcombined with
Quality of life,SF-36,SF-12,Oxford Hip Score,Visual Analogue
Scale, andWestern Ontario and McMaster University Osteoarthritis Index (WOMAC)
were used to search within Pubmed (U.S. National Library of Medicine). It returned 88
references (from the entire database up to 10 August 2014). We then removed same
references and case studies, resulting with 37 relevant references.
399
Results
Studies were reported from Japan, Korea, China, Taiwan, Thailand, India, and Turkey in Asia,
and USA, Canada, Belgium, England, Spain, Germany, Greece and Poland in Western
countries.
Evaluation scale
Generally, the health-related QOL involves the physical, mental, and social situations. These
studies used Medical Outcomes Study Short Form 36 (SF-36) and Short Form (SF-12) as
scale for QOL.
In addition, scale of physical activity (pain and activities of daily living) and evaluation of hip
joint (pain and physical situation of hip) were used. Visual analog scale was used to evaluate
pain, WOMAC scale for measuring arthritis symptoms, UCLA activity score for physical
activity, and Oxford Hip Score for hip patients symptoms.
Harris hip score and Japanese Orthopaedic Score were used to evaluate doctors
observations of hip patients.
The purpose of studies
The purpose of studies was to describe the outcome of surgical and conservative intervention
for treatment.
The evaluation of total hip arthroplasty, osteotomy, and bone grafting treatment were the
surgical intervention, and alendronate and exercise training were the conservative intervention.
The follow-up terms were three months, six months, one year, and two years. None of them
mentioned the QOL of patients not undergoing treatments.
Only two found were qualitative studies describing how patients are in need of more
information.
Majority studied less than 30 patients (50%), 4 studied 70~90 patients, and none studied over
100 patients, thus lacking level I evidence study.
There is no study that considers the QOL depending on what triggered ONFH in patients;
whether due to steroid treatment, alcohol abuse, or idiopathic.
Also, effects on patientslives are expected to vary according to the progressing stages, but
there is no research found that focuses on them.
Conclusions
There is not sufficient number of studies that describe QOL of patients with ONFH. This
suggests the necessity of extensive studies describing characteristics based on what triggered
their onset.
3-5 Key words
Osteonecrosis femoral head, quality of life, review of literature
400
Difficulties faced by nurses dealing with oncologic emergencies at

emergency centers
Junpei Haruna1, Mizue Shiromaru2, Migiwa Nakada2, Masako Monma3

1.
Graduate School of Health Sciences , Sapporo Medical University, 2. Department of Nursing,School

of Health Sciences,Sapporo Medical University, 3. Department of Nursing,School of Health
Sciences,Japan Health Care College
Presenting Authors Email: haruna@sapmed.ac.jp
Purpose
With the annually increasing prevalence of and mortality rates due to cancer, the number of
cancer patients transported to emergency centers due to a deteriorating or suddenly changing
pathological condition during treatment is also likely to increase in Japan. In order to address
this, it may be necessary to further improve the quality of nursing in oncologic emergencies.
This study aimed to clarify difficulties faced by nurses dealing with oncologic emergency
patients and their families, with a view to providing a basis for the appropriate nursing
management of oncologic emergencies.
Design
A qualitative and descriptive study.
Methods
Semi-structured interviews were conducted with 3 nurses working at an emergency center,
focusing on their difficulty in dealing with oncologic emergency patients and their families.
The nursesstatements were recorded to collect narrative data with their consent. From such
data, difficulty-related contents were extracted and categorized based on semantic similarities.
Analysis was performed by 3 researchers to ensure its validity.
Results
Regarding the nursesattributes, they had experience in working as clinical nurses for 7 to
14 mean11.6 years. They had dealt with oncologic emergency patients and their families
several times a year. Their difficulties were classified into the following 6 categories
401
difficulty due to insufficient knowledgesuch as difficulty in determining the extent of

tumor invasiondifficulty due to insufficient experiencesuch as difficulty in
appropriately performing narcotic injections due to insufficient experiencedifficulty
related to mental care such as difficulty in alleviating patientsmental distress
difficulty in supporting patientsfamily memberssuch as difficulty in appropriately
dealing with a patients family members who were not able to come to terms with their
mothers life-threatening conditiondifficulty related to the pathology of cancer: such
as difficulty due to the complex pathology of cancer; anddifficulty due to the characteristics
of emergency wards: such as difficulty due to a short period of time from admission to
ward-to-ward or hospital-to-hospital transfer.
Conclusions
This study revealed that nurses faced a number of difficulties when dealing with oncologic
emergency patients and their families. In order to improve the quality of their care for such
patients and their families, it may be important to reduce their sense of difficulty by providing
them with opportunities to improve their knowledge and skills.
3-5 Key words
Oncologic emergencies, nurses, difficulties
402
Patient anxiety corresponds with SigA levels over the course of pancreatic
surgery
Nanae Ikeda1, Rie Tomizawa2, Junko Yamanaka2, Rika Moriya3, Hiromasa Suzuki4,
Kouji Umeshita5
1.
Osaka University, Senrikinran University, 2. Senrikinran University, 3. Setsunan

University, 4. Toyohashi Hospital, 5. Osaka University
Presenting Authors Email: n-ikeda@cs.kinran.ac.jp
Purpose
One of the role of nursing is care for patient anxiety. However, the degree of change in a
patients anxiety state before and after surgery is not clear. Using the State-Trait Anxiety
Inventory (STAI) questionnaire and SigA measurements, we aimed to assess changes in
anxiety of peri-operative patients undergoing pancreatic surgery.
Design
We enrolled 28 patients who had a planned surgery for pancreatic disease at our hospital.
Patients were evaluated at three time-points over the course of the study: first, before surgery;
second, 3 days after surgery; and third, approximately 14 days after surgery.
Methods
At each evaluation, patients were administered the STAI questionnaire and salivary sampling
was conducted. The questionnaire comprised 20 items that the patients were asked to rate on a
4-point Likert scale, with 1 beingI dont agree at alland 4 beingI very much agree.
Saliva samples were used to measure SigA concentrations (g/mL). We conducted a one-way
analysis of variance for the STAI evaluations to get an average score and calculated the
relative change in SigA concentrations at the second and third evaluations from the initial
measurement. All patients provided signed informed consent and personally identifying
information was blinded to the investigators. This study was approved by the Ethical Review
Board at the investigating institution.
Results
403
Average STAI scores were 46.68.6 at the first evaluation, 49.48.4 at the second, and 42.0
10.1 at the third. For the SigA levels, as the first measurement was set as the base level 1, the
relative change in concentration at the second evaluation was 1.51.4, and 2.12.0 at the third.
None of the changes observed was statistically significant.
Conclusions
No significant differences were found in average STAI scores over the three evaluation
periods, but three general trends were identified. For several patients, anxiety appeared to
increase from before surgery to three days after surgery, and then decreased thereafter. For
other patients, anxiety gradually increased from before surgery through to recovery, while a
third group of patients showed initial high anxiety before surgery, which decreased once the
surgery was completed. SigA measurements showed three patterns consistent with those for
anxiety. These patterns suggest that the stress of surgery generally increases anxiety but that
these processes generally recede after a sufficient recovery period. Our results also suggest
that the critical time for nursing care to reduce anxiety is around the third day after surgery,
when the patients begin efforts to get up and move about, which can lead to renewed or
increased anxiety.
3-5 Key words
Peri-operative period, pancreatic disease, SigA, STAI, anxiety
404
Aggressive medical treatments received by terminal stroke patients in the

adult intensive care unit in the last of life
Pei-Yi Wang1, Chia-Chin Lin1

1.
Taipei Medical University
Presenting Authors Email: b005089091@tmu.edu.tw
Purpose
To realize the aggressive medical treatments received by terminal stroke patients in the adult
intensive care unit in the last of life, such as ventilators, cardiopulmonary resuscitation,
dialysis, mechanical circulatory support systems, artificial nutrition, blood transfusions,
antibiotics, inotropic agents, and sedative analgesic agents.
Design
This study was using secondary data analysis from the National Health Insurance claims data
in Taiwan.
Methods
The population were identified the diagnosis in ICD-9 codes in 430.xx to 438.xx during AD
2000 to 2010, the outcome code for death or against advise discharged, and were canceled a
policy in three days after discharged. Statistical in logistic regression to estimate the
terminally stroke patients about gender, comorbidity index, the hospital level and different
ages.
Results
The population were 22,107 patients, including 67.32% hemorrhagic stroke patients whos
average age were 63.9 15.7 year-old, and 32.68% infarction stroke patients whos average
age were 73.3 13.0 years old. The odds ratio about males treated in adult ICUs were1.36
times higher than females (95% CI: 1.29-1.44), about the patients with comorbidities treated
in adult ICUs were 2.23 times higher than those without comorbidities (95% CI: 2.10-2.36).
The ill patients above 85 years old accepted ventilator treatment were 5.32-fold than 18-64
year-old (95% CI: 4.68-6.05), received dialysis treatment were 2.34 times (95% CI: 1.39-
405
3.92), done in cardiopulmonary resuscitation were 1.44 times (95% CI: 1.34-1.62), used
inotropic agents were 2.09 times (95% CI: 1.86-2.35), and the analgesic sedation were 1.35
times (95% CI: 1.23-1.49).
Conclusions
The older the stroke terminally patients, the higher in received aggressive medical treatment
in the adult ICUs. So that the goal in palliative care for terminal patients is difficult to
accomplish. The palliative hospice care in Taiwan does not include the stroke patients. We
hope this finding can let more health provider pay attention to the end-of-life care in noncancer terminal patients, and the terminal patient can possess the peaceful at the time of death.
3-5 Key words
Stroke, aggressive medical treatments, aggressive end-of-life care, intensive care unit
406
The development of a framework to analyze the nursing process in critical

care nursing
Shinsuke Hashiuchi1, Yukiko Abe1, Ayumi Suematsu2, Akiko Nagata1, Toshie Yamamoto1
1.
Presenting Authors Email: sinhashi@chiba-u.jp
Purpose
The present study aims to describe a framework to develop nursing processes in Japanese
critical care nursing, and create a framework to analyse the nursing process in critical care
nursing.
Design
The present study employed a qualitative descriptive design.
Methods
Japanese textbooks that teach critical care nursing were analysed. Data was collected during
the period from August 1 to August 12, 2014. Using CiNii Books (Japanese search engine for
academic information), we searched publications pertaining to critical care nursing dated from
2005 to 2014 using the key words such as critical care nursing, ICU nursing, and CCU
nursing. Publications found were narrowed down according to the inclusion and exclusion
criteria. Data analysis was performed by extracting descriptions pertaining to critical care
nursing, abstracting and categorizing content. A framework to analyze the nursing process in
critical care nursing was discussed on the basis of our analysis results.
Results
Seven textbooks were found in the search. The search results, then, were divided into 2
categoriesSubject of nursing in the first category consisted ofA patient with a life
crisis,A patient with a physical, mental, and social crisis,The environment and
experiences of a patient, andA family with a mental crisis.Nurse in the second
category consisted ofThe ability to accurately assess characteristics of a patient,
407
Capacity for care and characteristics of care" andThe environment of critical care
nursing.
Conclusions
A framework to analyse critical care nursing is shown as follows.Subject of nursing
include a patient with a life crisis, as well as physically, mentally, and socially in crisis, and a
family with a mental crisis.Assessmentinvolves collecting information and making
decisions on the basis of the characteristics of critical care subjects, while making full use of
expert knowledge.Provision of careis the one in which expertise in critical care is fully
exercised.Re-assessmentinvolves assessing the following nursing necessity based on the
patients response to care.
3-5 Key words

Critical care, nursing process, conceptual framework
408
Nursing support for families facing surrogate decision-making on

withdrawal of active treatment for patients in intensive care units
Masayo Takeuchi1, Hitomi Sugisaki2, Ryuhko Fujimura2

1.
Suzuka Central General Hospital, 2. Graduate School
of Nursing ,Yokkaichi Nursing and
Medical Care University
Presenting Authors Email: masaru.june618@gmail.com
Purpose
The families of patients with life-threatening conditions in intensive care units (ICUs) have to
make vitally important decisions on behalf of the patients, as they are unable to make their
own decisions. This study focuses on involvement with families making surrogate decisions
about treatment plans for their loved ones after being told about withdrawal of active
treatment. Additionally, it seeks to shed light on the reality of the family support given by
nurses in ICUs.
Design
The present qualitative inductive research employed Berelsons content-analysis method.
Methods
A sample of eight nurses working in three general hospitals in Prefecture A with more than
ten years of clinical experience and more than five years of ICU experience were surveyed
using a semi-structured interview. The data were analyzed qualitatively, inductively, and
descriptively.
Results
The study centered on the support implemented by nurses to the families making surrogate
decisions about withdrawal of active treatment for their loved ones from the patients ICU
admission until after a surrogate decision was made. Data analysis identified 48 codes, which
were reduced to 13 subcategories and then led to the identification of four categories
Heightening the preparedness of nurses giving support to families in surrogate decisionmaking,Emotional support for families,Support to help families come to terms
409
with the reality of their situation,andSupport to help families avoid regretting their
surrogate decisions.The ICU nurses built trusting relationships with families by
understanding the whole picture and providing them with emotional support. In this way, they
built a foundation of support for surrogate decision-making. Furthermore, they shared the
surrogate decision-making process so that the families could make decisions on their own
initiative and made effort to reduce the familiesconflict and distress with continuing care
maintaining the dignity of the patients.
Conclusions
1. The ICU nurses providing support for families facing surrogate decision-making built a
foundation of support for surrogate decision-making and took preparatory action for the
surrogate decision-making process. For example, they built trusting relationships with the
families by making effort to understand the whole picture and providing them with emotional
support from the point of admission.
2. Support was offered to the families to help them understand the circumstances they were in.
However, depending on their emotional state, this support took time and, therefore, was
considered when the opportunity presented itself.
3. To help families avoid regretting the surrogate decisions they made, nurses supported the
familiesright to make surrogate decisions and offered positive words of encouragement,
approving of whatever decision they had made. Furthermore, support was given to the
families to reduce their distress following decision-making and during the transition to
terminal care, which is continuing care maintaining the dignity of the patients.
3-5 Key words
Intensive care unit (ICU), withdrawal of active treatment, surrogate decision-making, family
support
410
The role of nursing care in stroke patientsreturn to workA systematic

review
Yuki Gotoh1, Hitomi Sugisaki1, Noriko Hagi1, Naomi Yohikawa1

1.
Yokkaichi Nursing and Medical Care University
Presenting Authors Email: yukigoto@y-nm.ac.jp
Purpose
Introduction:Stroke is the third leading cause of death and a major cause of disability in Japan,
and the number of stroke patients has been increasing. Even when a stroke patient avoids
death, the aftereffects often present significant obstacles. For the middle-aged and elderly
worker in particular, stroke is associated with a substantial economic burden. Unemployment
after stroke leads to not only the breakdown of the family because of economic problems but
also national economic loss in terms of the work force.
Some research has suggested that promoting early rehabilitation after stroke could help
patients return to work (RTW). In order to RTW, multiple approaches and the cooperation of
experts such as medical doctors, nurses, physical therapists, and occupational therapists are
indispensable. In particular, nurses take part in patientscare as front-line professionals, and
thus their role in RTW is likely to be important. However, the evidence base is limited on
what is a nurses role in RTW.
PurposeThe present article aims to provide a systematic review of the published literature
on nursing care for stroke patientsRTW .
Design
A Systematic Review
Methods
Using Ichushi-Web, produced by the NPO Japan Medical Abstracts Society, and CINAHL,
with search termsstrokeandreturn to work,80 original articles were identified
concerning RTW of stroke patients. Of these, seven studies included a description of nursing
411
care.
Results
The research showed that function of hemiplegic hands, cooperation of physicians, and ability
to perform activities of daily living (ADLs) independently were significant determinants of
patientsearly RTW. Further requirements included nursing care to support independent
ADLs and to enhance stroke survivors' quality of life in terms of encouraging independence,
managing depression, and fostering interpersonal relationships. However, all of these studies
referred only to rehabilitation nursing.
Conclusions
There were few studies on acute nursing care for RTW in stroke patients. To clarify these
issues, more evidence is needed on acute nursing care just after hospitalization for patients
with disability following stroke.
3-5 Key words
Stroke, return to work, review
412
Nursing support for families of emergency patients in Japan

Mayumi Machida1, Mayumi Machida2, Misuzu Nakamura2
1.
Jichi Medical University Graduate School,Master of Nursing,Japan, 2. Graduate School of

Nursing,Jichi Medical University
Presenting Authors Email: mn1308@jichi.ac.jp
Purpose
The content of the support needed by patientsfamily members varies depending on their
and patientssituations, and this makes it difficult for nurses to appropriately support them.
In order to address this issue, it may be useful to examine the status of such support in the
field of emergency care.
Therefore, this study aimed to clarify the status and challenges of nursing support for families
of emergency patients in Japan.
Design
Graduate School of Nursing,Jichi Medical University
Methods
The content of the support needed by patientsfamily members varies depending on their
and patientssituations, and this makes it difficult for nurses to appropriately support them.
In order to address this issue, it may be useful to examine the status of such support in the
field of emergency care.
Therefore, this study aimed to clarify the status and challenges of nursing support for families
of emergency patients in Japan.
Results
In the study papers, patientsfamily members made efforts to compose themselves despite
their recognition of critical factors before transportation. Nurses assessed their needs in the
early stages, revealing the necessity of early nursing intervention for them.
The family members experienced varying emotions, according to changes in patients
conditions, from positive feelings and a sense of relief to negative feelings due to the lifethreatening event. They reportedly had difficulty in fully understanding the information
provided. In the case of severe consciousness disturbance preventing patients from
responding, the family membersshock was greater, and their situation became critical. In
such cases, nurses played an important role.
On the other hand, nurses had a sense of difficulty when supporting such family members. It
was difficult for them to sufficiently support the family members who were supporting
patients in cooperation with medical professionals. However, experienced nurses
continuously examined methods to provide patients and their families with optimal care while
taking actions.
Conclusions
In the study papers, patientsfamily members made efforts to compose themselves despite
their recognition of critical factors before transportation. Nurses assessed their needs in the
413
early stages, revealing the necessity of early nursing intervention for them.
The family members experienced varying emotions, according to changes in patients
conditions, from positive feelings and a sense of relief to negative feelings due to the lifethreatening event. They reportedly had difficulty in fully understanding the information
provided. In the case of severe consciousness disturbance preventing patients from responding,
the family membersshock was greater, and their situation became critical. In such cases,
nurses played an important role.
On the other hand, nurses had a sense of difficulty when supporting such family members. It
was difficult for them to sufficiently support the family members who were supporting
patients in cooperation with medical professionals. However, experienced nurses continuously
examined methods to provide patients and their families with optimal care while taking
actions.
3-5 Key words
Emergency, families, critical, nursing,
414
Thoughts and experiences of family members in attendance during

cardiopulmonary resuscitation
Akiko Tomioka1, Hiroaki Yamase2, Jyunko Tatsuno2, Yumiko Kinoshita1, Kimie Fujita1
1.
KYUSHU UNIVERSITY, 2. YAMAGUCHI UNIVERSITY
Presenting Authors Email: tomioka@med.kyusyu-u.ac.jp
Purpose
While medical staff attendance during cardiopulmonary resuscitation has been studied in
Japan and abroad, research concerning the experiences of families is scarce. This study,
therefore, examined the thoughts and experiences of family members who were present
during cardiopulmonary resuscitation.
Design
A qualitative descriptive design was used.
Methods
Family members of patients who underwent cardiopulmonary resuscitation at the emergency
medical care center at Yamaguchi University Hospital were surveyed from January to July
2008 on their impressions of the condition of the site where the procedure was administered,
their views on health care workersinvolvement with patients and the family as a whole,
their thoughts on being in the same environment as the patient while he/she was in critical
condition, and their opinions on the presence of family members during cardiopulmonary
resuscitation. Interviews were also used for data collection. Data were analyzed using
Krippendorff's content analysis method. This study was approved by the Yamaguchi
University Hospital School of Medicine Review Board for pharmaceuticals, trials, and
clinical research. Participants provided their written consent before the interviews, and
adequate explanation of the study was given, both orally and in writing.
Results
Five participants who were in their 30s to 60s were surveyed. Three were spouses and two
were mothers of patients. Two family members were present at the emergency medical care
415
center. Content recorded verbatim was classified into two groups(1) impressions of the
condition of the family during the procedure and (2) familys thoughts during the procedure.
Each was treated as a sampling unit and was analyzed according to procedure. One hundred
thirty-five codes, 49 subcategories, and 18 categories were extracted from 56 context units
and 172 recording units. The 9 categories extracted from Conditions and Impressions during
the Procedure includedShock unlike any Id ever experienced,All I could do was
pray,Irritation,Cutting it close/no time, Fear, andThe medical
professionals concern. The 9 categories extracted from Family's Thoughts during the
Procedure includedI cannot accept reality,Searching for a cause,Giving up
on resuscitation,Trusting in the medical professionals, andQuestions for the
medical professionals.
Conclusions
Being present during cardiopulmonary resuscitation provides family members with the
comfort of being able to witness the final breath of someone very important to them, and can
reduce feelings of regret later. However, it cannot be considered appropriate for all families.
Medical professionals believe they play a role in confirming the familys willingness to be
present once they have determined that family members who have accompanied a patient in
the ambulance and during their admittance to the emergency room show no signs of extreme
agitation during the patients resuscitation or in response to any sudden changes in their
condition. Additionally, this study clarified that the desire of families to be present was
dependent on the patients age and life prognosis, as well as changes in the patients
appearance. We believe this study significantly adds to the existing literature in confirming
the benefits and drawbacks of families being present during resuscitation.
3-5 Key words
Cardiopulmonary resuscitation, family presence, witnessed resuscitation, family-witnessed
cardiopulmonary resuscitations
416
The impact of preoperative organic brain damage or postoperative

complications to the postsurgical recovery process of mental function
Hiroshi Ono1, Koji Umeshita2, Yoshimi Endo2
1.
College of Nursing Art and Science University of Hyogo, 2. Osaka University Graduate School of
Medicine, Division of Health Sciences
Presenting Authors Email: hiroshi_ono@cnas.u-hyogo.ac.jp
Purpose
Early detection of postoperative delirium is an important issue in the field of perioperative
period. The aim of this study is to investigate the impact of preoperative brain organic damage
or postoperative complications to the postsurgical recovery process using NEECHAM
confusion scale (NCS).
Design
Prospective observational study
Methods
19 adult patients undergone esophagectomy at Osaka University Hospital were included in
the study. We observed patients continuously at bedside and scored NCS during one week
after surgery. We divided the patients into three groups (preoperative organic brain damage,
postoperative complication, normal), and analyzed the score. Then, we broke NCS down into
the three subscales (information processing, behavior, physiologic control) and compared
between each group. In addition, we analyzed the typical case of each group descriptively.
The study was implemented with the approval of the Ethics Committee of Osaka University
Hospital.
Results
On investigation, we assigned 3 patients to organic brain damage group, 2 patients to
postoperative complication group and the other 14 patients to normal group. NCS score of the
normal group tended to recover from postoperative decreased function states to a preoperative
level. But in the organic brain damage group, delay was found in the recovery of the score.
Also in the postoperative complications group, NCS score tended to recover but decreased
again with development of complication. In the analysis of the subcategory, the recovery of
the information processing category delayed in the organic brain damage group, and the
physiologic control category delayed in the postoperative complications group. In typical case
study, the practical data which supported the transition of the NCS score were presented.
Conclusions
The recovery process from postoperative decreased function states to a preoperative level was
found in normal group. In the organic brain damage group, delirious state is prolonged due to
delay of the information processing function recovery. Also in the complications group,
second attack invasion affect the physiologic condition and come into secondary risk of
delirium. For the early detection of Postoperative delirium, it is necessary to conduct the
observation that take each recovery process into consideration.
417
35Keywords
Postoperative delirium, early detection, recovery process
418
Characteristics of the content of the work of critical care nurses based on a

time-motion studyThrough comparison with neurology nurses
Yumiko Yatomi1, Tomoko Inoue1, Yoshiko Sasaki1, Yuko Kawamoto1
1.
Tokyo Medical and Dental University
Presenting Authors Email: yatomi.cc@tmd.ac.jp
Purpose
Critical care nurses engage in a broad range of complex tasksThey take care of severely
affected patients while supervising them in a highly intensive manner. This study aims to
clarify the characteristics of the job content of critical care nurses through comparison with
nurses working on neurology units who are considered to provide a great amount of care
among general duty nurses.
Design
An observational study was carried out on the job content of nurses working at university
hospitals.
Methods
The tasks of 10 critical care nurses and 10 neurology nurses from 8:00 to 17:00 were recorded
by a time-motion-motion study. The recorded tasks were classified in accordance with a job
classification table composed of 195 items and the two groups were compared against each
other.
Results
The result showed no significant differences in the years of experience or the total number of
tasks between the two nurse groups. The five most time-consuming items of critical care
nurses weretransfer,preparation and clearance of drugs and oxygen,handover
process and doctors rounds,preparation for entry and exit management of patients,
andbed bathing (for litter patients).Significant differences between the two groups were
observed in 34 of the 195 items and the work of critical care nurses was characterized by
sanitary care and postural change of litter patients, checking of routes and lines and duties
related to entry and exit management of patients. Both groups exchange information within
teams but by different methods: while nurses working on neurology units spent time on nurse
conferences, critical care nurses spent time on handover process and doctors rounds.
Conclusions
The work of critical care nurses is characterized by that they frequently make a short-distance
transfer within their units and that they carry out their tasks while communicating with
doctors. They also spend a large amount of time caring patients in bed as well as on
preparation and clearance of treatment and care. Thus, the study suggested the possibility that
review of their job operation could help allocate more of their time to assessment and care of
patients.
419
35Keywords
Critical care nurse, time-motion study, neurology nurse
420
A systematic review of methods of eye care for adult patients in the

intensive care unitA meta-analysis
Cai Hua Sim1, Bin Bin Zhan1, Xiu Hui Ding1, Pei Yoke Tay1, Noel Loke1
1.
Singapore General Hospital
Presenting Authors Email: sim_caihua@hotmail.com
Purpose
Eye care has often been neglected in intensive care units (ICUs) in favour of resuscitative care.
Various studies have shown that ICU patients have a higher risk of developing corneal
damage due to a higher propensity of being unconscious, sedated and paralysed. There is
currently no widely accepted practice for providing eye care to ICU patients. This study aims
to evaluate the effectiveness of closed versus open chamber methods of eye care in preventing
corneal damage in ICU patients.
Design
This study was done as a comprehensive systematic review by using meta-analysis to
compare the effectiveness of closed versus open chamber methods of eye care in adult
patients in the ICU.
Methods
A comprehensive electronic literature search was performed in May 2013 to identify relevant
articles from the following databases: EBSCO, PubMed, ScienceDirect, CINAHL, Medline.
Reference lists of relevant articles were also searched. The inclusion criterions for articles
reviewed in this study were1) the articles were published between 2006 to 2013, 2) they
dealt with interventions for corneal injuries in participants above 18 years old admitted in an
intensive care unit and 3) the articles are in English. The exclusion criterions were: 1) articles
published before 2006, 2) studies which included participants below 18 years old. Two
reviewers screened the search results and performed the data extraction independently. Joanna
Brigg's Institue MaStaRI Critical Appraisal tool was used by two independent reviewers for
appraisal of the studies' methodological quality and risk of bias.
Results
The literature search identified 5 articles evaluating the effectiveness of eye care interventions.
There were three randomized controlled trials, one cohort study and one systematic review.
Eye care methods were categorized into two groups, namely the closed chamber and the open
chamber methods. Both methods were formally compared in a meta-analysis using Review
Manager 5. Twenty-three of 371 (6.2%) patients in the closed chamber group vs. ninety-seven
of 377 (25.7%) patients in the open chamber group developed exposure keratopathy with a
summary odds ratio of 0.185 (95% confidence interval 0.000-6.127, p = 0.002). One of the 5
included articles showed no statistical significance between the closed chamber and the open
chamber methods of eye care.
421
Conclusions
The closed chamber method is statistically more effective in decreasing the incidence of
exposure keratopathy than the open chamber method of eye care for ICU patients. Traditional
methods of eye care in ICUs includes the use of normal saline to perform eye toilet. However,
this appears insufficient as high doses of neuromuscular blockers used in sedation leads to
incomplete closure of eyelids which leads to high risk of exposure keratopathy. The closed
chamber method creates a seal and allows for retention of moisture within the chamber while
the open chamber method requires frequent application of topical lubricants. Proper eye care
can decrease medical costs incurred due to potential treatment of corneal damage. Further
research can be done on different products used to create closed chamber eye care that might
benefit adult ICU patients.
35Keywords
Eye care, intensive care unit, exposure keratopathy, cornea, critical care
422
Excretion patterns of urinary melatonin after cardiac surgery in elderly

patients
Hiromi Arita1, Yukari Takeno2, Etsuko Fujimoto2
1.
Fukui Prefectural University, 2. Graduate School of Medicine, Nagoya University
Presenting Authors Email: arita@fpu.ac.jp
Purpose
Our previous study using an actigraph indicated that sleep-wake cycle of the elderly patients
in Intensive Care Unit (ICU) did not recover until at least four days after cardiac surgery. The
present study focused on melatonin, which is well known to regulate the circadian rhythm of
sleep. The purpose was to elucidate whether the circadian rhythm of melatonin was collapsed
in the elderly patients admitted to ICU.
Design
Experimental design.
Methods
Participants were elderly patients age over 65 who underwent cardiac surgery and transferred
to ICU. Their urine was collected every four hours following surgery for over four days, and
melatonin was measured by radioimmuno assay. Urinary collection was stopped at the time of
discontinuation of urinary catheterization. As control, urinary melatonin of a healthy
volunteer was also commeasured in a same manner.
Results
Seven patients (5 males and 2 females) were characterized as follows; the mean age was 72.7
4.1, and the mean duration of ICU stay was 3.00.8 days. The healthy volunteer was 75year-old.
Patterns of melatonin excretion in urine was examined from two approaches; acrophase and
amount of melatonin.
[Acrophase]
Throughout four days, the melatonin levels of the healthy volunteer showed the finelyregulated circadian rhythm, i.e. high during nighttime and low during daytime. An acrophase
of the melatonin excretion was detected at 3oclock every night. In all patients except one,
the melatonin levels also showed high during nighttime and low during daytime for four days,
and an acrophase of the melatonin excretion observed at 3 or 7oclock. One patient did not
have a significant acrophase.
[Amount]
In the volunteer, amount of the melatonin in urine was approximately between 29 and 42
pg/ml at the acrophase throughout four days. On the other hand, almost patients showed
between 4.4 and 37 pg/ml at the acrophase. The difference of the melatonin amount between
daytime and nighttime was small throughout four postoperative days. Only a few patients
showed that the amount of the melatonin excretion became gradually large from the second
postoperative day. However, it was still under the volunteer levels.
423
Conclusions
#1. Appearance time of the acrophase of urinary melatonin in patients were similar to that in
healthy volunteer. Therefore, it is considered that the circadian rhythm of melatonin was not
entirely collapsed in the elderly patients admitted to ICU.
#2. Amount of the melatonin was not enough as that of volunteer.
These #1, #2 findings, together with our previous report, suggest that amount of melatonin is
a key component promoting adequate sleep to postoperative patients in ICU.
35Keywords
Urinary melatonin, cardiac surgery, elderly, intensive care unit
424
An education program based on the health belief model for newly

diagnosed type 2 diabetes patients to promote self-care behaviors in Japan
Yuko Yamamoto1, Michiko Machiura2, Chieko Hatamochi2, Kyoko Tanaka2
1.
Setsunan University, 2. Osaka Prefecture University
Presenting Authors Email: y-yamamoto@nrs.setsunan.ac.jp
Purpose
The importance of early education has been emphasized in order to prevent serious
complications among type 2 diabetes patients. However, it is difficult for them to accept their
diabetes and perform self-care because there are few subjective symptoms during the early
stages. The purpose of this study was to develop an education program to promote self-care
among patients newly diagnosed with type 2 diabetes and to clarify the effects of the program.
Design
A quasi-experimental study design was adopted in which participants in the intervention and
control groups were matched according to gender.
Methods
Education programBased on the Health Belief Model (HBM), the program involved selfdirected learning using a brochure, reflection forms for recording personal health beliefs,
interviews with a nurse investigator, and self-monitoring of body weight, physical activity,
dietary behavior, and subjective symptoms.
Subjects Study participants were middle-aged patients who had been diagnosed with type 2
diabetes within the past three years, but who were not receiving insulin therapy.
Data collection All patients were asked to complete questionnaires comprised of items from
the Health Belief Model Diabetes Scale, Diabetes Self-Efficacy Scale, and Summary of
Diabetes Self-Care Activities Measure before, immediately after, and three months after the
program. Physiological indices of blood glucose, HbA1c, and body weight were obtained
from medical records at the time of completion of the questionnaires. The data were collected
between April 2011 and March 2013.
Data analysis Mann-Whitney U test was used to compare changes in scores across the three
periods between the two groups. The IBM SPSS statistical program, Version 19.0J for
Windows, was used, with a significance level of 5%.
Ethical considerationsThe present study was approved by the Research Committee of the
School of Nursing, Osaka Prefecture University, and respective hospitals.
Results
Thirteen pairs of subjects were divided into two groups; each group contained ten males and
three females. No significant differences were found in the baseline characteristics among the
groups.
In terms of patientshealth beliefs regarding the perceived benefits of self-care, scores in the
intervention group improved between the baseline period and immediately after the program,
although this increase was not significant (p=0.081). Moreover, self-care through physical
activity was significantly more favorably maintained in the intervention group as compared
425
with that in the control group three months after the program (p=0.042). In addition, body
weight was significantly reduced in the intervention group during the program (p=0.037).
However, there were no significant differences between the groups regarding other
parameters.
Overall, subjective evaluations of the program were favorable, except for the results of selfdirected learning.
Conclusions
The results of this study suggest that patients were aware of their health-related beliefs,
particularly those concerning the benefits of self-care, which may facilitate the process of
caring for themselves. Patientsweights also decreased as a result of better self-care, and this
weight loss was perceived by patients as a benefit derived from self-care. Contrary to previous
findings, beliefs regarding the perceived benefits of self-care had an important effect on selfcare behavior among newly diagnosed type 2 diabetes patients.
35Keywords
Patients newly diagnosed with type 2 diabetes, health belief model, self-care behavior,
diabetes education program
426
Increasing self-care ability can reduce hospital utilization in COPD patients

A systematic review
Sz-Ching Lin1
1.
Department of Nursing, National Yang-Ming University
Presenting Authors Email: lincgin2001@ym.edu.tw
Purpose
The COPD patients were always hospitalized or visit emergency, because of acute
exacerbation and didnt receive great nursing education and learn how to care themselves.
Good self-care management could reduce hospitalization rates and emergency visits. Nursing
education for chronic disease are important .Especially, correct self-care and acute
exacerbation reducing. The aim is if self-care ability increasing should reduce hospital
utilization ?
Design
Systematic review
Methods
Using CINAHL,Medline,PubMed and Google scholar, a systematic literature search was
performed to identify studies which evaluated hospital utilization in patients with COPD
published between 2003 to 2014.The following three groups of search terms were combined
using and: (1)COPD, pulmonary disease, chronic obstructive (2) self-care , selfmanagement (3) hospital utilization, hospitalization , emergency rate
Results
The data show that increasing self-care ability can reduce hospital utilization in COPD
patients, the patients received good self-care program will reduce emergency visit and
hospital admission rate. About 90% references used St.George respiratory questionnaire
(SGRQ) to evaluate quality of life and COPD patients receive interventions and following up
6 to 12 months will improve quality of life. More than 50% patients have frequent
hospitalization rates and emergency visits(more than 2 times in one year) , 60 % patients had
received information about medications from doctors and only 17% patients from
nurses .About 71% patients want to get more information about COPD.
Conclusions
COPD is an irreversible chronic disease. The patients suffering from chronic disease, must
have appropriate health care , the executor including the patient self ,family and profession
health provider. To unite three ways, chronic disease patients will have great quality of life
and decrease discomfort. Therefore, should be possess of good learning attitude ,skills and
knowledge by patient self .The members of family need to support patients and health
provider deliver information . Learning good self-care model could decrease recurrent rate
and co morbidity. How to learning good self-care model is what the health providers need to
deliver information about disease knowledge, skills and learn attitude.
427
35Keywords
COPD, self-care, hospital utilization
428
Efficacy of compression stockings in the treatment of venous ulcers

Yi-Teen Wang1, Hsiao-Chiao Wang2, Yung-Hui Tang3, Jia-Lin Lee4
1.
Taichung Hospital, Ministry of Health and Welfare, 2. School of Nursing, China Medical University,
3.
Kaohsiung Veterans General Hospital, 4. China Medical University Hospital
Presenting Authors Email: yiteen.w@gmail.com
Purpose
One of the standard treatments of lower extremity venous ulcers became surgery ablation
combined with elastic stockings in recent decades. Some patients still experienced ulcer
recurrence after surgery. Initial outcome of improving healing rates might be superior to using
compression stockings alone. The long-term recurrence rate in chronic venous leg ulcers still
remained high. Was surgical correction of isolated superficial venous reflux a must
consideration? The aim of this study was to evaluate effectiveness of elastic stocking therapy
in the treatment of venous stasis ulcers.
Design
This study enrolled 32 venous insufficiency patients presented to our outpatient department
with active leg ulcers. Duplex ultrasound was performed for evaluation of the venous valvular
reflux at entry. The leg ulceration was accessed according to the CEAP classification (clinical,
etiological, anatomical and pathophysiological) created by an international committee of the
American Venous Forum. All participants in CEAP 6 were selected in this study (12 male, 20
female).
Methods
The patients wore 280-Den (30-40mmHg) compression stockings when they finished wound
care every morning. The stockings were taken off when they went to bed in the evening. All
participants were instructed in wound care by trained nurses at the follow-ups. The patients
were followed on a two-week basis for ulcer management and varicose vein inspection.
Results
Twenty-two out of thirty-two patients had effective wound healing in a three- month study
period (P<0.05). The median time to wound healing was 68 days. The other ten patients had a
significant degree of wound contraction during study. Diabetes mellitus with poor glycemic
control increased the risk of unhealed wounds (P<0.05). The participants who adhered to the
compression stocking regimen resulted in better outcome in venous ulcer healing.
Conclusions
Providing elastic stockings seemed to be an effective way to eliminate superficial venous
reflux. Compared with the traditional therapy of surgical intervention and compression
stockings, the noninvasive therapy with elastic stockings alone would be a cost-effective
regimen in the treatment of venous stasis ulcers but might not suitable for all patients. Those
who could not follow the instruction for stockings and wound care at home were not the
candidates for single regimen of compression stockings. This study provided an alternative
treatment option of varicose vein in people with active venous ulcers.
429
35Keywords
Varicose vein, venous ulcers, compression stockings
430
Being a caregiver for patients with end-stage renal disease in Singapore

Kai-Jun Chan1, Ching Siang, Cindy Lee1, Hui-Chen Chen1
1.
National University of Singapore/Alice Lee School of Nursing
Presenting Authors Email: a0083010@nus.edu.sg
Purpose
In the 21st century, caregiving has become a new trend due to the increase in number of
people being diagnosed with End-Stage Renal Disease (ESRD). It is commonly associated
with negative connotations such as caregiver stress and caregiver burden. Recent findings
even suggest that the quality of life of caregivers of patients with ESRD is even worse than
the patients themselves. This negative appraisal of the caregiving experience and poor health
outcomes do not merely just reflect the caregivers status, but also affect their subsequent
care on the patient. Thus, the psychosocial concerns and support needs of caregivers for
patients with ESRD are vital areas of investigation. The aim of this study is to explore the
experience of caregivers for adult patients with ESRD in Singapore.
Design
A descriptive qualitative approach is adopted for this study.
Methods
Purposive sampling will be used to recruit 15 caregivers for patients with ESRD in one of the
regional tertiary hospital in Singapore. Data will be collected using a semi-structured face-toface interview that lasts for 45 minutes and analysed using thematic analysis.
Results
All findings from the caregivers will be shared and reported during the presentation. The
evidence from the caregivers is mapped against the conceptual framework, The Stress Process
Model. Preliminary findings on the experience of caregivers, their psychosocial concerns and
support needs will be reported during the presentation. This interest in the caregiver wellbeing
concerning the care of patient with ESRD is likely to implicate nursing practice by allowing
nurse to identify critical points for caregiver education and to provide the wanted support
needs of caregivers. When they are indeed appropriately supported, this could reduce
recurrence hospital admission due to caregiver issues and in turn improve patient outcome
and reduce healthcare cost.
Conclusions
Previous studies placed little focus on the psychosocial concerns and support needs of
caregivers of patients with ESRD. Findings from this study will provide future directions for
the development of long-term educational and support program for caregivers of patients with
ESRD and contribute to the body of knowledge in nursing.
35Keywords
End-stage renal disease, qualitative, caregiver experience, psychosocial , support needs
431
Experiences of patients undergoing haemodialysis in SingaporeAn

exploratory qualitative study
Leting Hong1, Hui-Chen Chen1, Wenru Wang1
1.
National University of Singapore
Presenting Authors Email: isa.hong@gmail.com
Purpose
This study aims to explore the experiences of the patients undergoing haemodialysis in
Singapore, specifically pertaining to the adherence with the recommended dietary and fluid
restriction regime.
Design
The study employs an exploratory qualitative research design, utilizing a semi-structured
interview guideline, to explore patients experiences of adherence with the dietary and fluid
modifications, among renal patients undergoing haemodialysis.
Methods
A purposive sample of 30 eligible participants is recruited from one of the tertiary hospitals in
Singapore. Semi-structured face-to-face individual interviews are conducted to explore the
participants experiences. Thematic analysis is conducted to interpret the true experiences of
patients undergoing haemodialysis. IBM SPSS 22.0 is used to analyze the participants
socio-demographics and medical data.
Results
The study will be conducted from September 2014 to January 2015. Findings of this study
will be presented during the presentation that highlights the facilitators and barriers of
adherence among renal patients, of various ethnic groups, undergoing haemodialysis.
Conclusions
In view of the global trend of increasing haemodialysis rate, there is a pressing need to
explore the experiences of these patients. Most facilitators and barriers can be tackled through
various interventions and educational strategies. The result is expected to facilitate the
appropriate channeling of resources to evaluate and improve existing educational strategies.
The subsequent strengthening of a nurse-patient supportive relationship may also facilitate the
interventions required for the improvement in the level of adherence. It is moreover inclined
with optimism that such will refine the risk of mortality due to non-adherence of the
recommended dietary and fluid restriction in Singapore.
35Keywords
Experiences, haemodialysis, adherence, diet and fluid restriction
432
Implicit end-of-life needs of patients with chronic respiratory disease and

their families in the home care setting
Yoshiyuki Takahashi1
1.
Chiba University
Presenting Authors Email: yosiyuki@faculty.chiba-u.jp
Purpose
End-of-life (EOL) care for patients with chronic respiratory disease (CRD) is typically based
in the home. Therefore, the needs of such patients are frequently overlooked by healthcare
professionals. This study aimed to identify the implicit EOL needs of patients with CRD and
their families in the home care setting.
Design
Quantitative research
Methods
Two groups comprising four nurses who provide home oxygen therapy in Japan were
interviewed for this study. Interviews were conducted from September 2011 to January 2012.
All nurses had about 8 years of experience providing care for patients with CRD. In the
interviews, we asked for their perspectives on EOL needs of such patients and their families.
All interviews were recorded and subsequently transcribed verbatim, and the dates were noted.
Results
Interviews lasted an average of 65 minutes. Based on responses from over 53 total interview
sessions, we created the following six categories of implicit care needsSupport for
enabling patients to approach their desired selves;Allowance of expression of what is
happening to self;Arrangement of machines for breathing, hygiene, and oxygen, which
the patient cannot control on his or her own;Correction and revision of care intervention
level according to the situations of self and family;Provision of information access and
opportunities for consultations; andSupport for coming to terms with the current
condition.
Conclusions
It is difficult for patients with CRD and their families to satisfy their needs independently.
Therefore, to provide a high standard of EOL care in the home, intervention should be
accurately administered at the right time.
35Keywords
End-of-life care, chronic respiratory disease, home care setting
433
Risk factors for foot lesions and related preventive care intervals in patients
undergoing maintenance hemodialysis
Yayoi Takahashi1, Sakiko Aoki1, Hiroe Takano1
1.
SEIREI SAKURA CITIZEN HOSPITAL
Presenting Authors Email: yayoi-t@sis.seirei.or.jp
Purpose
The present study investigated risk factors for foot lesions and related preventive care
intervals in patients undergoing maintenance hemodialysis.
Design
Qualitative resarch design.
Methods
Methods were divided into the following four stages1) A total of 161 patients undergoing
maintenance hemodialysis were surveyed using a 50-item foot care flow chart and risk factors
for infection and foot ulceration were extracted2) the probabilities of infection and foot
ulceration were calculated and scored based on the identified risk factors and patients
current foot care intervals 3) probability scores, previous studies and current foot care
intervals for patients with a history of foot lesions were used to investigate recommended
care intervals for foot lesion prevention 4) Preventive care was implemented for all patients
at the recommended intervals and reliability and validity were confirmed based on the
incidence of foot lesions. A 2 test and logistic regression analysis were conducted using SPSS
17.0 (p<0.05).
Results
The following four risk factors for infection and ulcerative foot lesions were identified:
diabetes, sensory dysfunction, and lack of preventive foot care. Probability scores for
infection and ulceration by risk factor were as followsDiabetes, 2sensory dysfunction,
and solitude, 1. Recommended preventive care intervals were then derived from total risk
scores as follows2, annually3, every 4 monthsand 4, monthly. Monthly preventive
care was also recommended for patients with a history of infection and foot ulcers. The
incidence of foot lesions at 6 months after the introduction of the recommended preventive
care intervals was 0%.
Conclusions
The implementation of preventive care intervals based on risk score appears to be linked to
the prevention of foot lesions; however, continued confirmation of interval validity is
necessary. Further investigation is also required regarding the effect of preventive care
intervals and risk factors for new foot lesions during the course of long-term preventive care.
35Keywords
Risk factor, preventive foot care, dialysis patient
434
Factors associated with self-care behaviors in Chinese chronic heart failure

patients
Cao Xi1
1.
The Chinese University of Hong Kong
Presenting Authors Email: caoxi@cuhk.edu.hk
Purpose
To describe the level of self-care behaviors and to examine the associated factors among
Chinese chronic heart failure (CHF) patients.
Design
A cross-sectional study was conducted.
Methods
A convenience sample of 127 CHF patients was recruited from August 2013 to January 2015
in two university-affiliated hospitals in Changsha of China. Participants were asked to
complete a questionnaire which consisted of demographic information, Self-care Heart
Failure Index (SCHFI,V6), the Type D personality Scale (DS-14), Medical Outcome Social
Support Survey (MOS-SSS), and the Heart Failure Knowledge Test. A score of 70 was used
as the cut-point to judge self-care adequacy. Clinic data were obtained from their medical
records. Multiple linear regression analysis was employed to identify the associated factors of
self-care behaviors.
Results
Among the participants, 61.4% were male and 38.6% for female, with mean age of 64.92
(SD=12.34). Only 1.6% and 3.9% patients had adequate self-care maintenance and self-care
management behaviors, while 12.6% patients had adequate self-care confidence. For self-care
maintenance behaviors, patients performed good adherence to medication, while poor
adherence to weighing regularly. For self-care management behaviors, while 80.3% and
74.8% of patients would not take the action of reducing intake of sodium and fluid restriction
respectively. For self-care confidence, patients showed more confidence for following doctors
advice and less confidence for taking measures to control HF symptoms. HF knowledge, type
D personality and the emotional-informational support were associated with self-care
maintenance behaviors. Moreover, type D personality adversely affected self-care
maintenance behaviors. While, HF knowledge, total social support, time of diagnosis with
CHF significantly associated with self-care management behaviors.
Conclusions
Chinese CHF patients performed inadequate self-care behaviors. Type D personality, social
support, and time of diagnosed with CHF were identified associated with self-care behaviors
which require specific attention, especially the type D personality.
35Keywords
Self-care, chronic heart failure, type D personality, social support
435
A study on decision making of the disease disclosure or nondisclosure in

diabetic patientsThe relation between internal personal factors, HbA1c,
patientssatisfaction, and diabetes disclosure to friends
Fumiyo Minamimura1
1.
School of Nursing,College of Health and Human Sciences ,Osaka Prefecture University
Presenting Authors Email: minamimura@nursing.osakafu-u.ac.jp
Purpose
The self-management is necessary in order to improve diabetes patient outcomes. The disease
disclosure or nondisclosure to other people in patients with diabetes may influence the selfmanagement behavior. The purpose of this study is to clarify the relation between internal
personal factors, glycated hemoglobin (HbA1c), patientssatisfaction after the decision, and
the disease disclosure to friends in patients with diabetes. Furthermore, it is to think about
nursing support for decision-making of the disease disclosure.
Design
Cross-sectional study.
Methods
It investigated in the self-reported questionnaire to 120 adult outpatients aged 20-69 years old.
Demographic and clinical data were collected in the questionnaire. The relational, internal
personal characteristics about decision making of the disease disclosure and their satisfaction
after the decision were also investigated. Information about their treatment regimen, clinical
characteristics and status of present glucose control (HbA1c) was obtained from their doctor.
Correlations between data were estimated using Spearmans rank correlation coefficient.
Multiple regression model was prepared to simultaneously evaluate the effects of the factors
on the disease disclosure. The criterion for statistical significance was set at p<0.05. Informed
consent was taken from all patients participated. This study was approved by the ethics
committee of the Osaka Prefecture University.
Results
Of the120 people contacted, there were 111 (92.5%) respondents. The age of the participants
ranged from 31-69 years old, with an average age of 58.93 7.45 (mean SD). The disclosure
or nondisclosure was related with the expectation to reduction of the stress, and feeling to
want to avoid negative effects and the resulting psychological stress in personal relationship.
The disclosure was not significantly correlated with HbA1c. The disclosure to friends was
significantly correlated with their satisfaction after the decision (r = 0.247, p= 0.009). The
following results were shown by multiple regression analysis. Strength of the thought that the
stress decreased by the disease disclosure ( = 0.403, p = 0.000), that diabetes was not what I
must cover ( = 0.282, p = 0.03), that I had enough information about coping strategy after
the decision making of diabetes disclosure or nondisclosure ( =0.234, p=0.003), and that I
didnt like people to whom I had disclosed the disease caring about me and feeling sorry (
= -0.196, p= 0.009) had a significant correlation with the disease disclosure to friends. The
436
value of R, the multiple correlation coefficient of this model was 0.672. The value of R2, the
coefficient of determination was 0.452 (adjusted R2= 0.431).
Conclusions
Results indicate that the expectation to reduction of the stress is strongly influence on the
decision making of disease disclosure to friends. It is suggested that the stress management is
essential to the support and that the support after the decision is necessary similar to decision
making support. The healthcare workers should support the patients to be able to disclose the
disease to important friends if possible, because it may influence on their satisfaction and
mental health.
35Keywords
Diabetes disclosure, self-management, support, stress, glycemic control
437
A case study regarding home nursing support provided by visiting nurses to

support the lives of people with chronic heart failure
Chinatsu Uetani1, Natsuko Seto1, Ayako Okada2, Chisono Ohara1, Yasuko Shimizu1
1.
Graduate School of Medcine, Osaka University, 2. College of Nursing art and Science, University of
Hyogo,
Presenting Authors Email: uetachnt@gmail.com
Purpose
Home care support for people with chronic heart failure is an important issue in Japan for
decreasing ratio of rehospitalization and shortening the average length of hospital stays. The
aim of the present study was to elucidate how visiting nurses assess the physical condition
and living situation of people with chronic heart failure and what kind of support they provide.
We also obtained suggestions for nursing support.
Design
Case study.
Methods
We conducted semi-structured interviews with 3 visiting nurses who had 3 or more years
experience with home care for people with chronic heart failure. Codes were generated to
represent visiting nursesassessments of the physical condition and living situation of people
with chronic heart failure as well as the content of support. The created codes were classified
according to their similarities into categories denoting the semantic content and were
qualitatively and inductively analyzed. The ethics committee of university A approved this
study.
Results
The results of our analysis revealed each visiting nurses (nurse A, B, and C) assessments of
the physical condition and living status of people with chronic heart failure as well as the
support that they provided.
On the basis of the belief that [visiting nurses must tread with care because the patient will not
often voice their complaints], visiting nurse A assessed the physical condition and living
status of individuals with chronic heart failure by [assessing deterioration of the patients
physical condition based on the patients ability to dress themself, clean up their own
excretions, and loss of appetite], [checking the prescription date and remaining quantity of
oral medication], and [comparing the patients current condition and symptoms with their
normal state].
Visiting nurse B observed characteristics and situations of patients and families such as
[patients sometimes being rehospitalized due to poor health following a gradual return to their
original lifestyle after discharge], [patients and their families starting to ask lots of questions
regarding the patients physical condition and solutions for when the patient is unwell
because they may have observed unstable aspects of the patients physical condition], and so
on. The visiting nurse supported patientslifestyles by [first ascertaining the patients
standard of living and checking whether this has changed or not] and [cautioning the patient
438
to gradually build up their level of activity because their condition can deteriorate if they
overdo it after discharge].
In situations where [it is difficult to make judgments following an assessment of the patient
s deteriorating condition based on their complex pathology and atypical symptoms], visiting
nurse C assesses the physical condition and living situation of patients with chronic heart
failure and provides support by [not overlooking visible signs of disease progression],
[assessing invisible symptoms from objective data], and so on.
Conclusions
The results of the present study revealed that visiting nurses assess the state of heart failure
deterioration from both a medical and lifestyle point of view and support patients so that they
can continue their lifestyles while receiving medical care.
35Keywords
Chronic heart failure, home nursing support, prevention of rehospitalization, chronic illness
nursing
439
The structure of nursing care for patients with intractable neurological

diseasesAnalysis of a nurses interaction with a patient who had
myasthenia gravis
Yuka Kanai1, Akiko Nagata1, Yukiko Abe1, Ayumi Suematsu2, Toshie Yamamoto1
1.
Presenting Authors Email: y-kanai@chiba-u.jp
Purpose
The aim of this study is to clarify the elements involved in nurse interaction with intractable
neurological disease patients and to identify the structure of this support.
Design
Case study.
Methods
Patient B, a Japanese man currently admitted to University Hospital A for myasthenia gravis
(MG), was treated by the author, a nurse with six years of nursing experience at the same
ward. The process of interaction was recorded in field notes in process record so that the
meaning of each exchange was not lost. Each meaning segment was used as asituation,
or material for analysis. Scientific abstraction was used to analyze data, and clarify both
individual elements as well as the overall structure of nurse interaction with patients who have
intractable neurological diseases.
Results
Patient B had received a diagnosis of MG 13 years previously. One year previously, he had
undergone emergency hospitalization for acute exacerbation of his condition. His MG-related
symptoms have currently stabilized, and he requires rehabilitation.
Before I began caring for the patient, a ward nurse said,His rehabilitation is not progressing
because he has no motivation.I wondered what was impeding the patients recovery.
After I began caring for the patient, I noted that he wiped his own face and engaged in
movements such as getting up. I took this as signifying thatThe patient is trying to use his
vital power on a daily basis.As the patient was able to get up by himself, I felt that if his
gown could be changed to trousers, he might have more opportunities to use his strength.
Therefore, I suggested he change out of his sleepwear. The patient agreed to this suggestion
and started getting up more frequently in his daily life.
I analyzed my interaction as followsI began caring for the patient while feeling that the
patient had problems that he himself had to solve, because of the message given to me by the
ward nurse. Throughout my interactions with the patient, I noted that the patient was able to
use his vital power. I focused on the fact that the patient was in an environment that meant
that he could spend his days without using his own vital power, and encouraged him to use
his own vital power by changing this environment.From my analysis results, I extracted the
following elements for interaction with chronic intractable neurological disease patients
440
Existing patient image,New patient image,Problems requiring solving,

Patient vital powerandEnvironment.
Conclusions
Results indicated that the structure of nurse interaction with patients who have chronic
intractable neurological disease consisted of nurses having aNew patient image,not being
taken in by theExisting patient image,clarifying where theProblems requiring solving
were, and adjusting theEnvironmentin order to utilizePatient vital power.
35Keywords
Patient-nurse interaction, structure, intractable neurological disease, scientific abstraction
441
Quality of life instruments for patients with systemic lupus erythematosus

A literature review
Mitsuyo Inoue1
1.
Department of Nursing, Graduate School of Medicine, OSAKA UNIVERSITY
Presenting Authors Email: inoue1217332@ybb.ne.jp
Purpose
The purpose of this literature review was to evaluate disease-specific Quality of Life (QoL)
instruments for patients with Systemic Lupus Erythematosus (SLE).
Design
Literature Review.
Methods
Medline and CINAHL were used for literature search. The following keywords were used for
the searchlupus, systemic lupus erythematosus, quality of life, instrument and questionnaire.
Eligibility criteria were 1) papers published in English between May 1997 and July 2014, 2)
original studies using QoL instrument and SLE in adult patients.
Results
Literature search identified 39 papers. Of these, six papers used disease-specific instruments
only, and 32 papers used both generic and disease-specific instruments. Five SLE-specific
QoL instruments were identified. These were the SLE-specific Quality of Life instrument
(SLEQOL), the Lupus Quality of Life tool (LupusQoL), the SLE Needs Questionnaire
(SLENQ), the Quality of Life in SLE (L-QoL) and the Lupus Patient-Reported Outcome tool
(LupusPRO). SLE-specific QoL instruments were developed in the United State of America
(2), United Kingdom (2), Singapore (1) and Australia (1) between 2005 and 2012. These
instruments measured psychometric properties, disease activity, organ damage and type and
severity of symptoms. All of instruments measured physical health and emotional health. In
regard to symptoms, fatigue was assessed by all instruments. However, sleep or mouth ulcer
was measured by one instrument. L-QoL, LupusQoL, SLENQ and LupusPRO evaluate social
support and intimate relationships. Health services were measured in SLEQOL, SLENQ and
LupusPRO. Body image and self-image were included in SLEQOL, LupusQoL and
LupusPRo. LupusQoL had strong psychological properties. Only LupusPRO measured side
effects of medication and number of medications. In addition, LupusPRO assessed
procreation, desires-goals in the future and stress coping. Internal consistency, reliability and
validity were evaluated and considered satisfactory in all instruments. However,
responsiveness and cross-cultural adaptation and validation have not been examined.
Conclusions
Methodological quality and culture background of five instruments differed. Of those,
LupusPRO covers various aspects of the QoL of SLE and was an excellent tool to examine
comprehensive QoL in SLE patients. When healthcare professional choose a SLE-specific
442
instrument in clinical practice and research, it is necessary to examine and compare content of
the instruments.
35Keywords
Systemic lupus erythematosus, quality of life, instrument, literature review
443
Health literacy in male patients newly diagnosed with chronic heart failure
Masaharu Kadono1, Chieko Hatamochi1
1.
Osaka Prefecture University
Presenting Authors Email: kadono@nursing.osakafu-u.ac.jp
Purpose
This study aimed to clarify the state of health literacy (HL) in patients newly diagnosed with
chronic heart failure (CHF) to establish this as a basis for investigating the state of nursing
practice in the future.
Design
Case study.
Methods
The subjects comprised three male outpatients who had been diagnosed with CHF within the
past year. The subjects underwent semi-structured interviews regarding their medical
treatment and self-management. The data were analyzed from the viewpoint of reading and
numeracy skills, comprehension, and capacity to use health information in decision-making,
and successful functioning in the patient role based on the concept of HL proposed by
Nutbeam (2000) and Carolyn (2005).This study was approved by the ethical review boards of
the authors university and the surveyed facility.
Results
The research subjects comprised Case A, Case B, and Case C ( 57~65 years old). Only Case
A was employed. Case A understood the necessity of strict water restriction and dietary
therapy during hospitalization but found it difficult to continue with such thorough
management after being discharged. Therefore, until his symptoms exacerbated after
discharge, Case A did not acquire information such as how to calculate water volume in daily
lifestyle and specific methods of dietary therapy. Case B only followed the instructions of the
medical professionals while hospitalized. After being discharged, he proactively acquired
information from pamphlets or books to get medical knowledge, enabling him to manage his
own symptoms and observed symptoms such as edema. When Case B found it difficult to
judge the extent of his symptoms or determine whether a medical examination was necessary,
he utilized the strength of others around him by. Case C who was motivated by past
experiences with painful symptoms was already considering methods for post-discharge
dietary management while he was hospitalized. Case C recorded the therapeutic meals that he
ate while hospitalized and selected information regarding adjustments that would be possible
for him to achieve from his inpatient lifestyle and explanations by medical staff. He then
applied these to his post-discharge convalescence. However, none of the three subjects
proactively discussed questions regarding future symptoms and their post-discharge lifestyle
with medical staff either during hospitalization or after they were discharged.
Conclusions
Patients with early CHF exhibited different abilities for researching information related to
symptoms and lifestyle management during their hospitalization and linked them to their post444
discharge lifestyle. In addition, they may also have been influenced by symptoms and postdischarge social background. These results suggest the importance of the capacity to use
health information in decision-making and successful functioning in the patient role after
discharge as a foundation. The status of HL regarding medical treatment and self-management
in patients with CHF differed according to each individual. And so their views regarding postdischarge symptom and daily lifestyle management must be confirmed while they are still
hospitalized and support should be offered to make them to acquire the necessary healthrelated information.
35Keywords
Health literacy, chronic heart failure, newly diagnosed patients
445
The challenges of living experience in patients with chronic heart failure

Chia-Chien Li1, Shiow-Ching Shun1
1.
Purpose
The purposes of this qualitative study was to explore the challenges of living experience in
self-care among the patients with chronic heart failure (CHF).
Design
A descriptive qualitative design with semi-structured interviews was employed. All
interviews were mp3 recorded, transcribed and analyzed using a content analysis approach.
The period of data collection was from 1st April to 15th September 2014.
Methods
Selecting patients from the given inclusion criteria included the following: patients were (1)
CHF classified according to NYHA functional classification II to IV(2) 20 years of age or
olderand (3) ability to speak and understand Mandarin or Taiwanese. Exclusion criteria
comprised significant cognitive impairment during baseline screening.
Results
Qualitative data were obtained from 18 individuals with CHF, included 8 female and 10 male.
Seven main themes were identified from the data: Being aware of impaired body, feeling loss
of roles, having difficulty in managing self-care, showing cognitive and emotional response,
adapting the new life, keeping faith in care and treatment, seeking for social support resources.
Conclusions
While facing physical impairment, role and lifestyle changed, patients had cognitive and
emotional responses. Furthermore, adjusting the illness representation , keeping faith in health
care and seeking social support helped patients to cope with those challenges. It is a dynamic
living experience depends on the duration and severity of CHF in patients. It is suggested to
appropriately and timely provide the support and education intervention according to patient
s challenges and needs.
35Keywords
Living experience, chroinc heart failure, challenges
446
Psychometric evaluation of the self-efficacy for appropriate medication use

scale-Korean version (SEAMS-K) among adults with Type 2 diabetes
Chun-Ja Kim1, Elizabeth Schlenk2, Dae-Jung Kim3, Moon-Sun Kim4
1.
Ajou University Collegae of Nursing, 2. University of Pittsburgh School of Nursing, 3. Ajou

University School of Medicine, 4. Ajou University College of Nursing
Presenting Authors Email: ckimha@ajou.ac.kr
Purpose
Low adherence to medication remains a significant barrier to achieving glycemic control in
Korean patients with diabetes. Self-efficacy is an important factor related to medication
adherence. This study evaluated the psychometric properties of the 13-item Korean version of
the Self-Efficacy for Appropriate Medication Use Scale (SEAMS-K) among 100 Korean
adults with type 2 diabetes.
Design
This study was part of an ongoing cross-sectional survey.
Methods
Participants completed SEAMS-K and Moriskys medication adherence questionnaires and
HbA1c was collected from medical chart review. Cronbachs alpha coefficient for reliability
and principal component factor analysis and Pearsons correlation coefficients for validity
of the SEAMS-K were used.
Results
The SEAMS-K had adequate internal consistency reliability with a Cronbachs alpha
coefficient of 0.863.The factor analysis of construct validity identified three dimensions of the
SEAMS-K, explaining 60.3% of the total variance. The SEAMS-K was positively correlated
with medication adherence (r= .410, p< .001), indicating convergent validity; it was
negatively correlated with HbA1c (r= -.202, p< .005), indicating discriminant validity.
Conclusions
SEAMS-K possesses adequate reliability and validity and appears appropriate for use in
Korean adults with diabetes.
* This research was support by Basic Science Research Program through the National
Research Foundation of Korea (NRF) funded by the Ministry of Education (grant number:
2013R1A1A2059806).
35Keywords
Diabetes, medication adherence, reliability, self-efficacy, validity
447
A study of the relationships between symptom burden and functional status

and health-related quality of life in patients with COPD
Hsiu-Yen Huang1, Wann-Cherng Perng2, Chi-Huei Chiang3, Kai-ping Yao4
1.
Shu-Zen Junior College of Medicine and Management in Department of Nursing, 2. Director,

Department of Critical Care Medicine, Tri-Service General Hospital, 3. Director, Pulmonary
Immunology and infection section, Chest Department, Taipei Veterans General Hospital, 4. Professor,
Presenting Authors Email: angel-1428@ms.szmc.edu.tw
Purpose
The purpose of study explored the relationships between symptoms burden, functional state
and quality of life (QOL) in patients with chronic obstructive pulmonary disease (COPD).
Design
A cross-sectional research design with a convenience sampling was used in this study.
Methods
The structured questionnaires including demographics, disease characteristics, Memorial
Symptom Assessment Scale (MSAS) and Functional Performance Inventory (FPI) and St.
George's Respiratory Questionnaire-COPDSGRQ-Cwith used to collect data .
Results
The results of this study showed the patients experienced a mean of 5.4 symptoms. Cough and
difficulty sleep were the most burdensome symptoms. Most patients showed the worse level
of functional performance, with the highest in spiritual activity. Physical care was the best
level of functional performance. The BODE index, six-minute walking distance, the number
of symptoms, symptom burden, fnctional status and quality of life were significantly positive
correlation. Education level, functional status and quality of life were significantly negative
correlation. Education level, BODE index, functional status, and total symptom burden
predicted 42.4% of the total variance in health-related quality of life (HRQOL).
Conclusions
The finding of this study may be the reference for the nurses to provide the individualized
care. The optimal goal will assist patients to reduce burden of symptom, improve of
functional status and HRQOL .
35Keywords
COPD, symptom burden, HRQOL
448
To evaluate the efficacy of a physical activity intervention program using a

log sheet for stroke impaired elderly
Yunlu Wang1
1.
Zhengzhou University
Presenting Authors Email: wangyunlu2006@163.com
Purpose
The aim of this study was to evaluate the efficacy of a physical activity intervention program
using a log sheet for stroke impaired elderly in the community.
Design
A quasi-experimental design with a control group with pre-and post-tests.
Methods
There were 108 stroke-impaired elderly recruited from two communities located Hangdong
and Linshanzhai in Zhengzhou City. They were assigned into two groups54 participants in
the experimental group and another 54 participants in the control group. The experimental
group participated a 8-week physical activity program using a log sheet to record their activity
level. The control group only attended two health education sessions. The study instruments
included demographic sheet, Chinese Self-efficacy for Exercise Scale (SEE-C), Questionnaire
of Exercise Adherence(EAQ), Barthel Index (BI) and Stroke Specific Quality of Life
Scale(SS-QOL) to evaluate the efficacy of the 8-week physical activity intervention program.
Data were collected in four time points: T1 (pre-intervention), T2 (post-intervention), T3 (one
month after the intervention ), T4 (three months after the intervention ). Data were analyzed
using the descriptive statistics, chi-square and t- test with SPSS17.0.
Results
Statistically significance was found in the scores of all the study measuresSEE-C, EAQ, BI
and SS-QOL in the experimental group, but there is no statistically significant in the scores in
the control group. The experimental group have shown significantly increase in the physical
activity level, exercise adherence, ability of daily activity and quality of life, compared those
to the control group.
Conclusions
The study findings have shown that a physical activity intervention program using a log sheet
to record the individuals activity level can sustain the participation of the program.This
study reports that the quality of life of the elderly with stroke impaired in the experimental
group has also been enhanced through this intervention program.
35Keywords
Stroke, self-efficacy, physical activity
449
Self management in patients with Crohns disease-A investigation of

expert nursesChinatsu Ishibashi1, Yae Yabushita2, Chieko Hatamochi2
1.
Nara Medical University, 2. Osaka Prefecture University
Presenting Authors Email: ishibashi@naramed-u.ac.jp
Purpose
The aim of the present study was to clarify the details of self management in patients with
Crohns disease.
Design
The present study was a qualitative descriptive study.
Methods
We conducted semi-structured interviews with five nurses who had three or more years of
experience caring for patients with Crohns disease. We performed a content analysis of
their accounts of self management that were extracted from the interview transcriptions.
The present study was approved by the institutional review boards of both affiliated
institutions of researchers and data collection institutions involved in the present study.
Results
From the results of the qualitative analysis of self management in patients with Crohns
disease, we extracted 59 codes and were able to classify the data into eight categories
[retention of the correct mental attitude for self managementmanagement of medical
nutrition therapymanagement of a diet that is appropriate for the patientmanagement of
appropriate medicinemanagement of activities of daily living (ADL) to prevent progression
of Crohnsymptoms management of recurrent symptoms building a partnership with
health care providersmaking use of available resources for disease management] and 21
subcategories.
The following points were characteristic of self management in patients with Crohns
disease1) Having a long-term perspective concerning symptoms and management of
symptoms2) Understanding that because the physical conditions of patients can change
depending on living conditions, detailed self monitoring is necessary in order to cope with
physical signs 3) Because physical signs that are not shown in test data can affect treatment,
it is necessary for patients to be able to explain their physical condition to their health care
providers4)Because symptoms and progression of symptoms are often cannot be confirmed
and can greatly influence ADL, patients with the same disease should share information and
experiences with each other.
Conclusions
We were able to classify the data into eight categories.
The results of the present study suggest the need for nurses to present an outlook to the
patients that encourages the formation of long-term perspective, improve their ability to
450
inform health care providers about their condition, and provide a place for patients to connect
with each other, such as self-help groups.
35Keywords
Crohn's Disease, self-management, investigation of expert nurses
451
Relationships of lifestyle with physical health and mental health in

Japanese late middle-aged patients on chronic hemodialysis.
Mizue Fujii1, Masako Uchida2, Gou Kimura3, Noritomo Itami4
1.
Sapporo City University, 2. Kochi University, 3. Sapporo city hospital, 4. NIkko Memorial Hospital
Presenting Authors Email: m.fujii@scu.ac.jp
Purpose
Good control of lifestyle factors such as diet and quality of sleeping is necessary for
maintenance of chronic hemodialysis. Guidelines recommend a healthy diet, physical activity
and rest, but there have been few reports on subjective evaluation of lifestyle and feelings.
The aim of this study was to determine the relationships of lifestyle with physical health and
mental health in Japanese late middle-aged patients on chronic hemodialysis.
Design
Quantitative study.
Methods
Questionnaires were given to patients by nurses in 11 institutions for hemodialysis patients
from March to May in 2014. The questionnaire including items on age, sex, hemodialysis
history, causative disease, subjective symptoms, activities of daily living, subjective
evaluation of self-management, work situation, social activities, and General Health
Questionnaire (12 items). Subjects were divided into 3 groups according to appetite (good,
medium, poor) and according to quality of sleeping (good, medium, poor). The odds ratios in
appetite (good, medium / poor) and in sleeping (good, medium / poor) were calculated using
multiple logistic regression analysis.
Results
The subjects were 215 patients (140 men and 75 women) with an average age of 55.9 years
and average hemodialysis history of 5.5 years. There was a positive correlation between
appetite and quality of sleeping (p=0.000), but there was no correlation between smoking,
alcohol consumption and physical exercise. Regarding relationships with causative diseases,
the percentage of subjects with a poor appetite was higher in patients with diabetic
nephropathy (p=0.007) but not in patients with chronic pyelonephritis. There was no
relationship with quality of sleeping. Analysis of the relationships between subjective
symptoms and quality of sleeping showed that the percentages of subjects with fatigue
(p=0.003) and itching (p=0.028) were higher in the group with poor quality of sleeping.
Regarding appetite, the percentage of subjects with fatigue was higher in the poor appetite
group (p=0.006). Regarding ADL, the percentage of subjects with a low level of activity was
higher in the poor appetite group (p=0.21). GHQ scores were lower in the good and medium
groups of both sleep quality and appetite (p=0.000p=0.000). Multiple logistic regression
analysis showed that there were significant relationships between quality of sleeping and
GHQ (odds ratio for the good/medium groups = 0.93 and, 95% confidence interval: 0.86-1.00,
p=0.05) and between appetite and GHQ (odds ratio for the good/medium groups = 0.83, 95%
452
confidence interval0.73-0.95, p=0.01).

Conclusions
The results suggest that good appetite and high quality of sleeping lead to good conditions of
metal health in middle-aged patients on chronic hemodialysis.
35Keywords
Hemodialysis, appetite, sleeping
453
Literature review for developing patient education program in prevent

aggravation of chronic virus hepatitis
Ying Cui1, Michiko Moriyama1, Mayumi Niitani1, Yaeko Takesita1
1.
Nursing Science Institute of Biomedical & Health Sciences
Presenting Authors Email: d134308@hiroshima-u.ac.jp
Purpose
Liver cancer incidence in China accounted for half of the world, and even in domestic China ,
liver cancer is the second factor of mortality among all malignant cancer. The type of B and C
viral hepatitis incidence was the highest pathogenesis in all types of hepatitis. Low
participation rate of inappropriate treatment, or discontinuation of treatment can proceed
chronic viral hepatitis occurrence. This study is to clear readmission factors of chronic viral
hepatitis B and C in China, and evaluate what kind of intervention is required.
Design
Literature review
Methods
1. The original papers were published in Duxiu academic web and PuBMED in Chinese and
English over the past 10 years (June 2004-2014 year).
2. The key word "hepatitis, readmission," and "hepatitis, patient education" were used to
search the paper.
3. Eligibility criteria: The paper eligibility to the purpose and the design of the paper is correct.
Results
The documents which made a hit by "hepatitis, patient education" had 25 cases, and 17
documents, which made a hit by "hepatitis, a rehospitalization factor". Among them, 20 cases
were analyzed.
1.Rehospitalization factors in chronic viral hepatitis patients.
The patient after discharge, or taking medicine treatment by disappointment, cancellation of
the periodical inspection, and fatigue at the workplace and home due to aggravation of the
liver function were the major factors of the rehospitalization.
2. State of the viral hepatitis patient in China.
During hospitalization, mental problems, uneasiness with the treatment, a sense of oppression
of the relationship with their family, were occurred. And after discharge, virus moving to
another person, the financial burdeof the treatment, uneasiness in the progress to severe, longterm treatment and difficult recovery due to negative psychology, sense of isolation from the
society, lack of correspondence for the side effect of the treatment and liver function turns
worse by eating and drinking, exercise and fatigue.
3. The present conditions of patient education in China.
Liver function improved after discharge effectively as a result of having offered the
knowledge about the physical and mental support by hospitalized nurses was reported in 2
papers. On the other hand, for the purpose of a long-term effect, the paper that was focused on
454
improve the patients self-management ability after discharge and educate patient about
taking medicine management, fatigue and stress reduction, and decreased the rate of
aggravation, and rehospitalization were not reported. In addition, though support from society
and their families is extremely important, these are still not focused on this area.
Conclusions
To avoid the re-hospitalization and maintenance the liver function of chronic viral hepatitis
patients in China, care sustained is not only during hospitalization as well as required after
discharge, additionally, for getting support and understanding from their families, there are
also needed to implement educational interventions for family members.
35Keywords
Chronic virus hepatitis, patient education, severe hepatitis prevention
455
Development and effect of the tool Life story to promote the

communication
Tomoko Hayashi1, Lei yu1, Masako Utida2, Kazuo Yosida3
1.
, 2. , 3.
Presenting Authors Email: 1372012@st.scu.ac.jp
Purpose
Recent investigation has indicated that having difficulty with mutual understanding leads to
degeneration of the morale for both a persistent disturbance of consciousness patient as well
as for the nurse. As for the tool a nurse shares the living information of the persistent
disturbance of consciousness patient with A family member or the patient`s family. Using a
tool the nurse clarifies the effect of the tool to promote the communication morale in the
relationships between a patient a family and the nurse
Design
Intervention study using the communication tool.
Methods
1. Investigation periodFrom July, 2013 to December.
2. Study subject.
Two patients in their 70`s, along with their attending family member, who have difficulty
with mutual understanding due to persistent disturbance of consciousness Woman X has been
hospitalized for 16 years and is attended by younger sister. Man Y has been hospitalized for 4
years and is attended by his wife One of the nurses is ward chief. The nurse understands
excellent unpleasantness of X .The wife not understanding the husbands actions.
3.The outline of the communication tool and how to use. The production of the
communication tool was designed with consideration to promote the active of a family
member and the nurse with the Expertise of the design. I Created the tool with a booklet form
with the B5/12p/ color / clear holder which filled it out with a pen at hand.
The nurse fills in the expression change. The nurse fills in the expression change section for
the patient being hospitalized with the information they received from a family member
including any reaction they may have noticed.
4.Data gathering process.
I listened to the initial opinion of a nurse as well as their opinion one week after using the tool.
Results
1.The nurse, using the information provided on the tool by Mrs. X`s sister, understood that the
patient enjoyed listening to Michael Jackson. Upon playing the CD, it was found that this
method of therapy, previously unknown to the team, seemed to be an effective rehabilitation
technique.
2. Mr. Y's information exchange was done with his wife in the sickroom.
The information made it possible to understand that Mr. Y`s peculiar habit of putting his hand
on his stomach was intended to show relief. "When the hand was applied to the stomach, one
is relieved" afterwards though the nurse was embarrassed with the custom that Mr. Y put his
456
hand in the diaper.

Conclusions
Discussion
The nurse changed the family member into a caregiving assistant by promoting
communication and the flow of information. Nurses, by not operating solely on directional
information but by collaborating with a family member are better able to give a patient the
care and personal respect the deserve.
Conclusion
"Life story" was able to promote the interactive communication between the family and the
nurse. In "Life story", because user's ideas influence the usage and the effect, it is this
discretion in how it`s used that is important.
35Keywords
Persistent disturbance of consciousness patient, promotion of the communication will,
communication tool
457
Diabetic related retinopathy and neuropathy and impacts on falls in

diabetics patients
Pi-Ling Tsai1
1.
Presenting Authors Email: tpiling@hotmail.com
Purpose
(1) the severity of DM induced neuropathy and retinopathy. (2) the severity of neuropathy
and retinopathy on patientsfall and at risk of fall experiences (incidence).
Design
A cross-sectional study was conducted in a medical center in Taipei.
Methods
A total of 200 DM patients with various levels of retinopathy were recruited. Patients were
assessed the severity of retinopathy and neuropathy by ophthalmologist and Michigan
Neuropathy Screening Instrument (MNSI). Falls were recorded retrospectively in the past six
months.
Results
The findings showed that (1) The most common diabetic neuropathy sensory symptom is pain
and numbness. The most common abnormal neuropathy sign was light touch
sense.(2)Simultaneously calculating patientsseverity of neuropathy, retinopathy and
balance ability on possibility of falling analyzed by logistic regression found compare to
binocular visual acuity difference0.6 and MNSI clinical examination score4 (a) MNSI
clinical examination score4 and binocular visual acuity difference > 0.6 the fall risk odds
ratio=3;(b) MNSI clinical examination score <4 and binocular visual acuity difference > 0.6
the fall risk odds ratio=2.71;(c) MNSI clinical examination score4 and binocular visual
acuity difference <0.6 the fall risk odds ratio=2.61.
Conclusions
The study provides information about the risk of falling among retinopathy and neuropathy.
Overall we hope that the finding will improve the quality of life and reduce falls.
35Keywords
Diabetes, falls, retinopathy, neuropathy
458
Development of the scaleLife reorganizationfor adults on chronic

hemodialysis in Japan-Examination of the effect differences in lifestyle and
medical environment Masako Uchida1
1.
University of Kochi
Presenting Authors Email: uchida@cc.u-kochi.ac.jp
Purpose
Adults on chronic hemodialysis would be confronted with critical life transitions by various
psychosocial problems. A new construct, Life Reorganization based on three works in illness
trajectory and restructuring life-world (Corbin & Strauss, 1985; Minami, 1987) was proposed
to explain long-term coping of adult in chronic hemodialysis. Life Reorganization was
defined as coping by mastering medical regimen, reviewing oneself, and reconstructing
reciprocal interpersonal relations through illness experience. The purpose of this study was to
develop a simple scaleLife ReorganizationLROfor adults on chronic hemodialysis
in Japan and to examine whether differences in lifestyle and medical environment affect to
generalize conclusions.
Design
Quantitative correlational study designs.
Methods
The subjects in this study were 30-64 years old, having been on hemodialysis for at least one
year, who agreed to this research, and completed the questionnaire.
The sample data was collected between July and December 1999 from 10 institutions for
hemodialysis therapy in the western districts (annual mean temperature=17) of Japan for
the first survey, and March to May 2014 from 11 institutions in the northern districts (annual
mean temperature=8.9) for the second survey.
The LRO has three subscales focused on mastery of medical regimen, recovery of oneself,
and reconstructing reciprocal interpersonal relations. Higher life reorganization means to be
progressive in reorganization of the life. Data processing was done for exploratory factor
analysis (EFA) using SPSS 21.0 and stepwise exploratory factor analysis (SEFA), then
confirmatory factor analysis (CFA) and structural equation model analysis using AMOS 21.0.
The validity and reliability of this scale was examined and modified.
Results
The characteristics of the subjects who responded the second survey were significantly older
age, and had a longer history of hemodialysis than the first survey respondents, but
significantly less of complications, leisure activities, and social activities.
In the first survey, 279 Japanese adults on chronic dialysis (male=170, female109,
age=M53.2SD7.7) , and 209 (men=139, women=69, age=M55.9SD8.1) in the second
survey agreed to the research and completed the questionnaire.
The results of the study showed that EFA and SEFA identified three factors solution with 10
459
items. The factor demonstrated acceptable internal consistency with Cronbachs alpha
reliability value. In addition, a sample of 90 provided good indication of test-retest temporal
stability (r=.76, p<.05).
In order to confirm the structural validity of this scale, confirmation factor analysisCFA
was conducted on these 10 items.
The major findings of this study support that the LRO satisfied statistical reliability (.83- .86)
and structural validity(GFI.978-.946, RMSEA.018-.038). Correlations with subjective
livelihoods, and sense of life-fulfillment (self-anchoring scales) also gave support for the
scales' validity (r=.172-292, p<.05).
Conclusions
These results suggested that the LRO usefulness to measure long-term coping critical life
transitions among adults on chronic hemodialysis, to maintain reliability and validity even in
situations where there are different lifestyles and medical environments in Japan.
35Keywords
Scale development, confirmation factor analysis, chronic hemodialysis, reorganization of the
life, adult
460
End-of-life care preferences in patients with chronic obstructive pulmonary

disease
Ting-Ru Chen1, Wen-Yu Hu2
1.
Chang Gung University of Technology and Science, 2. National Taiwan University
Presenting Authors Email: trchen.chen@gmail.com
Purpose
Patients with COPD(chronic obstructive pulmonary disease) likely received more intensive
treatments and less palliative care in the end-of-life. The purpose of this study was to describe
end-of-life care preferences of COPD patients in Taiwan.
Design
A cross-sectional descriptive research design was used in this study.
Methods
The human subject research review committee of the study hospital granted approval this
study. Participantspreferences regarding end-of-life (EoL) care interventions was assessed
from a validated instrument that consisted of twelve different life-sustaining interventions
under five various situations and outcomes. Seventy four patients with COPD were recruited
from one medical center in northern Taiwan. Data was collected by face-to-face interview.
Results
Although most patients(75%) agreed the EoL decisions should made by themselves, half of
COPD patients never discussed EoL issues with their families. Almost 80% patients represent
if the dying is unchangeable they would prefer receiving comfort care rather than prolong-life
treatments. Of all EoL care options, the most acceptable interventions is intravenous injection
such as antibiotics and other drug (mean 3.6).The invasive treatments like endotracheal
intubation, tracheostomy are less willingness(mean2.1). The increasing burden on care may
change the preferences of COPD patients regarding EoL treatments. When treatments are
futile COPD patients tend to forgo most of the aggressive treatments. The preferences
regarding EoL treatments can be affected by the diverse situations and outcomes.
Conclusions
Patients with COPD prefer to receieve palliative care and withhold life-sustaining
treatments.Decisions about EoL care often occur when patients lack the capacity. It is
important to facilitate advance care planning discussion in patients with COPD and their
family members.
35Keywords
End-of-life, life-sustaining, chronic obstructive pulmonary disease
461
The effect of relaxation-based interventions on health related outcomes of

patients with COPDA systematic review
Doris Yu1, Royce Yum2, Wing To3
1.
Hospital Authority, 2. Hospital Authority, Hong Kong, 3. The Chinese University of Hong Kong
Presenting Authors Email: royceyum@gmail.com
Purpose
Chronic obstructive pulmonary disease (COPD) has become an important public health
problem among the elderly population. With the global trend of population aging, urban air
pollution and increased life-style risk factors such as smoking, it is anticipated that the
epidemic of this life-threatening chronic disease will have an upward trend in the next decade.
Although psychological distress is highly prevalent among older people with COPD,
resources and effort spent in psychological care in people with COPD are insufficient.
As a result, a systematic review aimed at examining the effect of relaxation-based
intervention on health-related outcomes of people with COPD has been conducted. The
primary objective of this review is to identify the best available research evidence related to
the effectiveness of relaxation-based interventions on health outcomes of people with chronic
obstructive pulmonary disease (COPD). The secondary objective of this review is to compare
the effects of physical approach and non-physical approach relaxation on its outcomes of
people with COPD.
Design
Types of participants
This review included studies that examine adult patients aged 18 or above, with a clinical
diagnosis of mild, moderate, severe or very severe chronic obstructive pulmonary disease.
Types of intervention
Studies were considered for inclusion in this review if they examine the effect of the
relaxation-based intervention and compared it with the usual care on the health related
outcomes of people with COPD.
Types of outcomes
The primary outcomes of interest in this review were emotional status, symptom severity,
level of activity tolerance, health related quality of life.
Types of studies
Only studies that were written in English or Chinese and adopted the RCT design were
included in this review. In the absence of RCTs, other research designs such as nonrandomized controlled trials, quasi-experimental, before and after studies had also been
considered.
Methods
A three-step search strategy was utilized in this review. An initial limited search of
MEDLINE and CINAHL was undertaken followed by analysis of the text words contained in
462
the title and the abstract, and of the index terms used to describe article. Secondly, a
comprehensive search using all identified keywords and index terms have been performed
across all included databases. Thirdly, a hand searching for additional studies was completed.
Data was extracted by two independent reviewers.
Results
Twelve studies were identified in this review. Intervention of the studies included yoga,
progressive muscle relaxation therapy (PMRT), music, guided imagery and mindfulnessbased therapy. Effects on anxiety, level of dyspnea, 6-minutes walking test and health related
quality of life were inconsistent across the trails.
Conclusions
There are no consistent effects on anxiety, level of dyspnea, 6-minutes walking test and health
related quality of life. A variety of outcome measures among the studies leading to difficulty
in combining and interpreting the result. The current review indicates a higher
methodological quality of the research design is utmost important for development and
evaluation of relaxation-based intervention.
35Keywords
COPD, relaxation, health related outcomes
463
Nursing care of patients with gastric cancer and cachexia to learn home
parenteral nutrition.
Meng-Yuan Liu1, Yu-Kuei Chen1
1.
Presenting Authors Email: D03849018@ntu.edu.tw
Purpose
This article describes the nursing care of a patient with gastric cancer and cachexia, besides
physical discomforts, to feel anxious for accept home parenteral nutrition.
Design
The nurse apply Gordons 11-item function health assessment as a guideline to collect
subjective and objective datas through direct observation, care, communication and physical
assessment from Auguest 29 to September 9, 2011.
Methods
The nurse apply Gordons 11-item function health assessment as a guideline to collect
subjective and objective datas through direct observation, care, communication and physical
assessment from Auguest 29 to September 9, 2011.
Results
The major nursing problem were identified: malnutrition, risk of trauma, lack of knowledge.
The nurse provided care, listening, empathy to explore the needs of patient and family, to
evaluate the ability and will of learningTeaching correct skill of home parenteral nutrition
by demonstration and practices, the nurse use provision of company and sharing to help
patient adjusting pressure.
Conclusions
To keep continuous care, nurse use telephone interview after discharge.
35Keywords
home parenteral nutrition, gastric cancer, cachexia, ,
464
The nursing experience of caring a terminal hepatocellular carcinoma

patient with attempted suicide.
Hui-Chuan Chang1, Yu-Kuei Chen1, Ming-Ying Hong1
1.
Presenting Authors Email: joy6784@yahoo.com.tw
Purpose
This article described the role of nurse practitioner to care for a middle-aged male with
terminally hepatocellular carcinoma patient. The patient has in addition to physical discomfort,
but also face the impact of disease progression, and the absence of effective family support,
causing the patient wrathful to holding knife autolesion.
Design
The author in care cases process fulfilling the role of nurse practitioners function, and apply
Gordons 11-item function health assessment as a guideline to collect datas through direct
observation, physical assessment and interview.
Methods
The author in care cases process fulfilling the role of nurse practitioners function, and apply
Gordons 11-item function health assessment as a guideline to collect datas through direct
observation, physical assessment and interview.
Results
The major nursing problem were identified: pain, hopelessness, and ineffective family coping.
The period of nursing care was between August 5th, 2012 and September 25th, 2012, the
author was conducted multidisciplinary medical teams to care for patient, included pain
control, provide physical and spiritual comfort, and do the lubricant between the patient with
families. Help the patient make life review, and recognition of his sadness with reluctant for
families. Let family members accompany the last period of life.
Conclusions
By sharing this experience, so that the medical staff of terminal cancer patients in terms of
psychological distress or suicidal tendencies have greater sensitivity to provide immediate and
appropriate care.
35Keywords
suicide, liver cancer, multidisciplinary, ,
465
Factors affecting cognitive function in breast cancer patients receiving

hormonal therapy
Sena Yamamoto1, Harue Arao1, Erina Mashiro2, Tomoko Yoshioka3, Eiko Masutani4
1.
Osaka University Graduate School of Medicine, Division of Health Sciences, 2. Osaka University
Hospital, 3. University Hospital, Kyoto Prefectural University of Medicine, 4. Osaka University
Graduate School of Medicine, Cancer Education and Research Center
Presenting Authors Email: sena18@sahs.med.osaka-u.ac.jp
Purpose
Although hormonal therapy is useful in the treatment of patients with hormone receptorpositive breast cancer, some studies have reported that patients receiving hormonal therapy
experience cognitive changes. Therefore, in this study, we aimed to investigate factors
affecting cognitive function in breast cancer patients receiving hormonal therapy.
Design
A cross-sectional study using a self-administered questionnaire
Methods
A self-administered anonymous questionnaire survey was conducted on 133 breast cancer
patients receiving hormonal therapy. The data collected included demographic information
and data regarding cognitive function and symptoms that may affect cognitive function,
including menopausal symptoms, insomnia, fatigue, anxiety, and depression. Cognitive
function was evaluated using an 11-item scale, which we developed based on previous studies.
Each item was assessed on a 6-grade scale that ranged from 0 (not at all) to 5 (frequently).
The total scores ranged from 0 to 55, with higher scores representing worse cognition.
Menopausal symptoms were evaluated with the simplified menopausal index (SMI), a 10item scale that assesses symptom severity on a 4-grade scale. In SMI, higher scores (0100)
indicate a higher degree of severity. Other symptoms were assessed on an 11-grade scale from
0 (none) to 10 (severe). Responses were collected by mail. After calculating the correlation
coefficients, we performed a multiple regression analysis. For the data analysis, SPSS ver.21
was used. This study was approved by the Institutional Ethical Review Board.
Results
A total of 82 patients responded (response rate: 61.7%). Their mean age was 52.3 8.3 years,
and the mean duration of hormonal therapy was 25.0 17.2 months. The mean cognitive
function score was 20.8 12.2. The mean SMI score was 38.7 19.0. The mean scores of
insomnia, fatigue, anxiety, and depression were 2.8 2.7, 2.7 2.6, 3.6 2.6, and 2.6 2.6,
respectively. A regression model, including age, duration of hormonal therapy, types of
medication for hormonal therapy, and all symptoms as the main structural variables,
explained 30.3% of the total variation in cognitive function (adjusted R-squared = 0.303, p <
0.001). Cognitive function was significantly affected by the SMI score ( = 0.49, p < 0.001).
Depression was a marginally significant factor ( = 0.36, p = 0.07). Other symptoms, age,
types of medication, and duration of hormonal therapy did not significantly affect cognitive
466
function. The SMI score was significantly correlated with insomnia, fatigue, anxiety, and
depression (r = 0.560.67, all p < 0.001).
Conclusions
The severity of menopausal symptoms was a predictive factor for cognitive changes in breast
cancer patients receiving hormonal therapy. Menopausal symptoms may have an indirect
effect that is associated with other symptoms. It is therefore important to assess various
symptoms and cognitive function carefully in these patients.
35Keywords
Breast cancer, Hormonal therapy, Cognitive function, ,
467
The introduction of aCaring for couples coping with cancer (4Cs)

programme to support couples coping with cancer
Qiuping Li1, Yim-Wah Mak1, Wan-Chaw Shae2
1.
School of Nursing, The Hong Kong Polytechnic University, 2. Department of Applied Social
Sciences, The Hong Kong Polytechnic University
Presenting Authors Email: 11902615r@connect.polyu.hk
Purpose
The diagnosis of cancer and its treatment have a major impact on both patients and their
family caregivers, particularly the spousal caregivers. Being the primary informal caregiver
for cancer patients, spousal caregivers are the population at high-risk of hidden morbidity.
Factors impacting couples coping with cancer are complex, and there is mutual impact in
spousal caregiver-patient dyads. It is the purpose of this study to develop an acceptable,
feasible, and potentially effective Caring for Couples Coping with Cancer 4Cs
programme aims to provide support to couples coping with cancer in China.
Design
This is a mixed method study that includes quantitative and qualitative approaches.
Methods
There were three steps in the process of developing the Caring for Couples Coping with
Cancer 4Cs programme, which include (1) identifying the evidence: a series of extensive
reviews of literature and a focus group study were conducted; (2) identifying/developing
theory: a review of related frameworks and a preliminary Live with Love Conceptual
Framework P-LLCF was proposed; and (3) modeling process and outcomes of the 4Cs
programme: the Caring for Couples Coping with Cancer 4Cs programme was developed
based on the P-LLCF.
The theoretical concept analysis process was also applied to guide the step of
identifying/developing theory. This was done so according to the procedure for theory
construction. Two researchers each carefully examined the related concepts and components
of the relevant conceptual frameworks identified from the reviews of literature in step 1. Both
scrutinized each concept and component for its definition, attributes, antecedents, and
consequences, and examining their consistency in the context of cancer couple dyads. The
two researchers sat together to discuss thoughts and ideas, to resolve any disagreements. A
matrix table was created to delineate the relationship between the key concepts and
components in formulating the P-LLCF.
Results
The main contents of this developed 4Cs programme include six sections: primary stressors
(section 1); secondary stressors (section 2); dyadic mediator (section 3); dyadic appraisal
(section 4); dyadic coping (section 5); and a program overview (section 6). This programme
will be delivered by researcher/therapists over six weeks with emphasis on supporting couples
468
coping with cancer. A booklet was developed to provide participants an easy access to written
information on their common concerns in their caring for loved ones with cancer.
Conclusions
A potentially effective, feasible and acceptable Caring for Couples Copying with Cancer
4Cs programme was developed based on the proposed preliminary Live with Love
Conceptual Framework (P-LLCF). This was done with the extensive evidence support from
numerous reviews of literature, findings of a focus group study on cancer couple dyads, and a
proposed preliminary Live with Love Conceptual Framework (P-LLCF). Future research is
needed to pilot and evaluate the feasibility, modeling and outcomes of this 4Cs programme.
35Keywords
Cancer, spousal caregiver, caring, couples coping, intervention
469
Characteristics of communication skills of general ward nurses for endstage cancer patients and their families
Saori Yoshioka1, Michiko Kajiyama2, Maki Taniyama1
1.
International University of Health and Welfare, 2. Nursing School of Yokohama Medical Association
Presenting Authors Email: s-yoshioka@iuhw.ac.jp
Purpose
Over 300,000 people die of cancer annually in Japan, and most deaths (about 90%) occur in
general wards (Health, Labour, and Welfare Statistics Association, 2014). Therefore, general
ward nurses are required to provide quality end-of-life nursing care for dying patients and
their families. However, many nurses have difficulty and feel anxiety regarding this
communication. In Japan, about fifty percent of nurses are mid-career, with 5 to 20 years of
clinical experience. However, a previous study reported that there is a period during which
their practical abilities fail to improve (Tsuji et al., 2007), possibly exerting a negative impact
on the quality of end-of-life nursing care. The purpose of this study was to analyze
characteristics of the communication skills of mid-career nurses for end-stage cancer patients
and their families.
Design
A descriptive, cross-sectional, correlational survey.
Methods
Two hundred mid-career nurses working in general wards were asked to respond to a
questionnaire. The "active listening" of the Nursing Interventions Classification (NIC) was
used as a scale to evaluate communication skills in this study (Bulechek et al., 2013). The
MITORI care scale for evaluating nurse's end-of-life care ability (Yoshioka et al., 2009), the
Frommelt Attitude Toward Care of the Dying Scale - Form B Japanese version (FATCOD-BJ) (Nakai et al., 2006), and questions about learning experiences, existence of a role model,
and attributes were also included in the questionnaire. Descriptive statistics, Pearson's
correlation coefficients, and Student's t-tests were employed for the analysis. With regard to
ethical considerations, protection of anonymity and privacy were explained to subjects. The
Ethics Committee of the International University of Health and Welfare approved this study.
Results
A total of 165 (81%) valid responses were obtained. In terms of communication skills, scores
for the items establish the purpose for the interaction and clarify the message through
the use of questions and feedback tended to be low. In contrast, scores for the items be
aware of the tone, tempo, volume, pitch, and inflection of the voice and avoid barriers to
active listening (minimizing feelings, offering easy solutions, interrupting, talking about self,
and premature closure) were high.
A medium correlation between communication skills and nurse's end-of-life care ability was
observed (r = 0.54, p < 0.01), and a somewhat weak correlation between communication
skills and FATCOD-B-J (r = 0.35, p < 0.01) was observed. Scores for communication skills
470
were significantly higher for mid-career nurses, who had sufficient learning experiences in
family nursing and recognized the existence of role models for communication and nursing (p
< 0.05).
Conclusions
With respect to communication skills, mid-career nurses have problems establishing
relationships with end-stage cancer patients and their families, and lack skills to make
messages clear using effective questions and feedback. It was predicted that improvements in
communication skills would contribute to better quality end-of-life care. Moreover, nurses
who attached great importance to the relationship between family members, had positive
attitudes toward caring for dying patients and their families, and recognized the existence of
role models, demonstrated better communication skills.
35Keywords
cancer nursing, end-of-life care, communication, mid-career nurse,
471
Visitors needs and nursing support at cancer information section

Kiyomi Kurata1, Motomi Tao1, Junko Kitajima1, Mariko Koike1, Keiko Tazumi2, Harue
Arao1
1.
Osaka University Graduate School of Medicine, Osaka, Japan, 2. Osaka University Hospital, Osaka,
Japan
Presenting Authors Email: k-kurata@sahs.med.osaka-u.ac.jp
Purpose
In Japan, all cancer care hospitals are required to have a consultation support center as a
designated requirement under the Basic Law for Cancer Measures established in 2006. In
Hospital X, a cancer information section has been established since 2012 in addition to a
cancer consultation support room managed by a cancer nursing specialist. This information
section provides information on cancer and is open twice a week. Graduate students of the
oncology certified nurse specialist (OCNS) course and medical social workers take turns to
work in this section. The purpose of this study was to reveal visitors needs and the content
of nursing support at the cancer information section in Hospital X.
Design
This study was analyzed by using a descriptive statistical method.
Methods
Data were collected from April 2013 to March 2014. The number of visitors, visitors needs
and content of nursing support by graduate students of the OCNS course were reviewed. This
study was approved by the leader of the oncology center. Data were maintained in a secure
location, and the confidentiality of both the visitors and the graduate nursing students was
maintained.
Results
A total of 279 people (33% men and 67% women) visited the cancer information section.
Graduate students of the OCNS course counseled 122 of these visitors. The needs of visitors
were information about the disease, treatments and side effects (29%) and consultations about
wigs (12%) and so forth. Most people visited during the treatment period. The visitors
needs were met by provision of leaflets to visitors (33%), introducing visitors to the cancer
consultation support room (28%), accepting requests for correspondence by MSW (18%),
listening (10%), introducing patient advocacy groups (3%) and so forth. Graduate students of
the OCNS course assessed the plural needs of patients and their families in order to perform
the nursing support by judging whether they could deal with each case by only providing of
information or they needed to request for correspondence with nursing specialists assessing
the many needs of patients and their families.
Conclusions
Visitors of the cancer information section have multiple needs. Graduate students of the
OCNS course make it possible to practice appropriate, timely and continual nursing support
of cancer patients and their families.
472
35Keywords
Cancer patient, Needs, Nursing support, Graduate student of OCNS course,
473
Overview of and issues in nursing care for edema in patients with end-stage
cancer in Japan
Sachie Miyake1, Naomi Ota2
1.
Kawasaki University of Medical Welfare Graduate School of Health and Welfare Master & Program
in Nursing, 2. Kawasaki University of Medical Welfare
Presenting Authors Email: jgsmp306@ybb.ne.jp
Purpose
As lymphatic edema is aggravated along with cancer progression, many patients with endstage cancer in Japan have concurrent generalized edema caused by circulatory failure or
hypoproteinemia, resulting in impaired activities of daily living. Completed decongestive
therapy (CDT) is relatively contraindicated in patients with end-stage cancer because of the
potential of causing adverse events such as cardiac failure symptoms and increased ascites;
therefore, this therapy cannot be proactively performed at present. Consequently, the quality
of life is reportedly impaired in end-stage patients under treatment. The objective of this study
is to elucidate the overview of care, i.e., what type of care is administered to end-stage cancer
patients with edema in Japan, and the theme of future studies.
Design
Japanese literature review
Methods
Using the web version of the Japan Medical Abstracts Society as a literature search database,
we searched literature published between 1983 and 2014 containing the key words end
stage, edema, cancer, malignant lymphatic edema, generalized edema,
care, nursing, and skin care. We closely read the literature obtained and
examined only the studies reporting that nurses provided care for edema in end-stage cancer
patients.
Results
We studied literature contents and extracted 13 papers. The number of studies was one in
2002 and subsequently increased to two in 2008, showing a slight increasing trend. Most
studies were case reports, and there was no original article. The patients receiving care had
breast cancer, uterine cancer, prostate cancer, esophagus cancer, and malignant lymphoma.
The type of edema was not generalized edema even in patients with end-stage cancer; care
was administered to improve localized edema in the upper and lower extremities. With regard
to care method, the patients received manual lymphatic drainage (MLD), skin care,
aromatherapy, and acupuncture point pushing. The efficacy of care was evaluated by
perimeter measurement, face scale, and patient's feeling, with perimeter measurement and
face scale showing improvement. Care provided by directly touching the skin resulted in a
secondary effect of security and comfort, and mental and psychological improvements were
also observed.
Conclusions
474
The number of studies on edema in end-stage cancer patients in Japan is very limited, and
case studies of localized edema are the most common. No intervention study has been
conducted based on the needs of end-stage cancer patients with edema. The present study
suggested the necessity to conduct future studies to clarify the needs of patients, develop
programs, and conduct interventions. Studies are also required to develop assessment scales in
order to verify the efficacy of interventions.
35Keywords
End stage, edema, cancer patients, care, nursing
475
A research on the diverging point of YURAGI among cancer survivors

Misuzu Shimada1, Sawa Fujita2
1.
Ehime Prefecturaal University of Health Science, 2. University of Kochi
Presenting Authors Email: mshimada@epu.ac.jp
Purpose
Our research aims at defining yuragi of patients, who had been diagnosed with cancer for
the first time. This report focusses on a turning point of yuragi, which is one of the
characteristics of those cancer survivors.
Design
This research employs grounded theory for a qualitative and descriptive study design.
Methods
Its data concerning emotions and experiences of the patients after their cancer diagnosis was
acquired by using the semi-structured interview method. The Modified Grounded Theory
Approach (M-GTA), advocated by Professor Yasuhito KINOSHITA (2009), is adopted here
to analyze.
Results
We interviewed 20 survivors who had been diagnosed with cancer for the first time, and had
undergone gastrectomy. The patients yuragi started from severe mental turmoil. During
the process, the yuragi caused the patients to develop nostalgia for the days when they did not
face any major health problem, which led them to the state of being envious of themselves
before developing cancer. This state can be further subcategorized into two aspects, which
are coveting the healthy self in the past and hoping to recover to the previous healthy
state. By coveting the healthy self in the past, they mourned the good old days, could
not accept the present situation as cancer survivors, and showed feelings of tremendous
restlessness. Meanwhile, they recalled memories of being healthy, started hoping to
recover to the previous healthy state, and manifested their utmost efforts to complete
treatments in order to cope with the yuragi. Therefore, being envious of themselves before
developing cancer brings about two individual ways; one, to the retracting direction of
severe mental turmoil, and the other, to the counter direction of diminishing it.
Conclusions
The two subcategories of being envious of themselves before developing cancer, which
are coveting the healthy self in the past and hoping to recover to the previous healthy
state, differ in direction, because the former draws back to the state of severe emotional
struggles, whereas the latter tries to settle it down. Being envious of themselves before
developing cancer marks hence a turning point for the yuragi of cancer survivors.
35Keywords
Yuragi, cancer survivor, turning point,
476
Why do authors publish their own Tobyo-Ki? focus on books written

by breast cancer patients
Michiko Kadobayashi1, Mizue Shiromaru2, Takehiko Ito3, Migiwa Nakada2, Satomi
Mizutani4, Mikiyo Sato5, Mari Honma6, Tomoe Kodaira7
1.
Faculty of Integrated Arts and Social Sciences, Japan Women's University, 2. School of Health
Sciences, Sapporo Medical University, 3. Department of Psychology and Education, Wako University,
4.
Faculty of Health Care and Nursing, Juntendo University, 5. Department of Nursing, School of
Health Sciences, Tokai University, 6. Department of Rehabilitation, Sapporo Medical University, 7.
School of Nursing, Seirei Christopher University
Presenting Authors Email: m-kadobayashi@kmd.biglobe.ne.jp
Purpose
In Japan, there is a social phenomenon of publishing books about the experiences of patients,
which is called Tobyo-ki. The number of these types of publications has remarkably
increased with the increasing focus on the feelings of patients in the field of medicine since
the latter half of 1990s. Most of these books are written by patients with cancer, accounting
for approximately half of all the Tobyo-ki books, with those written by patients with
breast cancer being the most common of these.
Why do authors publish Tobyo-ki? We examined motivations for writing Tobyo-ki
books of patients with breast cancer in this study. We aimed to determine whether there are
any particular features of this experience that differ from those of persons affected by other
cancers.
Design
Qualitative investigation methods
Methods
We examined 63 Tobyo-ki books (54 authors), which were written by patients with
breast cancer and published in the 2000s. We extracted narratives about motivations and
grouped these into several categories.
Results
Most of the authors included in this study were journalists, writers, and essayists who were
accustomed to writing. Educators (professors or teachers) comprised the second largest group.
The third most common occupation was that of medical staff (doctors or nurses). A few
authors were famous actresses or singers. The average age of the authors at the time of
publication was approximately 48.7 years and that of breast cancer onset was approximately
43.8 years. Approximately 60% of the authors were in their 40s and 50s. Tobyo-ki by
477
patients with breast cancer differed from Tobyo-ki by patients with other disease in that
were the narratives describing the progress, following diagnosis. The time between diagnosis
and publication ranged from 1 year to more than 30 years. The motivations for publication of
patients with breast cancer were as follows.
The most common motivation for publishing Tobyo-ki was to share their messages
based on their experiences of breast cancer, which caused various types of suffering over
several years. However, they wished to share not only the painful aspects of their disease but
also the benefits discovered through their progress. Most of the authors wanted to be useful to
other patients and society. Some authors published their books to leave a proof of their lives.
In addition to sharing their experiences, some authors appealed strongly about the importance
of its diagnosis in early stages because breast cancer is a disease that women can detect by
self-examination. We observed that some authors were motivated by a firm sense of duty to
enlighten others rather than to suffer from breast cancer. Furthermore, we found that the latter
two motivations were associated with aging.
Conclusions
The motivations of the authors with their breast cancer experiences to publish Tobyo-ki
were classified into five categories: conveying their message, wanting to be useful,
leaving behind a proof of themselves, having a sense of mission, and wanting to
be understood.
35Keywords
Tobyo-ki, breast cancer , experience, motivation, publication
478
Difficulties faced by nurses caring for patients with hematologic

malignancies and their families
Kaori Murata1, Mizue Shiromaru2, Migiwa Nakada2
1.
Graduate School of Health Sciences , Sapporo Medical University, 2. Department of Nursing, School
of Health Sciences, Sapporo Medical University
Presenting Authors Email: kmurata@sapmed.ac.jp
Purpose
Hematologic malignancies progress more rapidly than solid tumors, leading to lower survival
rates. When dealing with such diseases, nurses are likely to face a number of difficulties.
Considering such a situation, this study aimed to clarify difficulties faced by nurses caring for
patients with hematologic malignancies and their families.
Design
A qualitative and descriptive study
Methods
Semi-structured interviews were conducted for 30 to 60 minutes with 7 mid-career nurses
with experience of working on hematology wards for 3 years or more, focusing on their
difficulties when caring for patients with hematologic malignancies and their families. The
obtained data were classified based on their semantic contents, summarized, and categorized
into categories and subcategories based on semantic similarities. This process was performed
by 3 researchers to ensure its validity. The study period was from January to March 2014.
Results
The numbers of males and females were 1 and 6, respectively, with a mean age of 31.4 (
6.95). The mean number of years working on hematology wards was 8.0 (1.15). Six had
been involved with transplantation, and 1 had not. The nurses difficulties when caring for
patients with hematologic malignancies and their families were classified into the following 4
categories, with 11 subcategories: [difficulty related to the disease or treatment]: such as
difficulty due to the complex pathology of hematologic diseases or transplantation; [difficulty
in facing life through nursing care]: such as difficulty in supporting patients in severe
conditions requiring long-term treatment, particularly when providing decision-making or
mental support; [a sense of helplessness]: such as a feeling of emptiness when facing
deterioration, leading to difficulty in maintaining motivation; and [difficulty due to the doctor
s different perspectives]: such as difficulty due to differences in opinions between the doctor
in charge and nurses.
Conclusions
In this study, all subjects had experience of working on hematology wards for 8 years or more,
and it was demonstrated that even nurses with such experience had a sense of difficulty
regarding the diseases they dealt with. This led to difficulty in appropriately providing nursing
479
care and mental distress, such as a sense of helplessness. In order to prevent nurses from
being burnt out or leaving their job, it may be urgently necessary to address such difficulties.
35Keywords
Hematologic malignancies, nurses, difficulties, ,
480
Narratives about chemotherapy in Tobyo-ki: From autobiographies written

by women with breast cancer
Mizue Shiromaru1, Satomi Mizutani2, Ito Takehiko3, Migiwa Nakada1, Mikiyo Sato4,
Michiko Kadobayashi5, Tomoe Kodaira6, Mari Honma1
1.
Sapporo Medical University, 2. Juntendo University, 3. Wako University, 4. Tokai University, 5. Japan
Womens University, 6. Seirei Chiristopher University
Presenting Authors Email: shiro.m@sapmed.ac.jp
Purpose
Womens morbidity of breast cancer has been increasing since 1975 in Japan. One of the
breast cancer treatments is chemical care using anticancer drug. It is assumed that breast
cancer patients experience physical and psychological pain cause by the side effects such as
feeling of sickness, vomiting, and hair loss. The purpose of this study is to unveil the patients
feelings and thoughts about chemical cure based on their Tobyo-ki or autobiography books. It
will be the first step in seeking for ways of helping breast cancers.
Design
Qualitative and quantitative approach by text mining
Methods
Five Tobyo-ki books written by people with breast cancer were extracted from 12
autobiographies published during 2010-2013. Text mining analysis was conducted using the
Text Mining StudioVer4.0. Narratives on the treatment of breast cancer focusing on the
chemotherapy were analyzed by categorizing the keywords of anticancer drugs in relation to
adjectives, and the use of reference to the contexts.
Results
Among the five Tobyo-ki books, two were published when the authors were in their 40s, one
in her 70s, and two were published after their death. The total number of the sentences is
5,682 consisted of 38,100 words. The adjectives associated to anticancer drugs were
miserable, impatient, and desperate. One example of the word miserable
was used in the context of acomia, where a patient suffered from hair loss: During hormone
therapy, I was irritated by trivial events and got tough and harsh to my daughter. I felt
miserable and had deep regret to myself and cried again. The word impatient was
used such as: I felt impatient toward myself because I hadnt had the courage to refuse
to accept the chemotherapy. The word desperate was used to express physical agony
such as: One week after I took anticancer drugs, I felt hot fever in my head which was
intolerably itchy. All these examples expressed feelings toward uncontrollable distress,
pain, and suffering.
Conclusions
481
According to the results of text mining analysis, co-occurred words such as miserable,
impatient, and desperate, represented the authors agony and frustration and hard
experience caused by side-effects.
35Keywords
breast cancer, text mining, Tobyo-ki,, side-effects, autobiographies
482
The current status of studies on benefit finding in Japan

Tomoki Maeda1
1.
Kawasaki University of Medical Welfare
Presenting Authors Email: w5313003@kwmw.jp
Purpose
To investigate studies on benefit finding reported in Japan, and clarify the current status and
issues of such studies.
Design
Literature review.
Methods
We conducted a literature review on studies published until 2013 by the Japan Medical
Abstract Society, CiNii, and Google Scholar using benefit finding as a keyword.
Conference proceedings were excluded. Six articles were selected for this review.
Results
Three qualitative and 3 quantitative studies were collected. Studies on benefit finding were
first reported in 2007 in Japan. Study subjects included cancer patients in 4 articles
(participants of support groups for cancer patients in 3 articles), patients with mental disorders
in 1 article, and patients with connective tissue disease in 1 article. One, two, and 3 articles
targeted subjects aged between 20 and 60 years old, those aged 20 years and older, and those
of all ages, respectively. Two quantitative studies used the translated version of the benefitfinding scale developed in another country. One quantitative study used the scale developed
by us. Although all articles defined benefit finding as the positive psychological change
experienced as a result of overcoming challenges in life, the positive psychological changes
that subjects showed differed among the studies.
Conclusions
There were few studies on benefit finding, as they are relatively new in Japan. No study
focused on benefit finding in patients with different types of cancer or elderly individuals.
Further studies must be conducted to examine the experience of benefit finding.
35Keywords
Benefit, Finding, Literature, Japan,
483
Nursing experience of caring a small cell lung cancer patient

in the terminal stage
Yu-Ju Chuang1, Yu-Kuei Chen1, Ming-Ying Hong1
1.
Presenting Authors Email: ativann@yahoo.com.tw
Purpose
This article described the nursing experience of caring a small cell lung cancer patient in the
terminal stage.
Design
The nursing care from Nov. 13 to Nov. 20, 2012, the author collected data which included
physical, mental, social and psychological through interview, observation, listening and
health assessment.
Methods
The nursing care from Nov. 13 to Nov. 20, 2012, the author collected data which included
physical, mental, social and psychological through interview, observation, listening and
health assessment.
Results
The patients health problems were identified as impaired gas exchange, pain and
anticipatory brief. We used non-medicines therapy to improve the patients dyspnea and
pain. In addition, we encouraged the patient to express her feelings toward the disease and her
though about dying in order to reduce the stress and grief.
Conclusions
Finally, we provided life review and religion, to help the patient and family to diminish the
feeling of fear, and let the patient to understand the value of life. This article could provide
clinical nursing staff more information in caring patients with terminal lung cancer.
35Keywords
Lung cancer, terminal Stage, Nursing Experienc
484
A case report: Nursing care for a single mother with neuroblastoma by

nurse practitioner
Yu-Fan Chen1, YU-Kuei Chen1, Ming-Ying Hong1
1.
Presenting Authors Email: sweet.yu.fan@gmail.com
Purpose
This article is to present the importance of establishing a data base for non-native speakers, an
effective medical referral system, and enhanced cooperation between the headquarter hospital
and branches by sharing the treatment experience of a 35-year-old female Indonesian patient.
Design
The patient coming from a single parent family was diagnosed with neuroblastoma and
suffered from critical development of the tumor, the disappointing treatment failure, and
consequent emotional breakdown. Unfortunately, the patients international background
made the patients treatment experience even harder.
Methods
the primary care nurse practitioner adopted the Neuman System Model was used to identify
the problems of healthcare during 1 August to 4 Oct 2013 of the neuroblastoma patients.
Results
The major contributors were found physical pain, hopelessness, and potential caregiver role
strain. As a result, the proposed solutions included fostering therapeutic nurse-patient
relationships by proactively listening to the patients physical and emotional needs,
providing integrated multidisciplinary resources, and offering healthcare consultation and
practical guidance.
Conclusions
With the joint efforts made by the medical team, not only the patients father was able to fly
over and extend his visa to take care of her in Taiwan but the patient may also be referred to
our branch hospital smoothly to continually take hospice care.
35Keywords
neuroblastoma, Neuman System, nurse practitioner, ,
485
Nursing care of young woman patient faced with the threat of pancreatic
cancer disease
Shiang-Lan Yan1, Yu-Kuei Chen1, Ming-Ying Hong1
1.
Presenting Authors Email: 020219@ntuh.gov.tw
Purpose
This article describes the nursing experience of a young women newly diagnosed with
pancreatic cancer end stage. during hospitalization.
Design
The nursing period extended from January 23 to March 1, 2013. The nurse use physical,
psychological, social, developing and spiritual aspects to accomplish the nursing assessment.
Methods
The primary nurse use cancer-related fatigue assessment toolspain controllisten
companionship and psychological support, the nurse helped to alleviate her physical
discomfort and establishing a forward view of the disease, along with to assist in
communicating with their families express their needs, reduce the patient anxiety.
Results
There major nursing problems were fatigue, pain, and anticipatory grief. The primary nurse
use cancer-related fatigue assessment toolspain controllisten companionship and
psychological support, the nurse helped to alleviate her physical discomfort and establishing a
forward view of the disease, along with to assist in communicating with their families express
their needs, reduce the patient anxiety.
Conclusions
Through this nursing experience to provide clinical nurses in the care of such patients with
individualized care and appropriate.
35Keywords
pancreatic cancer, young woman, Nursing, ,
486
Lower urinary tract symptoms of prostate cancer patients undergoing

treatments over eight-month follow-up
Hui-Chi Li1, Yu-Hua Lin1, Tai-Been Chen1
1.
I-Shou University
Presenting Authors Email: huichili@hotmail.com
Purpose
To examine the changes in lower urinary tract symptoms (LUTS) after open radical
prostatectomy (ORP), laparoscopic radical prostatectomy (LRP), and brachytherapy (BT) and
to determine which treatment resulted in improved LUTS at eight months follow-up.
Design
A time-series survey design with descriptive and comparative elements.
Methods
A sample of 51 prostate cancer patients was recruited: ORP = 20, LRP = 23, and BT = 8. Data
were collected at six time points: before treatment/baseline, 1 week post-treatment , 1 month
post-treatment, 2 months post-treatment, 3 months post-treatment, and 8 months posttreatment. The LUTS were assessed using the International Prostatic Symptom Score (IPSS),
with a higher score indicating a worse condition. One-way ANOVA was used to predict the
progress of urinary symptoms after treatments. Bootstrap re-sampling was conducted to
assess the stability of the outcomes.
Results
Although there were no significant differences in the LUTS among the three groups after
treatments, the LRP group had the lowest IPSS score at baseline. Compared with the baseline
symptoms for patients undergoing each treatment, there were significant improvements after
two months in the ORP and BT groups, and after three months in the LRP group.
Conclusions
The prostate cancer patients undergoing the three treatments have similar LUTS over eightmonth follow-up although different LUTS were presented before treatments. The aftertreatment changes of LUTS in each group were different over eight-month.
35Keywords
Brachytherapy, Lower urinary tract symptoms, Prostate cancer, Radical prostatectomy,
487
Development of a nursing model for supporting a shared decision making

process with a cancer patient
Yuko Kawasaki1
1.
University of Hyogo
Presenting Authors Email: yuko_kawasaki@cnas.u-hyogo.ac.jp
Purpose
Although many studies have been conducted on the decision-making support processes
between doctors and patients regarding treatment selection, few studies examine the
techniques specifically used for these processes as they relate to nurses and patients when
making care decisions. This study was a semi-experimental research to determine the effects
of the nursing shared structured decision-making model(NSSDM), when nurses support
cancer patients in decision-making in the treatment of cancer.
Design
A Quasi-Experimental Study
Methods
Cancer patients who participated in this study received decision-making support from clinical
nurse specialists in Oncology. Patients in the control group received conventional decisionmaking support while those in the intervention group received support with NSSDM.
Assessment of the effects of intervention was conducted with STAI and DCS.
Results
The number of cancer patients who participated in the study was 29 in the control group and
27 in the intervention group. The mean interview duration was 55.522.4 minutes/session in
the control group and 70.840.3 minutes/session in the intervention group, showing that one
interview session took 15.2 minutes longer in the intervention group in which the NSSDM
was used. In this study, eight clinical nurse specialists in Oncology conducted interview
consultation sessions regarding cancer care. The duration of the nurses experience was
170.546.6 months, with the affiliated medical institutions was 72.266.4 months, as clinical
nurse specialists in Oncology was 33.528.5 months, and in consulting was 43.521.3 months.
The number of the consultation cases they conducted was 28.115.9 cases/month.
Although the STAI scores after the interviews were lower than those before the interviews in
all sub-scales, there was no significant difference in the range for both state anxiety and trait
anxiety. No significant difference in all DCS sub-scales was observed between the two groups.
However, after excluding two cases with distinctive changes in DCS after the interviews
(sharp increase and decrease), there was a significant difference in the range of the scores in
two of the five sub-scales between the two groups. informed (P=0.02, 0.05)and
value clarity (P0.031, 0.05)
Conclusions
488
It was clarified that decision-making support with NSSDM is effective in helping the patient
clarify his/her sense of values. However, since cancer survivors may experience new conflicts
after receiving new information, healthcare workers need to support decision-making,
considering the situation of conflicts in cancer patients.
Cancer survivors are able to make decisions based on their own values by receiving a decision
support along this model from nurse.
35Keywords
cancer patients, shared decision-making, decision-support
489
The efficacy of His@home, an iPad application, for in-home palliative

care
Momoe Utsumi1, Satoshi Sasayama1, HIroshi Dekigai2, Shinichi Nomoto1
1.
Kyoto University, 2. Dekigai cinic
Presenting Authors Email: utsumi.momoe.8r@kyoto-u.ac.jp
Purpose
Personalized, in-home palliative medical care that provides an acceptable quality of life is in
high demand, although this requires collaboration between various medical professionals.
Unfortunately, these professionals are often based at different facilities, which can hamper the
effective sharing of information. Thus, we developed His@home (a patient-centered
Healthcare Information sharing System at home), an iPad application.
His@home enables home-care patients and their family members to input data on a daily
basis and uses cloud computing to communicate this information to their healthcare team in a
timely manner. The programs fonts and buttons are large enough to read easily, and the
application is intuitive.
Here, we report on the utility of His@home in providing in-home palliative care to cancer
patients.
Design
Observational study
Methods
Following a verbal explanation of the study, two patients and their healthcare teams agreed to
participate, and were given an iPad with His@home installed. To connect with the application
and access patient information, medical staff members were provided a secure username and
password, and all user access histories were saved in the server database. The His@home
application can only be installed on authenticated iPads. An interview was conducted after
usage. All comments and log dates were analyzed, and key words were extracted to categorize
content. All patient personal data was kept confidential and only healthcare staff could access
the system.
Results
Patient 1 was a 60-year-old woman with lung cancer, who used His@home for 298 days.
There were 612 entries created (2.05 items per day) by the patient (55%), nurse (15%),
physician (12%), pharmacist (12%), and care manager (6%). When the patient travelled to
visit her daughter for 3 weeks, she was able to maintain contact with her healthcare team, and
continued to receive appropriate medical care. She also used His@home during her hospital
stay.
Patient 2 was a 42-year-old woman with gastric cancer, who used His@home for 51 days.
There were 139 entries created (2.74 items per day) by the patient or her family (59%), nurse
(33%), and doctor (8%). Patient 2 stated that the application was an important bridge,
connecting her with her medical team. Once the patients situation became severe, her sister
490
and daughter created the entries for His@home, and the sister stated that using His@home
was emotional for her as well.
Both patients and medical staff were comfortable using the application, given its customized
settings. The patients stated that His@home provided active support and a safety line and
easy information transfer for in-home palliative care. Medical staff stated that
His@home provided continuous access to information, facilitated understanding of
other staff members views, and provided a sense of solidarity as a team. However,
the staff also reported an increase in extra work.
Conclusions
His@home provides a system for timely stored and updated sharing of home healthcare
information among healthcare professionals. Healthcare can be improved because the patient,
the patients family, and the healthcare professionals can enter, monitor, and review daily
condition changes even though the parties are not simultaneously present at the patients
side.
35Keywords
home care, palliative care, Information and Communication Technology, ,
491
Nursing experience of intra-arterial chemotherapy for oral cancer

Wei-Jung Chang1, Yu-Kuei Chen1, Ming-Ying Hong1
1.
Presenting Authors Email: yoko92001@gmail.com
Purpose
Intra-arterial chemotherapy (IAC) is a feasible modality with high response rate for head and
neck cancer. Here we described the care of a patient with recurrent oral cancer who received
IAC. Because of the unfamiliarity of IAC and discomfort associated with the tumors, the
patient presented with anxiety and had poor quality of life before IAC.
Design
We evaluated the patient from physical, psychological, social, and spiritual aspects through
direct observation, patient interview, and physical assessment in daily nursing practice.
Methods
We evaluated the patient from physical, psychological, social, and spiritual aspects through
direct observation, patient interview, and physical assessment in daily nursing practice.
Results
Adverse effects of IAC, infection, disturbance in body image, inadequate nutrition, and social
disability were identified during the courses of IAC. We designed the individualized nursing
plan for this patient, which included the instruction of performance and adverse effects of
IAC, diet consultation, self-care education, psychological counseling, and social networking
reconstruction.
Conclusions
The patient tolerated the treatment of IAC well. Further development of standard nursing care
for IAC is warranted.
35Keywords
intra-arterial , oral cancer, chemotherapy
492
The effectiveness of perioperative enteral immunonutrition in patients

undergoing esophageal cancer resection: a systematic review
Yu-Juan Xu1
1.
Presenting Authors Email: yujuanxu@kimo.com
Purpose
Specialized nutritional support containing immunonutrients such as arginine, omega-3 fatty
acids and ribonucleic acid significantly reduces the incidence of postoperative infective
complications and hospital length of stay in elective surgery patients. However, there is
limited evidence on its effectiveness in the patients undergoing esophageal cancer resection.
The purpose of this study was to evaluate the effectiveness of perioperative enteral
immunonutrition on reducing postoperative infective complications in patients undergoing
esophageal cancer surgery.
Design
Systematic review.
Methods
A systematic review of literature from 1970 to April 2014 was conducted using the PubMed,
CINAHL, Cochrane, MEDLINE, and EMBASE databases. The review included randomized
controlled trials published in English or Chinese. Research quality appraisal was rated using
the checklist developed by Melnyk and Fineout-Overholt.
Results
Of the 64 potentially relevant studies examined, only 4 randomized controlled trials with 318
randomized participants were identified. All studies failed to demonstrate consistent
differences in patients postoperative infection, length of hospital stay and inflammatory
marker levels between the immunonutrition and standard enteral nutrition.
Conclusions
Although postoperative enteral immunonutrition seems to improve humoral immunity in
patients undergoing esophageal resection, this improvement does not result in reductions in
infection rates or reduced hospital stay. Currently, there is no convincing evidence to
recommend routine use of immunonutrition in patients undergoing esophageal cancer
resection. When considering the issue of whether patients actually benefit from pre-, peri-, or
postoperative immunonutrition use, further well-designed prospective randomized trials are
required.
35Keywords
immunonutrition, esophageal cancer surgery, systematic review
493
The effects of group nutrition education program for postoperative oral

cancer patients
Shu-Ling TU1, Shu-Chen Ko1
1.
Changhua Christian Hospital
Presenting Authors Email: 21801@CCH.ORG.TW
Purpose
Oral cancer surgery may cause structural and functional damages, severe difficulty in
chewing and poor nutrition absorption, thereby affecting immune function of oral cancer
patients. A comprehensive nursing and nutrition intervention is important, for it provides
health promotion information and skills, and helps patients and families learn self-care skills.
The purpose of this study is to investigate the effects and satisfaction of group nutrition
education for postoperative oral cancer patients or families.
Design
A quasi-experimental (two-group pretest-posttest) design and a structured questionnaire were
used in this study.
We recruited cases for one year, from April ,2012 to March, 2013 . Totally 56 subjects from
ENT ward in one medical center were selected based on purposive sampling, and they were
divided into experimental and control groups.
Methods
The experimental group received the re-complied Liquid Diet Preparation for Postoperative
Oral Cancer Patients teaching material with more colored illustrations. In addition to
lectures, subjects were encouraged to participate in discussions to check if they understood.
The control group received the original Liquid Diet Preparation for Postoperative Oral
Cancer Patients teaching material in written form and the group education was conducted
by lectures only. The group teaching materials include diet choices after oral cancer surgery,
ways of food preparation, commercial formulas and tube feeding information. Pre-and-post
tests data were collected by questionnaire and analyzed based SPSS/PC.
Results
On nutrition cognition of postoperative oral cancer patients, the increasing rate for the
experimental and control groups were 18.62% and 6.67% respectively, indicating a
significant difference (P0.05). No significance was noticed regarding satisfaction between
two groups (P0.05). It is hoped that the results of the study contribute to education
program planning in the future.
Conclusions
Group education materials with colored real objects pictures are easy to understand.
Interactive teaching mode enhances mutual communication between the lecturer and
participants, and improves the nutrition cognition of patients and families. Continuous group
education programs with pictures and highlighted notes are highly suggested in wards.
494
Through group interaction, it is hoped to enhance the postoperative nutrition knowledge and
caring skills, prevent malnutrition and improve the life quality of patients.
35Keywords
oral cancer, postoperative nutrition, group education, ,
495
A literature review of factors of patient-related barriers to the use of

analgesics in early stage cancer patients
Mariko Koike1, Keiko Tazumi2, Ryoko Yamashita1, Harue Arao1
1.
Osaka University Graduate School of Medicine, 2. Osaka University Hospital
Presenting Authors Email: marinubo@gmail.com
Purpose
The purpose of this study is to clarify the factors of patient-related barriers to using analgesics
in early stage cancer patients through a literature review. The results will be useful for
designing the pain management of such cancer patients.
Design
Literature Review
Methods
A research of the literature was conducted by using Ichushi -Web Ver.5, MEDLINE, and
CINAHL. Our research criteria included reports published in Japanese and English between
2004 and 2014, and using the keywords cancer pain, patient, barriers and
analgesic we analyzed 9 reports from the literature for research purposes. We extracted
factors of patient-related barriers to using analgesics from the early stage in cancer patients
based on descriptions in the literature.
Results
We classified the following factors of patient-related barriers to using analgesics from the
early stage: Cognitive of analgesic use, Affective, Inadequate communication
with the medical profession, Inadequate pain relief Side effects of analgesic.
Emotions such as depression and anxiety, or perceptions such as concern and
misunderstanding about the analgesic, led to reluctance to report pain to members of the
medical profession, and were factors inhibiting the use of analgesic from an early stage.
We consider that affective factors caused by the diagnosis and treatment of cancer, and
cognitive factors that analgesic will hinder the treatment of patients during cancer treatment,
have inhibited the use of analgesics from an early stage.
Conclusions
The patient-related factors that inhibited the use of analgesics from the early stage, included
emotions and understanding about analgesics. Therefore, the provision of palliative care from
the early stage is necessary as an intervention against factors inhibiting the use of these
analgesics.
This work was supported by Grant-in-Aid for Scientific Research (B), No. 25293441.
35Keywords
Cancer pain, Barriers, Patient, Analgesics,
496
Associations between physical activity and fatigue in head and neck cancer
survivors in Taiwan
Yuan-Yuan Fang1, Shiow-Ching Shun1, Jenq-Yuh Ko2, Yen-Ju Chen1, Pei-Yun Hsieh1
1.
National Taiwan University, 2. National Taiwan University Hospital
Presenting Authors Email: dicircle@hotmail.com
Purpose
The purposes of this study were to explore the current status of fatigue in head and neck
cancer survivors in Taiwan and the relationship to their daily physical activity.
Design
This was a cross-sectional study design research in head and neck patients after complete the
treatment 3 months to 5 years.
Methods
We recruited 144 participants were diagnosis with head and neck cancer and have completed
treatments were following up in ENT outpatient clinic in medical center in Northern Taiwan.
Using Fatigue Symptom Inventory (FSI) and Godin Leisure-Time Exercise Questionnaire
(GLTEQ) to be the interments and assessing by the senior nurses.
Results
The intensity scale of fatigue (0-10): (1) felt most fatigued was 3.4 ( 2.5), (2) felt least
fatigued was 0.5 ( 1.2), and (3) average fatigue level was 1.7 ( 1.8). The patient still have
slight fatigue. The first three interference of fatigue were general level of activity (1.6
2.1), normal work activity (1.4 2.0), and mood (1.3 2.1). Affecting fewer items
was the daily activities of the bathing and dressing capacity (0.2 1.0). In a week, patients
would feel fatigue one to three days (1.4 1.7) and the major type of fatigue was no fixed
pattern (37.4%). There are still 79.6% of patients suffer from fatigue after treatment. We
compared patients fatigue experiences by three physical activity groups and exercise group
(insufficiently activity group and activity group) had significant lower fatigue intensity and
fatigue interferences than those did not have exercise.
Conclusions
This study showed that even the head and neck cancer survivor had complete the treatment
after 3 months to 5 years they still have slight fatigue intensity and would inference their
normal life (i.e. activity and ability). Physical activity could decelerate the progress and the
impact of fatigue, even do mild exercise (i.e. easy walking) was better than sedentary. It
suggests that to health care professional encouraging the patients have regular exercise
behavior after the treatment is good and helpful.
35Keywords
Head and neck Cancer, Physical Activity, Exercise, Fatigue, Cancer Survivor
497
Comparing survival rate between surgical resection and non-surgical

resection for colorectal liver metastasis of cohort study at medical center in
central Taiwan.
Chen Wen1, Chang Tung-Hao1, LIN YIH-JENG2
1.
ChangHua Christian Hospital, 2. Chienkuo Technology University
Purpose
According to previous research that liver is the most common site for colorectal cancer
metastases, and occur in about 50%of patients with colorectal cancer. The aim of this study
was to compare the survival rate of patients with colorectal liver metastases (CLM)
undergoing surgical resection liver versus non-surgical resection liver.
Design
We identified 120 Taiwanese colorectal liver metastases patients from the databases of the
cancer registry at Changhua Christian Hospital, which is located in central Taiwan. Data
collection for cancer in this medical center began in 2004/01/01 and continued until
2012/12/31.All patients were followed up closely until April 31, 2014.
Methods
Retrospective Cohort Study to gather SPSS/Windows 15.0 statistics studies including
descriptive analysis, Categorical variables were normally tested by the 2 test when
appropriate. In the Kaplan-Meier analysis, treatment subgroup (Surgical Resection liver vs.
Non-surgical Resection liver) was a prognosis factor related to 5-year Cause Specific Survival.
A case-match analysis by a propensity score method was used to obtain a one-to-two
match.The following covariates were matched for age and CEA level.
Results
During the study period, 120 patients had primary of the colorectal liver metastases (40
patients Surgical Resection liver and 80 patients Non-surgical Resection liver ). After a mean
follow-up of 2.3 years, the cumulative 1-, 3- and 5-year Cause Specific Survival rates were
85.0%, 64.2% and 48.2%,respectively, in the Surgical Resection liver and 67.8%, 26.7% and
12.5%, respectively, in the Non-Surgical Resection liver (p<0.001).
Conclusions
We have suggested that the feasibility of Liver resection provides the better survival rate in
colorectal cancer liver metastases.
35Keywords
colorectal liver metastases, surgical resection, survival rate, ,
498
The effect of therapeutic touch for cancer patients with pain-A systematic
review
Li Ting Chen1
1.
National Taiwan University Graduate Institute of Nursing
Presenting Authors Email: finlykiss@gmail.com
Purpose
Despite advances in pain management, cancer pain is managed poorly 20% of the patients
with cancer. The comprehensive pain management procedure not only pharmacology therapy,
but also includes physical, psychological, spiritual and social care. Therapeutic Touch (TT) is
a form of energy healing popular in the American nursing community, but the effect was
divided in cancer pain relieved.
Design
This study conducted a systematic review of reports to evaluate the effectiveness of
therapeutic touch as complementary and alternative management of pain among patients with
cancer.
Methods
Researchers searched six electronic databases for relevant articles published between 1972
and April 2014. Of these 49 articles, 5 articles met the inclusion criteria and were included in
the review, using the keywords therapeutic touch, healing touch, and cancer. A CONSORT
statement 2010 was used to evaluate the quality of the identified articles.
Results
Five studies met our inclusion criteria of targeting middle-aged subjects with cancer. There
was a total of 415 participants, with studies ranging from 18-163 participants. The majority of
participants were women, and with breast cancer(38%-52%) and gynecological cancer(19%61.2%); participant ages ranged from 36.8-83; 2 studies reported that therapeutic touch
reduced pain level of received chemotherapy patients; 1 studies reported that therapeutic
touch reduced pain level of received radiotherapy patients, and 1 studies reported decreased
level of post-operational pain.
Conclusions
Systematic review results indicate that therapeutic touch interventions have a significant and
positive effect on cancer patients undergoing chemotherapy, radiotherapy and post operation
pain controlled, but not during the patients received breast biopsy procedure; The majority
effect of therapeutic touch is reduce the chronic, and mild to medium pain level status. Larger
scale studies with more subjects and longer time periods are necessary to further confirm and
illuminate the effects of therapeutic touch and guide the design of effective, empirical- based
intervention programs.
35Keywords
Therapeutic touch, Healing touch, Cancer, Pain,
499
Changes in vital signs and level of consciousness as predictors for end-oflife care in patients with lung and gastrointestinal cancer at home
Yuki Kumagai1, Yasuko Tabuchi1, Astuko Maekawa2, Mayumi Abe2
1.
Saga University, 2. Nagoya University
Presenting Authors Email: kumagaiy@cc.saga-u.ac.jp
Purpose
Prognostic items are needed to optimize end-of-life care for cancer patients. Recently, vital
signs and level of consciousness have been reported as prognostic items. However, prognostic
items associated with shorter survival in patients followed at home have not been identified.
The purpose of this study was to examine changes in vital signs and level of consciousness in
the last 2 weeks of life in lung and gastrointestinal cancer patients cared for at home.
Design
Retrospective review
Methods
One hundred ninety two home-nursing records during the last 2 weeks of life of patients cared
for at home were reviewed. Survival time was divided into three time periods: last 11-14, last
4-10, and last 1-3 days of life. The rates of the following symptoms and signs were examined
in each period: SpO2 92%, systolic blood pressure 100 mmHg, pulse rate 100 beats per
minute, respiratory rate >25 per minute, and cannot respond to call. This study was carried
out with the approval of the Ethics Review Committee of Saga University. Informed consent
was obtained from the administrators of the visiting nurse stations and each patient (or
caregiver).
Results
Fourteen patients (12 males, 2 females; meanSD age, 73.211.7 years) were investigated.
The primary site of cancer was lung (n=8), colorectum (n=4), and stomach (n=2). The mean
SD number of follow-up visits by home-nurses was 13.75.9.
The rates of SpO2 92% for the last 11-14, 4-10, and 1-3 days of life in patients with lung
cancer were 14%, 63%, and 63%, respectively; in patients with gastrointestinal cancers, they
were 40%, 67%, and 67%, respectively.
The rates of systolic blood pressure 100 mmHg for the last 11-14, 4-10, and 1-3 days of life
in patients with lung cancer were 25%, 63%, and 38%, respectively; in patients with
gastrointestinal cancers, they were 60%, 50%, and 67%, respectively.
The rates of pulse rate 100 beats per minute for the last 11-14, 4-10, and 1-3 days of life in
patients with lung cancer were 71%, 75%, and 100%, respectively; in patients with
The rates of respiratory rate >25 per minute for the last 11-14, 4-10, and 1-3 days of life in
patients with lung cancer were 33%, 63%, and 63%, respectively; in patients with
The rates of cannot respond to call for the last 11-14, 4-10, and 1-3 days of life in patients
500
with lung cancer were 0%, 50%, and 88%, respectively; in patients with gastrointestinal
cancers, they were 0%, 25%, and 25%, respectively.
Conclusions
The SpO2 level could be used to predict survival of less than 10 days in patients with lung or
gastrointestinal cancer. Level of consciousness and respiratory rate could be used to predict
survival of less than 3 and 10 days in patients with lung or gastrointestinal cancer.
35Keywords
prognostic items, cancer, home, ,
501
Fear of cancer recurrence in patients with head and neck cancer

Hsin-Yu Hsu1, Yeur-Hur Lai1, Yen-Ju Chen2
1.
School of Nursing, College of Medicine, National Taiwan University/Department of Nursing,

National Taiwan University Hospital, 2. School of Nursing, College of Medicine, National Taiwan
University
Purpose
The purpose of this study is to explore the experience of fear of cancer recurrence (FCR) and
its association with impacts of cancer diagnosis in head and neck cancer patients.
Design
In this cross-sectional study, the inclusion criteria was head and neck cancer patients who
have completed surgery and concurrent chemo-radiation therapy (CCRT) for at least one
month and as a disease-free status during recruitment. Patients were recruited from two welltrained research nurses in the ENT inpatient wards and OPD in a medical center in northern
Taiwan.
Methods
We used the Impact Event Scale Revised (IES-R) and the Fear of Cancer Recurrence
Inventory (FCRI) to examine the psychological impacts on the time after diagnoses and FCR,
respectively. Descriptive statistics were used to characterize the distribution of demographic
surveys. Inferential statistics were used to describe the experiences among different groups,
the relationships between psychological impacts and fear of recurrence which conducted by
the independent t test, ANOVA and Pearson's correlation.
Results
A total of 100 patients were recruited. Mean age of participants was 52 years old (range from
23 to 74) and the majority were male. The results revealed that patients with higher level of
fear of cancer recurrence were younger age, having religious belief, taking more coping
strategies, and oral cancer diagnosis. Female patients tend to report to have higher levels of
trigger of FCR, distress related to FCR, reassurance, and overall level of FCR. Patients
perceiving higher impacts from cancer reported to have higher FCR (r=0.77, p=0.00).
Conclusions
Cancer is a life threatening event. In this study, generally, it showed that FCR is still a
concern for disease free head and neck cancer patients. Nurses should provide better care to
deal with this living with cancer issue and decrease patients distress.
35Keywords
Head and Neck cancer, fear of recurrence, cancer, ,
502
The impact of oncology case management on the effectiveness of cancer

care-The study on urinary tract cancer
Ru-Yi Wang1, Shiu-Shiuan Ju1, Guey-Ling Chang1, Ming-Ying Hong1, Yueh-Jiau Hwang1
1.
Presenting Authors Email: fantasy1218@gmail.com
Purpose
This study is to intervene in the oncology case management model for case managers to
understand the effectiveness of the care for patients of urinary tract cancer. And thus enhance
the urinary tract cancer patient quality of cancer care. Truly achieve the in order to patient as
the center of cancer care high-quality services for the purpose.
Design
The study adopts descriptive research design with objects comprised 805 patient of urinary
tract cancer recently diagnosed by the medical center in 2013. The research tool is urinary
tract cancer case management database.
Methods
To perform statistical analysis of urinary tract cancer case management indicators, including
the cure completion rate, and the improvement rate for treatment compliance before and after
the case manager intervention from 2013.After performing data analysis, for patients who
refuse and interrupt treatment, use the intervention of oncology case management model. The
implementation of management model is carried out by timely intervention of the oncology
case managers to assess the patient's condition in a timely manner to provide psychological
counseling and to track patient examination and treatment effectiveness of the implementation.
Periodic telephone interviews can be conducted to understand patients responses on the
effectiveness of the proposed treatments. The timely feedback can be turned to the clinicians,
and if necessary, the relevant units can be contacted to provide patient assistance and advice.
Allowing patients to successfully return to and follow treatment plan.
Results
Out of the 805 patients recently diagnosed,396 cases of urinary tract cancer that should
receive doctors recommended treatment, but only 386 cases of urinary tract cancer that
completed treatment. Upon intervention from case manager, the refusal and interrupted
curative rate is reduced and the improvement rate for treatment compliance before and after
the manager intervention is 60%. The percentage of the cure completion rate had risen to
98.99% from 97.47%.
Conclusions
This study confirmed case manager right has a significant impact on the effectiveness of
cancer treatment can enhance quality of care of urinary tract cancer patients. The oncology
case management model provided a clinical care and policy reference for patients with
Urinary Tract Cancer and comprehensive quality of care for such patients.
503
35Keywords
Urinary Tract Cancer, oncology case management model, care effectiveness, ,
504
Experiences of relationship with others from women diagnosed with

cervical precancerous lesion
Tomoko Otsuka1, Toshiko Ohno2, Tomoko Majima3
1.
Department of Nursing, Scohool of health sciences, Sapporo medical university, 2. Tokyo Kyosai
Hospital, 3. Graduate School of Nursing, Chiba university
Presenting Authors Email: t-otsuka@sapmed.ac.jp
Purpose
The purpose of this study was to examine the experience of women diagnosed with cervical
precancerous lesion in terms of their feelings toward and interaction with others during the
period of routine follow-up.
Design
A qualitative-inductive-descriptive approach was adopted.
Methods
Semi-structured interviews were conducted with ten subjects (average age 36.6) who had
completed treatment of high-grade cervical dysplasia or cervical cancer. Obtained data were
qualitatively and inductively analyzed.
This study was approved by the Ethical Committee of Chiba University Graduate School of
Nursing where the lead author did her thesis. Consent was obtained from relevant medical
institutions and care was taken to ensure that no prejudice was caused to the subjects.
Results
The time taken between the detection of a precancerous lesion and the confirmation of highgrade dysplasia or cancer ranged from three months to five years (average two years). The
experience of the subjects during this period was classified into four categories. Three of
them related to feelings toward medical professionals as well as family and friends; they were
Feelings of distrust toward male doctors who they felt were unsympathetic during
consultation, Friendliness felt toward female medical staff, and Gratitude toward
those who supported and helped them maintain a peace of mind. The fourth category,
Assessing the level of relationship when seeking advice/information from someone,
related to behavior and included such instances as not disclosing the diagnosis to others due to
fear of prejudice toward the disease, relying on the internet when gathering information and
carefully determining whom they could rely on when seeking specialist advice.
Conclusions
Women found it difficult to ask questions to medical professionals who they thought showed
little sympathy or willingness to provide information during consultation. On the other hand,
they felt female medical staff were comfortable to deal with and wanted to have a talk with
them. While showing appreciation to supportive partners, women did not disclose their
disease to those who they feared might express prejudice toward cervical cancer. Women
with precancerous lesion have to attend routine follow-up sessions for a long period of time
before treatment is indicated. During this period, the subjects obtained encouragement from
505
those around them but, at the same time, anxiety grew inside them because they could not
always seek advice/information from the third party for fear of prejudice.
The study showed that it is essential for women diagnosed with cervical precancerous lesion
to have someone they can confide in. It is also extremely important to provide a supportive
environment so that they can cope with a long period of routine follow-up and their anxiety
and distrust towards medical professionals are addressed. During the follow-up period when
they have limited contact with the medical professionals, female nurses can be good source of
information and play an important supportive role for them. The study suggested that nurses
should take care of the patients in a supportive manner at a routine follow-up and show
willingness to listen to them even after the session.
35Keywords
Cancer nursing, Cervical cancer, Follow-up, Relationship with others,
506
The health care professionalsbarriers to using analgesics to relieve the

chemoradiotherapy-induced oral mucositis of head and neck cancer
patients: A literature review
Jisho Takashi1, Yoshiko Takeda1, Keiko Tazumi2, Mariko Koike1, Ryoko Yamashita1, Harue
Arao1
1.
Osaka University Graduate School of Medicine, 2. Osaka University Hospital
Presenting Authors Email: jtakashi@sahs.med.osaka-u.ac.jp
Purpose
The prevalence of chemoradiotherapy-induced oral mucositis of head and neck cancer
patients is reported 80100% in Japan and other countries. Oral mucositis influences
accomplishment of treatment and patientsquality of life (QOL), thus the pain control is
important. This study aimed to clarify the barriers for medical professionals to using
analgesics to head and neck cancer patients and relieving their mucosal pain.
Design
Literature Review
Methods
A research of the literature was conducted using Ichushi-Web Ver.5, MEDLINE, and
CINAHL. Our research criteria included reports published in Japanese and English, and using
the keywords head and neck neoplasms, pain, analgesics, oral mucositis,
and health care professionals. We extracted descriptions of the barriers for health care
professionals to relieving patients mucosal pain and classified them by similarity of
semantic content.
Results
Thirteen reports met the study criteria. On analysis, 10 categories were observed;
difficulties of relieving pain by local analgesic medications, lack of knowledge about
pain management, absence of analgesic protocol, difficulties of using analgesics,
reluctance to use opioids at treatment period, fear of using opioids at treatment period,
difficulties of explaining to patients, difference of individual pain, difficulties of
preventing oral mucositis, increase pain due to infection.
Mucosal pain was hard to control, thus it was difficult to relieve them by using only local
analgesics and opioids were needed. However, health care professionals sometimes have
little knowledge about pain management, moreover, analgesic protocol had not established
yet. Head and neck cancer had the characteristics such as difficulties of swallowing, and it
was hard to choose analgesics and switch opioids. Health care professionals had few
experiences to administer opioids to patients at treatment period, therefore they were reluctant
to use them and fear that adverse effects would occur. They also felt hard to relieve mucosal
pain because it varied in individual cases, and the prevention of oral mucositis had not been
realized yet.
507
Conclusions
It was concluded that there were barriers for health care professionals when they use
analgesics to relieve mucosal pain of their patients. Oral mucositis remains inevitable for
patients who experience chemoradiotherapy, therefore it is important for health care
professionals to solve the lack of knowledge and the reluctance and fear to use opioids at
treatment period. They are also desired to establish analgesic protocol considered the
characteristics of head and neck cancer, and to begin early to treat the mucosal pain, which
different among individual patients. This work was supposed by Grant-in-Aid for Scientific
Research (B), No.25293441.
35Keywords
head and neck neoplasms, pain, analgesics, oral mucositis, health care professionals
508
The reliability and validity of a short form experience of close relationshipsRevised questionnaire in female cancer survivors
Chia-Chen Hsieh1
1.
Department of Nursing, College of Medicine, National Taiwan University
Presenting Authors Email: cchsieh1116@gmail.com
Purpose
Self-report questionnaires have facilitated attachment research, and validation of these
instruments in different languages, cultures and populations has become of importance. The
Experiences in Close Relationships-Revised measure (ECR-R) has not been adapted for
cancer survivors who may be order, in long-term stable relationships, and suffering from
chronic disease burden.The aim of this study was to assess the psychometric properties of the
Chinese version of the ECR-R and to develop a shorter version.
Design
quantitative research design
Methods
The present study is a secondary analysis of the longitudinal investigation of the determinants
of quality of life in female cancer survivors. Total 327 patients with breast cancer and
gynecological cancer completed the Chinese version of the ECR-R, BDI-II depression scale,
and STAI anxiety scale. A retest of the ECR-R was conducted at eight-week intervals. The
confirmatory factor analysis was applied to examine the construct validity of the short and
original forms of ECR-R.
Results
Based on concept-retention approach, 12 items were selected to form a brief measure.
Confirmatory factor analysis of short forms of ECR-R revealed a higher-order factor structure
in which five first-order factors (Anxiety about Relationships, Worry about Abandonment,
Fear of Rejection, Discomfort with Intimacy, Fear of Dependency) loaded on two secondorder factors labeled as Attachment Anxiety and Avoidance. Both short and original forms of
ECR-R showed a good internal consistency for anxiety and avoidant subscales of ECR-R.
The correlations of short and original form of ECR-R with BDI-II depression and STAI
anxiety revealed a good concurrent validity. In the test-retest reliability over the 8-week
period, both short and original forms of ECR-R showed a good stability.
Conclusions
The short and original forms ECR-R are equivalent in reliability test, factor structure and
concurrent validity. Therefore, using short form ECR-R in cancer patient is more appropriate
for enhancing their motivations of responding to this questionnaire.
35Keywords
adult, attachment, Experiences of Close Relationships, female cancer survivors,
509
Role transition in oncology case managers: A qualitative study

Ming-Ying Hong1, Guey-Ling Chang1, Ying -Siou Lin1, Chiu-Ping Su1
1.
Presenting Authors Email: mihorng@ntuh.gov.tw
Purpose
The oncology of case management model in clinical practice has created a beneficial
environment for uniting the 3 parties involved in cancer care- medical treatment team, cancer
patient, and nursing care team. In transition processes, oncology case managers confront
adapted difficulties and identity crisis, and can't be functioning well. It is important to
understand the role transition experience of oncology case managers. This article is aimed to
report the feelings, perspectives and expectations of oncology case managers. We hope that
our result can assist new comers in their adjustment to their new work and policy makers in
better allocations with medical human resources.
Design
Researchers used a qualitative research design.
Methods
We performed depth interviews with 10 oncology case managers of diverse age and clinical
backgrounds, from one medical center in Northern Taiwan. Oncology case managers were
recruited. Data was collected using a semi-structured interview format .We then transcribed
the records to verbatim and analyzed it using content analysis.
Results
The themes were developed as follows:
First, the factors of nurses transfer to oncology case managers include of selfimprovement, pursue of professional knowledge and ability and a job without night
shift.
Second, in role transition process, difficulties oncology case managers confront in term of
role, function and relation. Coping strategies include self-learning, discussing with
their directors, and peer-group oncology case managers
Third, other anticipations and concerns include too much work, lack of reimbursement of
health insurance, and further education program.
Conclusions
The oncology case managers provide nurses who seek improvement in their profession but is
unsuitable for administrational work another area to perform. It helps to attract those with
talent to remain in their position, make better use of human resources and offer better health
care service. Research results provide information for administrations to better understand the
adaption process of case managers, and offer a reference for developing future strategies to
improve nurse competency in handling their work.
510
35Keywords
Oncology Case Manager, Role Transition, Qualitative Research, ,
511
Fear of recurrence in gynecological cancer survivors

Yu-Ju Hung1
1.
Purpose
The five year survival rate for early stage gynecologic cancers (GYN) are relatively high
while compared to other type of cancers in Taiwan. For those GYN cancer survivors, fear of
cancer recurrence (FCR) is a common concern which might interfere patients life. The aims
of this study were: to (1) explore fear of cancer recurrence; and (2) identify factors related to
patients FCR.
Design
A cross-sectional study was conducted at the GYN OPD in a medical center in North Taiwan.
Patients diagnosed as gynecologic cancers, having finished major treatments, and currently no
cancer recurrence were eligible for this study.
Methods
Patients were assessed by Fear of Cancer Recurrence Inventory (FCRI), Post-Traumatic
Growth Inventory (PTGI), EORTC Quality of Life Questionnaire- Ovarian Cancer 28
(EORTC QLQ-OV28), and background information in OPD. Data was analyzed by SPSS 18.
Spearmans rank correlation and ANOVA were used to analyze the correlation between
FCR and related factors.
Results
A total of 136 survivors were recruited in the study. The results showed that: (1) Patients
perceived mild to moderate level of FCR, and about half patients have been fear of cancer
recurrence since diagnosis. (2) Patients FCR was triggered by fatigue, cancer-related
newspaper or report, and medical exams, and impacted their mood and the schedule in future.
(3) Most patients coped with FCR by using positively thinking. (4) FCR was related to age
(r=-0.40, p<0.01), the duration of the off-treatment (r=-0.26, p<0.01), education (r=0.20,
p=0.02), symptoms (r=0.20, p=0.02), and PTG (r=0.48, p<0.01) significantly.
Conclusions
The results suggested health care providers should pay more attention to patients FCR and
provide patients with mental support appropriately in clinical care. In order to reduce patients
FCR, future study could be developing the FCR related intervention.
35Keywords
Gynecologic cancer, cancer survivor, off-treatment, fear of cancer recurrence, post-traumatic
growth
512
Concerns among women living with incurable lung cancer: A qualitative

study
Yu-Chien Liao1, Yeur-Hur Lai2, Wei-Yu Liao3, Chong-Jen Yu3, Jen-Chang Ko4
1.
Department of Nursing, Yuanpei University, 2. School of Nursing, College of Medicine, National

Taiwan University, 3. Department of Internal Medicine, National Taiwan University Hospital and
National Taiwan University College of Medicine, 4. Department of Internal Medicine, National Taiwan
University Hospital, Hsinchu branch
Presenting Authors Email: liao.yuchien@gmail.com
Purpose
Lung cancer mortality and treatment can have various impacts on patients. In Taiwan, women
with lung cancer are primarily nonsmokers and are relatively young. The shock of this
diagnosis therefore can cause higher levels of distress and more concerns for them than male
patients. However, to date, few studies have focused exclusively on women with lung cancer.
This study was conducted to explore the concerns of women living with this life-threatening
disease.
Design
This study employed a qualitative methodology.
Methods
A purposive sampling method was employed to enroll 34 women with advanced or recurrent
lung cancer at a medical center in Northern Taiwan. One-on-one semistructured interviews
were conducted and recorded using a digital audio recorder and transcribed verbatim. An
inductive data-driven thematic analysis was performed to analyze the data. The researchers
first read and reread the transcripts line-by-line for entire data set to familiar with the data and
emerge the initial ideas and the initial coding. The analysis meetings were held for emerging
the themes and codes relation to the themes.
Results
The analysis revealed five themes: (a) family concerns, including changing roles, concerns
about family future and well-being, as well as fears about becoming a burden; (b) diseaserelated concerns, including fear of disease progression, emotional distress, concerns about the
effectiveness of treatment, dealing with distressing symptom, and fear of physical
deterioration and dependence; (c) social constraints, including frequent hospital appointments,
body image disturbance, and avoidance of overwhelming or unhelpful suggestions from other
people; (d) eagerness for receiving helpful self-care strategies, including nutritional support,
physical activity, and psychological coping skills; and (f) existential issues, including facing
eventual death and fear of a painful death.
Conclusions
Women with incurable lung cancer reported a wide range of potentially stressful concerns
during the illness trajectory. The study results can increase the awareness of health care
professionals that tailoring interventions for women with lung cancer is necessary. Further
513
research is required to develop and assess the effectiveness of interventions to manage patient
concerns more effectively
35Keywords
lung cancer, women, concerns, emotional distress,
514
The transformation process in nurses caring for dying patients

Ching-Chi Huang1, Jih-Yuan Chen2, Hsien-Heien Chiang3
1.
Mackay Medicine, Nursing and Management College/Department of Nursing, 2. Kaohsiung Medical

University/School of Nursing, 3. National Yang-Ming University/School of Nursing
Presenting Authors Email: chingchilaura@gmail.com
Purpose
Despite the recent increase in attention to care of the dying, little empirical evidence
documenting the emotional and mental transformation in caregivers is available.
This study was conducted to explore the transformation process in nurses, following spiritual
suffering and conflict after caring for dying patients.
Design
This qualitative study used individual interviews to explore the transformation process that
emerged after conflicts between personal spiritual suffering and work in caring for dying
patients developed in nurses. phenomenology with reflective analysis was used to guide
discovery of the actual experience of hospice nurses.
Methods
This tudy employed phenomenology to investigate 8 nurses (aged 27 to 40 years) who
worked in the hospice ward at a medical center in Taipei. Data were collected through openended questions in semi-structured interviews and reflectively analyzed.
Results
A three-stage transformation in the emotional processes of nurses caring for dying patients
was observed. In the first stage, nurses experienced acute emotional suffering as a result of
facing dying and death patients, possibly exacerbated by recollections of losing family
members. In the second stage, nurses adopted coping strategies, such as engaging with
soothing patients or dealing unfulfilled wishes, or participation in the funeral and memorial
services, to better take care of the self. In the third stage, nurses learned to provide better care
through emancipatory reflection and a reassertion of responsibilities toward the self, patients,
and patient families. After this stage, the initial emotional impact morphed into a medium for
self- strengthening, and nurses became more adept at detecting patient needs and providing
care, to fully complete the transformational process.
Conclusions
motional suffering was the primary factor that induced nurses to transform their personal and
professional selves. Adequate emotional self-management, dialogue with other nurses, and
personal reflection are all crucial for nurses to cultivate personal growth and implement
ethical practice, and dialogue with other nurses and personal reflection. Strategies such as
caring for patients, implementing reflective nursing practices, focusing on patient needs, and
utilizing past experiences can enable nurses to develop a heightened sense of responsibility
and awareness, thus empowering them to take better care of themselves and their patients.
35Keywords
515
phenomenology, palliative care, self-care, transformation,
516
State of daily living in breast cancer patients immediately after disclosure

of disease recurrence
Naomi Ota1
1.
kawasaki University of Medical Welfare
Presenting Authors Email: ota@mw.kawasaki-m.ac.jp
Purpose
After being informed of cancer recurrence, breast cancer patients are likely to face a crisis
arising from their awareness of death. In Japan, about 42% of breast cancer patients suffer
psychiatric disorders, such as adjustment disorder and depression, after finding out that their
cancer has returned. These disorders are likely to compromise daily life in these patients. The
present study was undertaken to investigate the state of patients daily lives immediately
following disclosure of breast cancer recurrence.
Design
Qualitative descriptive study
Methods
All participants of this study had received disclosure of breast cancer recurrence within the
preceding 2 months. The researcher interviewed each patient using a semi-structured
questionnaire. The interviews focused on how individual patients were conducting their daily
lives after finding out that their cancer had returned. From the interview data, thorough
records were prepared, followed by coding and categorization of responses regarding the state
of patients daily living. The study was reviewed and approved in advance by the ethical
committees of University A and the study site.
Results
Seven patients were studied. Their mean age was 43.5 (SD = 7.99) years. Responses
pertaining to patients daily living were classified into 8 categories: living and regularly
performing housework; living while avoiding unnecessary stress; living in an
ordinary manner, unchanged from the past; living with an optimistic mind; living
while avoiding activities that are a waste of time; living each day in a joyful manner;
living while paying attention to the health of family members; and living while
looking for something that can be enjoyed in a span of one year.
Conclusions
The study revealed that immediately after disclosure of recurrence, breast cancer patients
were focusing on housework (living to an extent allowing housework), attempting to
maintain their typical style of living (living in an ordinary manner, unchanged from the
past), or setting goals in consideration of their situation (living each day in a joyful
manner; living while looking for something which can be enjoyed in a span of one year,
and so on). These results suggest that nurses caring for such patients should discuss daily
517
living goals with patients and help them achieve these goals. Nurses should also make an
attempt to help patients find joy in daily life.
35Keywords
breast cancer, Daily living, coping, Reccurece,
518
Care needs and psychological distress in gynecologic cancer survivors.

Yu-Fang Chu1, Yu-Ju Hung2, Jen-Ju Chen3, Yeur-Hur Lai4
1.
National Taiwan University, 2. Master School of Nursing, College of Medicine National Taiwan
University, 3. Doctoral student School of Nursing, College of Medicine National Taiwan University, 4.
PhD, Professor School of Nursing, College of Medicine National Taiwan University (NTU)
Purpose
Gynecologic (GYN) cancer is one of the most threatening health problems for female.
Although the relatively good survival rate compared to other type of cancers, limited
information has been reported about GYN cancer survivors psychological distress and care
needs. Thus, the purposes of the study were to: (1) describe patients care needs and their
psychological status, and (2) explore the relationship between care needs and psychological
distress in GYN cancer survivors.
Design
A cross-sectional study was conducted in a medical center in northern Taiwan. Eligible
patients were gynecologic cancer survivors including cervical cancer, endometrium cancer,
and ovarian cancer. They have completed cancer treatment at least one month without cancer
recurrence.
Methods
Eligible subjects were assessed by research nurses using (1) Supportive Care Needs
Survey Short Form (SCNS-SF), (2) Hospital Anxiety and Depressive Scale (HADS), and
(3) Background information. Descriptive analysis, t-test, and Pearsons correlation were
used to analyze the psychological status, care needs, and the relationship.
Results
A total of 80 patients were recruited in the study. The results showed that: (1) Patients had
mild to moderate level of care needs, especially health system and information needs,
psychological needs, and patient care and supportive needs; (2) Higher level of care needs
were related to higher anxiety, depression, and shorter duration since completion of major
treatment (r=0.57, 0.48, -0.24, respectively); (3) Patients with married status or having partner
reported to have concerns about sexuality care needs than those who were single (t=-3.81,
p<0.01).
Conclusions
In conclusion, health care providers should pay more attentions on GYN patients care
needs in GYN cancer survivors. Providing individualized information and assistance for
patients were suggested. Development of evidence-based and individualized care plan should
be further tested of its effects on helping GYN cancer survivors to better cope with cancer.
35Keywords
519
gynecologic cancer survivors, anxiety, depression, care needs,
520
Body composition among prostate cancer patients undergoing hormone

therapy.
Junko Takagai1
1.
Akita University
Presenting Authors Email: jtakagai@hs.akita-u.ac.jp
Purpose
With the spread of the PSA test, prostate cancer patients is increasing worldwide and undergo
outpatient treatment it has been an increase in prostate cancer patients. However, the
researches on quality of life (QOL) of prostate cancer patients undergoing hormone therapy
seems fewer compared to other cancers especially.
The purpose of this study is to clarify the QOL and body composition among prostate cancer
patients undergoing hormone therapy.
Design
cross sectional study
Methods
The subjects were outpatients with prostate cancer undergoing hormone therapy, performance
status 1 or 0. The measurements included the SF8 Health Survey(SF8), Expanded Prostate
Cancer Index Composite (EPIC). Inbody430 was used for the measurement of body
composition, A-1000 EXPRESS/InSight was used to measure bone density.
The data was analyzed by descriptive statistics, ttest, oneway ANOVA, Pearsons
correlation coefficient, the data was analyzed by using SPSS statics20 software.
This study was approved by the ethics review boards of the participating facilities and written
informed consent was obtained from patients.
Results
Data from 79 subjects (valid response rate 88.8%) were analyzed. The average age was
74.1(SD=7.22). 35.4% have undergone radical prostatectomy, 24.1% have received radiation
therapy in the past. All of them were during hormone therapy. 95.0% were suffering from
chronic disease also other than prostate cancer. (e.g., diabetes, hypertension, and heart disease)
22.8% have a routine exercise (including physical labor).
Average of the body measurement, BMI was 25.1(SD=6.68), body fat percentage was
29.7%(SD=3.94), basal metabolic rate was 1361.5kcal/day(SD=137.4), bone stiffness was
79.13(SD=18.8).
The subscales of SF8 were 27.2~43.8, lower than the National Standard Value. The sexual
function of EPIC was as low as 30.2, and other subscales of EPIC were 86.0~92.2.
Conclusions
It was confirmed obesity and the reduced bone density as side effects of hormone therapy, but
this is also a sign as a general elderly.
521
In addition, the effects of hormone therapy are a large individual variation from that some
patients are skinny, even if you do not have a regular exercise.
Most of the prostate cancer patients are the elderly and most of them have chronic disease.
Therefore, it is possible that factors not associate with prostate cancer affect their QOL. The
study is needed in the future we can do what it as outpatient care for the QOL of them.
35Keywords
prostate cancer, QOL, hormone therapy, body composition ,
522
My dream is shattered: the impacts of a permanent colostomy after the

reversal of a protective ileostomy.
Jia Jing Sun1, Hsin-Ying Lin1
1.
Presenting Authors Email: c22881@hotmail.com
Purpose
To explore the impacts of the patents with anal sphincter preserving operations and stoma
reversal but fail and need to create a permanent colostomy.
Design
The design was exploratory and descriptive research focused.
Methods
We used a qualitative method to collect data through observations and interviews in a medical
center in Northern Taiwan, with a purposive sampling of three patients who need to have a
permanent colostomy after stoma reversal. The data were transcribed and analyzed using the
content analysis method to develop data categories.
Results
After received the operation of stoma reversal, the patients had the serious diarrhea over
6months without any improvement. They were admitted for a surgery again for the permanent
colostomy. Four major themes were emerged from the data, including: (1) I cant stay far
away from my toilet (2) The day that I had normal bowel movement will never come (3)
Suffering from the upset of repeated surgery (4)The dream of keeping my physical integrity is
shattered.
Conclusions
All patients of low rectal cancer after Sphincter-preserving surgery without a protective stoma
will have diarrhea for a period of time because of the shorter colon and the dysfunction of the
intestinal mucosa, but the symptoms will improve. The need of a protective stoma is depend
on the lower location of tumor near the anus, history of diabetes mellitus, the age or receiving
neoadjuvant chemotherapy etc. Therefore, with a protective stoma will be the major indicator
of patients prognosis. Their symptom of diarrhea may not be improved. Majority of the
researches which explored the experiences of the patients bowel symptom following
sphincter saving surgery for rectal cancer did not clearly describe their protective stoma. That
will Influence the understanding and judgments of their outcome. Health professional should
establish a correct concept about the patients diarrhea. Remind the possibility of having
permanent colostomy for the patients with a protective stoma which may prepare themselves
to face the challenge and decrease the predictability of their dream in gap.
35Keywords
Rectal cancer, protective stoma, Sphincter-preserving surgery, ,
523
Determinants of subjective and objective body image in patients with head

and neck cancer
Shu-Ching Chen1, Shu-Ching Chen1
1.
Chang Gung University of Science and Technology
Presenting Authors Email: shuching@gw.cgust.edu.tw
Purpose
The aims of the study were to describe: (1) body image following head and neck cancer
patients and healthcare providers; and (2) patients and healthcare professionals
determinants of body image.
Design
This study was a cross-sectional and correlational design.
Methods
Data on subjective and objective body image reported by head and neck cancer patients and
healthcare professionals in radiation outpatient department and oncology center of a medical
center in Northern Taiwan were collected using structured interviews. Patients self-esteem,
social anxiety, body image, facial disfigurement, performance status, demographic and
disease related information were assessed.
Results
Higher fear social anxiety, radiation dose, and avoidance social interaction were associated
with greater subjective body image concern. Patients objective body image significantly
determined by higher radiation dose, female, advanced disease stage, and higher avoidance
social performance.
Conclusions
Healthcare professionals tend to underestimate patients body image. Patients and
healthcare professionals view point on body image have not adequate assessed. A
qualitative study might be helpful to complete the description of patients and healthcare
professionals perception.
35Keywords
Head and neck cancer, Disfigurement, Body image, Self-esteem, Social anxiety
524
Helath related quality of life as a prognostic marker in men with prostate

cancer
Chiung-Yu Huang1, Hui-Ling Lai2, Hung-Yu Lin3, Chun-I Chen4
1.
I-Shou University, 2. Buddhist Tzu Chi General Hospital, 3. Urologist/E-Da Hospital, 4.

management/I-Shou University
Presenting Authors Email: chiung.huang@gmail.com
Purpose
Aims of this study were 1). to assess health-related quality of life (HrQoL) in men treated for
clinically localized prostate cancer; 2) to explore the relationships among demographic
information, sexual function, and mental and physical health related quality of life.
Design
A descriptive, correlational design.
Methods
A convenient sample of 133 individuals over 20 years of age and was diagnosed with prostate
cancer. Participants completed self-report their health related quality of life. Data were
collected for demographics, disease characteristics, self-control schedule, and SF-36. Patients
with prostate cancer aged 20 or above were recruited. Correlation, T-test, and ANOVA were
adapted to analyze.
Results
Most participants were married and their age were older than 65, about 50% have hormone
treatment. Prostate cancer-specific quality of life, erectile function, and learned
resourcefulness (LR) were positively related to both physical and mental health related
quality of life, but negatively related depressive symptoms of adults with prostate cancer. In
addition, learned resourcefulness had a positive mediating effect on increasing physical and
mental quality of life for patients with PC. There seems more likely no differences of
treatments on health related quality of life; however, significances of different surgery
methods and different illness severity (stage) on both physical and mental health related
quality of life.
Conclusions
Learned resourcefulness may help adults with prostate cancer to have a positive thinking and
enhancing HrQoL of patients. By employing the proper resourcefulness strategy, either
personal (self-help) or social (help-seeking), healthcare professionals can substantially
contribute to enhance health related quality of life for adults with prostate cancer.
35Keywords
Health related quality of life, prostate cancer, learned resourcefulness , erectile dysfunction,
525
The effects of Tai Chi exercise increase mental health with hypertension
Huimin Lo1, Huimin Lo2, Shu-Chuan Chang3, Yi-Lin Lin4
1.
St Mary Nursing and Management Junior College, 2. Assistant Professor ,Department of Nursing , St
Mary Nursing and Management Junior College , Yilan, Taiwan., 3. Associate professor, Department of
Nursing, Tzu Chi University , Hualien, Taiwan, 4. Head Nurse ,Department of Nursing , St Mary
Hospital , Yilan, Taiwan.
Presenting Authors Email: hmlo@smc.edu.tw
Purpose
The aim of this study was to evaluate the effectiveness of a Tai Chi Exercise intervention
program on mental health patients with hypertension.
Design
Good mental health can reduce health cost, but improve psychological function. The positive
effect of can increase patients confidence to face the challenge that was caused by disease.
However, this study had tended to focus on outpatient people. This study evaluated the effect
of psychological function on Tai Chi Exercise Program with hypertension patients.
Methods
The research designed using two-group repeated-measures. The experimental group received
Tai Chi Exercise Program intervention. The control group received routine care. The primary
analysis was conducted using repeated measures analysis of variance (ANOVA) on the
intervention group and time as predictors of self-efficacy, QOL, mood states and angerexpression were measured by structure questionnaire, and were measured at baseline, eight
and 12 week
Results
Repeat Measure ANOVA were not obvious to the time effect between three time points.
There was a great improvement on Self efficacy (F=3.23,P=.001), Quality of life
(F=5.44,P=.002), The Profile of Mood States (F=7.23,P=.56) and State-Trait Angerexpression (F=11.23,P=.76) between two groups over time.
Conclusions
A Tai Chi Exercise Program had a positive impact on psychiatric health with hypertension.
35Keywords
Tai Chi exercise, psychiatric health, hypertension
526
Effectiveness of medication adherence therapy for people with

schizophrenia: A randomised controlled trial
Wai Tong Chien1, Jolene Mui2, Eric Cheung2
1.
The Hong Kong Polytechnic University, 2. Hosptial Authority, Hong Kong
Presenting Authors Email: wai.tong.chien@polyu.edu.hk
Purpose
Despite the advent of newer antipsychotic medication with less severe side-effects, there is
little progress has been made in medication adherence. Poor adherence with antipsychotics is
associated with a substantial increase in illness relapse and poor psychosocial outcomes. The
purpose of this study was to test the effectiveness of anti-psychotic medication adherence
therapy (AT) on the clinical outcomes of patients with schizophrenia spectrum disorders and
poor medication adherence.
Design
This randomised controlled trial, using a repeated-measures control group design.The
Adherence therapy is a six-session motivational and insight-inducing educational program
that addresses patients awareness and knowledge of schizophrenia and skills of medication
management.
Methods
The two-site controlled trial was conducted with 134 Chinese patients with psychotic
disorders in Hong Kong. They were randomly assigned to either the medication adherence
program or usual psychiatric outpatient care. The patients levels of adherence, mental and
psychosocial functioning, insights into illness, and re-hospitalization rates were measured at
recruitment and at one week, 6 months and 12 months after the intervention. [This abstract is
mainly focused on the results at 12-month follow-up]
Results
At the 12-month follow-up, the patients in the medication adherence program reported
significantly greater improvements in their levels of adherence, illness insights, symptom
severity, and length of re-hospitalizations (all p values <0.01, large effect sizes of [eta]2=
0.48-0.69), when compared to those in usual care.
Conclusions
The findings provide evidence that the motivational adherence therapy can improve Chinese
psychosis sufferers medication adherence, insight into their illness and mental state and
reduce their illness relapse.
35Keywords
Medication adherence, schizophrenia, RCT, illness insight, relapse
527
Recognizing abuse against persons with seriously mental and physical

disabilities by staff working in related care facilities
Toshiko Matsushita1, Asako Kawaguchi2, Michi Harada3, Yuriko Tanabe1
1.
Nursing Course, School of Medicine, Yokohama City University, 2. Faculty of Nursing and Nutrition,
University of Nagsaki, 3. Kyushu University of Nursing and Social welfare
Presenting Authors Email: toshiko@yokohama-cu.ac.jp
Purpose
Since 2012, when Japanese law to prevent abuse of persons with disabilities was passed,
recognition of this abuse has increased. This law is based on the framework of the law to
prevent abuse of the elderly, which was passed in 2006. Abuse at home, long-term care
facilities, and companies employing persons with disabilities are assumed in this law. It is
important to note that the average age of people (users) in some facilities for those with
serious mental and physical disabilities is 80-90 years, which means that those who are
abused are both elderly and disabled. The purpose of this study is to identify abuse by the
staff of these facilities that care for persons with serious mental and physical disabilities.
Design
The research design was based on a qualitative study, from which the data was analyzed
inductively from interviews.
Methods
We carried out an interview investigation with select staff working at facilities that care for
persons with serious mental and physical disabilities. We explained the purpose, method, and
ethical considerations of the investigation to the mayor of each facility as well as the
interview candidates, and obtained a written agreement prior to the interviews. The guided
interview included the following questions: (1) What types of abuse occur within the
disability facilities?; (2) What kind of approach do you perform when addressing the abuse?;
(3) What happened as a result?; (4) What kind of reasoning is there regarding the background
of abuse?; (5) What kind of actions are you taking to prevent abuse?; (6) What types of
motivation do you have in daily care?; and (7) What do you learn through relationships with
the users? We recorded the interview contents to an IC recorder with participant approval
providing a verbatim transcript. The verbatim transcript was then analyzed qualitatively and
inductively.
Results
Interview participants were two females in their 40s and four females in their 50s. Job types
included four nurses, one caregivers, and one nutritionist. As a result of this classification, 9
categories were induced: Problem of name-calling, violent words, and disregarding through
physical violence; Lack of abuse recognition by veteran staff and difficulty in
correction; Circumstances and culture produce abuse; :It is not possible to warn
abusive staff because of power relations, even if we want to warn the staff; Going out
528
from the value that dealing with the issue quickly is best; Being discharged is death, for
patients ranging from 0 years old to 80 years old; Getting problem-consciousness
through study workshops; Promote caring by same-sex caregivers; and The pleasure
of inducing the abilities of users.
Conclusions
The background and factors for abuse of persons with disabilities by staff in related care
facilities were similar to elderly abuse in care facilities. Results suggest that abuse often
occurs in an unsociable environment and in long-term close relationships, and that staff
should refresh the cognition of abuse through workshops, and keep the culture open to the
prevention of such abuse.
35Keywords
abuse, persons with disabilities, an interview investigation, facilities that care for persons with
serious mental and physical disabilities, staffs
529
Visiting home care nurses view of sexual consciousness in elderly persons

with dementia: Interviews with visiting nurses
Toshiko Matsushita1, Michi Harada2, Asako Kawaguchi3
1.
Nursing Course, School of Medicine, Yokohama City University, 2. Kyushu University of Nursing
and Social welfare, 3. Faculty of Nursing and Nutrition, University of Nagsaki
Presenting Authors Email: toshiko@yokohama-cu.ac.jp
Purpose
We previously researched through interviews the sexual behavior and sexual consciousness of
elderly persons in a nursing home and the staffs cognition of these concerns. In the current
study, we investigated the experiences of visiting nurses with sexual behavior and sexual
consciousness in elderly persons with dementia undergoing medical treatment at home.
Furthermore, we also clarified how visiting nurses care for elderly persons with dementia who
show sexual behavior.
Design
Research design is qualitative study. We analyzed the data from interview inductively.
Methods
Individual interviews were conducted with six visiting nurses. Before conducting the
interviews, the researchers explained the purpose of the study, method, and ethical matters,
and obtained a written statement of cooperation from the participants. We recorded the
interview contents to an IC recorder with participant approval providing a verbatim transcript.
The verbatim transcript was then analyzed qualitatively and inductively.
Results
The interviewees were six married females in their 50s. Their clinical experience ranged eight
to 37 years and visiting nursing experience ranged four to 20 years. Analysis extracted these
important categories. The sex consciousness and sexual behavior of elderly persons with
dementia at home were described as patients enjoy through contact with a body, they
express their sex drive verbally to a visiting nurse, and casual contact to the visiting
nurses chest and buttocks. Nurses handled the behaviors by interacting words
smoothly with the elderly person with dementia so as not to insult him, tolerating body
contact of chest and buttocks, and always using words which maintain their dignity. In
addition, visiting nurses were conscious that sexual desire is not shameful and a sex
drive is vital to the elderly person with dementia.
Conclusions
530
Visiting nurses set their own tolerance limits as a person and as a nurse with regard to the sex
drives of elderly persons with dementia, and cared for them with the tolerance limits. In
addition, nurses affirmed the sex drive of elderly persons as natural reactions of human beings,
and nursed them with respect and dignity. In the future, it will be necessary to establish
systematic training opportunities for young or new visiting nurses to be able to respond
professionally without emotionally reacting to the sexual actions of elderly persons with
dementia. Furthermore, it will be essential to share our point of view of their sexual behavior
and our ethical care.
35Keywords
sexual consciousness , sexual behavior , elderly persons with dementia, visiting home care
nurses, an interview investigation
531
Development of smartphone application for alcohol use disorder

management
Jeong-Eun Park1
1.
Presenting Authors Email: syrinxje@gmail.com
Purpose
The influence of alcohol on health problem is an important subject in healthcare environment.
Alcohol use disorder (AUD) patients leaving hospital treatment are not offered evidence
based continuing care, though continuing care is related to better outcomes. The mobile
technology has played a significant role in self-management of chronic disease such as AUD.
The aim of this study was to development an ontology-based smartphone application for
AUD management.
Design
This study based on a rapid application development model (RAD Model) as one of software
system development life cycle model, and proceed progress sequentially as analysis - design development - evaluation.
Methods
An ontology-based smartphone application was developed in four phases: (1) analysis healthcare providers and users requirements, (2) design - architecture, system and user
interface, database of application, (3) development implementation of application,
ontology engineering, (4) evaluation heuristic and system usability evaluation for experts
and users.
Results
We represent the concepts associated with AUD using Protg (ver.4.3), and implemented an
application for AUD management. Using both qualitative and quantitative approaches, we
found that use of smartphone-based application made a particular meaningful contribution to
the prevention of relapse as a tool for AUD management.
Conclusions
The findings suggest that a smartphone-based application may have significant better outcome
to patients in continuing care for AUD.
35Keywords
Alcohol use disorder (AUD), smartphone, application
532
Applying the interprofessional practice to improving the effectiveness of

dangerous goods safety inspection in the psychiatric ward
Chun-Ti Yu1, Shih-Cheng Liao2, Hsiu-Yun Liu3
1.
National Taiwan University Hospital, 2. Department of Psychiatry/National Taiwan University

Hospital, 3. Department of Nursing/National Taiwan University Hospital
Presenting Authors Email: yuchunti@ntuh.gov.tw
Purpose
The main purpose of the project was to explore the interprofessional practice to improving the
effectiveness of dangerous goods safety inspection in the psychiatric ward.
Design
The design was used the project management process to explore the effectiveness of the
dangerous goods safety inspection about patients and their families, health care,
environmental and institutional dimensions from 2013 January to June in the psychiatric ward
of a medical center for problem description, behavior analysis and confirmed to be due.
Methods
The questionnaires, field observation, unusual events analysis and strategy matrix analysis
were applied as the methods.
Results
The cause of dangerous goods safety inspection incomplete were found as below:1. lack of
dangerous goods safety inspection standards. 2. The inpatients have too many personal items.
3. Inconsistent of dangerous goods safety inspection in cognition of nurses. 4. Inconsistent of
dangerous goods safety inspection in attitude of security guards. 5.Patients and their families
are not familiar with dangerous goods.
Conclusions
1.To establish dangerous goods safety inspection norms and standards. 2.Notify patients and
their families by the general physician about provides may carry of personal items.
3.Education and advocacy to nurses awareness of dangerous goods. 4.Standardize security
guards performed dangerous goods safety inspection process. 5.To make dangerous goods
guidance booklet. After the implementation of from July to December 2013. The average rate
of dangerous goods safety inspection was upgraded from 75% to 99.4%. The average rate of
self-harm behavior was dropped from 0.20% to 0.06%. This project will continue to
performed, in addition to the integration of interprofessional practice together to implement
the dangerous goods safety inspection. The project can achieve the goal of patient safety and
can be shared with other units.
35Keywords
interprofessional practice, psychiatry, dangerous goods safety inspection, ,
533
Families of patients with borderline personality disorder in Japan: Family

signs/symptoms and classification based on the family environment
intervention model
Yasuyo NIshimoto1, Naohiro Hohashi1
1.
Kobe University Graduate School of Health Sciences
Presenting Authors Email: yasuyo-n@panda.kobe-u.ac.jp
Purpose
Patients with borderline personality disorder (BPD) are affected by significant bias, cognitive,
and emotional problems, as well as poor interpersonal relationships. In most cases, their
behavior negatively affects their immediate family, and therefore family nursing intervention
may be warranted for BPD patients and their families. Effective BPD treatment has not been
established, and few studies have directly examined nursing provided to families of patients
with BPD in Japan. The purpose of this study was to clarify the family signs/symptoms
(FSSs), as proposed by Hohashi, among families of patients with BPD in Japan and to classify
the relevant intervention according to the family environment support model (FEIM).
Design
This study was literrature review.
Methods
The authors searched the existing literature in the PUBMED database using the terms
borderline personality disorder, family, and synonyms of intervention and
care. Eighty-seven reports met the search criteria. All 87 articles were perused, and those
in which the method of family intervention was not described were excluded. The remaining
66 articles were analyzed in relation to the method for assessment of family signs/symptoms
and the FEIM within the framework of the Hohashi's Concentric Sphere Family Environment
Theory/Model (CSFET/CSFEM).
Results
The descriptions of the cases of families of patients with BPD were collected from the articles,
and the data were used to assess FSSs. If we determined that a family exhibited overlapping
FSSs or complicated FSSs, these cases were labeled multiple FSS. One hundred and
seven cases with data on FSS have been extracted. The most common FSS (present in 57
cases) was development of the escape phenomenon in the family. The second most common
FSS was difficulty in interpersonal relationships within and outside the family. Other frequent
FSSs were maladjustment of the family system to stress, constraining beliefs of the family,
and social isolation of the family. Classification of families of patients with BPD based on the
FEIM led to development of intervention in the family internal environment, included
intervention that affected the patient and that aimed at other family members. Intervention for
the patient included therapeutic intervention, adjustment of the environment in which the
patient could control the conditions, improvement in the ability to control the conditions,
emotional intervention, and provision of information and knowledge. Intervention for other
family members included emotional intervention, provision of information and knowledge,
534
and enhancement of coping skills. Intervention for the family system as a unit included
therapeutic intervention, adjustment of family relationships, adjustment of family roles, and
enhancement of problem-solving skills of the family. Intervention for the external
environment of the family included emotional intervention, provision of information and
knowledge to a familys external resources, promotion of the use of social resources,
institutional development, and educational activities for the social system.
Conclusions
This study systematically formulated family intervention for the families of patients with BPD.
Further research into family interventions based on the results of this study will help to
identify effective practices in family nursing. For accurate assessment of nursing need of
these patients and their families, further studies will be required.
35Keywords
family signs/symptoms, family environment intervention model (FEIM), family nursing,
borderline personality disorder (BPD),
535
Analysis of pica behaviors by disorder observed in a Japanese psychiatric

hospital
So Yayama1, Chie Tanimoto2, Tomomi Kajiwara3, Kei Matoba3, Shunji Suto4, Masue Inoue3,
Yoshimi Endo3, Miyae Yamakawa3, Kiyoko Makimoto3
1.
Senri Kinran University, 2. Ishikawa Prefectural Nursing University, 3. Osaka University, 4. Nara
Medical University
Presenting Authors Email: s-yayama@cs.kinran.ac.jp
Purpose
Pica increases a risk of ileus, poisoning, or suffocation, and prevention of pica is especially
important in a psychiatric setting. Most studies of pica conducted so far in psychiatric
hospitals were case studies, and only a small number of studies have quantitatively analyzed
the contents of materials and the time of pica. The purpose of this study was to analyze the
incidence of pica in a Japanese psychiatric hospital reported by the staff and to discuss
preventive methods.
Design
This study was conducted at A Psychiatric Hospital with 400 beds. At A Hospital,
schizophrenic patients accounted for approximately 40% of all inpatients, and dementia
patients accounted for about 35%. Between 2000 and 2012, 5341 incident reports were
submitted to the Medical Risk Management Office at the study hospital, and of these, 150
reports were classified as pica.
Methods
We tabulated the frequencies of pica according to major diagnosis, ingested materials,
incident levels, and time of occurrence in the incident reports. This study was approved by the
Ethics Committees of Osaka University and A Hospital.
Results
The incidence of pica during the 13 years was 0.09/1000 patient-days, which was equal to
1/16 of the incidence of falls in the study hospital during the study period. Of the 150 cases,
pica behaviors were reported most frequently in dementia patients (N=73), followed by
schizophrenic patients (N=28).
The materials ingested by dementia patients comprised diapers in 28 cases, a piece of gauze
attached to the patients body during a medical procedure or treatment in 8 cases, feces in 6
cases, a piece of foam from a cushion in 6 cases, and toilet paper in 5 cases. By incident level,
45 cases did not require any treatment or medical procedure. The time of pica occurrence in
dementia patients was mostly before or during meals.
The materials ingested by schizophrenic patients were powdered detergent in 9 cases and
cigarettes in 4 cases. Although most of the patients exhibited pica on impulse or under the
influence of pathological phenomena such as auditory hallucinations, six cases were with
suicidal intent. Regarding incident level, 23 cases required medical treatment or procedures.
Pica behaviors among schizophrenic patients mostly occurred in the evening.
Conclusions
536
Dementia patients were over-represented in pica incidence. Items worn by dementia patients
or applied to their bodies were often subject to pica, and such behaviors mostly occurred
around meal time. Thus, the nursing staff were able to discover them quickly and treat most of
the cases without serious consequences. In contrast, schizophrenic patients were
underrepresented in pica incidents, and most cases involved in detergent powder or cigarettes,
resulting in more serious consequences requiring treatment. This study suggests that major
diagnostic categories were predictors of type of materials ingested, time of occurrence, and
severity of incident.
35Keywords
pica behavior, incident report, psychiatric hospital , ,
537
The characteristics of post-traumatic growth of bereaved spouses in

palliative care units.
Yumiko Takedomi1, Kimie Fujita2, Yasuko Tabuchi1, Yuriko Myouji1, Toshifumi Kosugi3,
Atsuko Hiura3, Kiiti Maesato4, Miho Okaguchi5
1.
Institute of Nursing, Saga University, 2. Department of Health Sciences, Faculty of Medical Sciences,
Kyushu University, 3. Saga medical center Koseikan, 4. Kahan hospital, 5. Kahan hospita
Presenting Authors Email: sp7014@cc.saga-u.ac.jp
Purpose
Purpose: Bereavement, particularly of a spouse, is a stressful life event that has a large impact
on the mind and body. This study explored the characteristics of the post-traumatic,
psychological growth of widows and widowers in palliative care units who had lost spouses.
Design
This was a quantitative, cross-sectional study.
Methods
Methods: A questionnaire study was conducted among survivors in two palliative care units
in Japan from April 2007 to March 2013. Participants were 550 people who were surveyed
between 6 months and 6 years after bereavement. The survey incorporated a measure of
demographic characteristics, the Post-traumatic Growth Inventory-Japanese (Taku, 2007), the
Coping Scale (Ozeki, 1993), and the Duke Social Support Index-Japanese (Iwase et al, 2008).
Results
Results: From 550 participants, 244 (44.4%) were returned; 26 questionnaires were
discounted because of problems. 108 spouses were made into the candidate among 218
persons. The average age of participants (SD) was 67.0 (9.9) years; 31 were widowers and 77
widows. The average age of the deceased spouses was the same. The mean palliative care unit
length of stay was 1.5 months, for an average of two years six months during a bereavement
period. High scores on the scale represented the amount of mental shock at the time of losing
a spouse. However, family care has also been enhanced from the general units is a palliative
care units, the spouse who was mental ready for inviting death was 62%. In addition, 85.2%
of spouses accepted their spouses death, but some participants had still not accepted the
death after six years. The post-traumatic growth (PTG) total scores for the sample were
moderate, but higher than for parents of paediatric osteosarcoma patients (Yonemoto et al.,
2012) and car accident survivors (Nishi et al., 2010). In addition, PTG scores were higher for
widows than for widowers, and there was a significant difference between these scores
(p=0.008). There were no significant differences in PTG on the following factors: separationby-death period of less than one year and one year or more; palliative care unit hospitalization
duration of one month or more, and less than one month; survivors age less than 65 years
old, and aged 65 and over; spouses who were mentally ready for their spouses death, and
spouses who were not; and spouses who did not accept death and spouses who did. PTG
538
showed a positive correlation with emotion-focused coping, problem-focused coping,

emotional support, and recognition evaluative support.
Conclusions
Conclusion: Spouses who lost partners through death in the palliative care unit had the highest
average ages. For these spouses, existence of the deceased was large. The shock at the time of
separation by death was also great. In addition, PTG was higher than in parents of paediatric
osteosarcoma patients or car accident survivors. For bereaved individuals who have lost a
spouse, nursing thing that can stress coping bereaved family and social support is important
has been suggested.
35Keywords
Post-traumatic growth, spouse, palliative care unit , ,
539
Relevance of stress coping and social adaptation on outpatients with

anorexia nervosa
Mina Tsukamoto1, Naoko Miyajima1, Yuki Kako2
1.
Faculty of Health Sciences, Hokkaido University, 2. Department of Psychiatry, Hokkaido University

Graduate School of Medicine, Sapporo
Presenting Authors Email: minna@hs.hokudai.ac.jp
Purpose
The number of patients with Anorexia Nervosa (AN) increased rapidly in the late 1990s in
Japan. A recent concern is that the incidence has increased among the elderly and the disorder
is prolonged. Therefore, A point of view of long-term prognosis is emphasized. In particular,
it is important for patients with AN to obtain coping skills for a variety of stressors in their
lives in order to prevent recurrence. The present study focused on patients with AN after
discharge.The purpose of this study was to clarify the relationship between stress coping and
social adaptation under various circumstances among outpatients with AN.
Design
Methods
The subjects were 25 outpatients with AN from November 2012 to February 2013. A selfrating questionnaire was composed of the following three sections:
(1) Basic information: age, housemates, social activities, supporters, and stressors.
(2) Tri-Axial Coping Scale-24 (TAC-24; Kamimura et al, 1995) comprising eight subscales:
"catharsis," "givie up," "getting information," "distractive recreation," "avoidance-like
thinking," "positive interpretation," "plan drafting, and "evading ones responsibility." We
used the full 24-item 5 method. A higher score indicated that the patient utilizes more stresscoping methods.
(3) SASS: Social Adaptation Self-evaluation Scale (Bosc et al, 1997) comprising three
sections: interpersonal relationships, curiosity and interest, and self-perception. We used the
full 21-item 4 method. A higher score indicated a higher subjective evaluation of social
adaptation. The SASS and TAC-24 data were analyzed using bivariate correlations with
Spearmans rank correlation coefficient by classifying each subject according to their
circumstances.
Results
Twenty patients participated in the study. The average age was 38.0 years (SD 11.2). The
effective response rate was 100%. There was no significant correlation between TAC-24
scores and SASS scores in the age group of 20. On the other hand, in the age group of over 30,
there were significant positive correlations of the total score SASS with the TAC-24
subscores "catharsis" (rs = .698, p < .01), "distractive recreation" (rs = .622, p < .05),
"positive interpretation" (rs = .618, p < .05), and "plan drafting" (rs = .535, p < .05). There
was no significant correlation between TAC-24 scores and SASS scores in the under 2-years-
540
after-discharge group. However, there was a significant positive correlation between the
TAC-24 "distractive recreation" and the total SASS score in the over 2-years-after-discharge
group (rs = .667, p < .05).
Conclusions
According to our study results, we offer the following two tips to patients with AN for
receiving support for social adaptation in the future.
1. The four methods for stress copingcatharsis, distractive recreation, positive interpretation,
and plan draftingare associated with social adaptation in the age group of over 30. These
methods can help patients with AN, who are aging or whose disorder is prolonged, to
successfully cope with stress.
2. The coping method of "distractive recreation" is likely to be helpful for patients with longterm AN.
35Keywords
Anorexia Nervosa, Stress Coping, Social adaptation, ,
541
Suicide in psychiatric hospital in-patients. A review of the literature.

Chie Tanimoto1, So Yayama2, Yoshimi Endo3, Kiyoko Makimoto3, Noel J. Chrisman4
1.
Ishikawa Prefectural Nursing University, 2. Senri Kinran University, 3. Osaka University Graduate
School of Medicine, 4. University of Washington
Presenting Authors Email: ctanimot@ishikawa-nu.ac.jp
Purpose
Psychiatric hospital in-patients are known to be at high risk of suicide. It is crucial to prevent
such suicides. The purpose of this literature review is to summarize papers reporting suicide
attempts in psychiatric hospital in-patients.
Design
A review of the literature.
Methods
Electronic databases of CINAHL and PubMed were searched for papers published between
1975 and 2014. Search terms used were ( suicide, attempt ) AND (psychiatric
department, hospital OR psychiatric nursing OR mental disorder) AND (risk
management OR hospital risk reporting). Articles that involved the suicide attempt
related to a specific psychotic symptom or disorder, to the emergency unit or general hospital
and community were excluded.
Results
Eight studies reporting suicides and suicide attempts were retained for review after 191
studies were retrieved. Clinical records were reported in most of the articles; the remainder
included a literature review, a case study, and interviews. Three studies were epidemiological.
They reported the incidence of suicide in psychiatric hospitals, and its associated
characteristics and risk factors. Reported incidence of suicide varied from 76 to 250 per
100,000 admissions. Most suicides occurred shortly after the patient slipped out of the
hospital and the common method of suicide was drowning. Risk factors included planned and
actual suicide attempt, family history of suicide, and diagnosed schizophrenia. Others of the
studies were related to the characteristic of multiple suicide attempters, assessment of suicide
risk 24 hours after psychiatric hospital admission, the characteristics of suicide attempts in
young people undergoing treatment for first episode psychosis, and case reports about high
risk and difficult suicidal psychiatric in-patients. There was a qualitative study about the
impact of serious incidents (including suicide attempt and suicide) on in-patient wards.
Healthcare workers were seriously shocked and suffered from negative emotion after such
serious incidents.
Conclusions
This review showed that epidemiological studies of suicide and suicide attempts in psychiatric
in-patients were limited. In order to prevent suicide among psychiatric in-patients, further
epidemiologic studies are necessary to elucidate risk factors of suicide. And further research
542
is also needed of groups at high risk of suicide and suicide attempts. The study of healthcare
staffs who experienced in-patient suicide will also be important.
35Keywords
suicide, suicide attempt, psychiatric hospital, in-patients,
543
Emotional well-being following religious conversion among women in

northeast Thailand
Suangsuda Charoenwong1, Siriporn Chirawatkul2, Lenore Manderson3
1.
Faculty of Nursing, Khon Kaen University, 2. Centre for Research and Training on Gender and
Womens Health, Khon Kaen University, Thailand, 3. School of Public Health, University of the
Witwatersrand, SA
Presenting Authors Email: su5599@hotmail.com
Purpose
This study aimed to describe the lived experiences of Thai women who converted from
Buddhism to Islam and who live in Isan, the northeast region of Thailand, and to analyse their
emotional well-being after conversion.
Design
In this qualitative study, the study was conducted using a phenomenological approach.
Methods
Key informants included 21 Thai women, who converted from Buddhism to Islam and
identified themselves as new Muslims (muallaf). They were obtained through convenience
and snowball sampling, using both personal and professional networks extending to the Isan
Muslim community. The data derive from in-depth interviews, natural conversations and
observations conducted from September 2012 to August 2013. The interview guide included
open-ended questions and suggested probes on womens experiences of conversion
religious change, the process of conversion, perceived benefits, challenges, barriers, and
management of their mental health. Data were analyzed thematically. This study, a part of
doctoral research of the first author, was approved by the Ethics Committee of Human
Research of Khon Kaen University (Khon Kaen, Thailand). Participants were informed of the
purpose and nature of the research prior to their written consent to the interview.
Results
Conversion took place either for pragmatic reasons because of marriage or for spiritual
reasons, but regardless of their motivation to convert, most women were deeply committed to
Islam. However, two contradictory themes became evident from their stories: women gained
a sense of happiness and peace in their new faith, and at the same time, they experienced
considerable suffering after conversion.
Conclusions
The relationship between religion and mental health is close, drawing attention to the need to
understand the effects of conversion on those who convert and on their families. Thailand is
mostly Buddhist, to provide appropriate care to and prevent mental health problems among
Isan women who convert from Buddhism to Islam, and other women in similar contexts,
health providers need to enhance their understanding of conversion and to be aware of life
544
experiences that impact on their emotional well-being. These impacts may need specific
nursing care.
35Keywords
Buddhism, conversion, emotional well-being, Islam, Thailand
545
The effects of reminiscence group therapy on agitated symptoms and

quality of life in elders with dementia
Fang-Yu Hsu1
1.
Department of Nursing, College of Medicine National Cheng Kung University
Presenting Authors Email: grace6782@gmail.com
Purpose
the purpose of this study was to apply and evaluate short and long-term effects of group
reminiscence on agitated symptoms and quality of life for patients' with dementia.
Design
This was a single group with repeated measure design, purposive sampling was used. Subjects
were residents with mild to moderate dementia recruited from five long-term care facilities in
southern Taiwan. Totally 40 subjects completed the study. Subjects received reminiscence
therapy session once weekly for ten continuous weeks with each 50 minutes in length.
Methods
Totally 40 subjects completed the study. Subjects received reminiscence therapy session once
weekly for ten continuous weeks with each 50 minutes in length. All subjects were assessed
by demographic data, Mini-Mental State Examination (MMSE), Chinese version of the
Cohen-Mansfield Agitation Inventory (CMAI) and Quality of Life-Alzheimers Disease
(QOL-AD) Scale one week before and after and three months after the intervention.
Results
Results showed that after receiving the group reminiscence, subjects overall agitated
symptoms did not change significantly (p=0.81), yet two agitated symptoms "wandering" had
long-term significant decrease (p=0.007); and akathisia had short-term significant
decrease (p=0.002). To analyze data by mild and severe agitation groups, results showed that
in severe agitation group, "wandering" (p=0.000) and akathisia (p=0.003) showed
significant long-term decrease. In addition, the overall quality of life showed significant
improvment (p=0.000), the effect can last to the end of the twelfth week after reminiscence
therapy. Quality of life also improved significantly in mild agitation group (p=0.000), the
effect can last to the end of the twelfth week after reminiscence therapy.
Conclusions
Findings of this study indicated that reminiscence therapy is beneficial to the decrease of
"wandering" and "akathisia" behaviors and the improvement of quality of life for patients
with dementia. It can be widely applied to clinical practice. Results of this study can be
references for professional or non-professional caregivers when managing the above agitation
behaviors. Also, it is a measure to improve quality of life for this group of patients.
35Keywords
reminiscence group therapy, dementia, agitated symptoms, quality of life,
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Measuring mental health of those living in a rural mountain area.

Heeseung Choi1, Insook Lee1, Kyung-Sook Bang1, Sungjae Kim1, Hye Jin Nam1, Jiyoung
Chun1, Inju Hwang1
1.
Seoul National University
Presenting Authors Email: hchoi20@snu.ac.kr
Purpose
Suicidal mortality has been increasing and the rate is doubled within the last decade in Korea.
Suicide is the fourth leading cause of death and 28.1 people per 100,000 population die by
suicide in 2012. Suicide mortality is amenable to diminution by controlling the risk and
protective factors and it is well known that depression is a strong predictor of suicide.
However Korean society possesses a strong negative prejudice against mental illnesses and
the stigma leads to delay in treatment for mental illness. Ministry of Health and Welfare of
Korea established a strategic plan for mental health management in a national health plan
Healthy People 2020. In order to provide an early intervention for depression as
emphasized by HP2020, it is crucial to screen depression early in community. The aim of the
study is to investigate relationships among self-reported measures and biomarkers of
depression and related mental health variables.
Design
This study used a descriptive correlational research design to investigate the associations
among different types of mental health measures.
Methods
Data was collected on August 2013 in a rural mountain area in Korea. A total of 170 adults
aged 35-79 participated in this study. The participants completed self-reported questionnaire
assessing depression, sleep disturbance and fatigue. Depressive symptoms were assessed by
the Center for Epidemiologic studies depression (CES-D) scale. The participants indicated
their current and for the last 24 hours of fatigue level on a 0-10 Likert scale. The quality of
sleep was measured using Verran and Snyder-Halpern Sleep scale (VSH). The EEG were
recorded using sliver-silver chloride cup electrodes attached on F3 and F4 (frontal), on C3
and C4 (central), on T3 and T4 (temporal) and on O1 and O2 (occipital) scalp regions of the
10-20 international system while the participants were seated in a chair with their eye-closed
for 5 minutes. The heart rate variability was acquired using data analysis software (TeleScan
Ver.2.8., Laxtha). The collected data were analyzed using t-test, Pearsons correlation, and
ordinal logistic regression by the SPSS/WIN21.0 program.
Results
The participants were consisted of 47.9% male and 51.6% female with the mean age of 58.8.
The results of the self-report measures were strongly correlated with each other ranging from
0.348 to 0.633 (p=<.001). CES-D scores were significantly correlated with EEG asymmetry
(i.e. inter-hemispheric alpha power of C3 and C4 channel asymmetry index differences)
(p=.047). Regarding sleep disturbance, it was related with an average heart rate difference and
the EEG measures of O1 and O2 channel asymmetry. (t=2.198, p=0.029; t=2.307, p=.022,
547
respectively). Using ordinal logistic regression, similar findings were observed that the EEG
asymmetry implies the sleep disturbances (R=.009, p=.017, 95% CI 0.113-1.169). Fatigue
was associated with frontal EEG asymmetry and an average heart rage difference (p=.025;
p=.013, respectively).
Conclusions
Findings from the present study demonstrated that biomarkers of depression, EEG asymmetry
and an average heart rate, and self-reported measures such as fatigue, sleep disturbance
possess associations with depression. These measures may be the markers of vulnerability to
depression and used as compensatory depression screening tools in community-based mental
health assessment.
35Keywords
Decreased HRV , EEG asymmetry, Self-report measures, particularly fatigue and sleep could
be reliable measures for depression , ,
548
Development and feasibility testing of web-based parent education program

for Korean parents of adolescents
Heeseung Choi1, Sumi Kim1, Heesung Koh1, Youngjoo Kim1
1.
Presenting Authors Email: hchoi20@snu.ac.kr
Purpose
Purpose: In Korea, various parent education programs have been developed and implemented
to promote parent-child relationships and prevent mental health problems among adolescents.
However, the existing programs are usually conducted in a group format and last for 8-12
weeks. These format and delivery method made it difficult or impossible for parents working
long hours and families living in rural areas to participate in the programs. Effective and
accessible web-based parent education programs are greatly needed. The specific aims of the
present study were to develop web-based parent education program for parents of adolescents
aged 11-15 years and assess the feasibility of the program.
Design
Design: The present study consists of two phases. We used qualitative descriptive study
design for phase I (education program development stage) and we used two-group
experimental study design for phase II (feasibility testing stage).
Methods
Methods: For phase I, we interviewed 27 parents of adolescents aged 11-15 years and nine
mental health professionals. Data were collected through individual and focus group
interviews and analyzed using qualitative content analysis method. The format and content of
the program were finalized through a consultation with experts on web-based study and
education. For phase II, parents recruited from four cities participated in the web-based parent
education programs.
Results
Results: We developed 4-week web-based parent education program. Each session lasts about
20 minutes. The main goals of the education programs were to: 1) increase parental
knowledge of adolescents development, common mental health, and available mental
health services; 2) enhance parental self-efficacy 3) promote effective parent-child
communication; and 4) reduce parent-child conflicts. A total of 112 parents (59 for
experimental group and 53 control group) completed the 4-week web-based parent education
programs. Participants completed survey assessing the main study variables three times
(baseline, immediate post-test, 1-month post-test). In addition to completing four education
sessions, parents completed assignments for each session and session evaluation forms.
Conclusions
Conclusions: It was feasible to develop and deliver web-based parent education program for
Korean parents. Based on the study, we were able to identified issues to be considered when
549
conducting web-based parent education programs such as recruitment and retention strategies.
For the success of the web-based education programs, a well-thought plan is essential.
35Keywords
parent education, web-based education, adolescent, mental health,
550
Case study: Impact of group sand-play therapy on self-concept of

adolescents with renal transplant
Sumi Kim1, Boojin Park2
1.
Seoul National University, College of Nursing, 2. Myoung-Ji University
Presenting Authors Email: hopedreamer4u@gmail.com
Purpose
This research is a case study aimed at figuring out how group sand-play therapy could make
an impact on self-concept of adolescents who received renal transplant, and how their
improved self-concept is reflected in daily living.
Design
This Study is a case study
Methods
The study examined male adolescents(n=3) as a single test group among those who
underwent renal transplant surgery six months ago at a general hospital located in Seoul. The
group sand-play therapy for the study was set to be made for 90 minutes each time, twice a
week, eight times in total. During the process, pre and post interviews on the participants and
their mothers, sand-play situations in every time, and the participants verbal and nonverbal
expressions were materialized via video recording, photographing and an assistant moderator
s documenting. With Cooper smiths Self-Esteem Inventory(CSEI), Childrens Depression
Inventory(CDI) and House-Tree-Person test(HTP) being used at pre-therapy, right after the
therapy and one-month after the therapy, the researcher analyzed whether the self-concept of
the participants improved or not, and how their improved self-concept was reflected in their
daily lives.
Results
The studys result sums up as follows; 1) The group sand-play therapy applied to the renal
transplant recipients had positive impact on the creation of their self-concept. 2) Their
improved self-concept led to enhancement in treatment process, confidence in their living,
problem-solving ability, self-expression, autonomy and relations with other people. 3) In the
process of the eight group sand-play therapies, the participants showed group dynamics that
contributed to a deep sense of closeness and fellowship, positive response to others, and
increase in the number of self-expression in the group. Improved self-concept in each
participant and positively changed group dynamics indicate that their improved self-concept
and positive group dynamics influence each other and move toward a better path.
Conclusions
The study includes some limits; the study was done in a short period of time in which the
participants were not able to enjoy the therapeutic effect fully. In addition, when it comes to
materials choice and analysis, there might be a lack of objectiveness. And there is no longterm research like six months after or one year later to see how long the improved selfconcept would last. To overcome these problems, the researcher can adjust timing, place and
551
frequency of treatment program that considers adolescents circumstances, and try to be

engaged in community system, if possible. Furthermore, objective data analysis method
should be researched and the consistent research on the same group should be proceeded.
Notwithstanding, the study has shown the potential role of group sand-play therapy as a
psychological intervention method for children and adolescents who suffer from chronic
physical disorder and long-lasting health problems. As the study attested to the concrete
change from the improved self-concept, it has significance.
35Keywords
adolescent, renal transplant recipient, sand-play therapy, self-concept,
552
Construction of psychiatric nursing clinical practice records applicable

form in Taiwan
Shu-Fang Su1, Jiin-Ru Rong2, Shu-Ping chou3, Pei-Ling Huang4
1.
National Taipei University of Nursing and Health Science;/Taipei City Hospital, Songde Branch;
Taiwan R.O.C., 2. National Taipei University of Nursing and Health Sciences /Psychiatric Mental
Health Nurses Association, R.O.C., 3. Taipei City Hospital, Songde Branch;;Taiwan R.O.C, 4. Bali
Psychiatric center ;Taiwan R.O.C.
Presenting Authors Email: sf0623@yahoo.com.tw
Purpose
(a)To construct a record of psychiatric nursing clinical practice applicable General Record
form.
(b)To construct a record of psychiatric nursing clinical practice applicableSpecial Record
form.
Design
The first stage of the researchers pooled the form of Taiwan's entire psychiatric teaching
hospital. The second stage through the nursing director of six psychiatric hospitals and four
associate professor level experts and scholars, etc. through a total of six focus groups to
discuss and amend the form classified
Methods
Qualitative research methods were used to collect deeper information in the psychiatric
nursing clinical practice applicable form,in Taiwan. Specifically, focus groups were held with
expert clinical practice and academia. 10 experts were invited to attend focus groups, each
group held 2 hours, to discuss and to reach an agreement for the construction of the record of
psychiatric nursing clinical practice applicable form.
Results
(A) General form: general psychiatric nursing must form. Include (a) Admission nursing
assessment form (b) high-risk assessment forms of violence, falls high risk form (c)Vital
sign record form (d)Health problem Record form(e) nursing education record form(f)
Medication and physical therapy records form (g) special observation records (h) Discharge
care records form
(B) Special formRefers to the use of the special needs of the form, including(a)special
units to assess records form (b)special needs assessment records form(c) Progress Record
Form includingGroup therapybehavior therapy supportive psychotherapy special
nursing carespecial medication nursing care.
Conclusions
Through empirical Process, the Result meets the needs of the practice of clinical nursing
record, based on clinical practice for teaching in order to improve the quality of care
outcomes.
553
35Keywords
Mental health, Psychiatric Nursing Care record Forms, focus group, ,
554
A review of the literature containing the Narratives of people with

autism spectrum disorder in Japan
Mami Yamamoto1
1.
Gifu College of Nursing
Presenting Authors Email: myamamoto@gifu-cn.ac.jp
Purpose
The purposes of this study were to review the literature containing the narratives of people
with autism spectrum disorder (ASD) in Japan, to organize the reported contents, to
investigate the significance of these "narratives" for people with ASD, and to obtain
information to guide future research.
Design
Systematic review.
Methods
The Ichushi-web was searched with keywords related to narrative by people with ASD. The
keywords were used combination; autism spectrum disorder, pervasive development disorder,
Aspergers syndrome, High-functioning autism, child, narrative, life story, person
concerned. Inclusion criteria ware focusing on narrative of people with ASD, literatures were
written by people with ASD, the answers of people with ASD. I include not only article but
also essay and commentary. I excluded duplicate literature, abstract of researches presented at
conferences.
Results
The literature that includes stories of people with ASD in Japan is mostly in books that
involve adults as research subjects or books written by adults with ASD. Study that examined
life histories told in free discussion investigated the process of social development in people
with ASD. Reports of group sharing sessions and roundtable discussions included the topics
of the difficulties of daily living, efforts to adapt to society, personal experience, and hope for
understanding, acceptance from others, and stable employment. Literature focused on
chatting outside the therapeutic context gave people with mental illness the opportunity
to discuss their daily life. Studies that conducted supportive counseling, intersubjective
involvement, or other forms of intervention for symptom relief proposed the importance of
the supportive approach of talking through the symptoms and intersubjectivity. Studies
reviewing the practice of student counseling in universities stated that the importance of
counseling was not about understanding the general and anticipated problems due to the
students diagnosis, but rather about understanding the problems of the individual student.
There are also many books written and many studies conducted by people with ASD. These
authors reported their own physical sensations, difficulties in daily living, general
misconceptions of ASD, and childhood experiences. The literature focusing on the stories of
children is extremely limited. Available literatures reported increases in childrens
vocabulary through collaborative remembering with adults and the cultivation of mutual
acceptance between children with ASD and others through the sharing of feelings. There are
555
also descriptions of the experiences of children with ASD revealed by phenomenological

methods and books written by children with ASD about their own experiences.
Conclusions
There has been no effort to gather or understand experiences from the stories of children. It is
important to listen to the stories of children with ASD to understand their internal reality and
experiences. There is a large body of literature that focused on the difficulties faced by people
with ASD. However, in the future, it is necessary to attend to the dialogue that takes place
outside the therapeutic context and to think outside the traditional approach to ASD to
understand the experiences of people with ASD.
35Keywords
autism spectrum disorder , narrative, dialogue, child, review
556
Dysmenorrhea self-care behaviors patterns in adolescents: A latent class

analysis
Yu Chao chih1, Twu Bor-yaun2
1.
Min-Hwei Junior college of health care management, 2. National University of Tainan
Presenting Authors Email: ccyu@mail.mhchcm.edu.tw
Purpose
to investigate Dysmenorrhea Self-Care Behaviors Patterns in Adolescents
Design
This study used the approach of stratified sampling. The subjects of the study were from
female students in senior high and vocational high schools in Tainan. They have suffered
from dysmenorrhea cramps for more than twice during the last six months and the valid
sample size is 359. Adolescent Dysmenorrhea Self-Care Scale was used.
Methods
M plus was used to analysis dysmenorrhea selfcare behaviors patterns in adolescents.
Results
Four latent classes of dysmenorrhea selfcare behaviors patterns in Adolescents were modeled.
class 1(seeking for assistance, 31%) they can verbalize discomfort and seek assistance from
outside, still will seek relevant information; class 2(expressing feelings, 27%) these girls can
expression physical discomfort through oral, and also seek assistance, but less relevant
knowledge gathering; class 3(aggressive, 23%) these girls initiative to seek knowledge,
expression of their own discomfort, and seek to resolve the problems; class 4(escapism, 19%)
these girls neither the initiative to express feelings, seek less problem-solving approach.
Conclusions
4 patterns of dysmenorrhea self-care behaviors among female students. This result can serves
parents and teachers more understand dysmenorrhea self-care behaviors categorys in
adolescents.
35Keywords
adolescents, dysmenorrhea, selfcare behavior patterns, LCA,
557
Effectiveness and experience connotation of art therapy among

rehabilitation patients at the day ward
Shiu-Feng Lu1, Ching-Feng Huang2
1.
Kaohsiung Veterans General Hospital, 2. School of Nursing, Chang Gung University of Science and
Technology at Chiayi Campus
Presenting Authors Email: sfiu0218@yahoo.com.tw
Purpose
The purpose of the Research: The utilization of art therapy can assist patients to integrate
internal power and self status by creating own life story. In addition, they are able to connect
self with others in the climate of the group dynamics. The research aims to explore the
effectiveness and experience connotation of art therapy among rehabilitation patients.
Design
The research recruited 33 rehabilitation patients. They regularly participated in 6-week art
therapy group. Each group session lasted one hour and scheduled on Tuesday. At the end of
6-week art therapy group they filled in the questionnaire.
Methods
The questionnaire used 5-point Likert scale based on the five aspects of the holistic nursing
assessment.
Results
(A) experience connotation: a sense of freedom graffiti happy, comfortable feel
relaxed, understanding the feelings of others, the opportunities of sharing own life
stories, joy of cooperating with other members, understanding of others
perceptions, and effectiveness of catharsis.(B) The effectiveness of art therapy was to
(1) feel more relax (87.8%) and increase activity (78.7%) on the physical aspect; (2) feel more
comfort and safe (90.9%), relieve and improve emotional status (96.9%), and express own
feelings and thoughts on the psychological aspect (93.9%); (3) illuminate the meaning of own
drawing (84.8%), integrate past experience (75.7%), and understand others ideas (87.8%)
on the cognitive aspect; (4) explore self and interpersonal barriers in the adaptation process
(72.7%), and promote interpersonal learning and share experience with others (93.9%) on the
social aspect; and (5) facilitate self-understanding and self-growth (81.8%), and understand
and accept own life experience (87.8%) on the spiritual aspect.
Conclusions
The utilization of art therapy activity can help patients express feelings and thoughts toward
selection and discard, experience the unrepeatable characteristics of life, and further
modify own mind through creation. It promotes patients interaction skills and interpersonal
relationship as well as facilitates catharsis, emotional exchange, and self-worthiness through
an individual extending a group and from the presentation of single work to a group project.
In order to promote nursing professional ability and quality of nursing care, art therapy may
558
be good to be part of nursing education programs and to integrate into routine treatment
modalities.
35Keywords
Rehabilitation patients, art therapy, experience connotation
559
The role of forensic psychiatric nursing in family support

Atsuko Nakabayashi1
1.
Chiba University
Presenting Authors Email: atsuko.n@chiba-u.jp
Purpose
This study surveyed about forensic psychiatric nursing and aimed at clarifying the role of
nursing in family support.
Design
By comparing how the family members of offenders with mental illness experienced the
forensic psychiatric system in the United States and Japan, the situations and needs of family
in each country have been clarified.
Methods
Literature review of selected papers searched MEDLINE, Ichushi-Web and books from 2000.
A search was performed using the combination of several keywords such as forensic nursing,
psychiatric, mentally ill offenders and family. For instance, search for forensic nursing
produced 25 references, which reduced to 8 when it was restricted to psychiatric on IchushiWeb. Also a search for Mentally ill offenders and nursing produced 282 references, which
reduced to 31 when family was added. The references were restricted by abstract, keywords
and the contents.
Results
In the United States, very large numbers of severely mentally ill offenders fall under the
jurisdiction of the criminal justice system and returned to the community. Although it is noted
that burdens for families when looking after a patient with a criminal history are heavy and
complicated, there is a potential for community treatment to enhance the quality of family
relations. The families of the offenders are holding burdens, especially the uneasiness in
family relations, in Japan. Therefore Japanese forensic mental health system is designed to
assist the families in the reconstruction of relationship.
Conclusions
One of the important roles in forensic psychiatric nursing is intervention in family relations in
both countries. However, there are differences in how to be concerned with family for a nurse.
Japanese forensic psychiatric nurse should start building a confidential relation with family
and to make structure for cooperation when the patient enters the hospital.
35Keywords
Forensic psychiatric nursing, mentally ill offenders, family relations
560
The educational and psychological support actual condition to the

emergency department (ED) nurse corresponding to the suicide attempters
in Japan
Naruto Goto1, Keiko Sugimoto1, Kazuaki Hirai1, Takayuki Kageyama1
1.
Oita University of Nursing and Health Sciences
Presenting Authors Email: goton@oita-nhs.ac.jp
Purpose
A suicide attempters risk of performing a re-plan is high, and it is important to render a
mental care at the ED, and to certainly connect to psychiatric care. However, the medical staff
of an ED is in the tendency which is easy to have negative feeling in a suicide attempters. It is
supposed that there also needs to be much time in connection with a suicide attempters, and
needs to be substantial of especially the nurse engaged in an ED in educational support or
psychological support. However, there are few reports investigated about the actual condition
of these support. Then, it investigated for the purpose of clarifying the actual condition of the
support to the ED nurse corresponding to the suicide attempters in Japan.
Design
Cross sectional study
Methods
To 2410 ED nurses (Ten persons were extracted from each institution at random.) of the ED
of critical care center 241 institution currently opened to the homepage of Japanese
Association for Acute Medicine, The question paper and the request document include the
contents about the existence of the follow to the staff corresponding to the opportunity of the
education about the correspondence to a suicide attempters, the guideline, and the attempted
suicide, etc. were mailed, and the reply was obtained from 399 persons (16.6%).
Results
First, about the educational support to the ED nurse corresponding to a suicide attempters,
112 persons (28.1%) answered that there was an opportunity of education, such as training
about the correspondence to a suicide attempters. Moreover, the number of what which
answered had participated in the training among what answered that there was training was 39
(34.8%). Although it had not participated, as a reason, 106 persons (94.6%) answered "There
is no time", and 104 persons (92.9%) answered "Uninterested." In addition, the number of
what answered the treatment of training on service when it came to the participation in
individual time was 93 (79.5%). About the existence of a guideline, the number of what
which answered were was 70 (17.5%), and the guideline had many which answered that it
was what was uniquely created with the institution as 27 persons (38.6%). Moreover, there
were most things that how to use as a reason by especially 34 (48.6%) in what answered that
there was a guideline saying that the guideline is not utilized was not known as 13 persons
(38.2%). Subsequently, 290 persons (72.7%) answered that he omitted the mental follow in
particular to the staff corresponding to the suicide attempters about psychological support.
561
Conclusions
The result of main enumeration showed that educational and psychological support to the
Japanese ED nurse about the correspondence to a suicide attempters were insufficient.
Moreover, it also turned out that there is the present condition which cannot fully be being
utilized even if there are an educational opportunity and guideline. It will become an
important issue how it is made to permeate from now on in addition to enriching educational
and psychological support to the ED nurse corresponding to an attempted suicide.
35Keywords
Suicide attempters, emergency department, critical care center, nurse, educational and
psychological support
562
What facilitates recovery from mental illness? Views of psychiatric nurses

and people living with mental illness in Japan
Setsuko Shimmitsu1
1.
National Center of Neurology and Psychiatry
Presenting Authors Email: shimmitsu@ncnp.go.jp
Purpose
The purpose of this presenting study was to explore the views of psychiatric nurses and
people living with mental illness (PMI) on what facilitated recovery from mental illness,
aiming at clinical implications of the differences between their views.
Design
This study utilized qualitative design for data collection and analysis using grounded theory
approach.
Methods
Conducted were individual interviews with (A) 20 psychiatric nurses who were working at
psychiatric wards, outpatient clinic, day care facility and home-visit nursing care station, and
(B) 17 individuals who were diagnosed as schizophrenia, schizoaffective disorder, depression
or bipolar disorder, and who were living in the community in Japan. In the semi-structured
interviews, interviewees were asked about their definition and meaning of recovery from
mental illness, and factors that they thought facilitated or hindered the recovery. All
interviews were audio recorded and transcribed verbatim. Data were analyzed qualitatively
using QSR NVIVO 10, one of the computer assisted qualitative data analysis software
(CAQDAS).
Results
The codes on what facilitated recovery were categorized as four factors: individual,
environmental, relational and medical factors. (A) In the views of psychiatric nurses,
comprised were (1) individual factors such as taking medicine, understanding
disease, self-monitoring, having hope and having own initiative, (2)
environmental factors such as suitable social resource, existential place, family,
role model, supports for supporters, and surrounding peoples understandings,
(3) relational factors such as trust relationship, ties, sense of security, sense
of being understood and sense of being supported (4) medical factors such as right
time support, multidisciplinary team approach, suitable medicine, promoting
independence, stance on care and believing clients could regain their own lives.
(B) In the views of PMI, (1) individual factors such as taking medicine, understanding
disease, self-monitoring, symptom management, maintaining life rhythm,
stress management, efforts toward better relationship, believing oneself,
improving abilities, and having fun time, (2) environmental factors such as social
resource, family, peer and supporter, (3) relational factors such as sense
of being understood, (4) medical factors such as treatment and patient education
563
were comprised. While various codes were distributed to each category in the nurses
interview data, most codes derived from PMIs interviews were categorized as individual
factors. Neither having hope nor having own initiative was included in the PMIs
views, on the other hand those two subcategories appeared to be quite important parts in
individual factors from psychiatric nurses views. However, it was considered that
believing oneself and having fun time could be quite important to PMI for having
hope or having their own initiatives. Also, it was considered that efforts toward better
relationship and improving abilities could be seen as acting with hope and initiatives.
Conclusions
It is implicated that psychiatric nurses perceived factors facilitating recovery from more
diversified viewpoints and that PMI focused on their own tasks when perceiving facilitating
factors. From PMIs viewpoint, though self-belief and fun time were not directly linked to
illness management, they could be the important factors or incentives that helped PMI have
hope and move on to recovery.
35Keywords
Recovery, mental health, patients' experience, nurses' experience, qualitative approach
564
The investigation of metabolic syndrome among patients with severe mental

illness
Yi-Hsin Chen1, Chia-Yi Wu2, Ming H. Hsieh3, Fey-Hsiu Hsiao2, Lian-Hua Huang2
1.
National Taiwan University Hospital, 2. National Taiwan University, 3. NTU & NTUH
Presenting Authors Email: jungchenchang@ntu.edu.tw
Purpose
Patients with severe mental illness (SMI) have been reported to have high odds of metabolic
syndrome (MetS). The immediate goals of this study are to understand the profiles of the
subjects with SMI.
Design
A cross-sectional, descriptive study design.
Methods
The current study consecutively collected a total of 115 subjects with SMI. An individual
with SMI have the clinical diagnoses as schizophrenia or bipolar disorders. There were six
steps to recruit cases with SMI as well as four inclusion criteria and four exclusion criteria
were applied. MetS was defined according to the NCEP ATP III criteria (Expert Panel on
Detection Evaluation and Treatment of High Blood Cholesterol In Adults, 2001) with the
adjustment for waist size in Asian subjects (World Health Organization, 2000).
Results
The subjects were 60 (52%) male, 86 (75%) single, 105 (91%) with schizophrenia, and 31
(26%) having college or higher education. The average age and the age of onset were 49.6
10.2 and 26.59.6 years old, respectively. The central obesity (n=58 (68%)was the most
prevalent index among five criteria of MetS, following by low HDL (54%), high TG (31%),
raised BP (21%), and elevated fasting glucose (10%). There were less than 40% of the
subjects had ever been diagnosed and treated for their MetS conditions.
Conclusions
The nurses who take care of subjects with SMI are encouraged to develop preventive
strategies and nursing care plans, to regular screen MetS condition, and to follow the progress
of cardiovascular and metabolic health for their SMI clients as well as their caregivers.
35Keywords
Severe mental illness, metabolic syndrome, schizophrenia, central obesity
565
Multidisciplinary approach to promote a practical radiation culture in

Fukushima, Japan
Emiko Konishi1, Atsuko Yabuki2, Toru Kikuchi3, Yasuko Mitsumori4, Junko Omori5,
Mikako Arakida6, Makiko Orita7, Chie Kawasaki8, Wakanako Ono4, Maasa Kobayashi4,
Kiyomi Asahara9
1.
Kagoshima University Faculty of Medicine Graduate School of Health Sciences, 2. Regional Health
Division, Iwaki City Public Health Centre, 3. Jichi Medical University Radioisotope Center, 4.
St.Luke's International University, College of Nursing, 5. Tohoku University School of
Medicine, 6. School of Nursing and Rehabilitation Science at Odawara International University of
Health and Welfare, 7. Department of Nursing, Graduate School of Biomedical Sciences, Nagasaki
University, 8. National Institute of Public Health, 9. St. Lukes International University, College of
Nursing
Presenting Authors Email: emikok88@yahoo.co.jp
Purpose
More than three years after the Fukushima nuclear accident, many persons in the accidentaffected areas continue to follow an unhealthy and unnecessarily protective lifestyle due to
fears about radiation, although radiation levels in their communities have been confirmed to
be safe. The International Commission on Radiological Protection (ICRP) states:
Dissemination of a practical radiation culture within all segments of the population,
especially within professionals in charge of the public health and education is key to the
success of protection strategies in the long term. Against this background, this paper
reports a multidisciplinary approach to promote a practical radiation culture in a model
community in Fukushima Prefecture.
Design
This study is part of larger action research project to deal with post-nuclear accident public
health challenges by a multidisciplinary research team: researchers in public health nursing,
radiological health nursing and radiation protection, and public health nurses (PHNs)
practicing in communities in Fukushima.
Methods
The PHNs developed radiation teaching sessions as part of their routine health programs for
specific target populations of the community such as elderly persons, mothers of young
children or persons with psychiatric problems. Working with the PHNs, the researchers gave
face-to-face interactional lectures to the targeted resident group that addressed issues in their
daily life such as eating, drinking and outdoor activities in combination with the provision of
updated radiation monitoring data related to those activities.
Results
The interactions eased the residents anxieties about radiation and encouraged them to
regain their normal life style; participants made such comments as Oh, drinking tap water is
safe! I will tell todays knowledge to my family and neighbors. Also, the sessions
empowered both PHNs and researchers to live through this difficult time.
566
Conclusions
PHNs, although they lack detailed technical knowledge about radiation, are professionally
prepared to employ referral strategies and to collaborate with appropriate professionals, thus
they can take the initiative in the creation and dissemination of a practical radiation culture in
the communities where they serve. Effective and practical risk communication with residents
who live in low level radioactively contaminated areas is achieved when this is given face-toface as part of the local PHNs health programs. This collaborative approach has
empowered the residents, PHNs and researchers by promoting mutual understanding and
trustful relations.
Funding: This study was funded by Ministry of the Environment, Japan.
35Keywords
Fukushima nuclear accident, practical radiation culture, public health nurses, risk
communication
567
Developing radiation teaching materials for public health nurses of

Fukushima, Japan.
Chie Kawasaki1, Atsuko Yabuki2, Emiko Konishi3, Wakanako Ono4, Toru Kikuchi5, Makiko
Orita6, Junko Omori7, Mikako Arakida8, Maasa Kobayashi4, Yasuko Mitsumori4, Kiyomi
Asahara4
1.
National Institute of Public Health, 2. Iwaki City Government, 3. Kagoshima University Faculty of
Medicine Graduate School of Health Science, 4. St.Luke & International University, College of
Nursing, 5. Jichi Medical University, 6. Department of Nursing, Graduate School of Biomedical
Sciences, Nagasaki University, 7. Tohoku University School of Medicine, 8. School of Nursing and
Rehabilitation Science at Odawara International University of Health and Welfare
Presenting Authors Email: kawasaki-chie@niph.go.jp
Purpose
More than three years after the Fukushima nuclear accident, people in the accident-affected
community appear to have regained their composure. However, public health nurses (PHNs)
have noted that residents vague uneasiness about radiation has not subsided. The PHNs had
difficulty in responding to those peoples attitudes. Also, PHNs have suggested that general
educational materials about radiation do not meet residents needs. This background
information motivated us to conduct this study in a model community in Fukushima.
Design
This study is part of an Action Research project undertaken by a multidisciplinary research
team: PHNs practicing in the model community, radiation experts, and public health nursing
researchers. The project consists of three parts: 1) Teaching sessions about radiation for
residents as part of the PHNs routine health programs; 2) Collaborative meetings with
PHNs and researchers to evaluate the teaching sessions, explore residents needs, and share
PHNs concerns; 3) Activities to promote radiation protection culture in the community.
Methods
The study, in part 3 of the project, proceeded as follows: 1) Researchers identified residents
needs related to radiation through part 1 & 2 of the project. 2) Five major themes were
extracted and contents of each theme constructed. 3) Material format was designed for
PHNs practical use. 4) A set of teaching leaflets was drafted. 5) PHNs gave feedbacks
about the leaflets regarding appropriateness of content and ease of use. 6) Researchers refined
the drafts based on the PHNs feedbacks and discussions among researchers. This process
was repeated several times until the materials were finalized.
Results
Part 1 & 2 of the project indicated that the residents had a vague uneasiness, although
radiation levels in their community was confirmed to be safe. The residents needs about
radiation information were apparent. However, information so far available in general did not
meet those residents needs and lifestyle. We noted that their concerns about daily life such
as food, water, and out-door activities vividly reflected their way of life and culture. Based on
568
those findings, we developed materials that had five themes: 1) Food: market and wild
products; 2) Drinking water : tap, well, and bottled water,3) Living environment: gardens,
mountains, fields, and hot-spots in the environment, 4) Childrens out-door activities such as
playing with the sand, swimming in the sea,5) Health risks and total health.
Conclusions
The selected themes are related closely to residents daily life. They differ from materials
that provide general knowledge about radiation. It should be noted that residents who have
their own lifestyle and culture cannot utilize the knowledge from those general materials and
therefore a vague uneasiness about radiation remains. Giving information and teaching
sessions reflecting the residents lifestyle and culture is the most important approach to
reduce uneasiness and resolve doubts of residents. This is also an effective way to promote
radiation protection culture. The effectiveness of the materials will be evaluated after PHNs
have used the materials in their practice.
This study was funded by Ministry of the Environment, Japan.
35Keywords
Radiation teaching, public health nurses, Fukushima, ,
569
Mental health problems and the risk of subsequent internet addiction in

adolescents: Results of a prospective cohort study in Japan
Shunyue Cheng1, Masayo Ayukawa2, Hiromi Hara3, Minako Yashima3, Hidemi Sasaki3,
Tadahiko Maeda4
1.
Gifu Univeristy of Medical Science, 2. Gifu University of Medical Science, 3. Hiroshima Bunka
Gakuen University, 4. The Institute of Statistical Mathematics
Presenting Authors Email: jsei@u-gifu-ms.ac.jp
Purpose
It has been reported that several mental health disorders, such as depression, anxiety, and
social phobia, are associated with internet addiction. However, the causal relationship
between mental illness and internet addiction has not been demonstrated. The purpose of this
study was to identify the impact of mental health disorders on subsequent internet addiction
among adolescents in Japan.
Design
A prospective cohort study.
Methods
A prospective cohort study was conducted in Hiroshima, Japan from November 2012 to
January 2014. A total of 1826 students from 8 high schools (4 junior and 4 senior) completed
both baseline and follow-up surveys conducted one year later. Of the 1826 students, 1382
were not classified as having internet addiction at baseline and had complete data available
for analysis. Internet addiction was assessed using the 20-item Youngs Internet Addiction
Test (IAT). Mental health was assessed using the self-report version of the Strengths and
Difficulties Questionnaire (SDQ). Information regarding participant characteristics, lifestyle,
and internet usage patterns were obtained. A multiple logistic regression analysis that adjusted
for potential confounding factors was used to determine the impact of adolescent mental
health on the risk of internet addiction. The study was approved by the Ethics Board of the
School of Nursing, Hiroshima Bunka Gakuen University. All participants provided written
informed consent prior to participation.
Results
At baseline, students with abnormal SDQ subscale results included 9.5% with emotional
symptoms, 7.9% with conduct problems, 7.7% with hyperactivity, 4.2% with peer problems,
31.8% with abnormal total difficulties scores, and 25.5% with abnormal pro-social scores.
Approximately 34% of students reported that they spent prolonged time online and 11.6%
developed internet addiction. There was an increased risk of internet addiction for those who
reported prolonged time spent online [odds ratio (OR), 10.5; 95% confidence interval (CI),
6.2-17.9] and for those who had more internet friends than school friends (OR, 5.54; 95% CI,
1.81-17). Moreover, adjustment for potential confounding factors including the above two
variables resulted in an internet addiction risk that was significantly increased among students
classified as having conduct problems (OR, 2.55; 95% CI, 1.33-4.99), as well as those with
borderline abnormal or abnormal scores on the total difficulties scale (OR, 2.18; 95% CI,
1.263.77 and OR, 2.08; 95% CI, 1.20-3.62, respectively).
570
Conclusions
The results show that adolescents who are initially free of internet addiction but have mental
health problems may consequently develop internet addiction. Conduct problems at baseline
are especially predictive of internet addiction at one-year follow-up. This result indicates that
adolescents with poor mental health are most at risk for internet addiction and that prevention
or early intervention targeting groups with identified risk factors is effective in reducing
internet addiction among adolescents. Screening for mental health problems to identify
individuals at risk may be an effective early prevention strategy for internet addiction.
35Keywords
Internet addiction, mental health, prospective study, adolescents, Japan
571
Difficulties experienced with nursing activities by nurses working in rural

and remote clinics
Tomoko Sekiyama1, Misugi Yuyama1, Shingo Esumi1, Kumikio Suzuki1, Tomoe Tsukamoto1,
Hiroko Shimada1, Sagiri Aoki1, Sanae Haruyama1
1.
Jichi Medical University, School of Nursing
Presenting Authors Email: sekiyama@jichi.ac.jp
Purpose
To examine in detail the difficulties experienced with nursing activities by nurses working in
rural and remote clinics.
Design
This study was a cross sectional study.
Methods
Subjects: Subjects were nurses in 833 rural and remote clinics.
Method: Self-administered questionnaires were mailed to participants.
Survey items: Demographic characteristics of the nurses participating in this study (gender,
age, years of practical experience as nurses, service years at the current clinic, etc.) were
collected.
Difficulties experienced with nursing activities: These were measured through 19 items
included in the survey questionnaire.
Data analysis: An exploratory factor analysis using the maximum likelihood method (promax
rotation) was used to identify the factor structure of the 19 items that were used to assess the
difficulties experienced by nurses with nursing activities at rural and remote clinics, and the
reliability coefficients for each factor were defined. A t test was performed to determine the
association between the extracted factors and the presence or absence of problems attributable
to a shortage of social resources. The statistical analysis was performed using SPSS (Ver.21)
and the significance level was set at 0.05.
Results
The number of responses to the questionnaire was 337 (valid response rate: 40.2%).
The statistical analysis extracted 3 factors with respect to the difficulties experienced with
nursing activities by nurses working in rural and remote clinics, including less
support/liaison with the nursing activities, insufficient compensation and lack of
training/education opportunity, and unclear definitions of nursing services, other work
tasks, and private life. There were statistically significant differences between the three
above mentioned factors and the presence or absence of problems attributable to a shortage of
social resources.
Conclusions
The three extracted factors matched the nature of work and difficulties experienced with
nursing activities in rural and remote areas. In addition, the shortage of social resources is a
common characteristic of rural and remote areas. These findings suggested that the difficulties
572
experienced with nursing activities by nurses working in rural and remote clinics were
associated with the inherent characteristics of rural and remote areas and carrying out nursing
work in rural and remote areas.
Therefore, the identity, diversity, and interest in nursing in rural and remote areas should
focus on providing training and continuous nursing education in order to reduce the
difficulties experienced by nurses working in rural and remote areas.
35Keywords
Rural and remote area, clinic nurse, nursing activity, difficulties
573
Survey of specified acts of medical assistance to be provided by nurses in

rural and remote area clinics
Shingo Esumi1, Kumiko Suzuki1, Tomoe Tukamoto1, Hiroko Shimada1, Tomoko Sekiyama1,
Sagiri Aoki1, Sanae Haruyama1
1.
Jichi Medical University, School of Nursing
Presenting Authors Email: s.esumi@jichi.ac.jp
Purpose
The team medical care promotion projects in Japan contain two proposals requiring expansion
of opportunities for nurses to use their own judgment, and expansion of nurses roles in
actual clinical settings. In light of the above-mentioned proposals, the aim of this study was to
clarify actual medical assistance provided by nurses who worked at clinics in rural and remote
areas, which are operated by a small number of specialists. The assessment was based on 12
acts, which were extracted from the specified 41 medical assistance acts proposed by the
Ministry of Health, Labour and Welfare (MHLW), Japan.
Design
This was a cross-sectional study.
Methods
The subjects were nurses from 161 clinics, each of which consisted of 1 full-time doctor and 1
full-time nurse. The clinics were located in rural and remote areas all over Japan. The survey
was conducted by mailed questionnaires, and one form per clinic was sent. The survey items
were the 12 specified acts of medical assistance extracted from the draft list of the specified
acts of medical assistance proposed by MHLW, based on a previous study (Haruyama et al,
2009; Haruyama et al, 2011; Toda et al, 2012; Sakamoto et al, 2010; Shinozawa et al, 2004 ) .
The 12 specified acts included arterial line securement, implementation of
echocardiography, selection and dose adjustments of nonopioid analgesics/adjuvant
analgesics, dose adjustments of opioids, blood sampling by direct arterial
puncture, abdominal ultrasound, bladder fistula catheter replacement, insulin
dose adjustments based on blood glucose, oral/nasal intubation, replacement of
gastrostomy catheter/tube/button, debridement/hemostasis of decubitus necrotic tissue,
and diagnosis of severity of dehydration and correction by transfusion. The subjects were
asked to use a 3-point scale to rate their experience of any of the above-mentioned 12 acts;
they were also asked to rate on a 2-point scale how crucial they considered each act, and
whether it had been accompanied by a protocol.
Results
The number of valid responses was 86 (53.4%). Some subjects experienced all of the 12 acts.
More than 10% of the subjects answered that they had experienced 11 of the 12 acts. For 38
subjects (44.2%), the most common experience was diagnosis of severity of dehydration
and correction by transfusion, followed by debridement/hemostasis of decubitus necrotic
tissue for 29 subjects (33.7%). Furthermore, most subjects (14, 16.3%) answered that
574
diagnosis of severity of dehydration and correction by transfusion was highly crucial,

and 32 subjects (37.2%) reported the presence of a protocol for this procedure.
Conclusions
Nurses working in clinics in rural and remote areas operated by a small number of specialists
performed many medical assistant acts, including high-level techniques. Compared with the
subjects who had the protocols, the number of the subjects who answered the acts were highly
crucial was smaller. Future research should examine the reason for this difference in more
detail.
35Keywords
Specified acts of medical assistance, community nursing, rural and remote clinic
575
Association between religiosity and sexual attitude among prisoners in

lembaga pemasyarakatan kelas II a Wirogunan Yogyakarta
Birrul Qodriyyah1, Wenny Artanty Nisman1
1.
School of Nursing, Faculty of Medicine, Universitas Gadjah mada
Presenting Authors Email: birrulqodriyyah@yahoo.co.id
Purpose
To investigate the correlation between religiosity and sexual attitudes, religiosity level
overview and description of the sexual attitudes of prisoners in Lembaga Pemasyarakatan
Kelas II A Wirogunan Yogyakarta
Design
This study was a cross-sectional quantitative study
Methods
85 samples of a total population of 330 inmates who meet the criteria for inclusion; men, able
to understand Indonesian languages, and willing to be respondent. Inmates that identified
transgender and those who begins on free period are excluded from the study. The instrument
used in this study is the adoption of the instrument The centrality of Religiosity Scale (CRS)
and the Brief Sexual Attitude Scale (BSAS). Mann Whitney test is statistically used in this
study.
Results
A total of 86% of respondents included in the category of very religious. There were no
significant differences between sexual attitudes in general (p = 0, 181), permissive attitudes (p
= 0, 21), instrumentallity attitude (p = 1, 0), and communion attitude (p = 0.092) in the group
of inmates was very religious and religious. There are significant differences between
communion attitude in the group of prisoners with rape criminal background and non rape
criminal backgrounds(p = 0, 006).
Conclusions
The level of religiosity inmates are mostly very religius.There is a no relationship between the
degree of religiosity inmates with general sexual attitudes, permissive sexual attitudes,
instrumentallity sexual attitude, communion sexual attitudes, but there are significant
differences between the groups of inmates sacred sexual with background criminal rape and
non-rape.
35Keywords
Sexual attitudes, religiosity, lembaga pemasyarakatan, inmates
576
Knowledge and attitude of health workers in Yogyakarta to increasing HIV

test scope by using PITC approach
Rizka Setyaningrum1, Ema Madyaningrum1
1.
Faculty of medicine Gadjah Mada University
Presenting Authors Email: ayu.islamic@gmail.com
Purpose
To determine knowledge and attitudes of health workers are nurses, midwives, and physician
of primary health care about the PITC and 3 principals of PITC are counseling, consent, and
confidentiality.
Design
This study was a cross sectional descriptive study design.
Methods
The instrument as a questionnaire arranged from the guideline of PITC by WHO 2007 and
P2PL 2010. Samples were taken with a proportional random sampling technique consisted of
33 nurses, 40 midwives and 32 physicians. Analysis of data used frequency distribution and
chi square test.
Results
A total of 62.5% of midwives and 56% of physician have a good level of knowledge, but
51.5% of nurses in enough. As much as 66% physicians and 67.5% midwives have a positive
attitude, but 51.5% of nurses being negative. There was no difference in knowledge and
attitudes between health workers of primary health care who had gotten a duty of HIV-STI
Services Comprehensive Continuous or yet. (p 0.05)
Conclusions
Majority of health workers were good knowledge and had positive attitudes to support the 3
principal application of PITC, also there was no difference in knowledge and attitude.
35Keywords
Knowledge, attitude, health worker, PITC
577
Mothers accepting attitudes towards the care and educational support

provided for their children with disabilities in an underpopulated area
Hibino Naoko1, Matsuda Nobuko2, Noro Chizuko3
1.
Gifu College of Nursing, 2. Kobe University, 3. Sonoda Womens University
Presenting Authors Email: hibino315@gifu-cn.ac.jp
Purpose
To analyze mothers accepting attitudes towards the care and educational support provided
for their children with disabilities in an underpopulated area.
Design
Qualitative study involving a focus group interview survey.
Methods
This study was conducted in an underpopulated area facing an aging population and a low
birth rate, involving mothers of children attending a daycare facility for disabled children. A
focus group interview (FGI) was used in this study. An interview guide focusing on
accepting attitudes towards the care and educational support provided for children was
used to collect data from the mothers, as well as facility staff in order to supplement and
confirm the data obtained from the mothers. The obtained data were analyzed using a
qualitative approach. This study was conducted with the approval of the ethics committee of
the research directors university.
Results
The study area, facing an aging population and a low birth rate, had serious healthcare
resource problems, such as a chronic medical staff shortage and the aging of general
practitioners. The study subjects were 8 mothers and 7 medical staff. FGI (approximately 90
minutes) was conducted once for each group (the group of mothers and that of medical staff).
All FGI data were transcribed verbatim, and a total of 126 summarized items were extracted.
They were then categorized into structural components: antecedents, attributes, and
consequences, to analyze mothers accepting attitudes towards the care and educational
support provided for their children. Concerning antecedents, a shortage of healthcare
resources and prejudice against and a lack of understanding about attending a daycare facility
made it difficult for the mothers to have favorable attitudes towards the care and educational
support provided for their children. Concerning the attributes, the mothers deepened their
understanding about the care and education provided for their children with disabilities by
obtaining advice from facility staff or medical providers and actually experiencing the care
and education provided at the facility. Concerning the consequences, the mothers developed
accepting attitudes by obtaining sympathizers and family support and becoming aware of the
effects of the care and education.
Conclusions
The mothers have developed favorable attitudes towards the care and educational support
provided for their children by understanding the regional characteristics and taking into
578
consideration the growth and development of their children as well as their family members.
Although medical resources were limited, advice and support from the facility staff or
medical providers helped them to become aware of the growth of their children and accept the
reality of the situation. The analysis of mothers accepting attitudes towards the care and
educational support provided for their children with disabilities suggests the possibility of
proposing practical support methods for such mothers.
35Keywords
Underpopulated area, care and educational support provided for children with disabilities,
mother, accepting attitude
579
Community leaders views of disaster-relief activities as providers of

support in the event of a disaster
Chizuko Noro1, Naoko Hibino2
1.
Sonoda Womens University, 2. Gifu College of Nursing
Presenting Authors Email: c_noro@sonoda-u.ac.jp
Purpose
When a depopulated area was hit by a typhoon, some residents in the community provided the
elderly with support even though they were also disaster victims themselves. The present
study aimed to discuss their views of changes in the lives of the elderly and their health
conditions prior to and following the disaster, as well as their support activities.
Design
Qualitative study using a qualitative data analysis method.
Methods
The study area was a depopulated area designated as an Area Stricken by Torrential Rain and
Serious Disasters in 2011 by the Act on Special Measures for Promotion of Independence of
Underpopulated Areas. It is one of the heavy rainfall areas in Japan, and several floods
occurred there in the past. The subjects were five people who had served as community
leaders, such as the chairperson of the community association, social workers, and volunteers
for the promotion of health. The survey period was between October 2012 and September
2013. A semi-structured interview with the five leaders was conducted to examine their views
of disaster-relief activities, and the results were analyzed using qualitative data analysis. With
due consideration given to research ethics, the present study was conducted with the approval
of the research ethics committee of the institution to which the author belongs.
Results
The mean population aging rate in the subject area was 34.0% (2011), and 50% or higher in
some marginal villages. As a result of the survey, three core categories, nine categories, and
nineteen subcategories were extracted. The chronic diseases of some disaster-stricken elderly
people worsened, and there were some disaster-related deaths. As reconstruction of the
houses of elderly people is related to their financial situation, some pensioners gave up
rebuilding their houses and moved. The leaders helped build evacuation centers and
attentively listened to the elderly, as persons in charge of providing support in the event of a
disaster, although the leaders themselves were also disaster victims. Some of the leaders who
were involved in the attentive listening re-experienced mood enhancement and depression, or
became worried about whether they were allowed to conduct interviews as non-professionals.
Others learned that their visits helped the elderly feel relaxed. Some leaders blamed
themselves for having been unable to provide support immediately after the disaster.
Following their visit to the disaster-stricken area, the leaders suggested that it is important to:
establish positive relationships with neighbors in daily life, promote the spirit of self-help to
protect their own lives, and distinguish collaborative support, provided by the leaders, from
public support.
580
Conclusions
The analysis of descriptions provided by the leaders suggested that they, as non-professionals,
had difficulty listening to disaster victims attentively and providing them with support at the
time of the disaster. Further studies involving a larger number of subjects should be
conducted to increase the reliability of the results, and public health nurses, as support
providers in the event of a disaster, should discuss psychological care support to be provided
for the affected residents including their leaders.
35Keywords
Community leaders, disaster-relief activities, psychological care, non-professionals
581
Hand-washing guidance for elderly people in the community to prevent

infection
Yukiko Yamamoto1, Tomonori Kayano1, Yasushi Kimura1, Hibiki Tanaka2
1.
Sonoda Womens University, 2. Tottori College of Nursing installation preparation room
Presenting Authors Email: yyukiko@sonoda-u.ac.jp
Purpose
Hand-washing guidance is important for preventing the spread of influenza virus or norovirus
in the community. In this study effective methods of hand-washing guidance for elderly
people were observed.
Design
Associate experimental study
Methods
The volunteers of this study were 20 elderly people living in community with guardian
consent. This study was done after approval of an ethic committee of a university.
We have examined an effective hand-washing lesson for elderly people as follows.
Guidance of hand-washing
1) We explained that hand-washing was important for prevention of infection.
2) After they applied a fluorescent lotion to a hand, they washed their hands.
3) They confirmed with a fluorescent lamp whether they were able to wash off a lotion.
4) We explained effective hand-washing methods using the poster of hand-washing.
Evaluation of hand-washing methods
Before guidance and after guidance, volunteers wash their hands with non-medicated liquid
soap, and then we observed the methods of their hand-washing. Extraction ratio of ATP
(adenosine tri-phosphate) on their hands by washing was measured.
Statistical analysis: A paired Students t test was used to determine the difference among the
ATP value. A chi-square test was used to determine the difference among the ratio of person.
These analysis were performed using statistical analysis software Excel version 10.
Results
ATP reduction ratio
Before hand-washing guidance, ATP reduction ratio was 88.610.4%. But after guidance, the
ratio was significantly increased to 93.95.0% (P<0.05).
Hand-washing method
Before hand-washing guidance, 65% of persons rubbed back of hands, 40% rubbed
interdigital spaces, 15% rubbed tips of the fingers, 5% rubbed thumbs and 40% rubbed wrists.
After guidance, 100% of persons rubbed back of hands, 80% rubbed interdigital spaces, 90%
rubbed tips of the fingers, 85% rubbed thumbs and 95% rubbed wrists. After hand-washing
guidance, ratio of the persons who rubbed their back of hands (P<0.01 vs before guidance),
interdigital spaces (P<0.01), tips of the fingers (P<0.001), thumbs (P<0.001) and wrists
(P<0.001) were significantly increased. In addition the persons who dried their hand enough
582
were 40% before guidance. However, after guidance, the ratio was increased significantly and
became 80 %(P<0.01).
The results of a questionnaire
Only 15% of person had learned hand-washing methods. While 35% is that they didnt
know appropriately how to wash their hands at all (10%), or know it a little bit (25%). 10% is
interested in this instruction with fluorescence lotion and feels it fun, 30% is also interested in
watching residual lotion visually on their hands as fluorescence. In the end, 65% realized that
their usual hand-washing method was not enough for sure.
Conclusions
ATP reduction ratio has been improved by instructing hand-washing because the number of
people, who can wash the parts of their hands having been missed to wash before guidance, is
increasing. In this point of view, hand-washing guidance of this time is enough effective.
35Keywords
Hand-washing, guidance, elderly people , community, infection control
583
Measures that community health nurses perform to secure quality of

business for outsourcing
Yukari Maeno1, Yoko Hatono1, Koji Mori2, Tomofumi Sone3, Tomoko Nagata2, Yoshiyuki
Shibata2
1.
Kyushu University, 2. University of Occupational and Environmental Health, 3. National Institute of

Public Health
Presenting Authors Email: maeno@med.kyushu-u.ac.jp
Purpose
In Japan, to develop health services, outsourcing utilizing private companies has started to be
introduced. This study aims to demonstrate measures which community health nurses in cities,
towns and villages who predominate in providers of health services in Japan have addressed
to secure and improve the quality of the services.
Design
The study subjects were all the 1741 municipalities as of April 1, 2013 (except the local
governments within evacuation zones following disaster). A self-report questionnaire survey
was conducted by post for the public health nurses who have managed the entire public health
nurse's duties in each municipality. The content of this survey included, the measures that
public health nurses adopted to provide high-quality services in outsourcing of care
prevention services and subjects were required to answer open-ended questions.
Methods
For analysis, the description about measures that a respondent underwent was extracted and
summarized, and then classified based on the similarity of the meaning and contents.
This study was approved by the ethical review board of Kyushu University. The purpose,
method, and security of arbitrariness of study participation were described in the consent form.
The consent for participation in this study was obtained when each nurse returned the
completed questionnaire. Personal data protection and data leakage prevention were paid
great attention.
Results
Of 951 responses, 183 responses, in which the measures were mentioned, were analyzed.
The measures that community health nurses adopted for outsourcing were extracted as
follows: 5 categories of the measures in the planning phase; 2 categories of the measures in
the check phase; 2 categories of the measures in all the phases.
The detailed five categories in the planning phase were as follows: [information-gathering
enough to outsourcing], [Selection of company which can accomplish services] ,
[Development of detailed specification of which contents can be understood] , [Setting of an
opportunity to allow outsourced companies to understand and share the purposes and
contents] , [Development of effective program manual] . The detailed two categories in the
check phase were as follows: [Involvement of a public health nurse in monitoring and
feedback], [Action to improve outsourcing and to develop the business] . The detailed two
categories in all the phases were as follows: [Implementation of teaching and training to
improve outsourced companies skills], [Communication to allow public health nurses to be
584
involved in the business].

Conclusions
It was found that public health nurses operate and manage outsourcing of health services by
adopting measures in plan, check, and act phases of plan-do-check-act (PDCA) cycle in order
to secure the quality of the services. To ensure high quality services can be provided even if
health services are outsourced, it was thought that the following were required:
operation/management of the business outsourced; education to improve outsourced
company's skills; communication to facilitate building of relationship with the local
government and outsourced companies, and relationship among outsourced companies.
35Keywords
Public health service, outsourcing, local government, public health nurses,
585
Comparison of daytime and nighttime fatigue among shift workers

Ayako Ogata1, Yoko Hatono2, Masahiro Nakano1, Tsukasa Sasaki3
1.
Department of Nursing, Faculty of Health Sciences, Junshin Gakuen University, 2. Department of

Health Sciences, Graduate School of Medical Science, Kyushu University, 3. The Chronic Fatigue
Research Center, The Institute for Science of Labour
Presenting Authors Email: aco_bee@yahoo.co.jp
Purpose
This study was conducted for the purpose of comparing fatigue among shift workers working
at night and during the day, and obtaining suggestions for preventing health risks among night
shift workers.
Design
Fact-finding investigative study
Methods
The subjects of the study consisted of male shift workers employed in the manufacturing
industry. The study was conducted in the form of a self-administered questionnaire filled out
after work each day. The contents of the survey consisted of basic attributes and subjective
fatigue. A scale that was developed in Japan and has been confirmed to be reliable and valid
was used to evaluate fatigue. The scale is composed of five subscales (drowsiness, instability,
uneasiness, dullness and eyestrain) with five items each, and the subjects were asked to
respond using the five-point Likert scale. Those subjects exhibiting higher scores, calculated
based on the scores of the five subscales (1 to 5 points) and the total score for all subscales (5
to 25 points), were judged to have a higher degree of fatigue. With respect to ethical
considerations, this study was examined and approved by the ethics committee.
Results
Complete sets of data were obtained following five consecutive night shifts from 38 subjects
among 94 subjects working consecutive night shift.The average of total scores for 5 days of
working at night was 11.04.0, while the average of total scores for 5 days of working during
the day was 10.43.9 (p=n.s.). In the case of looking at the scores for each subscales,
although average scores were similarly high for working at night with the exception of
apprehension (p=n.s.). When a comparison was made between daily scores for working
during the day and working at night, respectively, a significant difference was observed in the
total scores between working at night (10.74.2) and working during the day (9.73.7) on the
second day (p<0.01). In looking at each subscales, although drowsiness was significantly
higher for working at night on all days. In looking at fluctuations exhibited during each shift,
among night shift workers, total scores decreased on the second day as compared with the
first day, rose on the third day, and remained at that level until the fifth day. With respect to
subscale scores, the days on which the highest scores were observed differed according to the
scale item. Among day shift workers, both total scores and subscale scores decreased on the
second day from the first day and rose on the third day in the same manner as night shift
workers.
586
Conclusions
Night shift workers were thought to be more susceptible to fatigue than day shift workers and
it tended to be more difficult to recover from that fatigue. In a comparison of individual
subscales, the fact that drowsiness scores were significantly higher among night shift workers
suggests the need for support for the manner in which night workers are able to sleep when
working consecutive night shifts.
This study was conducted supported by a grant for young researcher scientific research (B)
(No. 25862272).
35Keywords
Consecutive night shifts, fatigue, subjective symptoms
587
Mothers social competence in building social support networks while

child rearing
Hikaru Honda1, Nobuko Matsuda2, Michiyo Hirano1, Kazuko Saeki1
1.
Faculty of Health Sciences, Hokkaido University, 2. Faculty of Health Sciences, Kobe University
Presenting Authors Email: hikaru.honda@hs.hokudai.ac.jp
Purpose
Many mothers feel lonely staying only with their babies and being away from the
communities they belonged to before having babies. They need various kinds of social
support for staying healthy and happy while they care for their children. However, it is
difficult for mothers to build supportive networks in contemporary Japanese society because
of the declining birthrate, diversification of values, and prevalence of individualism.
There are few opportunities for normal interaction among mothers. They have to take
responsibility for building their own networks of social support. In this study, we clarify
mothers social competence in building social support networks for parenting in the
community today.
Design
We use a grounded theory approach.
Methods
We interviewed 24 mothers of children 1-4 years old. We collected data at a community
parenting support center via semi-structured interviews that lasted from 25 to 58 minutes,
with an average length of 36 minutes. We asked them about their experience of forming
beneficial networks in their child-rearing years, and used a qualitative analysis method to
analyze the data. In addition, we consulted five public health nurses experienced in maternal
and child health while analyzing the mothers social competence. This study was conducted
with the approval of the Ethics Committee of Hokkaido University.
Results
Seven categories were identified in the mothers social competence for building networks of
social support while child rearing. (1) Rising to the challenge and taking the opportunity to
contact other mothers first; having the courage to get involved with existing mothers
groups at an unfamiliar child support center; competence in understanding the group
dynamics there. (2) Striving to interact socially with other mothers as much as possible; being
a friendly, open-minded person who, for example, tries to be the first to say hello. (3)
Discovering what they and other mothers have in common and being able to assess the
closeness of relationship; understanding another mothers personality and values; judging
the appropriate psychological distance needed and exchanging email addresses. (4)
Competence in building networks intentionally; understanding the benefits of having a
connection with others and of building networks of reciprocity. (5) Competence in developing
desirable relationships; choosing the topics of conversation according to the person being
spoken to and to the situation. (6) Sound common sense; being attentive to others, for
588
example, by paying attention to their childs behavior. (7) Striving to maintain good
relations with the husbands parents and being considerate of their feelings; arranging for
children and paternal grandparents to spend time together; accepting the husbands
parents kind offers and asking them for help.
Conclusions
We identified the mothers social competence in forming networks in their child-rearing
years. These findings can be used to understand mothers dispositions and for setting up
early intervention for mothers who have difficulty in forming networks on their own. On the
basis of these findings, we are planning to develop a Social Competence Scale for use in
supporting mothers in forming community networks.
35Keywords
Maternal and child health, social competence, social support networks, community support,
grounded theory approach
589
Long term care nursing competence and its relationship with knowledge,
attitude and practice
Pei-Lun Hsieh1, *Ching-Min Chen2

1.
Institute of Allied Health Sciences College of Nursing /National Cheng Kung University, 2.
Department of Nursing / National Cheng Kung University
Presenting Authors Email: pelen0444@gmail.com
Purpose
Longer average life expectancies and a rapid ageing pace have made long-term care an urgent
and important issue in Taiwan. In an aging society, there is an increasing need for training to
enhance nurses Long Term Care Nursing Competence (LTCNC).
Design
A cross-sectional, descriptive correlation design.
Methods
Total sampling technique was used to survey Taiwanese nurses who participated long term
care training course offered by Ministry of Health and Welfare in 2013. The research
instrument included long term care knowledge, care intension, practice and LTCNC was selfdeveloped with acceptable internal consistency (Cronbach's Alpha=.69-.98) and content
validity (CVI=.92-.99). A total of 300 questionnaires were sent to those agreed to participate
on web and 122 effective returns were noted.
Results
The findings showed positive correlations between pursuing continue education with
knowledge (t=-2.89, p<.05), intension (t=-4.61, p<.001) and practice (t=-3.18, p<.05). Those
working in LTC facilities (t=2.51, p<.05) had better knowledge. Higher job title had more
practice experience (t=3.18, p<.05). Years of nursing working experience (r=.18, p<.05) and
long term care experience (r=.28, p<.001) were related to practice. Reason of participation
was related to knowledge (F=3.5, p<.05) and intension (F=3.09, p<.05). Those passed the
exam had significant more practice (t=-2.41, p<.05). Significant positive correlations were
590
found between LTCNC and knowledge (r=.23, p<.05), intension (r=.53, p<.001), practice
(r=.26, p<.001), married (t=-2.60, p<.05), and continue education (t=3.62, p<.001). Results of
stepwise regression revealed pursuing continue education (B=0.25, p<.05), married (B=0.14,
p<.05), and intention (B=0.42, p<.001) positively predicting LTCNC.
Conclusions
Results of this study revealed the important factors of pursuing continue education and
intension to LTCNC. The study are expected to provide further nursing education, practice,
research and policy recommendations for the development of long term care in Taiwan.
35Keywords
Long term care, nursing competence, knowledge, attitude, practice
591
Effects of a family nursing seminar for nurse with differing years of clinical
experience
Fumiko Okamoto1, Miyuki Nakayama1, Aya Yamauchi2
1.
Osaka Prefecture University School of Nursing, 2. Osaka Prefecture University Graduate School of
Nursing
Presenting Authors Email: fumiko@nursing.osakafu-u.ac.jp
Purpose
Nurses in Japan are interested in family nursing practice, but several studies report that nurses
often find it difficult to approach families. Through basic nursing education in Japan, some
nurses have been trained in family nursing, whereas other nurses have not. Therefore, we
need to educate nurses more consistently in family nursing.
The purpose of this study was to investigate the effects of a family nursing seminar for nurses.
Design
The study design included comparative research.
Methods
The inclusion criteria were nurses interested in family nursing, who understood the purpose
and method of the research and agreed to participate.
The seminar included 3 sessions offered over a 2-month period. The first sessions content
included an introduction to family nursing, family theory, and family assessment. The content
of the second session included the conduct of family assessment and case conceptualization.
The third session was a lecture on decision making and the conduct of the family interview.
The data were collected using selfreport questionnaires completed by participants in the
family nursing seminar. Two questionnaires were used. The first questionnaire, which
covered family nursing practice (11 items), was administered before the first session and one
month after the third session. The second questionnaire, which assessed perceived
understanding and satisfaction with the 3 sessions (20 items), was administered after the
completion of the seminar. The questionnaire items used a 5-point Likert-type scale (range: 1
to 5; higher scores indicating better practice, understanding, or satisfaction).
The participants were classified by their number of years of clinical experience: Group I
(fewer than 15 years) and Group, II (more than 15 years). The data were analyzed using the
Mann-Whitney test or Wilcoxon test.
This study received approval from the ethics committee of the Institutional Review Board of
Osaka Prefecture University School of Nursing.
Results
The participants included 32 individuals (2 males, 30 females). The mean number of years of
experience as a nurse was 14.4 6.2, with a range from 2 to 28 years.
Before the seminar, there were significant differences between Group I (n = 13) and Group II
(n = 19), in terms of the following family nursing practices: I have daily conversation with
families and I notice changes in the familys behavior and expression. One month
after the seminar, however, there were no differences in practices between Group I and Group
592
II.
Additionally, there were significant differences between Group I and Group II after the
seminar in their responses to the following items: I am satisfied with the introduction to
family nursing, I am satisfied with the content on the family nursing process, and I
am satisfied with the content on writing genograms and ecomaps. However, there were no
other significant differences in understanding and satisfaction between Group I and Group II.
Conclusions
The family nursing seminar is effective for nurses with fewer than 15 years clinical
experience. The present findings suggest that further education in family nursing practice is
necessary depending on years of clinical experience.
35Keywords
Family nursing, practice, clinical experience, education
593
Nature of previous attempt to quit smoking and methods that smokers

preferred to use in any future quit attempts in Japanese men hospitalized
with cardiovascular diseases
Ayako Okada1, Erika Froelicher2, Nancy Sttots3
1.
University of Hyogo, College of Nursing Art and Science, 2. Department of Physiological Nursing &
Department of Epidemiology & Biostatistics, Schools of Nursing and Medicine, University of
California San Francisco, 3. Department of Physiological Nursing, Schools of Nursing, University of
California San Francisco
Presenting Authors Email: ayako_okada@cnas.u-hyogo.ac.jp
Purpose
This study aims to explore nature of previous attempt to quit smoking and preferred to use in
any future quit attempts of smokers in Japanese men hospitalized with cardiovascular disease.
Design
This is a cross-sectional design.
Methods
The study subjects were recruited from four Japanese hospitals with a CVD diagnosis
including angina pectoris, myocardial infarction, congestive heart failure, or arrhythmias.
Smokerswas defined as an individual who has smoked at least 100 cigarettes in their
lifetime. Subjects excluded if they had a history of psychiatric disorder(s); were unconscious
or using sedative medication; or were critically ill or medically unstable. A structured
interview using a questionnaire was used to collect the data. The modified questionnaire
based on the Global Adult Tobacco Survey core questionnaire and Smoking and Health
Problem Questionnaire were used to obtain the data.
Results
The 104 men smokers were recruited, of the those 65% (67 out of 104) had made at least one
attempt to quit in the past and of these, 20.9% had done so in the past 12 months. The total
number of quit attempts ranged from 1 to 15 with a mean of 2.5 (2.6). The reasons given for
their quit attempt (n=67) arebad for health,having experienced a bad health
condition., orcost of cigarettes.
The methods that subjects reported that they used in their past quit attempts (n=67) were
My own way(or self-help) (98.5%). Medications were used by only 12 men (17.9%).
Smoking cessation methods in their future quit attempts,my own waywas given by
87.1%, and pharmacological treatment was given by 20.8%, and non-pharmacological
interventions such as education and counseling was reported by 10.9%. A few (6.9 %) would
consider a combination of treatments. Anecdotally, many participants believed that the key to
success depends on the strength of an individuals will power not to smoke. This may
explain the finding that most of the smokers (87.1%) reported that their preference for future
quit attempts wasMy own way.
594
Conclusions
About two thirds of participants made at least one quit attempt in the past. However most of
them used self-help methods and less utilized pharmacological treatment, furthermore
majority of smokers still consider the methods that my own way for their future quit
attempts. These findings suggest that it is necessary to provide more support in their smokng
cessation effort to succeed quit smoking through in depths education, counseling and
behavioral interventions.
35Keywords
Cardiovascular diseases patients, smoking cessation, quit attempts
595
Supporting workers with depression: A literature review
Yukiko Mochizuki1, Emiko Saito2

1.
Teikyo University, Faculty of Medical Technology Department of Nursing, 2. Graduate School of

Human Health Sciences, Tokyo Metropolitan University
Presenting Authors Email: myukiko@med.teikyo-u.ac.jp
Purpose
The depressive state of workers is a state which matters the most in mental health at
workplace. The sources of stress affecting workers with depression include not only personal
factors but also the presence of work stress. In addition, there is the effect of stress induced by
workplace environment which cannot be eliminated by workers alone. Therefore, we can
presume that factors affecting the mental health of workers with depression are based on a
broad concept. However, factors supporting workers with depression have not been
adequately examined in past studies. We believe that elucidating the factors associated with
support for workers with depression will serve as a fundamental investigation of mental
health support appropriate for workers.
Design
The purpose of this study is to describe supporting workers with depression with review of
literature.
Methods
For literature search, we conducted thesaurus search using Igaku Chuo Zasshi (ICHUSHI), a
bibliographic database in Japan, and PubMed. The key words used for literature search were
"depression," "occupational health," and "worker." Among thesaurus terms, no terms
indicating environmental factors at workplace were identified. Therefore, we selected a
thesaurus term "occupational health," as its definition includes adapting work to workers and
workers to work (WHO/ILO, 1950). The search period was between 1982 and 2014.
Results
596
In the publications between 1982 and 2014, the terms "depression," "occupational health,"
and "worker" were identified in 8,604, 10,164, and 4,481 publications, respectively, in
ICHUSHI. A total of 145 publications included all the three terms, "depression,"
"occupational health," and "worker." From these 145 publications, we excluded publications
focusing on medical care, overlapped publications by the same researcher using the same tool,
and publications on factors supporting workers with depression not conforming to the purpose
of our study; as a result, 28 publications remained. In PubMed, we searched publications
using "depression," "occupational health," and "employment" as MeSH terms. The search
using the terms "depression," "occupational health," and "employment" identified 43,881,
18,639, and 28,312 publications, respectively. The search using all the three terms
"depression," "occupational health," and "employment" identified 20 publications. From these
20 publications, 8 publications related to factors supporting workers with depression were
extracted, and a total of 36 publications were analyzed. Characteristics of factors supporting
workers with depression included medical history and current condition, employment status,
work performance, personality, personal relationship, stress status, satisfaction with work,
stress management method, social support, and competence at work.
Conclusions
The review has revealed the characteristics of workers with depression and suggested that
those characteristics are useful for studies to identify the conditions of workers with
depression and to provide support in early stage and for intervention.
This work was supported by JSPS KAKENHI Grant Numbers 26861994.
3-5 Key words

Occupational health, depression, job analysis, occupational mental health
597
Types and features of elderlies in the state of self-neglect in Japan
Emiko Kishi1, Masashige Saito2, Mihoko Shimozono1, Yuka Nojiri1, Yukiko Mochizuki1,
Yasuko Aso1, Sachiko Yoshioka3, Yuko Hamazaki4, Momoe Konagaya5, Shohei Nomura6,
Junko Yonezawa7
1.
Teikyo University, 2. Nihon Fukushi University, 3. Saitama Prefectual University, 4. Kanazawa
Medical University, 5. Showa University, 6. Ministry of Justice Tokyo Probation Office, 7. National
Institute of Public Health
Presenting Authors Email: e-kishi@med.teikyo-u.ac.jp
Purpose
In order to clarify types and features of elderlies in the state of self-neglect in Japan, a
question survey was conducted.
Design
A self-administered questionnaire survey was conducted with Regional Support Centers
nationwide (4,038 Centers) to investigate the number of cases of self-neglect observed by
specialists and to consider counter-measures against them.
Methods
34 items were determined as indicating self-neglect with early intervention, by reviewing past
literature and through discussion among investigators. They are items such as extremely
unhygienic residence, extremely unhygienic self, refusal of medical and other
services, negligence of necessary care and attention, isolation from neighbors and
local community, inadequate financial control, etc. Nonhierarchical cluster analysis
was conducted using SPSSVer.22. The survey was conducted with the approval of Ethics
Committee of School of Medicine at the Universities of participating investigators. Special
considerations were made not to disclose individuals involved in the survey.
Results
846 elderlies who are subjects of early intervention for self-neglect were analyzed.Of the 34
items indicating self-neglect with early intervention, more than 50% of respondents answered
598
yes or slightly so to 18 items. The highest was 82.4% for only take meals that are
undernourished, followed by 79.0% for refuse necessary health and welfare services,
76.7% for not taking bath, 74.6% for wear dirty clothes and 73.3% for food and
garbage left unattended.
As a result of cluster analysis, classification from Types C1 to C6 were determined, since 6
clusters were considered most appropriate from the distance to the center of cluster. Males
accounted for approximately 70% in C1 but females accounted for approximately 60% in C2,
C3 and C6. C5 had the least number of solitary elderlies and approximately 70% had
supporters. C2~C4 had low level of dementia independence and C1, C3 and C4 had low level
of independence of daily living. More than 50% in C1~C4 had not yet applied for nursing
care insurance coverage. Approximately 50% of elderlies in C1 and C6 suffered from chronic
diseases and approximately 20% in C1 had diabetes. It was agreed among investigators to call
C1 as isolated group refusing medical care, C2 as non-isolated, unhygienic group,
C3 as isolated group refusing medical care with inadequate financial control, C4 as
severe group(garbage house) as all items are applicable to this group, C5 as mild
group with supporters and C6 as mild group with high level of independence.
Conclusions
C1, C3 and C4 are considered to be in need of intervention urgently, considering the state of
elderlies refusing personal engagement as well as medical services and neglecting their lives
and health. Especially those in C4 live in houses that are virtually garbage houses and more
than half are over Grade 3 of dementia independence scale, requiring medical care and
services urgently. There were only few respondents in C5 and C6 due to difficulty of
intervening by specialists since they are considered as mild elderlies. It is also necessary to
provide legal framework and system to enable specialists intervention to such elderlies.
This work was supported by JSPS KAKENHI Grant Numbers 24390513.
3-5 Key words

Self-neglect, elderly, Regional Support Centers
599
The development of a questionnaire to explore the factors related body

mass index on adolescents in southern Taiwan
Ya Ping Yang1, Yi-Chen Lin2 , *Hail-Lin Lu3

1.
Institute of Allied Health Science / National Cheng-Kung University, 2. Jiading Junior High
School, 3Department of Information Management Chia Nan University of Pharmacy & Science
Presenting Authors Email: nimotop3368@gmail.com
Purpose
The purpose of this study was to develop a questionnaire which can be used to explore the
factors related body mass index on adolescents.
Design
This study was a cross sectional descriptive research design.
Methods
The initial items of questionnaire were developed through literature review and the content
validity (CVI) was then assessed by six experts in education (CVI=0.83). In addition, the
internal consistency reliability of the pilot study was 0.74. The 567 respondents who filled the
questionnaire either online or paper-based are 12 to 18 years old from southern Taiwan. Data
obtained in this study were analyzed with regard to internal consistency and exploratory
factor analysis.
Results
The internal consistency reliability was 0.71. After examined using exploratory factor
analysis (EFA), Four factors from sixty items were identified, i.e. the personal exercise habits,
diet of family, sports curriculum of school, and sleeping time of a week. The factor loadings
of these sixty items accounted for 54.96% of the total variance. The re-assessed internal
consistency reliability was 0.79.
Conclusions
600
This questionnaire is a useful reference for school nurse, sport teachers and parents that can
be used to know the related factors of body mass index on adolescents and raising the
awareness of the health related fitness of adolescence through dynamic life and a balanced
diet.
3-5 Key words
Adolescents, body mass index, instrument development
601
The effects of health promotion program using forests on mental and

physical health of school-aged children in Korea
Insook Lee1, Kyung-Sook Bang1, Heeseung Choi1, Sungjae Kim1, Inju Hwang1
1.
Presenting Authors Email: lisook@snu.ac.kr
Purpose
While various health benefits of forests have been discussed, the effects of health promotion
program using forests on physical and mental health of children in Korea have not been
examined yet. Main purpose of this quasi-experimental study was to examine the effects of
health promotion program using forests on health of children between the ages of 10 and 11
years. Target outcomes of the program include stress, depression, attention deficit
hyperactivity disorder (ADHD), physical health, and health promoting behavior.
Design
Quasi-experimental study with control group pre-test and post-test design was used.
Methods
A total of 23 students living in Pyeongchang (forests areas, experimental group) and 51
students living in Seoul (urban areas, control group) participated in the study. The
intervention was provided once a week for a period of 6 weeks during November to
December in 2013. Program consisted of education and practice for health promotion life
style including eating, exercising, sleeping habits, and healthy communication and
cooperation with peers. The control group did not receive any intervention. Chi square test, ttest, and Mann-Whitney U test were used to assess the effect of the health promotion program.
Results
Compared to the control group, children who participated in the health promotion program
exhibited significantly improved scores in ADHD score (t=-2.00, p=.049) and HRV score
[(low frequency (p=.026), high frequency (p=.026), and heart rate (p=.004)] after the
602
intervention. Although depression and attitude to natural environment were not different
between two groups in post-test, findings from the present study indicated that the health
promotion program using forests are effective in enhancing both mental and physical health
of school-aged children.
Conclusions
The finding demonstrated the needs for policies and strategies to utilize forests as resource for
school curriculum for childrens health promotion. Further studies testing the long-term
benefits of health promotion programs using forests for children are needed.
3-5 Key words
Health promotion, children, forest
603
Transdisciplinary collaboration in home health care with a pharmacist as a

team member
Mikiko Sadamura1, Yuriko Yamakawa2, Hisashi Kojima1

1.
Teikyo University of Science, 2. Ibaraki Prefectural University of Health Sciences
Presenting Authors Email: sadamura@ntu.ac.jp
Purpose
Expansion of home health services is much in need as the number of the elderly living alone
increases. Especially, medication management at home for the people with dementia is an
important issue. Poor management of medications could lead to medication errors that could
harm the person. Collaboration between home visiting nurses and pharmacists in the
community would help create an environment for a safe and smooth management of
medications at home. Such collaboration, however, currently has not been done fully: home
visiting nurses do not have a good understanding on what roles, functions, and activities these
pharmacists take in the community. At the same time, it seems that such pharmacists have not
made much effort to have other healthcare professionals in the community understand their
work and capability. This study explores how nurses and pharmacists can work together,
based on a result of a survey on the participation of community pharmacists in home health
services for the elderly.
Design
A questionnaire that has two parts: a set of multiple choice questions field and a free
description field was sent to each participating pharmacist by mail.
Methods
The ethics committee of the Teikyo University of Science approved the research plan. The
questionnaires were mailed to the members of the Adachi Ward Pharmacists Association
(n=171). The questions include basic information (business management style of the
pharmacy, the number of pharmacists, gender, age, and business hours), whether or not home
visiting medication instruction services has been done, the issues with home visits, and the
604
situation of users. The result was statistically analyzed. The descriptive content was
categorized.
Results
The number of effective replies was 111 or 65%. And, 20% of the respondents had
participated in home health services. The 26.1% of the pharmacies was privately owned,
while 29.7% owned more than one pharmacy and 42.3% owned by pharmacy chain stores.
The largest percentage of pharmacies (43.2%) had 1 or 2 full-time pharmacists. Only 26.1%
answered that they had 5 or more full-time pharmacists. The reasons for not doing a home
visit included no request by residents and the lack of confidence due to possible lack of the
knowledge and skills required for home visiting pharmacists.
Conclusions
It is essential to create an environment where pharmacists can gain knowledge necessary for
home health care and improve their skills so that they may work as a member of a home
health care team. Also, building a firm business foundation is important to secure a sufficient
number of pharmacists that allows them to visit homes and offer medication education to the
elderly at home. Other health care professionals, such as physicians, nurses, and home health
aides, should also be more willing to learn what pharmacists can do in the community and
facilitate a better communication with pharmacists.
3-5 Key words
Community nurse, pharmacist , transdisciplinary
605
The community capacity for care of persons with chronic illness conditions.
Charunee Sorakrij1, Khanitta Nuntaboot2

1.
Faculty of nursing, Khon Kean university, 2. Faculty of nursing, Khonkean University
Presenting Authors Email: sorakrij@gmail.com
Purpose
The aim of this study was to explore the community capacity to support care of the persons
living with chronic illness conditions
Design
This study employed an ethnographic approach aimed at providing detailed descriptive data
associated with community capacity in care of persons living with chronic illness conditions
in rural Northeastern Thailand.
Methods
The major modes of data collection are participant observations, in-depth interviews and
focus group discussions. Participants were purposely selected including persons with chronic
illness conditions and their family caregivers, health volunteers, community leaders, health
care providers, Local Administrative Organization chief and officers, who involved in the
care for persons living with chronic illness conditions. Methodological triangulation, which is
research strategy of comparing information sources, was used to examine the quality of data.
Data was analyzed by content analysis. An ethical consideration and the research protocol
were approved by the Khon Kaen University Ethics Committee for Human Research based on
the Declaration of Helsinki and the ICH Good Clinical Practice Guidelines.
Results
The findings revealed three main issues. Firstly, community capacity includes human
resources, social and physical community infrastructures, community welfare fund and other
support. Secondly, living conditions and social context signify health care activities and
services in the community. Finally, the characteristics of community care and services were
ranging from; providing activities that promote physical and psychological well-being; basic
606
rehabilitation services; producing food safety; creating opportunity for income generation
activities, employment, and increasing household economic; establishing community welfare
fund and financial institution of community; and managing environments to reduce risk
factors and life threatening conditions. The key actors in the care for those persons with
chronic illness are health volunteers, civil society groups, community leaders, community
nurses and health care providers, and Local Administrative Organization.
Conclusions
The finding of this study will help community nurses and other health care providers
understand community capacity based on social and cultural context. This would lay strong
foundation for interventions or programs for capacity building of key actors to promote
healthy lifestyles and reduce health threats and risks in the community. Strengthening
community capacity is crucial for sustainable care of persons living with chronic illness
conditions.
3-5 Key words
Chronic illness conditions, community capacity, community care
607
The development and validation of the self-efficacy questionaire related

low-calories diet and exercise in community populations
Li-Chun Hsaio1, Chi-Jane Wang1, Jing-Jy Wang1

1.
Department of Nursing, College of Medicine, National Cheng Kung University
Presenting Authors Email: w87412@gmail.com
Purpose
This study attempted to examine the construct validity, internal consistency and intra-rater
reliability of the self-efficacy for low-calories diet and exercise questionnaire.
Design
A cross-sectional study design.
Methods
There were two phases for developing and validating the questionnaire. In phase one, items of
the questionnaire was developed through a self-efficacy scale of health-related diet and
exercises which was developed by Sallis (1988). Then, six experts were invited to evaluate
the content validity of the questionnaire. In phase two, in order to examine reliability and
validity of the questionnaire, 210 adult community dwelling residents were recruited from
communities of southern Taiwan. The construct validity was examined by exploratory factor
analysis (EFA), while internal consistency and inter-rater reliability were tested by
Cronbachs alpha coefficient and spearman correlation analysis.
Results
A total of 185 subjects completed the questionnaire. Item analysis showed each correlation
coefficient of inter-item was higher than .3, indicating that these responses were reliable. The
18-item questionnaire of self-efficacy related low-calories diet and exercise was developed
and three factors were extracted which were Calories intake, Subjective exercise persistence,
and Objective exercise persistence through EFA. Factor loadings of the three factors were
between .49 and .86 accounted for 64% of total variance, indicating that this instrument has
good construct validity. Cronbachs of each factor ranged from .85 to .89 for internal
608
consistency and spearman correlation coefficient of each item ranged from .53 to .71 (p< .001)
for inter-rater reliability, indicating these items have good consistency and stability.
Conclusions
The self-efficacy questionnaire of low-calories diet and exercise was a valid and reliable
instrument. We expect that this questionnaire could serve as a tool for community nurses
when executing a program of weight management to assess and identify the restricted effects
of program.
3-5 Key words
Low-calories diet, exercise, self-efficacy, reliability and validity, community
609
Characteristics of dropouts from a biochemical feedback intervention study

for preventing exposure of kindergarten children to second-hand smoke
Harumi Bando1, Tohru Yoshida2

1.
Shiga University of Medical Science, 2. Gunma University
Presenting Authors Email: bharumi.phn@gmail.com
Purpose
A biochemical feedback intervention study that reported urinary cotinine values of
kindergarten children has been shown to result in progress in the stage of behavioral change
among smokers in the household (Bando et al., 2014). In total, 228 participants were included
in the present intervention study; of these, 118 (51.8%) did not respond to the postintervention test. The characteristics of the dropouts from this intervention study were
examined.
Design
Re-analysis of an intervention study.
Methods
Participants in the intervention study were smoking family members of children enrolled at
five kindergartens in two cities in Japan, and the pre-intervention test was completed between
December 2009 and January 2011.
Data of analyzed characteristics were collected via a pre-intervention questionnaire; these
included information on the childs health, number of children in the household, attempts to
prevent the childs exposure to second-hand smoke (in the house, car, and restaurants),
number of years of smoking, number of attempts made to quit smoking, number of cigarettes
smoked per day, number of smokers in the household, number of family members who had
already quit smoking, family relation of the smoker to the child, and stage of behavioral
change before the intervention. Urinary cotinine values of each child were also included.
Data were analyzed by the chi-square test, followed by multiple logistic regression analysis,
in which being a dropout or not was the dependent variable.
610
Results
Thirty-four participants (14.9%) felt anxious about the childs health and 203(89.0%) had
more than one child. In total, 116(50.9%), 121(53.1%), and 81(35.5%) participants did not
attempt to prevent the childs exposure to second-hand smoke in their house, car, and
restaurants, respectively.
With regard to the smokers history, 129(56.6%) smoked for a duration 20years,
113(49.6%) experienced smoking cessation one time, and 109(47.8%) smoked 20
cigarettes per day.
In the household, there was more than one smoker were present in 72 cases (31.6%) and more
than one ex-smoker in 57 cases (25.0%).
In total, 73(32.0%), 106(46.5%), 49(21.5%), and 0(0.0%) participants were in the first half of
the pre-contemplation, latter half of the pre-contemplation, contemplation, and preparation
stage, respectively.
The urinary cotinine value was 10 ng/mgCr, which suggests exposure to second-hand smoke,
in 122(53.5%) cases.
Using the chi-square test, the urinary cotinine value of the child (p<0.01), smoking in the car
(p<0.05), numbers of years of smoking (p<0.05), number of smokers in the household
(p<0.01), and family relation of the smoker to the child (p<0.05) were significantly associated
with dropout. In multiple logistic regression analysis, the urinary cotinine value [odds ratio
(OR), 1.8; 95% confidence interval (CI), 1.03.4; p<0.05] and number of other smokers (OR,
2.8; 95% CI, 1.36.0; p<0.01) were significantly associated with dropout. A high urinary
cotinine value and more than one smoker in the household appeared to be the cause of
dropout in the present study.
Conclusions
A new intervention study may be required to develop effective intervention methods for such
smokers to prevent the exposure of kindergarten children to second-hand smoke.
3-5 Key words
Kindergarten children, smoking family members, urinary cotinine value
611
Effects of the health education program based on the theory of planned

behavior for farmers exercise behavior change
Susumu Fukita1, Hiromi Kawasaki1, Akihiro Kihara1, Satoko Yamasaki1, Kotomi Yamashita1,
Ayako Yamashita1, Mika Nishiyama2, Pete DAngelo3
1.
Hiroshima University, 2. Hiroshima Bunkyo Womens University, 3. Doi Clinic
Presenting Authors Email: fukita1234@hiroshima-u.ac.jp
Purpose
There are problems that farmers are getting old and lack of successors in Japan. The selfgoverned farming communities have been established by farmers to maintain the local
agriculture. Its important for farmers to maintain their health to play a role in the selfgoverned farming community. In our previous study, we thought the theory of planned
behavior suits to enhance their behavior change. We conducted the health education program
based on the theory of planned behavior. Purpose of this study is to identify the effects of the
health education program based on the theory of planned behavior for farmers exercise
behavior change.
Design
A single group before-after study.
Methods
The health education program was consisted of classes two times after an interval of 5 month.
121 farmers participated in the program. The original exercise designed for farmers was
introduced at the class. We emphasized that it is necessary for them to do exercise to go on
farming. In addition, we sent the letter three times to encourage them to do the exercise. We
studied 38 male farmers who participated in the program. They answered the questionnaire
before and after the program. The questionnaire was made based on the theory of planned
behavior that composed of Attitude toward the behavior (Do you think that farming
requires exercise?), Subjective norm (Do you think that families expect you to maintain
health for farming?), Perceived behavioral control (Do you think that it is easy to do
612
exercise by habit? and Do you know methods of exercise? ), Intention (Do you intend to
do exercise?), and Behavior(Do you do exercise for farming?). We used Chi-square test
to compare the data before and after the program.
Results
The average age was 66.18 years 10.06 standard deviation. The percentages of farmers who
thought that farming requires exercise, that families expect them to maintain health for
farming, that it is easy to do exercise by habit and that they intend to do exercise were 89.5%,
94.6%, 51.4%, 65.8% before the program and 91.7%, 97.2%, 56.8%, 66.7% after the program.
The percentages of farmers who did exercise and knew methods of exercise after the program
were significantly higher than those before the program (51.4%vs80.6% p=0.013,
29.7%vs75.7% p<0.001).
Conclusions
Our study results showed that the health education program improved farmers exercise
behavior. We think this change emerged because the farmers had high Attitude toward the
behavior and Subjective norm before the program, and the program increased their
knowledge (a part of Perceived behavior control) after the program. Another part of
Perceived behavioral control was middle level and no difference before and after the
program. We need to support them to enhance Perceived behavioral control using the
close ties of self-governed farming community to continue the exercise. We suggest that they
integrate the exercise into routine activities of self-governed farming community.
3-5 Key words
Health education, the theory of planned behavior, exercise
613
The influence of the social environment related to playing sports for

physical activity and general malaise.
Kotomi Yamashita1, Hiromi Kawasaki1, Satoko Yamasaki1, Susumu Fukita1, Ayako

Yamashita1, Masahiro Kawasaki1, Mika Nishiyama2, Pete DAngelo3, Mika Yuasa1
1.
Hiroshima University, 2. Hiroshima Bunkyo Womens University, 3. Doi Clinic
Presenting Authors Email: m135891@hiroshima-u.ac.jp
Purpose
The purpose of this study is to investigate the impact of sports activities within the
environment/community on childrens health, both physical and mental. Recently, in Japan,
lack of exercise and feelings of uneasiness (malaise) among school children has become a
problem.
Design
Descriptive Study
Methods
We conducted the survey for all of the 4th grade students, aged 10-11, who live in the target
area (an area high in facilities and programs for sporting activities) using a questionnaire
designed by researchers. Participants and their parents received explanation about the purpose
of the investigation and the ethical consideration from the local government. Answering the
questionnaire was considered to be informed consent. The question paper was distributed and
collected at each school in July 2014. Sex, sports, exercise and general feelings of well-being
were investigated. Simple tabulation according to boy and girl was used for analysis. The
Japan Sport Council and the survey of eating habits of the children 2011, was used as
reference for comparison.
Results
220 children (98%) (boys were 110, girls were 110) answered. 72 boys (65.5%) and 56 girls
(50.9%) belong to a sports club (e.g. baseball, swimming, soccer, dance, volleyball, handball).
73 boys (67%) and 41 girls (38.0%) play sports or do exercise every day (59.2% of boys,
614
38.0% of girls in Japan). 101 boys (91.8%) and 84 girls (77.1%) engage in physical activities
during their free time at school (74.6% of boys, 54.0% of girls in Japan). The results showed
that within our target area, physical exercise was higher than the national average. In regard to
general malaise, 38 boys (34.5%) and 42 girls (38.2%) have orthostatic syncope (40.8% of
boys, 48.1% of girls in Japan). 78 boys (70.9%) and 73 girls (66.4%) feel tired (70.3% of
boys, 71.9% of girls in Japan). 52 boys (47.7%) and 48 girls (44.9%) are unmotivated (57.8%
of boys, 68.3% of girls in Japan). 70 boys (63.6%) and 68 girls (61.8%) are irritated (73.4%
of boys, 69.5% of girls in Japan). General malaise was found to be lower than the national
average.
Conclusions
Physical activities of the children were high. In this area, there are many sports facilities.
Professional sports teams, community-based sports clubs and junior sports clubs are
supported by the local government. So children can play sports with pleasure and watch
professional sports games and get close to sports from the childhood period. Therefore, it is
suggested that children would do more activities if sports environment is more accessible
offering a greater number of facilities and opportunities to participate. It is important within
the social environment to play sports to encourage exercise. However, our research showed
that many children have a degree of malaise in spite of the high rate of sports activity. So, in
addition to physical activity, diet and sleep regimens should be taken into account in future
studies.
3-5 Key words
Health care of children, physical activity, social environment, ,
615
Development and evaluation of psychological health promotion program in

children: Prevention of depression
Hyunju Park1
1.
Kangwon National University at Chuncheon
Presenting Authors Email: hpark@kangwon.ac.kr
Purpose
The purpose of this study was to develop and evaluate psychological health promotion
program focusing on problem-solving ability in 5th grade elementary school children.
Design
The design of this study was experimental study, in particular, nonequivalent control group
pre/post test design.
Methods
Once a week, a total 4-week program to increase problem-solving ability was developed and
applied to 5th graders. Subjects were from 242 experimental and 202 control groups. As
outcome variables, depression and stress level was measure at baseline (pretest), at the end of
the program (post test 1), and 6-month after the end of the program (post test 2). Frequency,
mean, SD, t-test using SAS version 9.1 were conducted to analyze data.
Results
Depression was significantly decreased in the experimental group than in the control group
(p=.035) at post test 1, but the difference became non-significant at post test 2. Level of stress
was significantly decreased in the experimental group than in the control group at post test
1(p=.0004), but the difference became non-significant at post test 2.
Conclusions
The finding suggests that the preventive program to promote psychological health in children
was effective but the effects was not persist until the 6-month after the program. To develop
the preventive program that has long lasting effects is required.
616
3-5 Key words

Psychological health, depression, children, preventive program
617
Characteristics of mothers with a risk of child abuse and negative emotions

towards their children in Japan: A case study
Hiroko Suzuki1, Jun Yaeda2, Emiko Saito1

1.
Tokyo Metropolitan University, 2. University of Tsukuba
Presenting Authors Email: suzuki-hiroko@ed.tmu.ac.jp
Purpose
It is imperative to develop a secure attachment between mothers and children in order to
prevent the child abuse. However, there exist those mothers who do not actually love their
own children. This would create a significant problematic case in the family. To provide
appropriate psychosocial support for those mothers is not easy. The purpose of the study was
to analyze various assessment data obtained by 10 public health nurses who have such cases
in Japan.
Design
Case study
Methods
A questionnaire was directly handed by the present researcher to each of the 10 public health
nurses at their job sites in metropolitan Tokyo as of March 2013. Among their 24 current
cases, 5 cases were identified as having the risk of unloving mothers. Data was obtained
regarding the demographic characteristics of such mothers, their family backgrounds and
lifestyles, and their mind-sets and behaviors of child rearing. Assessment information was
obtained through the infant medical records at their age of 3-4 months and home visitation by
public health nurses.
Results
The mean age of the 5 mothers was 27.04.4 years. The 4 mothers had their jobs either fulltime equivalent or part-time. One of them had a personal disorder, 2 had a mild depression,
and these 3 mothers had not been medically treated yet.
Four children were the first babies of their parents. The mean birth weight was 3000.6321.1g.
618
No disability was found among them. Two fathers were the age of 30s, 2 fathers were at
50s, and the last fathers age was unknown. The 2 couples were unmarried officially, and
the both fathers did not have a full-time job and faced financial troubles.
The major characteristics of the 5 cases could be grouped into 2 types: the self-pity type
due to the burden of child rearing, and the unstable living type due to the heavy financial
difficulties. All the mothers skills of home management and child rearing were very low.
The 3 cases fell into the self-pity type, and the mothers would feel disturbed by the
presence of their own children. They would often use abusive words and become neglected of
child rearing. The 2 cases fell into the unstable living type and the mothers skills of
child rearing were low and received very little support from others. They did not seek any
formal and informal social supports and their problem-solving skills were low.
Conclusions
Implications of the case study included that the both self-pity and unstable living
could be the cause or the trigger of their negative emotions towards their own children at an
infantile. Identifying and dealing with such causes or the triggers should ameliorate their
negative emotions towards their children. Furthermore, providing timely support and
appropriate mental health services with the unloving mothers is crucial.
3-5 Key words
Child rearing, child abuse prevention, family support
619
Association between weight self-stigma, body image, media influence and

intension to weight loss in university students
Kuan Pin Lin1, Shu Wen Lin2

1.
Department of Nursing, Hung Kuang University, 2. Department of Nutrition, Kuang Tien General
Hospital
Presenting Authors Email: linkp@sunrise.hk.edu.tw
Purpose
The study aimed to understand the association between weight self-stigma, body image,
media influence and intention to weight loss in university students.
Design
A cross-sectional study and convenience sampling was conducted on students from a
university in central Taiwan.
Methods
A structure questionnaire was used to collect data about age, gender, body weight, body
height, body mass index (BMI, calculated as body weight divided by body height squared
m2), weight self-stigma (Weight Self-stigma Questionnaire), body image (Multidimensional
Body-Self Relation Questionnaire), media influence (Media Influence Questionnaire) and
intention to weight loss. Data analysis was used by SPSS 20.0 for Windows. Descriptive
statistics were expressed as mean values stand deviation and percentage. The t-test and 2
test were used to detect the correlation between the variables, and the logistical regression
analysis adjusted for confounding variables was performed to calculate odds ratio (OR) with
95% confidence intervals (95% CI) for the association between variables and intention to
weight loss in all participants.
Results
A total of 611 university students participated in this study, of which 29.6% were men, 70.4
were female, 50% had weight reduction experience, and 72% had intentions to weight loss in
the next six months. Participants with experience in weight control had a higher score in
620
weight self-stigma and media influence than those without experience in weight control.
Within the next 6 months, those who with intention to weight loss had a higher score in
weight self-stigma, body image, and media influence than those who without intention to
weight loss. Weight self-stigma, media influence, female, and BMI were significant
independent risk factor for future intentions to weight loss after adjustment for confounding
variables.
Conclusions
According the findings suggest that health care professionals deal with the female who want
to lose weight and with high BMI, should confirm the effect of weight self-stigma and media
influence. In addition, provide health and non-prejudice intervention to maintain a healthy
lifestyle.
3-5 Key words

Weight self-stigma, body image, media influence, intention to weight loss
621
The study of translation of the Center for Epidemiologic Studies Depression

(CES-D 20) Scale into Indonesian version
Pratiwi Gilang Dwi1, Chi-Jane Wang2

1.
Department of Nursing, College of Medicine, National Cheng-Kung University, 2. Department of

Nursing, College of Medicine, National Cheng Kung University
Presenting Authors Email: gilangdwipratiwi@gmail.com
Purpose
The aim of this study was to translate the Center for Epidemiologic Studies Depression (CESD 20) scale into Indonesian version. In addition, the content validity was also examined.
Design
Descriptive design was applied in this study.
Methods
Modifying Brislins Translation Model (Jones et al, 2001) with five steps was applied in the
process of translation. The first, two bilingual professionals translated into Indonesian version
independently. Next, words and phrases of the Indonesian version was discussed and
reviewed by the research group (including the researcher and 2 bilingual experts). After
agreeing on the consensus version, back translation process from Bahasa to English was done
independently by another two translators in the meanwhile, both them were blind to the
original English of CES-D 20. And then, the two English natives were invited to check the
back translated English version by comparing with the original English version of concepts
and linguistic. Afterward, six nursing experts were invited to examine the content validity of
Indonesian version.
Results
After translating CES-D 20 into Indonesian version, the I-CVI and S-CVI were applied to
examine content validity. For I-CVI, the score of each item was above 0.85, meanwhile
average I-CVI was 0.97. Moreover, S-CVI was 0.97.
622
Conclusions
The results of this study show that Indonesian version of CES-D 20 had a good content
validity after using modified Brislins Translation Model with five steps. The validity and
reliability of Indonesian version is necessary to do in the following step.
3-5 Key words
CES-D 20, back translation, content validity, depressive synptom
623
A study of casual sex intention among adolescentsThe construction on

extended theory of planned behavior
Ying-Hua Tseng1, Fan-Hao Chou2, Shih-Hsien Kuo1

1.
Fooyin University, 2. Kaohsiung Medical University
Presenting Authors Email: u98840003@cc.kmu.edu.tw
Purpose
The purpose of this study was to develop a model of casual sex intention among adolescents.
Design
This study is a cross-sectional study. Researchers adapted theory of planned behavior (TPB)
as the framework, furthermore combined three external variables, as follows: pornography
exposure experience, peer interaction related to sexual issues, and parent-child
communication about sex.
Methods
In this cross-sectional study, 443 participants were recruited from two senior high schools and
one university in southern Taiwan. Data analysis used structural equation models.
Results
The results showed that parent-child communication about sex was below average, peer
interaction related to sexual issues was above average, and the level of pornography exposure
experience was low. The explained variance of casual sex intention model was 62.5%.
Attitude and subjective norm (SN) have positive effect on behavioral intention (BI), however,
perceived behavioral control (PBC) of preventing casual sex had negative effect. The
influence of PBC has the biggest effect. Both peer interactions related to sexual issues and
pornography exposure experience have indirect influence on BI of casual sex.
Conclusions
The findings of this study can predict casual sex intentions of young people, providing
education, counseling, clinical practice and future reference for intervention studies.
624
3-5 Key words

Adolescent, casual sex, theory of planned behavio
625
Factors associated with being bullied among Taiwanese adolescents
HuiWen Huang1
1.
Kaohsiung Medical University
Presenting Authors Email: cjjojp@hotmail.com
Purpose
The aim of this study was to examine the associated factors of being bullied among
Taiwanese adolescents.
Design
Cross-sectional survey.
Methods
Students aged 13-16 years from seven junior high schools (n = 377) in Southern Taiwan were
recruited in this study. An anonymous self-reported questionnaire was used to collect
demographic characteristics, resilience, peer interaction, school affinity, parental supervision,
social support, and experience of being bullied. Logistic regression analysis was used to
examine the important explanatory factors of being bullied.
Results
There were 15.7% (n = 59) of students reporting having been bullied verbally and by
relationship, and 4.5% (n = 17) reported having been bullied physically and having
belongings snatched in the past year. Adolescents who had been bullied had a significantly
lower score of resilience, peer interaction, school affinity, parental supervision of delinquency
behavior, parental supervision of daily life, family support, teacher support, and peer support
than those of not being bullied. Logistic regression analysis indicated that school affinity
(OR=0.38), parental supervision of daily life (OR=0.47) and peer support (OR=0.48) were
significant explanatory factors of being bullied. The final model explained 23.5% of the total
variance in being bullied and correctly predicted 80.1% of participants being bullied.
Conclusions
626
To prevent being bullied among adolescents, school nurses need to design school-based
programs that provide adolescents with interaction skills training, friendship enhancement,
and teaching parents about enhancing supervision to improve adolescents habits of daily
life.
3-5 Key words
Adolescent, associated factors, being bullied
627
Characteristics of nursing care for cancer patients undergoing outpatient

chemotherapy by visiting nurses
Yumi Hirahara1, Kayoko Kawahara2, Yasuko Kurosawa3

1.
Japan Visiting Nursing Foundation asukayama visiting Nursing staition, 2. Graduate School of
Human Health Sciences, Tokyo Metropolitan University, 3. Kurosawa Medical Clinic
Presenting Authors Email: hirahara@jvnf.or.jp
Purpose
Providing early nursing care for patients with cancer, which is the number one cause of death,
is becoming increasingly important to improve quality of life (QOL). It has been
demonstrated that cancer patients undergoing outpatient care encounter difficulties in homebased care while undergoing treatment, such as discomfort and anxiety about a recurrence.
Visiting nurses offer physical, psychological, and social support to cancer patients undergoing
outpatient chemotherapy at home and provide holistic care that includes the patients family.
Few studies have clarified the details of holistic care provided by visiting nurses. Therefore,
we aimed to elucidate the characteristics of nursing care provided in the home environment by
analyzing the content of home-visit nursing care for cancer patients undergoing outpatient
chemotherapy.
Design
The investigation was a qualitative descriptive study.
Methods
Subjects were four nurses with experience providing home-visit nursing care to cancer
patients undergoing outpatient chemotherapy. All had clinical experience with adult cancer
patients and 2 or more years of home-visit nursing care experience. Data were collected
hrough semi-structured interviews
Results
Subjects were in their 30s and 40s, and had 2 to 13 years of experience as a visiting nurse. We
extracted 25 subcategories in 9 categories on nursing care by visiting nurses for cancer
628
patients undergoing outpatient chemotherapy. The category of holistic understanding of

patients, which was the most fundamental aspect of nursing care, demonstrated how the
nurses tried to understand the patients values from conversations with them and their
expressions as well as to learn about the patients life. For its assessment, the category of
understanding the patients lifestyle was used, so that each patients lifestyle was
used to determine how the nurse should respond. Specifically, nutritional status and
awareness of food were determined from the state of the kitchen, bathroom, and used to
determine areas where livelihood support was needed. Support for the family involved
discovering the thoughts, relationships and strengths of family members. Detection of
changes consisted of assessment by nurses using their finely-honed eyes, ears, and other
sensory organs to detect changes in the lifestyles of the patient and their family. Nurses
provided explanations based on expertise when the patient was interested in receiving
such information, thereby achieving the patients and familys trust. Relief from
physical pain, was centered on physical assessment, pain relief. In the conditioning the
body category concerning concrete care measures, nurses carried out rehabilitation and
massages and applied warm compresses. Nurses provided flexible individualized care
based on the expressions and conversations of the patient and their family to ensure the
patients acceptance. Nurses also carried out a role that coordinated care, maintaining close
collaboration with doctors and care managers.
Conclusions
We elucidated the characteristics of care provided by visiting nurses to cancer patients
undergoing outpatient chemotherapy. This study may encourage the use of home-visit nursing
care in the future to raise the QOL of home care patients.
3-5 Key words
Outpatient chemotherapy, cancer patients, home-visit nursing care, nursing care
629
Abuse of individuals with mental retardation by caregivers in Japanese

homes: A literature review
Makiko Morita1, Motoe Yamamura1

1.
Tokyo Metropolitan University
Presenting Authors Email: morita-makiko@ed.tmu.ac.jp
Purpose
The aim of the present study was to analyze and discuss the current state of abuse of
individuals with mental retardation living in the community using reports and relevant
literature published over a 10-year period, which included periods before and after
enforcement of the law for the prevention of the abuse of disabled individuals and support
for the caregivers of disabled individuals in 2012.
Design
A iterature review
Methods
We searched five databases using the keywords abuse, caregivers, and disabled
individual. Of the 120 papers extracted, we reviewed 30 reports that met all the adoption
criteria.
Results
Caregivers who abused their patients in Japan were most commonly the sons of the patient,
and abuse was more likely to occur in the case of young caregivers aged 59 years who were
dependent on the abused individuals pension or income. Abuse came in the form of
physical abuse (69.1%), psychological abuse (38.0%), abandonment of nursing care duties
(28.1%), and financial abuse (28.1%). The most common form of support for caregivers
offered by professionals was institutionalization of the patient and separation from the
caregiver. Moreover, 30% of caregivers received no support after the abuse had subsided or
ended, and the most common reason for this was separation of the parties concerned.
630
Conclusions
Professionals must address living and social independence measures for caregivers together
with the caregivers both before and after separating them from the patient.
3-5 Key words
abuse, caregivers, home care
631
Applying structured physical activities to promote obese children of grade

4-6 for reducing the sedentary behaviors of class breaks: A school-base
approaching
Wei-Ping Lee1
1.
National Cheng Kung University
Presenting Authors Email: nanjojoy@gmail.com
Purpose
The aims of this study were to explore that educational professionals implemented the
structured physical activities on obese school children whether that could reduce childrens
sitting behaviors of class breaks and improve their physical health.
Design
A school-based single-subject design with repeated-measurements was applied in this pilot
study.
Methods
A total of 10 out of 27 children of grades 4-6 with body mass indices over 26 were recruited
from a primary school which located in a remote-rural area and totally included 54 students.
After all subjects agreeing, they were invited to participate this pilot study. A structuredphysical-activity program, including running, jump rope, Chinese yoyo and other fun games
was implemented by three educational professionals during class breaks twice a week for at
least four months. In addition, their performances were repeatedly recorded by a self-report
for sitting time/minutes per day during class breaks in this period. Besides, body weight lost
and physical fitness were also measured at before and after the program.
Results
The results show that average of sitting time decreased 20 minutes per day after
implementing the structured physical activities during class breaks, while compared the
accumulation of sitting time at before and after. There were 60% of participants' body weight
632
lost in average of 1.0 kg. Furthermore, 80% of participants with the level of physical fitness
were promoted the grade from 2nd to 3rd or 4th.
Conclusions
The findings of this single-subject study could provide a good example to educational
professionals to design a program for reducing the sedentary behaviors among obese school
children and improving their physical health. It is strongly recommended that to increase the
numbers of samples and to set a control group for improving quality and effectiveness of
researches in future studies.
3-5 Key words
School children, obesity, structured physical activities, physical fitness
633
Characteristics and changes in subjective QOL of caregivers of adult

cerebrovascular disease patients
Tomoko Watanabe1, Akemi Fujita2, Reiko Nakamura3

1.
Graduate School of Health Sciences Akita University, 2. Hirosaki University Graduate School of
Health Sciences, 3. Tohoku Fukushi University Faculty of Health Science Department of Nursing
Presenting Authors Email: watanabt@gipc.akita-u.ac.jp
Purpose
To ascertain means to support adult caregivers of cerebrovascular disease patients transferred
from recovery phase rehabilitation wards to home care, we assessed their subjective QOL.
Design
We did semi-structured interview and the analyzed qualitative study of category.
Methods
For adult caregivers of cerebrovascular disease patients who were transferred from recovery
phase rehabilitation wards in Japan to home care (patients), we measured subjective
QOL using SEIQoL-DW at the time of discharge to home and at 46 months after transfer to
home care. The index contents and cues at each point were examined and compared. With
respect to ethical considerations, after ethical review, approval was received from the
institutions and medical facilities where the researchers worked. We explained the survey to
subjects and received their consent to participate.
Results
The 10 surveyed caregivers (one man, nine women) were 57.3 years old, on average. By
family relationship, they included eight spouses, one adult child, and one adult childs
spouse. The mean duration after transfer to home care was 152.9 days (SD30.3 days). The
patients were seven men and three women. The average FIM score at the time of discharge
was 117.7 points (85.0 points for motor items, 32.7 points for cognitive items). The mean
score of caregivers SEIQoL-DW index scores was 44.1 (SD22.4) points at discharge and
62.0 (SD12.4) points after transfer to home care. The score obtained after transfer to home
634
care showed a significantly higher value (p= .014). The means evaluated by multiplying the
cue level by the cue weight in the SEIQoL-DW were family (47.226.9),
money (15.133.9), health (48.018.9), and self (caregiver) (48.310.0) at
discharge. They were family (62.919.5), health (61.927.9), work (53.915.4),
and money (43.325.0) after transfer to home care.
Conclusions
1. At the time of discharge of cerebrovascular disease patients to their homes, the subjective
QOL of adult caregivers showed awareness of their own conditions and financial matters in
addition to family and health.
2. Subjective QOL was regarded as improved because they were satisfied in terms of finances,
health, and family at 46 months after transfer to home care.
3-5 Key words
Subjective QOL, adult cerebrovascular disease patients, caregivers, changes, home care
635
Caregiving management for terminal stage patients in communitys ways

of life
Ariya Sornboon1, Khanitta Nunthaboot1, Bumpenchit Sangchart1

1.
Faculty of Nursing
Presenting Authors Email: ariyasornboon@gmail.com
Purpose
This study aimed at examining the management of care provided by family and community
to the terminal stage patients
Design
This is the ethnographic study, qaulitative design.
Methods
The ethnographic study was conducted in a local community of the Northeastern Thailand
using participant observation, in-depth interview and focus group discussion. Data were
collected from 84 participants who were patients at terminal stage, caregivers, neighbors,
public health officers at the local health centers, community leaders and community
volunteers. Data were analyzed using content analysis.
Results
Findings indicated that changes of population structure and becoming semi-urban society
resulted in altering ways of living of the patients. At least 5 aspects of ways of living were
categorized based on the involvement of the prime care givers, instability of health status,
accessibility of welfare, accessibility and benefit packages to public health services, and
housing.
Conclusions
Results revealed the cultural conditions influencing the management of such 5 factors that can
be used to develop guidelines for concrete policy development and deployment in each of the
636
local community. In order that the health and welfare needs of the patients and their family,
policies should be developed to foster and to enhance care and support to maintain the
patients dignity at their terminal stage of life.
3-5 Key words
Teminal care, community care, end of life care
637
Perspectives on chronic pain management in community-dwelling older

adults
Hyungran Park1, Eunyoung Park1, Jee-Won Park1, Sunjoo Boo1

1.
Ajou university
Presenting Authors Email: hyungran@ajou.ac.kr
Purpose
This study was aimed to identify barriers to effective chronic pain management for lowincome community-dwelling older adults from home-visiting nurses perspectives.
Design
A qualitative methodology utilizing focus group interviews was employed to collect data.
Methods
Four groups with 23 nurses (five to six participants in each focus group) were interviewed at
local home-visiting nursing care centres in Suwon, Korea. The inclusion criteria were nurses
with direct experience of chronic pain management in home-visiting care for at least three
years. After receiving the specific information for this study, nurses provided informed
consent. The interviews were conducted by a moderator, guiding the participants through
discussion and monitoring group dynamics to ensure all participants were involved in
discussion. Data were collected with a semi-structured interview guide. The interview guide
for discussion was developed from nurses experience about chronic pain management, in
particular, barriers to assessing and managing chronic pain in low-income communitydwelling patients. Data were analysed with inductive thematic analysis.
Results
They had a median age of 46 years (range 3253) and had related experience of 313 years
(median = 5.7). Patient-related, nurse-related, and organizational barriers were identified.
Patient-related barriers included lack of understanding, lack of motivation, noncompliance,
and financial hardship. Nurse-related barriers were fixed ideas about chronic pain, lack of
knowledge and experience, lack of confidence, and uniform interventions. Organizational
638
barriers included inadequate staffing, time constraints, lack of national support policies, lack
of clear guidance, and limited access to available resources.
Conclusions
Focusing on the nurses experience in caring for older adults with chronic pain, this study
provided insights into how nurses perceived barriers to and what they needed for adequate
pain management in community-based settings, which may be different from acute care
settings. This understanding may pave the way to developing innovative practice strategies for
chronic pain management in primary health care services.
3-5 Key words
Chronic pain, pain management, older adults, community health
639
The analysis and assessment of dangerous factors in the visual lifestyle of

children from the view of myopia prevention
Shu-Ching Chiu1, Wan-Ru Wu 2

1.
National Taipei University of Nursing & Health Science; Central Taiwan University of Science
and Technology, 2. Central Taiwan University of Science and Technology
Presenting Authors Email: scchiu@ctust.edu.tw
Purpose
Background: As the myopic population is continually increasing worldwide, the prevention of
myopia has become an unavoidable issue in public health.
Objective: Purpose of this paper was to examine the risk factors for myopic occurrence.
Moreover, from a public health perspective, this paper also proposed a framework and
describing measures for the prevention of myopia
Design
A literature review paper.
Methods
Method: This article is a literature review that analyzes vital factors affecting the development
of myopia. It was conducted utilizing MEDLINE, CINAHL Plus with Full Text, academic
search complete on the EBSCO database for a period of 1990 to June 2014. Subsequently,
we used PubMed and Google Scholar to search for literatures in relation to vision and
lifestyle patterns and continued with the work of consolidating the gathered literatures.
Results
Results: In this study, vital factors affect the occurrence of myopia including viewing distance,
individual reasons, family, education, and social scene of the nation. Other than proposing a
framework of multiple factors that influence vision-related lifestyle, this study adopts a
preventive and public health point of view to investigate methods that are currently being
used to assess childrens visual health and vision-related lifestyle, to organize and
640
summarize scenarios related to visual tasks, to assess visual aid resources, and to follow up on
the current status of refractive conditions in children.
Conclusions
Conclusions: The prevention of myopia has to start from childhood. More specifically, it has
to start from understanding the process of childrens visual development, analyzing their
visual lifestyle, and enabling children to develop healthy visual habits. The knowledge
acquired, herein, can provide future researchers and public health professionals with a
foundation for developing a primary framework targeting myopia prevention.
3-5 Key words
Visual lifestyle, prevention, myopia, public health, risk factor
641
A study on the visiting nurses& attitude to the home care patients
Lihua Wang1
1.
International University of Health and Welfare
Presenting Authors Email: sarusama1004@gmail.com
Purpose
This study aims to make clear what the visiting nurses regard as important in the care of the
home care patients.
Design
We collected the interview data from five visiting nurses and analyzed the data statistically.
Methods
1) Objective: Five visiting nurses in Tohoku area.
2) Data collection: We had the semi-constitutive interview with five visiting nurses for about
an hour individually, using the interview guide in September, 2012.
3) Analysis method: We used inductive and qualitative analysis to analyze the data.
4) Ethical regard: We carried out our study with permission from the ethical committee of A
University.
Results
66 phrases were extracted and classified into the following four categories:
Category 1: care practice on the basis of the nurses' individual viewpoint on nursing
Category 2: cooperation with other professions based on sharing information and conference
Category 3: use of social resources that satisfy patients and families
Category 4: considering patients as ordinary person and developing care devices based on
their daily lives
Category 1 consists of eleven sub-categories such as 'determination to prevent the bedsore'
and 'condition control. Category 2 consists of two sub-categories: 'mutual conferring' and
'communication with the care manager in case of concern'. Category 3 consists of three sub-
642
categories: 'using a variety of services to relieve the families of their burden', 'planning to use
both visiting nursing care and the medical care insurance', and 'make up a schedule that can
make the most of the social resources'. Category 4 consists of four sub-categories: 'recycle
care supply goods and avoid unnecessary waste', 'using commodities', 'be careful not to
become the source of infection', and ' infection prevention instruction to the families'.
Conclusions
It becomes clear that visiting nurses understand the lives of the patients and their families
comprehensively, and they recognize the importance of their lives. And the visiting nurses
consider it important to cooperate with other professions when they take care of their patients.
These attitudes on the care show that the visiting nurses take care of their patients based on
their own individual view on nursing, they recognize their house patients as ordinary person,
and they are taking care of the patients based on the patients daily lives. As the nurses
care reflects their view on nursing, a change of the visiting nurse may break off the continuity
of the care. So, visiting nursing care needs the cooperation and collaboration with other
professions to keep the continuity of the care. And indeed, the visiting nurses we interviewed
recognize the importance of these issues.
(This study was supported, in part, by Grant-in-Aid for Scientific Research(C) (Number:
24593533) from the Ministry of Education, Culture, Sports, Science and Technology of
Japan.)
3-5 Key words

Visiting nurse, cooperation, family, home care patients
643
Survey on hospital discharge planning in Authorized Health Insurance

Medical Institutions in Saitama Prefecture, Japan
Mariko Zensho1, Koji Sugano2, Ryo Kubota3, Hajime Toda4

1.
Saitama Prefectural University & Doctoral Program, Graduate School of Nursing, Kitasato
University, 2. Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical

Sciences, Division of Palliative Care and Psycho-oncology, Nagoya City University
Hospital, 3. Saitama Prefectural University, School of Health and Social Services Department of Health
Sciences / Laboratory Sciences, 4. Kitasato University Graduate School of Nursing
Presenting Authors Email: zensho-mariko@spu.ac.jp
Purpose
Medical and long-term care support systems are currently revised on account of changes in
lifestyle, escalation in medical costs arising from changes in population composition and
other factors. This study was carried out as a part of the fundamental research from 2012 to
2013 to investigate how to integrate hospital discharge planning (DP) into Health Insurance
Medical Institutions. It was based on the support and mutual understanding for patients and
their family members, who were users of limited social resources such as local medical
services.
Design
Field work of the fundamental research design.
Methods
Research methods included mail surveys with self-administered questionnaires. Guidance and
advice were received from healthcare, medical care and welfare specialists who were wellversed in on- and off-campus home assistance and other topics. Research was conducted for
four weeks in March 2014. Survey contents consisted of 33 indispensable questions regarding
hospital DP.
The subjects were 135 facilities that met the criteria for DP fee addition under the List
of authorized health insurance medical and health insurance pharmacies in Saitama
Prefecture published on the Kanto-Shinetsu Regional Bureau of Health and Welfare
644
website viewed on December, 2013.

Ethical considerations: Written consent was obtained from each participant after a thorough
explanation of the purpose and method of the study and private information protection.
Results
Among 135 facilities, 43 questionnaires were returned (response rate 31.9%). The job
positions were (circle one) 19 nurses (44.2%), 22 social workers (51.2%) and 2 medical office
clerks (4.6%). The mean (SD) of job years on the study population were 16.19.4 (95%
confidential interval [CI] 3-35). Appointment status in the DP-Departments (circle one):
Exclusive appointments were 25 (58.1%); Special appointments 14 (32.6%); Other 4 (9.3%).
Type of wards (circle all that apply): General 38 (88.4%); Recuperation (Post-surgical
Recovery) 16 (37.2%); Recovery Phase Rehabilitation Ward 4 (9.3%); Disabled Ward 1
(2.3%). The total number of sickbeds: Less than 20, 21-49, 50-99, 100-199, 200-299, 300-399,
400-499 and 500 or more were three (7.0%), one (2.3%),.six (14.0%), 16 (37.2%), five
(11.6%), seven (16.3%), one (2.3%) and four (9.3%), respectively. The special screening
variables or criteria (open-ended) were classified into seven core categories: 1. Living
conditions: family relation, family members problem, elderly and solitary, financial
situation, living environment; 2. Patient's conditions: medical-care, age, ADL, dementia; 3.
Transitional Care: after discharge, functional status before hospital; 4. Follow-up service; 5.
The opinions professionals; 6. DP; 7. Nothing. Common types of requests to the DPDepartments (open-ended) were classified into eight core categories: 1. Home-care
management; 2. Transfer to a different hospital or facility-care services; 3. Use of the longterm care services; 4. Financial situation; 5. The long-term care insurance System; 6.
Provision of medical-information; 7. Family-caregivers supports; 8. Other.
Conclusions
DP-Departments with diverse backgrounds and common requests were able to efficiently
coordinate high-quality care service to patients and family-caregivers requesting support.
Because an adaptable DP-Departments plays an important role in the medical setting, a more
streamlined service will be more effective.
3-5 Key words
Hospital discharge planning, health insurance, medical institution, ,
645
The various aspects of hospital-based support system for palliative care: A

field study
Mariko Zensho1, Koji Sugano2, Ryo Kubota3, Hajime Toda4

1.
Saitama Prefectural University & Doctoral Program, Graduate School of Nursing, Kitasato
University, 2. Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical

Sciences, Division of Palliative Care and Psycho-oncology, Nagoya City University
Hospital, 3. Saitama Prefectural University, School of Health and Social Services Department of Health
Sciences / Laboratory Sciences, 4. Kitasato University Graduate School of Nursing
Presenting Authors Email: zensho-mariko@spu.ac.jp
Purpose
As Japan has the highest proportion of elderly people in the world, enhancements in the
Palliative Care support systems are being worked on at a national level. This study took place
in the areas core hospital and it received a high evaluation from the national field of
investigation concerning an integrated Palliative Care Support systems. The purpose of this
study was to clarify the various aspects of hospital-based palliative care support systems in a
field study.
Design
Field work of the qualitative research design.
Methods
The participants were; a Palliative Care Doctor, a Discharge Nurse, a medical office clerk.
The interviewers were the author and three colleagues. Based on the common theme of all of
the interviews ("Practice problems with Hospital-based Palliative Care Support System "), we
made an interview guide in line and performed a semi-structural group interview. The
interviews were recorded, and a word-for-word record was created. The interviews took place
in 2012 and lasted for 2 hours. Data analysis was extracted and the important contents from
the word-for-word record were abstracted.
Ethical considerations: The participants were given written and spoken explanations about the
research and about private information protection. Written consent was obtained.
646
Results
The results were classified into four core categories and related subcategories as follows.
Patient and family support; flexible support according to the patient's condition changes,
informed consent, end-of-life-care and deathwatch, determinants, and self-determination.
Logistical support to "Palliative Care Support Systems" in collaboration with relevant
departments in the hospital; medical office work, and the administrative office.
Volunteer training for local residents.
Regional partnership; excellent home care doctors, information management and a support
system for collaboration and coordination.
Conclusions
Our findings suggest that improvements in the quality of hospital-based support systems for
palliative care could be made in four areas, as follows; patient and family support, logistical
support, volunteer training, regional partnership.
3-5 Key words
Hospital-based support system, palliative care, a field study
647
Changes in the physical health condition of family caregivers caring for the
elderly at home.
Yasuko Torimoto-Sasai1, Ayumi Igarashi2, Takashi Wada3, Yasuko Ogata1, Noriko

Yamamoto-Mitani2
1.
Tokyo Medical and Dental University, 2. the University of Tokyo, 3. the Jikei University
Presenting Authors Email: sasagh@tmd.ac.jp
Purpose
Although 15 years have passed since the introduction of public long-term care insurance
for elderly persons in Japan, support programs for family caregivers have not been widely
implemented. In many cases, family caregivers face various challenges caused by the care
needs of the care recipient. Researchers have not yet assessed the changes in caregivers
health over time, using survey methodology. Any discussion of support programs for family
caregivers requires understanding the variations in their health during caregiving. The purpose
of this study was to examine the changes in subjective health conditions of family caregivers,
compared with non-caregivers, using a 1-year follow-up study.
Design
A 1-year follow-up comparative study.
Methods
A survey was conducted among family caregivers and their non-caregiver counterparts at
baseline, 6-month and 1-year time points, from June 2011 to August 2013. Family caregivers
were recruited into the study via 26 agencies providing LTCI services in Tokyo, Osaka, Kobe,
and Ibaraki. Non-caregivers were recruited through a university health checkup center located
in an urban area in Tokyo. The survey collected information on demographics and subjective
health conditions, and caregivers only were asked questions about the care recipient. The data
on variations in subjective health conditions over the three time points were analyzed using a
Friedman test, and a Mann-Whitney U test was used to compare caregivers and noncaregivers.
648
Results
At baseline, the survey was administered to 149 pairs of caregivers and non-caregivers,
matched for age and sex. Of those, 112 caregivers and 100 non-caregivers were surveyed at
both 6-month and 1-year follow-ups. Data were analyzed from 100 non-caregivers compared
to 47 caregivers who had experienced no change in the intensive level of care required by the
elderly family member they were caring for at home.
The caregivers experienced worsening health over time in the following areas, as
measured by the SF8 Health Survey: physical functioning (PF), role physical (RP), bodily
pain (BP), general health (GH), social functioning (SF), role emotion (RE), and physical
component summary score (PCS) (p<.05). They showed no variation over time in vitality
(VT), mental health (MT) and mental component summary score (MCS). At baseline,
caregivers scored less than non-caregivers in only one health condition: VT (p<.001).
However, at 6-month and 1-year follow-ups, caregivers had poorer health in PF, RP, BP, GH,
VT (only at 6 months), SF, RE, and PCS (p<.05). There were no differences in MH and MCS
between caregivers and non-caregivers.
Conclusions
Caregivers reported worsening health, primarily physical health, over time while
caregiving at home. No changes were seen in mental health over the time period. At present,
most programs for family caregivers involve counseling and sharing their distress and
troubles with others. The current findings suggest that family caregiver support programs
need to focus on physical health and include strategies to address caregivers changing
health conditions while caregiving.
3-5 Key words
Family caregivers, long-term care, health condition
649
Development and psychometric evaluation of the institutionalized elders

perceived caring scale
Huei-Lih Hwang1
1.
National Tainan Institutional nursing
Presenting Authors Email: cutehwang@gmail.com
Purpose
Purpose : To develop and explore the psychometric structure of a perceived caring scale for
institutionalized elders.
Design
The scale development process took place in three stages.
Methods
In the first stage of development, a 34-item Institutionalized Elders Perceived Caring Scale
was generated via literature reviews and interviews with institutionalized elders. Twenty-nine
items were retained after item analysis and content validity testing. In the second stage, 19
items were retained after exploratory factor analysis of 300 institution-dwelling elders. In the
third stage, the factor structure and reliability were further tested in 216 elders using
confirmatory factor analysis.
Results
Confirmatory factor analysis indicated that a 12-item scale with a 2-factor structure best fitted
the data (2 =106.990, d.f. = 53, p < .001, 2/d.f. ratio = 2.019, GFI = .926, CFI = .958, TLI
= .948, RMSEA = .069). This scale had acceptable Cronbachs values (range .827
to .907).
Conclusions
This scale had satisfactory validity and reliability for measuring institutionalized elders
perceptions of caring.
650
3-5 Key words

Caring, caring, long-term care, elders, scale development, elders, long-term care
651
Nurse assistants perception on the safety issues for the elderly living in
the residential care facilities: A phenomenological study
Panpan Wang1
1.
Presenting Authors Email: panpan200930010205@163.com
Purpose
To explore the perception of nurse assistants on the safety issues for the elderly living in the
residential care facilities in Zhengzhou.
Design
A qualitative study using phenomenological approach
Methods
A phenomenological approach was adopted in this study. In-depth interviews were conducted
with 15-20 nurse assistants working in the residential care facilities located in the City of
Zhengzhou. Data were analyzed by Colaizzis 7-step analysical procedure
Results
There were ten nurse assistants recruited from the three residential care facilities located in
the City of Zhengzhou to examine their perception on safety issues caring for the elderly. The
initial findings were analyzed using Colaizzis 7-step procedure. It has been found that
nurse assistants awareness of safety issues in the residential care facilities were ignoring the
assessment of the elderlys emotional stability, lack of knowledge in caring for elderlys
safety and dealing with elderlys ethical issues in their clinical decision-making.
Conclusions
The findings of this study will provide guidelines for nurse assistants on the safety issues in
caring for elderly living in the residential care facilities in order to provide high quality of
care for these elderly in the long term care
652
3-5 Key words

Aged care on safety, phenomenology, residential care facilities, ,
653
Advance care planning program for institutionalized older people
Chia-Ying Lin1, Huei-Chuan Sung2, Sheng-Yu Fan3, Shu-Chen Wang4, Meng-Wei Lin5,
Graeme D. Smith6
1.
School of Nursing, National Taipei University of Nursing and Health Sciences, 2. Associate professor,
Department of Nursing, Tzu Chi College of Technology & Taiwanese Center of Evidence-based
Health Care, Hualien, Taiwan, 3. Assistant professor, Institute of Gerontology, National Cheng Kung
University, Tainan, Taiwan, 4. Deputy director, Department of Nursing, Buddhist Tzu Chi General
Hospital, Hualien, Taiwan, 5. BSN student, Department of Nursing, Tzu Chi College of Technology &
Taiwanese Center of Evidence-based Health Care, Hualien, Taiwan, 6. Professor, School of Nursing,
Edinburgh Napier University, Scotland, UK
Presenting Authors Email: chiaying1988@gmail.com
Purpose
This pilot study was to evaluate the effects of advance care planning program (ACP) on
knowledge and attitude of hospice care among older people in a long-term care facility.
Design
A one-group pretest-posttest design was used.
Methods
A convenience sample of 25 older people in a long-term care facility was recruited and they
received the ACP program which consisted of a one-hour individual life review interview
using an ACP handbook and two sessions of group patient education on hospice care and
advanced directives. All participants received the pre-test and post-test assessment using the
Knowledge and Attitude scales of Hospice Care and Advanced Directives questionnaire.
Results
After receiving the ACP program, the participants mean knowledge score of hospice care
and advanced directives had a significant increase from 3.84(SD=1.95) at pre-test to
10.56(SD=5.64) at posttest (p<.001). Their mean attitude score also had a significant increase
from 78.24(SD=6.96) at pre-test to 85.56(SD=6.83) at posttest (p=.001).
654
Conclusions
ACP program can improve the knowledge and attitude of hospice care and advanced
directives among institutionalized older people. Nurses can be an active advocator to provide
information about hospice care and advanced directives to older people in long-term care
facilities., nurses can help older people express their views regarding medical treatments and
care when it comes to the end of life, and this can help older people enhance their autonomy
and decision-making to plan for their end-of-life care in advance, avoid unwanted and
ineffective medical treatments.
3-5 Key words
Older people, advance care planning, hospice care, long-term care,
655
Rainstorm and flood disasters in Japan and role of public health nurses
Ngatu Nlandu1, Megumi Nishigawa1, Miho Morosawa1, Sakiko Kanbara1, Yoko Nakayama1,
Sayumi Nojima1
1.
University of Kochi
Presenting Authors Email: doc.rogerngatu@gmail.com
Purpose
Floods are the leading cause of natural disaster-related deaths worldwide, being responsible
for 6.8 million deaths in last century. In Japan, a country that is still striving to recover from
the quadruple disaster (earthquake, tsunami, fire and explosion at Fukushima nuclear plant)
following the massive 9.0 magnitude earthquake that struck East-Japan region in 2011,
devastating flood disasters have been taking place recently. This report presents the frequency
of rainstorm and flood disasters occurring in 2013, their human and environmental impacts,
and Nursing activities conducted by Public Health Nurses (PHN) in disaster setting.
Design
Retrospective descriptive study.
Methods
We conducted a mini-review of reports on rainstorm and flood disasters, occurring in Japan in
2013, from local and foreign media agencies as well as prefectural and national governments.
A record of nursing interventions implemented in disaster settings was also performed.
Results
Rainstorm and Flood disasters caused 58 deaths, 331 cases of injury and 589,000 displaced in
Japan in 2013. In addition, rainstorm, flood and subsequent mudslide destroyed 3,972 houses;
more than 27,000 houses were flooded. Rainstorm and flood-caused environmental damages
were cost about 2 billion yen in 2013. The main activities performed by PHN were 'Health
surveys and monitoring'.'Assessment of hygiene and sanitation status in shelters'.'Health
consultation and care for people with chronic diseases',care for 'Prevention and management
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of Low Back Pain' and 'Mental Health Promotion' through preventing anxiety mostly in
elderly people.
Conclusions
Although efforts to counter water-related disasters are made, there is still more to do in order
to efficiently prevent their human impact in Japan. Preventive measures such as removing
obstacles on river bed, avoiding constructions near water space and terrain at risk of mudslide
should be applied by competent governmental and other specialized agencies. In addition, at
individual and community levels and in case of imminence of rainstorm and flood disaster,
the provision of safe 'Shelter', being ready for a 'Timely evacuation' and warning 'Others'
(family, neighbors) to take a 'Prompt decision to evacuate' are important measures to be
aware of. Furthermore, organization of periodical water-related disaster drill to increase
awareness among inhabitants might contribute to improving disaster preparedness and
reducing their human impact. To achieve this goal, preparedness and a good coordination of
disaster relief interventions undertaken by governmental, non-governmental specialized
agencies and the contribution of PHN are of utmost importance
3-5 Key words
Disaster, flood, Japan, public health nurse, rainstorm
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Case studies of the professional growth of public health nurses who

Saori Iguchi1, Mina Ishimaru1, Misako Miyazaki1

1.
Graduate School of Nursing, Chiba University
Presenting Authors Email: saori.iguchi@chiba-u.jp
Purpose
When the Great East Japan Earthquake occurred, not only people who lived in the area, but
also public health nurses (PHNs) were faced with a serious situation. PHNs provided
healthcare services that included assessment of individual needs, community empowerment,
and implementation of a healthcare network as public officials, even though their lives were
threatened by secondary disasters, and they suffered physically and psychologically. The
purpose of this study is to clarify the professional growth of PHNs who experienced the
earthquake through their nursing activities, and to obtain suggestions for ways to support such
PHNs. In this study, professional growth is defined with reference to the concept of posttraumatic growth, as PHNs being able to find positive aspects to their experience, or to find
new ways of thinking and seeing, through a process of giving meaning to their experience.
Design
This was a qualitative, inductive study.
Methods
Participants were three female PHNs in positions of leadership. The average length of
experience was 24 years. Narrative interviews were carried out with three PHNs who
experienced the earthquake and provided healthcare services for more than a year following
the earthquake. Data was collected from the interviews, focusing on how PHNs found
positive aspects or new ways of thinking and seeing with regard to situations in which they
had had to make decisions or take actions in response to difficulties. The data was categorized
by similarity and themes were named for each case. The data from the three cases was
integrated.
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Results
Data was categorized into 16 themes. These were characterized in terms of 3 broad aspects:
the aspect of self-understanding, the aspect of how to think about relationships with others,
and the aspect of beliefs and values about the occupation of PHN. The aspect of selfunderstanding consisted of 3 themes, including Positive self-perception and
Acceptance of pain and loss. The aspect of how to think about relationships with others
consisted of 7 themes, such as Positive perception of relationships with PHNs
colleagues, and Positive perception of relationships with other department staffs. The
aspect of beliefs and values about the occupation of PHN comprised 6 themes, including
Believing in the abilities of citizens and working together, and Need for a sense of
mission and resolution.
Conclusions
The results showed that PHNs could understand themselves from various perspectives, see
others as reliable people, and develop their beliefs about their profession. Their professional
growth helped them to provide better healthcare services. It is suggested that it is necessary to
create formal and informal opportunities for PHNs to reflect, in order to promote the giving of
meaning to their experiences to develop their professional growth. Thus, it is important to
create an environment in which they can talk without anxiety with reliable colleagues.
This study was supported by a Sasakawa Scientific Research Grant from The Japan Science
Society.
3-5 Key words
The great east Japan earthquake, public health nurses, professional growth
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Factors associated with the resumption of social activities in elderly people

after an earthquake disaster
Chuhyang Oh1, Misaki Matsuta2, Emiko Saito Saito1

1.
Department of Nursing Sciences, Graduate School of Human Health Sciences, Tokyo Metropolitan
University, 2. Mitsui Memorial Hospital
Presenting Authors Email: ohchuhya@tmu.ac.jp
Purpose
The purpose of this study was to clarify the factors associated with the resumption of social
activities in elderly people after an earthquake disaster.
Design
We conducted a cross sectional study using a self-reported questionnaire
Methods
The questionnaire consist mainly of 10 items of basic attributes, 6 items of participation
resumption of the group activity after the earthquake disaster, 11 items of daily activities, 3
items of the going out situation, and 6 items of the everyday social activity. Additionally, in
140 participants of elderly residents in a rural city, t test, Mann-Whitney examined the chi
square test about the ordinal ranking scale, the nominal scale of participation resumption time,
and the association between each variable by the analysis. A significance level of less than
5% was used and statistical analyses were performed using IBM SPSS 20.0J.
Results
The number of collected questionnaires was 49 (35%). The number of valid responses was 45
(32%). A mean age of 71.0 years (SD 4.8) participated in the study. Forty-two percent of the
respondents were men. We divided into 2 groups according to their resumption timing. The
first group consisted of residents who, after a disaster, resumed participation in an activity
from the first opportunity (a first-time resumption group), and the second group comprised
residents who resumed participation sequentially later (a sequential resumption group); their
circumstances at resumption were compared. The first-time resumption group had a
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significantly higher proportion of participants who had a sense of responsibility to participate

in the group activity (P=0.009), and who use bicycle, driving on their own, or walking as
moving means for participation in the group activity (P=0.033).
Conclusions
In the first-time resumption group, it was suggested that means of moving to the activity
venue was related to resumption, as was voluntary participation because of a sense of
responsibility to the association or related reasons. The results of this study show that, for
residents who have difficulty resuming social activities soon after a disaster, both convenient
transportation, and solicitation are effective for encouraging resumed social participation.
3-5 Key words
Disaster, elderly, social activity
661
Learning the states of displaced people living through fieldwork placement

at a health information room in Fukushima.
Toshiko Ikeda1, Yumi Tamura1, Mie Naiki1

1.
The Japanese Redcross college of nursing
Presenting Authors Email: dkmwm077@ybb.ne.jp
Purpose
The Great East Japan Earthquake is well documented. Fukushima citizens were forced to
relocate due to the nuclear power plants accidents is less reported. I, a DNGL program student,
had an opportunity to do field work at a Health Information Room located in C-city for
people replaced from their hometown B-town to C-city. It is collaboratively supported by Btown and Japanese Red Cross Society and Japanese Red Cross College of Nursing. This
presentation aims to share my learning of the peoples state of living through the fieldwork.
Design
Descriptive investigation on own field notes
Methods
During the 5 days fieldwork in August 2014, I have had opportunities to participate in home
visiting for health check on five households and three kind of events with B-town people,
these events beingmother and child support, gymnastics activities and a noodle
stand of the local festival. The field notes were taken from my participative observation of
all of my field activities. For reflection my field notes, first, I read them thoroughly, and then
meaningful features were extracted on peoples living appearance. The focus of analysis
was on B-town their tone of voice and words and phrases they used.
Results
The analysis led to two themes that express my understandings of the peoples state of
living :
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1.Reiteration of hope and disappointments regarding not giving up on going to their

hometown, at the same time people face to reality of difficulties of regaining their own
community and local culture, etc.
For example, people told I want to go back to my hometown even I built a new house in
this town, and want to see my town to be recovered. But I know it is an impossible dream
Or, people told, I have to face this reality as I see my dilapidated house when I was allowed
to go to my home for a brief visit.
2. Replacement imposes inconveniences to their life and influences their resilience.
For example, a woman told, my husband broke his leg because his working office had to be
moved to 2nd floor accessible by stairs only, and them our daily life changed of that. Access
to medical and health care is also inconvenient, and health support is not enough for our
needs.
Additionally, I have learned that this Health Information Room has a very important role that
people from the same district can meet and experience their hometown there, as part of health
support.
Conclusions
Since this fieldwork placement was a very short period, my understanding of peoples voice
was limited. However, this fieldwork reawaked me to understand realities of displaced people
s life. Although, superficially, they seem to live ordinary, realistically their daily life has been
changed and deeply affected their soul. Therefore this kind of long term support project is
very important for these displaced people. Need to have further fieldwork activities there for
better understanding displaced peoples life.
3-5 Key words
Fieldwork, reflective learning, displaced people, peoples voice
663
Radiation risk communication and health consultations for local

government staff on long-term evacuation due to disaster impacts
Chiaki Kitamiya1, Ikuo Kawazoe1, Ruriko Kidachi1, Kazuya Norikane1, Kazuki Iwaoka2
1.
Hirosaki University Graduate School of Health Science, 2. Hirosaki University Department of

radiation Physics Institute of radiation emergency medicine
Presenting Authors Email: chiaki@cc.hirosaki-u.ac.jp
Purpose
Background
Three years after the Fukushima Daiichi Nuclear Power Station accident, local government
staff members in Namie-machi, Fukushima Prefecture, are working to return to the
Evacuation Directive Lift Prepared Areas, preparatory to the lifting of the evacuation
directive. It has been the policy of staff memberswho, together with the local residents,
have been evacuated for a long periodto remain close to the local people, and provide
necessary support.
Purpose
This study reports on the risk communication with these staff members, which involves
two-way communication with specialists offering advice with regard to worries and
uncertainties about radiation risk, as well as with regard to any action plans undertaken by
them in response to the health consultations.
Design
Design
This study is an intervention study, focusing on the health of local government staff forced
into long-term evacuation. The program was comprised of the following: 1) basic knowledge
on radiation from radiation specialists (90 minutes including questions and answers), 2) health
education by public health nurses (30 minutes including questions and answers), which
started with a discussion about recreation, was followed by explanations centering on findings
of the health impacts of earthquakes on staff, and concluded with an explanation of stress
management, and 3) health consultations (interview style), with public health nurses, nurses,
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and radiation specialists.

Methods
Methods
To evaluate the program, we conducted an anonymous questionnaire survey at the end of the
program. The survey asked questions about radiation, about health worries, about the content
of the health talks, and included a screening survey for depression and anxiety (K6: Kessler,
2002). As regards ethical considerations, the gist of the questionnaire was explained,
answering it was voluntary, and returned questionnaires were treated as confidential.
Results
Results
1)
Participants attributes: The participants included 13 men and 8 women, for a total of
21 participants. Eight were under 40 years of age, and 13 were 40 years of age or older.
2)
Basic knowledge on radiation: The participants listened intently to the radiation
lectures, but did not ask any questions.
3)
Health education: Eighteen survey respondents (85.7%) said that the lecture content
was helpful.
4)
Health consultations: Five staff members wanted consultations; three were under forty
years of age, and two were forty years of age or older; two were men and three were women.
All wanted their blood pressure taken, and blood pressure was a central concern.
5)
Questionnaire: Five people (23.8%) were worried about their health. Only one person
was worried about radiation. Seven people (33.3%) said that if periodic health consultations
were offered in the future, they would want to attend.
Conclusions
Conclusion
There were few worries about radiation, but health worries were not confined to the middleaged and elderly, with staff members less than 40 years of age also having worries. We intend
to continue to strive to maintain an ongoing interest in their health via periodic health
consultations, and to provide an environment that allows them to confidently express their
worries about radiation.
3-5 Key words
Health consultation, local government staff, radiation education, risk communication
665
Verification of a causal model of team empowerment factors and teamwork

function in nursing activities in the acute post-earthquake Phase
Kimiko Hayano1, Kayoko Kawahara2

1.
Japan SelfDefense Forces Asaka General Service Medic, 2. Tokyo Metropolitan University
Presenting Authors Email: kimidaritaru@yahoo.co.jp
Purpose
The acute phase medical activity system after a disaster has been established and maintained
in Japan based on experiences with large-scale earthquakes. The present goal is to coordinate
medical teams that can immediately respond to the needs of afflicted areas, which requires
team leaders strategically empowering team members. This study aims to elucidate the
mechanism of effective empowerment of team members.
Design
Hypothesis model settingTeam empowerment was operationally defined based on
preceding studies. Constituent elements were i) information sharing, ii) resource coordination,
and iii) mutual support coordination.
The scales of "team activity efficiency" and "team activity satisfaction" were used for
teamwork function. In the aforementioned model, we hypothesized that three factors, i)
information sharing, ii) resource coordination, and iii) mutual support coordination, are
interrelated and that these three factors causally promote "team activity efficiency" and "team
activity satisfaction." The study objectives are to verify the validity of team empowerment
factors based on a hypothesis model showing associations between team empowerment
factors and teamwork function.
Methods
The subjects were nurses who performed nursing activities after earthquakes in Japan. The
study was conducted in March 2010, by sending self-administered questionnaires by mail.
The questionnaire was comprised of 9 items pertaining to basic attributes, 15 items to
teamwork and empowerment, 8 items to team activity efficiency, and 4 items to team activity
satisfaction. We performed exploratory factor analysis and confirmatory factor analysis to
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verify the constituent items of the team empowerment scale and factor structure validity. We
calculated the degree of conformance using pass analysis to verify the hypothesis model.
Results
We requested that 1100 nurses at 10 institutions complete the questionnaire and we received
replies from 1021 nurses (92.7%). Of them, valid replies from 971 nurses (88.2%) were
analyzed.
1) Exploratory factor analysis extracted 3 factors and 12 items pertaining to team
empowerment, as follows: first factor "information sharing" ( = 0.87), second factor
"resource coordination" ( = 0.85), and third factor "mutual support coordination" ( =
0.77). The results of confirmatory factor analysis were GFI = 0.94, AGFI = 0.90, CFI = 0.95,
and RMSEA = 0.09, showing an acceptable degree of conformance.
2) Three team empowerment factors were presented in scale and pass analysis was performed
according to the hypothesis model. The results showed that in an appropriate model, i)
information sharing and ii) resource coordination have a causal relationship with "team
activity efficiency," and that iii) mutual support coordination is causally related to "team
activity satisfaction." The conformance indices were GFI = 0.99, AGFI = 0.95, CFI = 0.99,
and RMSEA = 0.09.
Conclusions
We confirmed that in the function of team empowerment, i) information sharing and ii)
resource coordination affect team activity efficiency, whereas ii) mutual support coordination
affects team activity satisfaction. These three team empowerment factors can be utilized for
coordination function of team leaders empowering team activities.
3-5 Key words
Team empowerment ,teamwork function, disaster nursing, ,
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Preparedness for chemical, biological, radiological, nuclear, and explosive

disasters in Japan: A literature review
Yumiko Ogawa1, Yoshiko Sasaki1, Hanae Miura1, Yoko Imazu1

1.
Cooperative Doctoral Course in Disaster Nursing, Graduate School of Health Care Sciences, Tokyo
Medical and Dental University
Presenting Authors Email: dn140001@tmd.ac.jp
Purpose
Last year, the International Olympic Committee selected Tokyo as the host city for the 2020
Olympic Games. In the past, host cities of Olympic Games have often become terrorist targets.
In Japan, people have plentiful experience with natural disasters such as earthquakes,
tsunamis, and typhoons. As a result, hospitals are well prepared for such events. However,
they are not yet sufficiently prepared for Chemical, Biological, Radiological, Nuclear, and
Explosive (CBRNE) disasters. The purpose of this study was to conduct a literature review in
order to identify both current and directions for future research on CBRNE disasters and
CBRNE disaster preparedness in Japan.
Design
literature review
Methods
Using the Ichushi-Web (Japan Medical Abstract Web), we searched for Japanese articles
published from 1983 to August 2014 with the following words in the title and abstract:
disaster; disaster and chemical; disaster and biological; disaster and
radiological/nuclear; disaster and explosive; and disaster and CBRNE/ NBC.
Articles focusing on labor, natural, and other types of disasters were excluded.
Results
A total of 16247 papers were extracted that included the word disaster. Among these, a
total of 316 papers that included the terms chemical disaster (48), biological disaster
(13), radiological/nuclear disaster (176), explosive disaster (21) or generic
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disaster (58) were extracted. Furthermore, after confining the search to only original
articles, we found 1648 disaster articles, including 28 on CBRNE disasters, broken down as
follows: chemical (4); biological (2); radiological (13); explosive (7); or all of the above (2).
The most common articles concerned radiological disasters. This finding was considered to be
affected by the accident at Fukushima Nuclear Power Plant after the Great East Japan
Earthquake, which resulted in a leak of radioactive material. Focusing on chemical, biological
or explosive disasters not involving radiological or nuclear disasters, the articles dialing with
such disasters showed the same tendency; that is, there was an increase in the number of
articles published following an incident. In terms of subject, most articles focused on victims,
nursing or public health nursing, institutions such as hospitals, or Disaster Medical Assistant
Teams, and were researched or investigated from various perspectives. Other articles focused
on doctors and radiologists. Each area of CBRNE was also investigated from various
perspectives. The studies were performed using quantitative or qualitative approaches, case
studies, surveys, and literature reviews. An equal number of quantitative or qualitative studies,
case studies, and surveys were noted, whereas fewer literature reviews were found, likely
because the number of CBRNE studies was small. This finding indicates that this area of
research is developing.
Conclusions
Based on these studies about disasters, there appear to be few original articles related to
CBRNE disasters in Japan. We need to learn from past experience in order to recognize and
minimize the risk of a possible disaster. Further research is required to prepare adequately for
such disasters.
3-5 Key words
CBRNE, disaster, literature review
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Characteristics of elderly nuclear disaster evacuees - Through until two

years after the six months after the earthquake -
Yukari Kamei1, Kazuhiro Ito2

1.
Japanese Red Cross college of Nursing, 2. St Luke & International University
Presenting Authors Email: y-kamei@redcross.ac.jp
Purpose
The purpose of this study is to describe elderly nuclear evacuees to experience what that
evacuation life, whether are you living to think what kind of thing, to clarify the
characteristics of the elderly.
Design
This qualitative study used a grounded theory approach.
Methods
Study participants were14 residents age 65 years or older who were evacuated from their
homes because of the nuclear accidents. In September 2011 to March 2013, was carried out
four times a semi-structured interview to six months each data collection period.This study
was approved by the Ethics Committee of St. Lukes College of Nursing (approval no. 11049&12-042).
Results
In half a year after the earthquake, it is difficult to accept the fact that it was supposed to be
evacuated by the nuclear accident, there was a sense of hopelessness and disappointment to
life.
In one year after the earthquake, acceptance of the situation have progressed, but disappointed
to life lasted still.
Inspiring thoughts became stronger on the other hand, myself.
I think in a year and a half after the earthquake, to the anger of the nuclear accident will
change, conflict to the feedback was observed.
On the other hand, they had been living create a new connection between people.
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In the two years after the earthquake, the wrath of nuclear changed to distrust, conflict to
return became a resignation to the feedback.
From the above, as a characteristic elderly nuclear evacuees, psychological stress after a
disaster is seen as well as the other age groups, there was a difficulty to and can not live
independently from children households Economically. In addition, elderly nuclear evacuees
is an effort to try to continue to live in evacuation shelters and inspire yourself, you were they
are about to go live to withstand quietly the current state and without disturbing the children.
Conclusions
For the process of the victims psychological after a disaster, you do not understand what
happened at a time of 2 to 3 from the disaster immediately after the occurrence of "stupor
phase", you are trying to deal with the situation after the disaster in solidarity then
"honeymoon phase" and there followed by "disenchantment phase" (Tyhurst, 1950 , Rafael,
1989) .
Has not been conducted interviews during periods corresponding to "stupor phase" in this
study, but is in a period of disappointment elderly nuclear evacuees of six months after the
earthquake, it can be said that was necessary time to migrate to the honeymoon phase.
In addition, there were four steps in life rebuilding for older nuclear evacuees. Initially there
was anger about the nuclear accident. Next was disillusioned with the shelter. Then they
adapted to that life to solve their problem. Finally was resolution in re-organization of their
community.
Nuclear accident is an event for the first time in Japan, stigma of nuclear evacuees and be
noticed from the public, suffering due to spread of rumor is present, there is a need to explore
to continue.
3-5 Key words
The great east Japan earthquake, nuclear disaster, elderly evacuee, life rebuilding process,
longitudinal study
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The effects of music interventions for adult patients undergoing

colonoscopy: A systematic review
Shuk yee Ko1, Chau Janita Pak-Chun2, Wong Eliza Mei-Ling2, Chan Chi Chung1
1.
Hospital Authority, 2. Chinese University of Hong Kong
Presenting Authors Email: KOlc02@yahoo.com.hk
Purpose
To assess the effects of music interventions on reducing anxiety, sedative requirements, pain
and improving physiological outcomes and satisfaction among adult patients undergoing
colonoscopy.
Design
A systematic review of randomized controlled trials.
Methods
Randomized controlled trials that compared music interventions and standard care with
standard care alone for reducing anxiety, sedative requirements, pain, and improving
physiological outcomes and satisfaction in adult patients (18 years old) with colonoscopy
were included in this review. Articles were searched in English and Chinese databases
including MEDLINE, Cochrane Central Register of Controlled Trials, EMBASE, CINAHL,
AMED, PubMed, PsycINFO, and WangFang database. Hand searching of journals and
reference lists were conducted. Two reviewers extracted data and assessed methodological
quality independently, and seeking additional information from the trial researchers when
necessary. Results were presented by mean differences (MD) for outcomes measured by the
same scale and standardized mean differences (SMD) for outcomes measured by different
scales. Heterogeneity was assessed by calculating the I^2 measure of inconsistency. Pooled
estimates were calculated using the fixed-effect model unless there was significant
heterogeneity (I^2 > 50%), in which case the random-effects model was used. 95%
confidence intervals (CI) were calculated for each effect size estimate.
Results
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The initial search identified 10,448 articles. Thirty-nine relevant articles met the inclusion
criteria and subsequently critically appraised for methodological quality. Eleven articles were
of appropriate quality for inclusion in the review, and one study was removed due to duplicate.
All randomized trials were published from 2000 to 2011. Studies were from worldwide.
The results showed that participants who received standard care combined with music
listening did not significantly differ in their reported anxiety levels from those participants
who received standard care (SMD -2.47, 95%CI -5.13 to 0.19, P = 0.07). In respect to
sedative drug requirements, no statistically significant between the music intervention group
and the control group (MD -0.31, 95%CI -0.86 to 0.24, P = 0.27). Nevertheless, a statistically
significant reduction of pain was found (SMD -0.77, 95%CI -1.25 to - 0.29, P = 0.002).
Listening to music had also a significant effect on reduction of heart rate (MD -7.85, 95%CI 10.41 to -5.29, P < 0.00001) and diastolic blood pressure (MD -5.59, 95% CI -10.13 to -1.06,
P = 0.02), however, the systolic blood pressure had not been improved (MD -10.5, 95% CI23.09 to 2.08, P = 0.10). Similar results had been found with regard to the procedure
satisfaction (SMD 3.79, 95%CI -1.74 to 9.31, P = 0.18).
Conclusions
This systematic review indicates that patient listening to music during colonoscopy is an
effective way and inexpensive technique in reducing pain, heart rate, and diastolic blood
pressure. More importantly, no harmful effects were observed for all the studies. Thus, it is
reasonable to offer this non-invasive modality to patients during colonoscopy in clinical
settings.
3-5 Key words
Music, colonoscopy, anxiety,
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Aromatherapy intervention for nurses in work-stress effectiveness
Hsia-Ling Wu1, Koong-Liang Huang2, Min-Hui Tsai2

1.
Taipei Venterans General Hospital Su-Ao & Yuanshan Branch, 2. Fo-Guang university
Presenting Authors Email: ysvh1933@mail.ysvh.gov.tw
Purpose
Nurses often face to patients live and death, they are even more stress on other sectors of the
industry, is a high stress often due to the characteristics required to alternative three shifts for
work, by the patient's condition changes arising from stress and anxiety situations increasing,
affect their health and disease. How to find an easy and effective a way to lift stress, it is
extremely important. Aromatherapy is popular alternative therapy, for the stress to remission
have its history of witness, and the results are good, aromatherapy method is simple and a
highly acceptable adjuvant therapy.
Design
This study used a single group, measured before and after the bergamot essential oil
intervention.
Methods
The participants is clinical nurses on the day shift at a local hospital were collected from the
2013 October to November total 16. Subjects bergamot oil drops to the mask by direct
inhalation for 15 minutes of intervention. Then used the heart rate variation(HRV)
electroencephalogram(EEG) and subjective relaxing questionnaire to measurement the
perception of stress. Using SPSS statistical analysis.
Results
The results showed that the subjects involved in the essential oil of bergamot moment, HRV
of high frequency (HF) increased, heart rate (HR) decreased, EEG , wave with increases
and significantly (p<.05) showing participants is relax; The subjectively perceived physicalmental relaxation scores from 5.5 to 7.2 were significantly increased(p<.05).
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Conclusions
The results showed that the essential oil of bergamot via direct inhalation, improve the nurses
working stress , and provide medical institutions can adopt to reduce the stress of a way.
3-5 Key words
Nurse, stress, aromatherapy, HRV, EEG
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The effects of music on psychophysiological responses and opioid dosages in

patients undergoing total knee replacement surgery
Hui-Ling Lai1, Hsin-Ji Chen2, Chiung-Yu Huang3, Tsung-Ying Chen2

1.
Tzu Chi University/ Tzu Chi Buddhist General Hospital, 2. Buddhist Tzu Chi General Hospital, 3. IShou University
Presenting Authors Email: snowjade@mail.tcu.edu.tw
Purpose
Patients awaiting total knee replacement (TKR) surgery are often anxious. Music is
considered an adjuvant therapy to calm patients. However, the effects of music on
psychophysiological parameters, pain relief, and the amount of analgesic drugs have varied
among studies, which has resulted in uncertain clinical significance and limited its
applications in clinical settings. We examined the effects of listening to music on
psychophysiological parameters (blood pressure, heart rate, and respiratory rate) during
preoperative and postoperative days and determined whether listening to music could lower
pain intensity and opioid dosage during postoperative days in patients who underwent total
knee replacements.
Design
Randomized clinical trial.
Methods
This was a two-group repeated measures design for 30 subjects aged 53-85 years who were
scheduled for total knee replacement. Subjects were randomly assigned to either a music
group or a control group. Psychophysiological parameters were obtained from patients'
monitors. A visual analog scale was used to assess postoperative pain. Opioid dosage was
recorded and converted to standardized units. Mann-Whitney U test and generalized
estimating equation analysis were used to compare groups.
Results
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Respiratory rates while in the surgical waiting area were lower for the music group than for
the control group (p = 0.002). There was no significant difference between these groups for
blood pressure, heart rate, pain intensity, or opioid dosage. However, a within-group
comparison showed that systolic blood pressure in the music group was significantly and
consistently decreased during postoperative recovery (POR) (Wald = 9.21; p = 0.027).
Conclusions
Our results provide evidence for the beneficial effects of music in reducing patients'
respiratory rates while in the waiting room before TKR surgery. Listening to music also
stabilized systolic blood pressure in patients during POR. The effects of music on
psychophysiological parameters, pain intensity, and opioid dosage in a surgical setting require
further research.
3-5 Key words
Music, total knee replacement, vital signs, pain intensity, opioids
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Meta-analysis on the effects of therapeutic use of art drawing
Shu-Jen Chen1, Jui-Tai Hung2, Shu-Hui Yeh3, C. Asphodel Yang4

1.
Central Taiwan University of Science and Technology, 2. Hungkuang University, 3. Show-Chwan

Care System, 4. National Taichung University of Science and Technology
Presenting Authors Email: ujchen@ctust.edu.tw
Purpose
This project was to examine the therapeutic effects of art drawings. With the current
emphasis on evidence, it is found that little review studies estimated the positive effects of
creative art therapies on the specific populations. Yet, no project has reviewed and focused on
only the effectiveness of the use of art drawing, painting or colouring (briefly called as art
drawings).
Design
A systematic review and meta-analysis on the RCTs of art therapy were conducted to estimate
the effects of only the therapeutic use of art drawings, excluding the other art formats such as
music, drama etc.
Methods
On January 2014, randomized controlled trial and art therapy were used for the
search of seven electronic databases and other resources. After exclusive criteria applied, 18
articles presenting 1142 participants in 17 RCTs were selected. The selection was focused on
only those RCTs applying sessional or brief use of art drawings either in group or by
individuals. The overall effects immediate after treatments were computed regardless any
particular group of participants. The quality of every studies were assessed, publication bias
and heterogeneity were tested. Standard mean difference (SMD), known as Cohens d, was
estimated as the pooled effect after treatment.
Results
Because of high heterogeneity, four psychological constructs, including quality of life,
depression, anxiety and self-esteem, were evaluated in the random effect model, except the
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only construct, cognition, being explained in the fixed model. Their effect sizes (SMD) are:
Quality of Life is 0.844 (95%CI:-0.060 to 1.748); Depression and Self-Esteem are o.884
(95%CI:-0.330 to 2.097) and 1.047 (95%CI: -0.0075 to 2.168); the State- and Trait Anxiety
are 1.909 (95% Confidence Interval: 0.485 to 3.333) and 2.257 (95% CI: 0.301 to 4.213)
respectively. The effect of cognition in the fixed model is 0.670 with the 95% CI between
0.412 and 0.929.
Conclusions
In conclusion, the therapeutic use of art drawing, painting or colouring improves peoples
quality of life and emotional wellbeing greatly, rather than their cognition.
3-5 Key words
Art therapy, meta-analysis, randomized controlled trials, art drawing
679
What elementary school students have learned after attending the class A
Course on Life given by a midwife
Yasuko Sugiyama1
1.
Suzuka Uninersity Of Medical Science
Presenting Authors Email: sugiyama@suzuka-u.ac.jp
Purpose
A Course on Life has been carried out since 2002, targeting elementary school students,
with the purpose of making them understand the importance of Life. In the beginning of year
2002, our country was facing a social background in which occurred such cases as serial
murders of infants and murders by early adolescent boys. Parents who felt anxious
about those cases asked me, a midwife, to teach children the preciousness of Life. The
program content of A Course on Life is as follows: 1. What is the most important thing?
2. The beginning of Life 3. A look on how a baby in the uterus is growing (including
explanations on damages of tobacco) 4. Listening to how pregnant women feel 5. The
different of the heart rate of a baby in the uterus, of an elementary school student and of an
adult 6. How are babies born? 7. The job of a midwife 8. The feelings of a mother, of a father
9. A gift of words from a midwife 10. Questions and Answers. Classes last from 50 to 100
minutes according to the needs of each school. Written descriptions of childrens
impressions after attending the class A Course on Life will reveal what they have learned.
Design
Qualitative Descriptive Research
Methods
Content analysis of written impressions from 28 children who attended the class A Course
on Life on November 2011
Results
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What children who attended the class A Course on Life have learned includes the
followings: 1. Improved self-esteem, 2. Growing feeling of consideration towards others, 3.
Gratefulness to parents, 4. Knowledge of the damages caused by smoking led them to build
awareness towards a health behavior in the future, 5. Knowledge about the job of a midwife
raised their interest to their job in the future.
Conclusions
A Course on Life, which has been carried out in the purpose of teaching the importance of
Life, enabled children who attended the class, to understand the importance of taking care of
themselves, being considerate to others. As children could build awareness towards health
behavior in the future, and take interest in their job in the future, giving A Course on Life
can be considered as being significant.
3-5 Key words
Life, elementary school students, midwife
681
The feasibility and influence of secondary triage on the patients in an

emergency department
Bey-Jing Yang1, Shou-Ju Lin1, Zui-Shen Yen1

1.
Presenting Authors Email: miffy@ntuh.gov.tw
Purpose
Overcrowding has been a general problem for major hospitals, especially in emergency
departments. It will be quite precious and essential of effectively utilizing the period while
patients waiting for medical treatment to re-evaluate their relative condition. This study aims
at investigating the feasibility and impact of a secondary triage on the patients in an
emergency department.
Design
The study is a non-randomized clinical experiment. 500 patients were given secondary triages,
which were conveniently sampled from 3,334 eligible patients in an emergency department of
medical center in Taipei, Taiwan.
Methods
The study focused on the adult non-trauma patients satisfying the conditions of scales 2 or 3
for Taiwan Triage and Acuity Scale (TTAS). The patients meeting both of the following two
conditions will receive a secondary triage. The two conditions are (1) the patients who have
not yet been received any physician assessment, and (2) the patients who were triaged as scale
2 and have been waiting more than 10 minutes, or triaged as scale 3 and have been waiting
more than 30 minutes. A dedicated nurse will base on the classification of TTAS and treat the
patients with a secondary triage according to their consciousness and vital signs.
Results
After the secondary triage performed, 1.2% of patients, i.e., six people, were triaged serious
than the previous one, in which two people whose scales were altered from 2 to 1, and four
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people whose scales were altered from 3 to 2. The alteration rate of scale 2 is 2.7 times of
that of scale 3.
Conclusions
By implementing a secondary triage process, the patients could obtain timely and proper
medical treatment, which greatly ensure patients safety and benefit to clinical care.
Moreover, the timing for the secondary triage should be triggered by computer system so as to
provide timely assessment and the process should be responsible by dedicated and trained
nurses.
3-5 Key words
Secondary triage, triage classification, overcrowding, emergency department
683
Perception on patient safety culture and safety nursing activity in hospital

nurses
Kyung-Sook Lee1, Eun Hwa Shin1, Aeyoung So1, Sun Ha Choi1

1.
Gangneung Wonju National University
Presenting Authors Email: kslee@gwnu.ac.kr
Purpose
The aim of the study was to describe the Perception on patients safety culture and to
understand safe nursing activity at a university hospital.
Design
The questionnaire survey was conducted to 233 nurses at a regional university hospital in W
city from December 20 to December 31, 2013.
Methods
In order to evaluate the perception on patients safety culture, the tool developed by an
agency for healthcare research and quality (AHRQ) in 2004 and adapted by Kim, Jung-Eun
(2004) was used. The level of patients safe nursing activity has been evaluated by the tool
developed by Lee, Keum Ok (2009). The data were analyzed using the SPSS WIN 20.0
program for descriptive statistics, t-test, ANOVA, Pearson correlation coefficient.
Results
The perception on total patient safety culture was 3.37 out of 5 and patient safety
grade evaluation was 3.59 out of 5. In subscale, the patient safety culture was a 3.45 within a
unit, 3.18 for the patient safety culture in hospital, and systemic medical errors reported as
3.50.
The positive recognition such as Strongly agree, agree on the patient safety
culture by each category was as follows: immediate supervisor/manager attitude 75%,
organizational learning 66.5%, teamwork within a unit 65.1%, openness of communication
61.8%, overall perception on safety 50.2%, staffing 21.5%, an attitude of hospital
management 46.5%, interdepartmental cooperation system, handoffs and transporting the
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patient 26.4%, feedback and communication on errors 85.8%, frequency of accident reporting
64.2%, a non-punitive response to errors 25.4%, and for the evaluation of patient safety grade
60.5%.
For patient safety nursing activities, the mean scores were 3.79 out of 5. Safe nursing
activity level and work experience in current work unit had a negative correlation relationship
(r=-.139, p=.034). Shorter the work experience in current working unit, there were higher
level of safety nursing activities.
Patient safety nursing activities had a significant positive correlation with patient
safety culture in a unit (r=.439, p<.001), patient safety culture in hospital (r=.398, p<.001),
systemic medical errors reported (r=.308, p<.001), the evaluation of patient safety
grade(r=.272, p<.001).
Conclusions
Based on our study, it is necessary to identify the factors affecting the patient safety and safe
nursing activities, especially the causes other than the awareness of patient safety culture and
groups that affects the safe nursing activity. By department and working experience, it is also
needed to improve strategically for those groups that patient safety nursing activity are not
actively performed. For the patient safety culture, the management and the practitioners of
hospital should consider the patient safety as the priority and must focus on the prevention of
accidents. Active efforts to form non-punitive organization culture and to establish the interdepartment relationship and direct communication between the departments will be needed.
3-5 Key words
Patient safety, safety management, nurses
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Satisfaction with home visit nursing care and relational coordination

among home healthcare professions
Mahiro Sakai1, Takashi Naruse1, Satoko Nagata1

1.
The University of Tokyo
Presenting Authors Email: sfmahiro-tky@umin.ac.jp
Purpose
Home visit nursing recipients sometimes receive other home healthcare services provided by
long-term care insurance and medical insurance in Japan. Home healthcare professionals
work is interdependent and time constrained. This situation requires a well-coordinated
relationship between nurses and other professionals to improve nursing care. However, the
effect of this relational coordination has not been sufficiently identified, especially in the
home care setting. Therefore, this study aimed to identify the relationship between satisfaction
with nursing care and relational coordination among home visiting nurses and other home
healthcare workers.
Design
This quantitative study employed a Web-based or mail survey.
Methods
In November 2013, the authors requested cooperation with 64 home-visit nursing agencies in
Miyazaki prefecture. A total of 190 nurses working in 34 agencies participated, and 119
returned data through the Web-based or mail survey. General satisfaction with nursing care
among their clients was evaluated by nurses on a scale from 0 to 10. Nurses relational
coordination with nursing colleagues, nursing managers, clinicians, care managers, and home
helpers were measured using the Japanese version of the Relational Coordination Scale (RCSJ). The RCS-J score was obtained by calculating the arithmetic mean of all professions with a
possible range from 1 to 7. Finally, data were analyzed from 91 nurses after excluding
participants with missing data and whose job status was nursing manager. Nursing care
satisfaction was divided into two groups: a low satisfaction group (Low-SG: 41 nurses) and a
high satisfaction group (High-SG: 50 nurses). The authors used descriptive statistics and a
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bivariate logistic regression analysis to identify the relationship between relational

coordination and nursing care satisfaction. This study was approved by the ethics committee
of The University of Tokyo.
Results
Most of the participants were female (97.8%), and 62 were full-time workers (68.1%). The
RCS-J scores were 3.50 (SD = 0.65) and 3.82 (SD = 0.48) for Low-SG and High-SG,
respectively. Bivariate logistic regression analysis showed that RCS-J score was positively
associated with nursing care satisfaction (OR = 2.94, 95% CI: 1.246.94, p = .014).
Conclusions
The findings suggest that relational coordination among home health care professions is
associated with quality of care. However, this study has limitations; it depended on subjective
data from the nurses. Future research should include objective data and develop an
appropriate study design to determine causality.
3-5 Key words
Home healthcare, home visiting nurses, relational coordination, satisfaction with care, crosssectional study
687
Prevention of falls by promoting cllaboration between patients/families and

the medical staff in Japan
Rei Ushiro1, Mika Terayama2, Masako Kitsunezuka2, Naomi Kawai2, Mariko Tsurumi2,
Masaru Ichida3, Ryutarou Kawano3, Tsuyoshi Hasegawa3
1.
School of Nursing, Seirei Christopher Universuty, 2. Jichi Medical University Hospital, 3. Jichi
Medical University
Presenting Authors Email: reimdsc1w@gmail.com
Purpose
The Medical Safety Promotion Department of Jichi Medical University Hospital has reduced
the incidence of falls among patients since 2008, by promoting cooperation between the
medical staff and the patients/families, and having the patients themselves take measures to
avoid falling and share in the responsibility for their safety with the medical staff. This study
reports a series of actual approaches and their results.
Design
Research design of this study is a longitudinal study.
Methods
This study involved inpatients in wards, excluding pediatric and psychiatric wards. As an
approach to fall prevention, since fiscal year 2009, we began to distribute a pamphlet with
information necessary to avoid falling, on dangerous actions that may lead to falling during
hospitalization, etc., to the patients before admission. As approaches after admission,
posters to inform the patients of potentially dangerous actions, with photographs of such
dangerous actions in actual hospital rooms, have been displayed in toilets; since fiscal year
2011, a fall prevention DVD has been shown to the patients; in fiscal year 2012,
handrails were installed in all hospital rooms and toilets.
The efficacy of these approaches was assessed by evaluating the annual rate of falls from
fiscal year 2008 (before the aforementioned activities were introduced) to fiscal year 2012,
caused by movement without assistance of patients who are not allowed to move by
themselves. In addition, a questionnaire survey was conducted among patients who gave
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consent each year from 2008 to 2012. The questionnaire items pertained to the use of the
nurse call system (when necessary) and change in footwear to shoes. This study was
conducted with the approval of the Research Ethics Committee of Jichi Medical University.
Results
The annual rate of falls caused by movement without assistance of patients who were not
allowed to move by themselves tended to decrease somewhat (0.88 1.14 0.95) from
2008 to 2012. In addition, in the results of the patient survey, the use of the nurse call system
(when necessary) tended to increase somewhat, and the use of slippers and shoes
(heeled shoes that have been used for a long time) as footwear during hospitalization
tended to decrease and increase, respectively.
Conclusions
The approaches produced definitive results from the standpoint of the patients behavioral
changes to avoid falling. However, the rate of falls caused by movement without assistance of
patients who were not allowed to move by themselves did not decrease much. This may be
because the approaches in this study were targeted at alert and conscious patients. In the
future, it is necessary to consider approaches for patients with cognitive function impairments,
such as patients those with dementia.
3-5 Key words
Prevention of falls, patient safety, collaboration, ,
689
Effect of applying a hot towel against the skin for a short period during bed
bathing -Changes in keratin fluid volume and skin surface temperature-
Inaho Shishido1, Sakiko Kutomi2, Rie Miyata2, Yuka Yamaguchi2, Rika Yano2
1.
Hokkaido University Graduate School of Health Sciences, 2. Hokkaido University
Presenting Authors Email: inapocchi@gmail.com
Purpose
Applying a hot towel against the skin for several seconds before cleansing during bed bathing
provides warmth and comfort to patients. Moreover, it may reduce friction stimulation by the
humidity retention. The aim of this study is to identify the effect of applying a hot towel
against the skin for a short period during bed bathing on keratin fluid volume and skin surface
temperature.
Design
We performed a crossover examination on eight healthy student volunteers.
Methods
We performed a crossover examination on eight healthy student volunteers at University A.
The subjects were placed into groups depending on the application of hot towels against the
skin for either 5, 7, 10, or 15 seconds prior to performing bed bathing. Hot towels were heated
by immersion in a 50C water bath. Keratin fluid volume and skin surface temperatures were
monitored at the inside of the forearm. Keratin fluid volume and skin surface temperature
were measured at the beginning of the experiment (T1), shortly after applying a hot towel
against the skin (T2), after bed bathing (T3), and after wiping with a dry towel (T4). Data
were analyzed with Friedman analysis of variance and multiple comparison Bonferroni
method.
Results
The subjects were three males (37.5%) and five females (62.5%), with an average age of 22.9
0.9 years old. The mean keratin fluid volume and skin surface temperature at T1 for the four
groups were not significantly different. The mean keratin fluid volume was significantly
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higher for each group at T2, T3 and T4 relative to T1 (p<.00). The mean keratin fluid volume
at T2 was 38.50.8% (T1=31.71.5%) for 5 seconds, 38.50.6% for 7 seconds, 38.31.0% for
10 seconds, and 38.00.9% (T131.70.9%) for 15 seconds. The mean of the skin surface
temperature was significantly higher at T2 (p<.00) and T3 (p<.05). The highest mean skin
surface temperature was detected for the 15 seconds group at T2 (T1=33.10.6C versus
T2=36.80.5C). When the hot towel was applied against the skin for a shorter period, the
mean skin surface temperature at T2 was reduced. The mean surface temperature at T2 for the
5 seconds group was the lowest (T1=33.30.7C versus T2=36.00.6C). The change of skin
surface temperature at T4 was not significantly different between the groups (0.11.8% for 5
seconds, 1.50.6% for 7 seconds, 1.61.1% for 10 seconds, and 1.91.2% for 15 seconds).
Conclusions
Applying a hot towel against the skin for a short period increased the keratin fluid volume,
which suggests that this practice has the potential to protect skin from the friction stimulation
with towel. Furthermore, when a hot towel was applied against the skin for more than 7
seconds, the skin surface temperature was maintained at a rate of increase of 1.5% after
having wiped it off with a dry towel. Based on our findings, holding a hot towel against the
skin for 7 seconds was the most effective way to increase both the keratin fluid volume and
skin surface temperature. This likely provided a warm sheath and comfortable feeling to the
patient.
3-5 Key words
Applying a hot towel, bed bath, keratin fluid volume, skin surface temperature
691
Characteristics of assessments performed by nurses for the selection of the

intravenous insertion site for infusion using a short peripheral catheter
Tsuneko Masamoto1
1.
Hokkaido University, Graduate School of Health Science
Presenting Authors Email: tpoppo@hotmail.com
Purpose
The study aims to clarify the characteristics of assessments performed by nurses, focusing on
what they observe and how they select the intravenous insertion site for infusion using a short
peripheral catheter
Design
Using a descriptive and comparative research design.
Methods
This study surveyed seven nurses, each with at least 3 years of clinical experience, who
agreed to participate in our research.
1. Motion analysis by video recording: In experiments A and B, we recorded the process
until intravenous insertion site for infusion was selected on the forearm of a mock patient,
under the requirement that intravenous infusion should be administered using a 22G catheter.
Visible vein of the mock patient on the skin surface at rest in experiment A, and invisible vein
in experiment B.
2. Interview research: The interview aimed to clarify what types of data were collected
during site selection and how such data was organized and analyzed by each nurse. After the
experiments, we interviewed the participants with video from experiment B. For the analysis
methods, the Dartfish Software was used to analyze the average time for site selection, the
standard deviation, the position for application of tourniquet and the distance from elbow
joint, and variations in methods for swelling veins. Moreover, we compared the consistency
of insertion site selected. We identified observations and palpation methods from the
interview content.
692
Results
The time used to select the site was 64.6 27.7 seconds in experiment B, longer than 46.5
19.3 seconds in experiment A. In both experiments, all participants chose the upper arm for
the tourniquet position. In experiment B, the average distance between the elbow joint and the
tourniquet position was 6.9 cm. To distend the vein almost all subjects ordered the thumb
inside and grasped the fingers, and a few of them rubbed the forearm and lightly tapped over
the vein. In experiment B, the brachium cephalic vein and the median antebrachial vein were
chosen. As for the observation points, all subjects mentioned the elasticity of the vein. In
addition, the thickness and the straightness of the vein were observed 71.4% and 42.9% of
subjects. For palpation, nurses used the first or second fingers on the left hand or the second
finger on the right hand. For analysis of fingers motion, we identified several methods,
although the most common was to move the finger in parallel to the vein while keeping the
finger pulp in contact with the vein, and then moving the finger along the vein.
Conclusions
Insertion site selected took 46.5 to 64.6 seconds. In spite of various techniques for palpation,
the points to be prioritized were determined by taking into account the length of the catheter,
Indwelling time, and elasticity, thickness, and straightness of the vein. Therefore, observed
these points, it is likely that individual nurses have acquired the palpation techniques from
experience. Previous studies have not elucidated the specific methods for insertion sites
selected and palpation motions. Therefore, it is necessary to focus on this research and
visualize these methods in the future.
3-5 Key words
Short peripheral catheter, assessment, insertion sites selected
693
Comparing bacterial contamination of mobile phones of medical staff in

hospital with that in nursing home
Shih-Hui Huang1, Chao-Ying Yang2

1.
Department of Nursing, 2. Department of Health Business Administration/Fooyin University
Presenting Authors Email: sc042@fy.edu.tw
Purpose
The purpose of this study was to find the type of bacteria on the mobile phones of the medical
staff, patients, and patients caregivers in hospital and nursing home. Furthermore, the study
aimed to improve infection control and patient safety.
Design
A cross-sectional study.
Methods
128 mobile phones obtained from nursing home and 102 mobile phones obtained from Fooyin
University Hospital, which were a total of 230 mobile phones, were included. Mobile phones
included belonged to medical staff, patients, and patients companions.
Swab samples were collected from the surface of the mobile phones and underwent culture.
Culture growth result was identified per standard microbiological procedure. Swab samples
were investigated with disk diffusion method according to the recommendation of Clinical
Laboratory Standards Institute. Questionnaire was used to collect demographic and
characteristic usage of mobile phones in the 2 institutes. Swab samples were analyzed to
identify the type of bacteria and their antibiotic susceptibility to nosocomial infection.
SPSS20.0 statistics software was used to analyze the data.
Results
A total of 230 mobile phones were included, 128 mobile phones obtained from nursing home
and 102 mobile phones obtained from Fooyin University Hospital. 89(nursing
home):55(hospital) belonged to medical employees, nurse assistants , administrative assistant
and 39(nursing home) :47(hospital) to patients and patients caregivers .In the group of the
694
hospital, different types of bacteria were detected on 34.7%(17/49)of the mobile phones of
medical staff ; 60%(3/5) of nurse assistants ; 100%(1/1) of administrative assistant; 30 (63.8%)
of the patients group(p=0.025,p<0.05). In the group of long-term institutes, different types
of bacteria were detected on 45.8%(27/59) of the mobile phones of medical staff;40.9%(9/22)
of nurse assistants; 25.0%(2/8)of administrative assistant; and 53.8%(21/39)of the patients
group(p = 0.455).Furthermore, greater number of bacteria was present on the mobile phones
of nurse assistant( 1.2 *105colonies/ m2 )in nursing home. Greater number of bacteria was
present on the mobile phones of patients group (18.9 *104colonies/ m2 )in the hospital. In
the group of nursing home ,statistical analysis showed that the age and bacterial growth
correlated significantly (p=0.019)In the group of hospital , level of education and bacterial
growth revealed significant difference (p=0.02).
Conclusions
Our findings suggest that mobile phones of medical staff, patients, and patients caregivers
have a greater risk of nosocomial bacterial colonization. Specific measure of infection control
may be required for this threat.
3-5 Key words
Bacteria, mobile phones, infection control, ,
695
Certified nurses in infection control address the use of skin disinfection

before subcutaneous injection
Yuko Yoshida1
1.
Hokkaido University Faculty of Health Sciences
Presenting Authors Email: yuko790402@hs.hokudai.ac.jp
Purpose
Traditionally, skin disinfection before subcutaneous injection was deemed necessary to
cleanse contaminated skin, but recent reports suggest that this practice is not necessarily
required for clean skin (Hutin et al. 2003; Frid et al. 2010). In Japan, it is standard procedure
to disinfect the injection site with an alcohol wipe prior to administering injections. This study
aims to determine the opinions of certified infection control nurses regarding the advantages
and disadvantage of skin disinfection before subcutaneous injection. The certified nurses in
infection control used in this study have proficient nursing skills and are knowledgeable about
infection control.
Design
Qualitative research design
Methods
We collected data from certified nurses in infection control working at nine local hospitals.
We conducted individual, semi-structured interviews to assess their opinions regarding the
use of skin disinfection before subcutaneous injection. The interviews were recorded using an
IC recorder to maintain a verbatim record. A qualitative descriptive analysis method was used
to analyze the data.
Results
This study surveyed 10 nurses who had 21.34.43 years of total nursing experience and 5.3
1.1 years of nursing experience after having obtained the qualification of certified nurse in
infection control. The opinions on the omission of skin disinfection before subcutaneous
injection were categorized as follows: (1) Omission of skin disinfection can be accepted by
696
everyone if there is a sufficient evidence; (2) Skin disinfection can be omitted in certain cases;
(3) The infection risk is low even if skin disinfection is omitted; and (4) It is unthinkable to
omit skin disinfection. We identified four advantages for omitting skin disinfection:
reduction of cost, reduction of labor, alleviation of the psychological burden at
the time of self-administration, and avoidance of skin irritation due to the antiseptic
solution. On the other hand, four disadvantages for omitting skin disinfection were
identified: the absence of skin disinfection would make it impossible to maintain the
awareness of cleanliness during the administration of injections, it is possible that
infection risks would persist, society would not accept the omission of skin disinfection
and nurses would require new skills.
Conclusions
Although previous studies have indicated that the infection risk is relatively low even if skin
disinfection is omitted prior to subcutaneous injections, there is little likelihood of its
omission being followed by medical staff and the general public. Some of the key
disadvantages of omitting skin disinfection that were identified, other than the potential of
increased infection risk, included the difficulty for nurses to perform their tasks and the
difficulty to change an established procedure. On the other hand, we identified some
advantages from the perspective of the individual, including the reduction of cost, time, and
waste, as well as those from the macroeconomic point-of-view, including the reduced medical
cost. Future studies are needed to assess the diverse opinions regarding the omission of skin
disinfection before subcutaneous injection, taking into account the advantages and
disadvantages of this practice on the potential burden on the medical economy and patients.
3-5 Key words
Subcutaneous injection, skin disinfection, evidence
697
The study of the relationship among role expectation and quality of care in
hospital nursing attendant
Chun-Ju Lin1, Shiow-Ching Shun2, Meei-Ying kao3, Yu-Ming Chen3

1.
Department of Nursing, National Taiwan University Hospital, 2. Department of Nursing, National

Taiwan University, 3. Graduate Institute of Humanities in Medicine, Taipei Medical University
Presenting Authors Email: morphine1203@gmail.com
Purpose
Nursing attendants were members of nursing service, whose role were to perform basic and
simple nursing task advising by nursing professionals. The role perception, expectation, and
performance of nursing attendants will affect the quality of care. The objective of this study
was to determine the influences of role expectation of nursing attendants on care quality.
Meanwhile, we compared different viewpoint to the role and care quality of nursing
attendants.
Design
We conducted a cross-sectional study by using data triangulation method, and collected data
from three kind of population, nursing attendants, nursing professionals, and patients .
Stratified sampling design was used to select nursing attendants from three contract nursing
attendant company A, B, and C in a medical center of northern Taiwan. Nursing professionals
and patients matched by the sampling nursing attendants in the same care team were also
selected.
Methods
We designed three different questionnaires for the nursing attendants, patients, and nursing
professionals respectively. The reliability of these questionnaires, represented as Cronbach's
, were as follows : .77- .86 on role expectation, .95-.98 on care quality of nursing
attendants, and also with high reliability on entire questionnaire. We also analyzed the results
of open questions from the three kinds of study populations on the relationship between role
expectation and care quality.
698
Results
We initially included 117 nursing attendants, 117 nursing professionals, 53 patients, and then
fully matched 53 sets as study population. The results showed (1) there was positive
correlation among role expectation and care quality of nursing attendants (2) with regard to
role expectation on nursing attendants of three persons each matched sets, though there was
no statistical difference on quantitative analysis, we found the same role expectation on the
open question analysis of nursing attendants, nursing professionals, and patients(3) the role
expectation on nursing attendants of nursing professionals and patients were predicting
factors of care quality satisfaction.
Conclusions
The expected clinical implication of this study were to enhance the visibility of nursing
attendants in the acute care, and facilitating the consensus among nursing attendants and the
health care team in order to improve the quality of care.
3-5 Key words
Nursing attendant, role expectation, quality of care, triangulation
699
Comparison between subjective QOL in < 65-year-old and 65-year-old

cerebrovascular disease patients who were scheduled to transfer from a
convalescent rehabilitation ward to home
Akemi Fujita1, Tomoko Watanabe2, Reiko Nakamura3

1.
Hirosaki University Graduate School of Health Sciences, 2. Graduate School of Health Sciences
Akita University, 3. Tohoku Fukushi University Faculty of Health Science Department of Nursing
Presenting Authors Email: a_fujita@cc.hirosaki-u.ac.jp
Purpose
To elucidate characteristics of subjective QOL (quality of life) by age in order to provide
effective discharge guidance for use with cardiovascular disease patients (hereafter, patients)
who are scheduled for discharge from a convalescent rehabilitation ward to home.
Design
Comparative descriptive design
Methods
Subjective QOL was measured by the SEIQoL-DW (Schedule for the Evaluation of
Individual Quality of Life Direct Weighting) at discharge in patients who had been
hospitalized in a convalescent rehabilitation ward in Japan and were scheduled for discharge
to home. We compared the index and cues of the SEIQoL-DW for patients less than 65 years
old and those equal to or more than 65 years old. Informed consents were obtained from the
patients, and the study was approved by the ethics committees of the institutions that the
researchers belonged to and the hospital where the patients were hospitalized.
Results
Thirty-four patients (17 patients < 65 years old and 17 patients 65 years old) were surveyed.
The average age of all the patients was 63.4 12.5 years, with 53.4 8.3 for those < 65 years
old and 73.5 6.2 for those 65 years old. Eleven patients among the < 65-year-olds (64.7 %)
had continuously worked, and 4 among those aged 65 years (23.5 %). Ten cerebral
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hemorrhage cases (58.8 %), 5 cerebral infarction cases (29.4 %) and 1 subarachnoid
hemorrhage case (5.9 %) were observed in patients < 65 years, and 4 cerebral hemorrhage
cases (23.5 %) and 11 cerebral infarction cases (64.7 %) occurred in those 65 years old.
The SEIQoL-DW index and FIM were compared by age; averaged SEIQoL-DW indices were
64.4 22.0 points for those aged < 65 years and 68.9 27.8 points for those aged 65 years,
indicating a higher averaged SEIQoL-DW index among patients aged 65 years, but not
high enough to be of statistical significance. The FIM among patients aged< 65 years was
significantly higher than that among those aged 65 years, with 119.5 5.1 points for
patients < 65 years old and 112.1 12.6 points for those 65 years old (p=0.034).
When comparing SEIQoL-DW cues, family, health, and work obtained more
cues for those aged < 65 years and family, health and care of garden plants
obtained more cues for those aged 65 years. When comparing SEIQoL-DW categories,
health, family and future life obtained higher weightings for those aged < 65
years, while health, family and relations with neighborhood obtained higher
weightings for those aged 65 years.
Conclusions
1. The subjective QOLs for both < 65-year-old and 65-years-old patients were
characterized by an emphasis on family and health. 2. More patients among the < 65-year-old
group placed greater importance on work, whereas those aged 65 years placed greater
importance on hobbies and personal relations.
3-5 Key words
Cerebrovascular disease patients, subjective QOL, convalescent rehabilitation, ,
701
Effects of anesthetic gel on patients receiving the procedure of urethral

catheterization: A systematic review and meta-analysis
Chia-Chi Kuo1
1.
Chi-Mei Medical Center
Presenting Authors Email: kuochiachi63@gmail.com
Purpose
Urethral catheterization is a common and painful invasive procedure performed in medical
settings. Extensive research explored the effects of anesthetic gel such as lidocaine on
decreasing pain and adverse effects, but there are no systematic reviews regarding their
outcomes. The purpose of this study was to evaluate the effects of anesthetic gel on urethral
catheterization through systematic review and meta-analysis.
Design
Systematic review and meta-analysis.
Methods
The foreground questions and PICO were identified according to the 2011 Oxford Centre for
Evidence-based Medicine steps. Six databases (Cochrane library, Trip, PubMed/MEDLINE,
CINAHL, Airiti Library, and Index of Taiwan Periodical Literature System) were searched
from the earliest year available to July 2014. The search was limited to RCT and humans by
using (urethral catheterization OR urinary catheterization OR foley) AND
(anesthetic gel OR lidocaine OR xylocaine OR lignocaine OR octocaine OR dalcaine) as
key words. Critical appraisal sheet of RCT of CEBM 2011 was used to examine the validity
and reliability, importance, practice and applicability of included articles. Extracted data were
entered and analyzed using Review Manager 5.2 software.
Results
Seven RCT articles (Level of Evidence: Level 2) regarding the effects of anesthetic gel as
compared to those of nonanesthetic gel were reviewed. Participants included men, women,
and children. The results indicated that urethral pain (five trials, 335 participants, pooled
702
standardized mean difference = -0.55, 95% CI = -1.02~ -0.09, p = .02) and childrens
distress (two trials, 52 participants, pooled standardized mean difference = -0.80, 95% CI = 1.37~ -0.23, p = .006) with the use of anesthetic gel were significantly lower than those with
the use of nonanesthetic gel. There were no significant differences with regard to urethral
bleeding (one trial, 36 participants, risk ratio = 1.00, 95% CI = 0.29~ 3.39, p = 1.00) and
insertion success rate in one attempt (one trial, 36 participants, odds ratio = 3.40, 95% CI =
0.32~ 36.27, p = .31). No adverse event of anesthetic gel was reported.
Conclusions
Using anesthetic gel before urethral catheterization could effectively reduce urethral pain and
decrease childrens distress such as crying, struggling or resisting. Thus, our findings
support that anesthetic gel such as lidocaine is suggested for regular use before urethral
catheterization to reduce procedure pain.
3-5 Key words
Urethral catheterization, anesthetic gel, lidocaine, systematic review, meta-analysis
703
Association of cognitive function with falling in the elderly admitted to a

tertiary hospital: Preliminary data
Yuko Tsumoto1, Miki Fukuma1, Hiromi Uchida1, Shyusaku Tsumoto1

1.
Shimane University
Presenting Authors Email: tsumotoy@med.shimane-u.ac.jp
Purpose
Studies show that the incidence of falling is high among the elderly with dementia; for
example, those admitted in nursing homes and similar institutions. Nonetheless, there are no
published data on specialty hospitals. The purpose of this study was to obtain preliminary data
on the predictors of falling among the elderly with dementia.
Design
Prospective cohort study.
Methods
The subjects were 20 elderly patients (>65 years of age; 10 males) who were admitted to the
general ward of a tertiary hospital and had provided consent. The study period was August
September 2014. During hospitalization, we evaluated the association of falling with the basic
characteristics, the main disease, speech status, physical functioning, and results of a nutrition
survey, and assessment of cognitive function. {We calculated the correlation coefficient
between cognitive function and scores from a quantitative assessment of falling (the Fall
Scale). A fall was defined as unintentional falling when a patients hand or knee touches an
object at a lower level or on the ground. This definition also included falling from the stairs or
bed.
Results
Hypertension was the most prevalent health problem (nine patients, 45%), followed by five
cases of bone and joint disease and five of cataract (25% each). Moreover, there was one case
with underlying dementia. Eight patients were taking antihypertensive drugs (40%), and 6
were taking oral laxatives (30%). The body mass index was 22.1 4.7, and the muscle mass
704
index was 37.9 4.6. With regard to the physical functioning, 12 people had grip strength of
15.0 5.4, and 60% were certified as needing long-term care. Four patients had 3.3 2.7
Izumi points, and five patients had 1.3 1.3 STRATIFY points. The average number of falls
was three among the eight patients who had 40 27.2 points on the MFSMorse Fall
Scale. The patients scored 5.5 2.0 on the Cognitive Assessment for Dementia, iPad
version; cognitive function was impaired in seven patients. There was a strong positive
correlation between MFS and Izumi scores (r = 0.715, p = 0.001) but not between cognitive
function and the Fall Scale. There were no falls during hospitalization.
Conclusions
Only one patient had the diagnosis of dementia among the 20 subjects, but there were seven
patients with impaired cognitive function. Therefore, it is important to assess cognitive
function among the elderly. At healthcare institutions providing treatment of acute diseases,
nursing of the elderly with signs of a cognitive decline is also an important issue. In
conclusion, the relationship of cognitive function and falling needs to be assessed on a larger
sample size.
3-5 Key words
Elderly, fall, cognitive
705
Movement of nursing studies on patients with traumatic brain injury in

Japan From the perspective of advocating rights
Kiyoko Itagaki1, Ruriko Kidachi1, Akio Kitayama2

1.
Hirosaki University Graduate School of Health Sciences,Japan, 2. Department of Health Sciences

Nagano College of Nursing
Presenting Authors Email: sunsun2199@gmail.com
Purpose
While many reports that show the occurrence frequency of traumatic brain injury are
available abroad, the estimated figures are only available in Japan. The patients with
traumatic brain injury often have impaired memory immediately after having trauma and they
are not able to explain the situation of the accident. As a result, they often end up being in a
disadvantaged position. However, it is unclear whether nurses who raise the patient advocacy
recognize such disadvantages of the patients. The purposes of this study are to figure out
contents of nursing studies by reviewing literatures on nursing patients with traumatic brain
injury from the perspective of advocacy; and, to have basic data for nursing studies on
advocacy for patients with traumatic brain injury.
Design
Literature review; and, quantitative and qualitative study.
Methods
Literatures about nursing studies on traumatic brain injury, which were published in Japan,
were reviewed. The search tool was Journal of Japan Medical Abstracts Society (web version)
and CiNii, which were used to search articles published from 1980 to 2014. Searching words
used were traumatic brain injury, brain injury, high cerebral function disorder, traffic accident,
traffic injury.
Results
Through searching, 165 articles on traumatic brain injury, 261articles on brain injury, 704
articles on high cerebral function disorder, 335 articles on traffic accident and 84 articles on
706
traffic injury were obtained.

Literatures were divided into five categories; nursing patients with traumatic brain injury,
nursing patients with high cerebral dysfunction and the role of nurses, support for family of
the patients with high cerebral dysfunction, nursing patients with prolonged impaired
consciousness, nursing pediatric patients. Most of the studies were about nursing patients in a
recovery phase and a treatment phase. Although high cerebral dysfunction was not mentioned,
one of the few articles, which focused on traffic victim, pointed out financial problems,
response from the offenders after the accident and negotiation process with insurance
companies. Another study explained advocacy for the patients and respecting the
decision made by the patients with high cerebral dysfunction. Yet, it limited to the basic
explanation of response to hospitalized patients, and it was not mentioned about nursing the
patients with PTSD and assistance to financial problems due to traumatic brain injury.
Conclusions
Since the number of specific literatures on advocacy for the patients with traumatic brain
injury is low in Japan, there is a possibility that nurses cannot use their knowledge even if
they know the concept. It is said that victim assistance in Japan is behind for 20 years
compared to the USA. In future, it is necessary to educate and enlighten nurses so that they
take a role in advocacy as well as crime victim assistance.
3-5 Key words
Traumatic brain injury, high cerebral function disorder, advocacy, victim assistance, victim
rights
707
Examination of theInfluencing factors on the collaboration culture of the

workplace when accepting foreign care workers in Japan
Kaori Hatanaka1, Tomoko Tanaka1

1.
Graduate School of Humanities and Social Sciences Okayama University
Presenting Authors Email: yukilunarmisty@yahoo.co.jp
Purpose
Based on economic partnership agreements, foreign care workers have started entering the
field of care in Japan. In the field of medical and elder care, confusion due to the rapid
changes that have occurred since the introduction of foreign care workers has been reported.
Adjustment of the work environment to ensure co-operation between foreign care and
Japanese workers has become an important issue, and it is necessary to guarantee the quality
of care and safety. In this study, we examine the influence of the empathetic ability and
collaboration skills of the Japanese to the collaboration culture of the workplace.
Design
The study design was a questionnaire survey method.
Methods
A total of 253 Japanese staff who work within the elder care facilities or hospitals that accept
foreign care workers were participated in this study in February 2014. The questionnaires
content included (1) empathetic ability scale (Maemura, 2009), (2) collaboration skills scale,
and (3) collaboration culture scale.
Results
Valid responses were obtained from 144 Japanese staff. The subjects of mean age was 39.01
(SD=12.38) and 103 (71.5%) were women. Factor analysis was conducted on the empathetic
ability scale which constructed of three factors such as cognitive empathetic ability, emotional
empathetic ability, and motivational empathetic ability. Collaboration skills were divided into
five factors such as active companionship, considerations of work, reconfirmation of duties,
708
utilization of tools, and language considerations. The collaboration culture was constructed of
three factors such as cross cultural consideration, collaboration environment, and
interpersonal relations.
The analysis of covariance was conducted to examine the hypothesis model for collaboration
culture of the workplace. Results indicated that the model fit indices satisfied statistical
requirements (GFI = .95, AGFI = .97, CFI = 1, RMSEA = 0, p = .58). Through setting a
higher potential factor for each layer, the empathetic ability positively affected collaboration
skills (=.64, p.001) and collaboration culture was positively affected by collaboration
skills (=.77, p.001). However, the empathetic ability didn't have significant effect on
collaboration culture (=-.24, n.s).
Conclusions
The empathy ability of Japanese staff was insufficient to create collaboration culture of
workplace. It suggested that increasing the ability of Japanese staff to have empathy for
foreign care workers, and acquiring the skills which correspond to the culture differences and
knowledge would create better collaboration culture of workplace. In order to improve
practical collaboration skills of Japanese staff to collaborate work with foreign care workers
with different cultural backgrounds, intercultural education in the care field would be
effective. Further research of recipient of care should be conducted to show that the
collaboration culture of workplace would lead to guarantee the quality of care and safety to
elder and patient
3-5 Key words
Collaboration culture, collaboration skills, foreign care workers, Japanese staff
709
Effectiveness of an education and multiple risks control intervention for

falls prevention in long-term care facilities
Liao Su-Jung1, Wang Mei-Li2

1.
School of Nursing, National Taipei University of Nursing and Health Science, Taipei,
2.
Taiwan, Department of Nursing, Mennonite Christian Hospital, Shou-Feng Branch, Hualien Taiwan,
Hualien city,
Presenting Authors Email: t3701735@yahoo.com.tw
Purpose
Falls and fall-related injuries were the most common accidents in long term care (LTC)
facilities. Studies demonstrated that fall prevention in LTC setting should involve multifactorial approaches, which require conducting comprehensive assessments of the elderly
persons and environment, controlling the risk factors, and implementing a set of continuing
education for LTC staff. The main purpose of this study was to evaluate the effectiveness of
the multifactorial falls prevention (MFP) intervention on the incidence of falls and the injury
severity of older adults living in LTC settings.
Design
In this study, the MFP intervention on falls and falls risk factors in LTC facilities is a multiyears research program (2011-2014) that seeks to identify best practices in fall prevention and
implements these strategies for LTC settings. This was a four years longitudinal study via a
single group pre-post study.
Methods
This study analyzes the cause of elderly residents sufferers fall due to: insufficient knowledge
of the nurses and staffs on fall prevention, elderly residents lacks of knowledge for falls
prevention, lack of monitor the risks factors of LTC settings. The MFP interventions include:
1. fall prevention continue education for nurses and staffs; 2. building the safety
environmental; 3. execution safety environmental check every eight hours, 4. marked with
broadcast remind; 5. improve the bathroom marked with the strengthening of the base plate
non-slip; 6. use fall prevention ground sensors; 7. implement lower extremity strength
710
training for the elderly. Primary outcomes measures by the rate of falls and the proportion of
fallers recorded over a 12 month period.
Results
The three and half years follow-up was completed found that: 1. The incidence rate of falls
(falls/person-year) dropped from 0.30% (2011), 0.12% (2012), 0.13% (2013) to 0.07% (2014);
2. The severity of falls injury was decreased from severe injuries (fractures), mild injuries to
no damage; 3. The mean scores of falls prevention knowledge of nurses increased from 53.9
points to 100.0 points.
Conclusions
The MFP intervention was effective in increasing nurses' knowledge and ability to care for
preventing of falls, improving the safety environment, and controlling fall risk factors. This
MFP intervention is a benefit to LTC setting and hospitals and the older adults they care.
3-5 Key words
Falls prevention, long-term care facilities, patient safety
711
Effects of a nurse-led fall prevention program in a medical center-A

retrospective cohort study
Shu-Jung Wang1, Li-Fang Chang2

1.
Department of Nursing, College of Medicine, National Taiwan University / Department of Nursing,

Tr-Service general hospital, 2. Department of Nursing, Tri-Service General Hospital
Presenting Authors Email: wsj2785@gmail.com
Purpose
To report a study of the association between the occurrence of fall-related injuries and the
implementation of a nurse-led fall prevention programme at a medical centre, Taipei, Taiwan.
Design
A retrospective cohort study
Methods
A convenience sample of 125,206 inpatients from a medical centre in Taipei, Taiwan between
January 2010 and December 2012 was audited. While patients were admitted between
January 2010May 2011 (phase I) received the usual care, patients were hospitalized between
June 2011December 2012 (phase II) received the nurse-led interdisciplinary fall prevention
program .The program includes high-risk fall group reminder, shift mechanism,
information system labeling fall-causing medications, health education using fall notices from
physicians, and fall incident reviews. Changes in fall incidents and fall-related injuries
between two observational periods and their associations with the nurse-led fall prevention
program were analysed using logistic regression.
Results
There were 61,024 and 64,182 patients in the phase I and phase II groups, respectively. A
total of 341 falls and 175 fall-related injuries of which 50 were serious. The fall monthly
incidence rates were 0.37 (0.18 -0.63) and 0.37 (0.22 -0.55) in the phase I and
phase II groups, respectively. There was no difference in the incidence of falls and serious
fall-related injuries between two observation periods. However, the nurse-led fall prevention
712
program significantly reduced fall-related injuries risk in female group (OR = 0.480, p < .01) ,
whereas no difference was found in males. In addition, the risk of moderate and above fallrelated injury in male control group was significantly higher (OR=2.641, p=.042), but there
was no difference in females.
Conclusions
The nurse-led fall prevention program produced some benefits when compared to usual care.
3-5 Key words
Accidental falls, fall-related injury, fall prevention program, nurse-led intervention
713
Transfer of critically ill patients to intensive care unit time
Tzu-Tsui Tsao1
1.
Lin Shin Hospital
Presenting Authors Email: nancytsao0918@gmail.com
Purpose
Promoting Complete and Thorough Nurse Change Shift Reporting in an ward of critically ill
patients to Intensive Care Unit time.
Design
Because of hospital expand to A,B two building, when the patient has emergency need to
transfer to Intensive Care Unit,the nursing shift has to tell the personnel person and families,
preare thing etc, causing the worker work load and more pressure.
Methods
Use questionnaire and chronograph measurement, found that transfer time too long is because:
Not familiar with patient transportationpreparation nursing shift change not complete
not familiar with transfer linewait the elevator too long.
Results
Design transportation cardpreparation checklist and nursing shift change standardbuild
transfer line and control the elevator,make the time 3161 second reduced to 1832 second,
decline 42%.
Conclusions
take this nursing experinces provide medical personnel know about management by walking
around understand the current status and assessment effectiveness, use statistics analysis to
reduced the time form transfer, implement patient care to the high nursing care quality,
maintain patient safety.
3-5 Key words
714
Critically ill patients, passes along, nursing shift change, nursing care quality
715
The use of Zolpidem in Taiwan from 2000 to 2012
Jung-Chen Chang1, Chau-Shoun Lee2, Wen-Ing Tsay3, Chia-Ming Chang4, Meng-Hsiu Wu3,
Ming-Kung Yeh3
1.
National Taiwan University, 2. Mackay Memorial Hospital & Mackay Medical

College, 3. TFDA, 4. Chang Gung Hospital
Presenting Authors Email: jungchenchang@ntu.edu.tw
Purpose
Sleep problems with or without being diagnosed as insomnia has become a serious health
issue in the contemporary society. Zolpidem has become the most popular hypnotics in
Taiwan for the past decade. The current study was to analyze a national dataset for the use of
Zolpidem.
Design
A retrospective, descriptive study design was applied to analyze the National Health
Insurance Dataset in Taiwan.
Methods
The total quantity of Zolpidem, the days of prescriptions, the major diagnosis, and the
characteristics of both patients and physicians were acquired from national health insurance
dataset for inpatient and outpatient services from year 2000 to 2012. The defined daily dose
(DDD) was used to calculate the use of Zolpidem.
Results
The ratios of prescribing Zolpidem were 0.52 in 2000 and gradually increased up to 3.16 in
2009. The averaged DDD of Zolpidem per prescription was significantly increased (from 18.2
12.5 in 2000 up to 23.56 in 2012). There were about 10% and 0.5% of prescriptions of
Zolpidem with double and triple DDD, retrospectively. In addition, there were 347,609 and
848,189 individual patients taking Zolpidem in year 2001 and 2008, correspondingly. All of
the information strongly signaled the potential risk of Zolpidem abuse or dependence. There
716
were special regulations initiated by Taiwan Food and Drug Administration (TFDA) in year
2009 and afterwards which relieved the escalated amounts of Zolpidem.
Conclusions
The national, longitudinal dataset has provided evidence of abuse and dependence of
Zolpidem which has been top use of hypnotics in Taiwan and many other regions. There are
educational needs for nursing students and staff nurses who will often encountered patients
with complaints of insomnia or with risk of abusing hypnotics. Non-pharmaceutical
managements should be developed to empower the patients who can manage their own life
style, sleep hygiene, and utilize diverse ways to deal with insomnia and reduce the risk of
substance abuse derived from medical treatment.
3-5 Key words
Drug safety, drug abuse, Zolpidem, insomnia, hypnotics
717
Autonomy in diabetes management in adolescent patients with type 1

diabetes mellitus: A systematic review
Shao-Hui Shu1, Ruey-Hsia Wang2, Mark Hayter3

1.
Kaohsiung Medical University, Tzu Chi College of Technology, 2. Kaohsiung Medical

University, 3. University of Hull
Presenting Authors Email: shaohui.shu@gmail.com
Purpose
The development of autonomy is a crucial aspect of diabetes self-management. we conducted
a systematic review of studies that examined the effects of adolescent autonomy on diabetes
control to facilitate the development of recommendations to support adolescent patients with
type 1 diabetes mellitus (T1DM).
Design
We conducted systematic searches of 4 databases and identified 16 relevant studies.
Methods
The PubMed, CINAHL, Ovid, and ProQuest (ProQuest Health Management, ProQuest
Medical Library, and ProQuest Nursing and Allied Health Source) databases were searched
using the keywords autonomy, diabetes, and adolescence. The following
screening criteria were used: (a) the participants in the studies were aged between 10 and 20
years; and (b) the studies were quantitative.
Results
The results indicated that the development of autonomy was associated with measures linked
to the successful management of T1DM. Common factors associated with the development of
autonomy were age and the adolescent patient-parent relationship. The development of
autonomy in adolescent patients was also associated with improved diabetes self-care and
glycated hemoglobin control.
Conclusions
718
The integration of a diabetes self-care regimen into adolescent patients lives and parents
efforts to shift the responsibility of self-care for diabetes management to their child are the
major challenges involved. The health care should to provid to adolescent diabetes patients
fully and effectively addresses the challenges associated with autonomy.
3-5 Key words
Type 1 diabetes mellitus, adolescent, autonomy
719
The nursesmental model in the adoption of an innovative decision

support technology
Betty Khong1, Shu-Yin Hoi2, Eleanor Holroyd3, Wenru Wang4

1.
Alice Lee Centre for Nursing Studies, 2. Tan Tock Seng Hospital Pte Ltd, Singapore, 3. RMIT
University, Bundoora, Melbourne, Australia, 4. Alice Lee Centre for Nursing Studies, Singapore
Presenting Authors Email: A0108027@nus.edu.sg
Purpose
To unravel the mental model of the nurses making decision to adopt the Clinical Decision
Support System (CDSS) as a change in nursing practice.
Design
An exploratory, descriptive, qualitative study was adopted using both interview and active
participatory observation to solicit the conscious and unconscious mind of nurses as they
decided on the use of the CDSS for their wound management.
Methods
A pluralistic framework using the Diffusion of Innovation Theory, Mental Model Theory and
Clinical Decision Making Models was used as its theoretical framework. A purposive,
theoretical sample of 14 registered nurses were recruited from a tertiary public hospital in
Singapore. Recruitment of nurses was carried out upon approval obtained from local ethical
board and stopped when data saturation has reached. Upon consent, individual face to face
interviews followed by observations were conducted. All interviews were audio-taped and
transcribed. Concurrent thematic analysis was carried out. The subthemes derived were coded
and further reduced into categories and themes. Observational data were triangulated with the
interview data. The finalized themes were member checked with the participants.
Results
Nurses were found to have evoked the cognitive segment of her mind more frequently with
six themes surfaced in their daily practice when deciding to adopt the CDSS. These were the
720
use of CDSS, the beliefs in CDSS, the influences of the workplace culture, contemplating the
extent of the benefits and having the control over nursing practice. The use of knowledge was
tapped on either cognitively or intuitively. The intuitive sphere of her mind transacted the gut
feeling. The emotions were expressions of the affect mind. The model gives perspectives to
the nurses mind as they meander their ways in adopting the use of technology amidst her
tight timelines and hefty workload. Notably, there is high complexity in synapses between the
different mental models in decision making involving another technological knowledge
arising from the complications in the interactions of concepts in the mental model.
Conclusions
This research has contributed to portraying the mind map of nurse-computer interaction using
the mental model from three domains cognitive, affective and intuitive. The mental models
provided the link to the behavior conduct of the nurse in the decision to adopt innovative
technology. These mental model concepts played an imperative part in influencing their
decisions to adoption of the CDSS. It surfaced the dynamic and complex difficulties in
adoption of CDSS. This provides opportunities for re-calibration of undesired or
misrepresented concepts of the mental model and re-designing of the ontology of CDSS to
advance the interactions of human and computer. Considerations ought to include examining
the mental model of nurses for the particular population and settings in their decision making
towards adoption of any information technology.
3-5 Key words
Clinical decision support system, adoption, mental model, information technology, qualitative
descriptive
721
Structural analysis of interpersonal conflict between nurses in a medium

size hospital in Japan
Naoko Inoue1, Satoru Yamada1

1.
University of Kochi
Presenting Authors Email: ezu05626@nifty.com
Purpose
To analyze the structure of interpersonal conflict occurring between nurses at workplace in
Japanese medium size hospital.
Design
A cross-sectional study was conducted in which an inventory survey was undertaken in MIE
prefecture, Japan. In total, 797 nurses from five medium size hospitals (200-400beds)
participated; they were requested to answer an self-administered questionnaire.
Methods
Interpersonal Conflict Style Scale was used as the measurement tool. This scale was
developed by Obuchi (2005) and consists of 28 items, rating considering 5-point scale. The
director of nursing in each of the participating hospitals was asked to distribute the
questionnaire to nurses. Participation was voluntary and if they agree with participating the
research, they will return the completed survey sheets to the researcher using a stamped reply
envelope. Ethical approval was obtained from the Ethics committee of the MIE prefectural
College of Nursing. Data were analyzed with SPSS Statistics version 21.
Results
There were 339 respondents for a response rate of 42.5%, however only valid data from 325
respondents (95.5%) were analyzed.
An exploratory factor analysis was conducted using promax rotation. This analysis allowed to
extract 6 factors from 28 items.
Validity test was performed and there exploratory factor analysis resulted in the following
factors; (1) I strongly maintain my opinion; (2) I understand my co-workers opinion but
722
maintain my opinion; (3) I negotiated with my co-worker by considering his/her feeling of coworker; (4) I avoided communication with my co-worker; (5) I did my best to negotiate with
my co-worker; (6) I helped my co-worker to have a good mood.
(Relationship between the factors)
1. A positive correlations was found between factor 1 I strongly maintain my opinion
and factor 4 I avoided communication with my co-worker (.483).This suggests that
nurses who strongly maintained their opinion tended to avoid interaction and communication
with co-worker involved in the conflict.
2. A positive correlations was found between factor 2 I understand my co-workers opinion
but maintain my opinion and factor 4 I avoided communication with my co-worker
(.483). Nurses could understand also tended to avoid to communication.
However not correlation when found between factor 1 and 2 (.041).
3. A positive correlations was found between factor 3 I negotiated with my co-worker by
considering his feeling of co-worker and factor 5 I did my best to negotiate with my coworker (.483).
Conclusions
This study showed that interpersonal conflict between nurses in Japanese medium size
hospitals was comprised of 6 factors. Nurses who strongly maintain their personal
opinion and those who pay to attention to co-workers the feeling of involved tended to
avoid interaction and communication with their counterparts.
3-5 Key words
Structural analysis, interpersonal conflict style, medium size hospital
723
Changes of the chronic heart failure patients by the telenursing

intervention model -From the results of a pilot study
Nobue Ishibashi1, Masumi Azuma1, Shinko Fujinaga1

1.
University of Hyogo
Presenting Authors Email: nobueishibashi@gmail.com
Purpose
We clarify change which took place to the patient, as the results of carrying out pilot study
which uses the telenursing intervention model. And the suggestion about the usefulness of our
remote nursing intervention model is obtained.
Design
This research design used semi- experimental research.
Methods
We created the telenursing intervention program which uses the model, and inquired by
carrying out the program for three months to three advanced age heart failure patients. They
were three 75-80 year-old men and women. The nursing intervention was performed once per
month for 2-3 months after leaving hospital per week for one month after discharge using a
TV phone.
We recorded the speech and conduct of the patients under intervention and after intervention,
analyze qualitatively after the end of remote nursing, and clarify change which took place to
the patient.
Results
The patients have forgotten measurement and record of blood pressure or weight frequently.
But forgetting was lost while intervening repeatedly.
Moreover, the researcher was asking questions about the observation item in alignment with
an intervention model in the beginning. However, before the researcher asked patients from
the two to 3rd time, they came to talk.
724
In addition, they noticed changes of their own condition, consider the cause, and came to talk.
Conclusions
By carrying out telenursing by this model, patients had three changes.
1. Although patients may have forgotten measurement and record of blood pressure or weight,
they came to be able to do it certainly.
2. Before the researcher asked questions, they came to talk from patients about themselves
conditions and changes.
3. Patients noticed changes of condition by themselves and came to consider the cause.
From the above thing, it was suggested a possibility that our telenursing intervention model
would stimulate a patient's self-monitoring.
However, we need to perform further verification,since there were few patients in this study.
3-5 Key words
Telenursing, chronic heart failure, self-monitoring
725
A systematic review on factors associated with health-related quality of life

in patients with implantable cardioverter defibrillator
Florence Wong1, Janet Sit2, Mi Ling Wong2

1.
Tung Wah College, 2. The Nethersole SChool of Nursing
Presenting Authors Email: florencewong@twc.edu.hk
Purpose
To integrate findings from primary studies for a better understanding of factors associated
with health-related quality of life (HRQOL) in patients with implantable cardioverter
defibrillator (ICD)
Design
A systematic review is used.
Methods
A systematic literature search (1985 September 2011) was conducted to identify relevant
studies that reported factors associating with HRQOL in ICD patients. Primary studies written
in English and Chinese were included if adult patients (18 years old) received ICD for
primary or secondary prevention but excluded if they had abdominal implantation or Brugada.
Results
Eleven studies meeting the inclusion criteria and methodological quality according to JBI
guideline were retrieved, including nine cohort and two descriptive studies. Total sample size
of patients was 1146 ranging from 42 to 223 patients with mean age from 51 to 74 years. Old
age (60 years old), ICD shock experience, anxiety, and depression were consistently and
negatively associated with HRQOL in ICD patients; however, associations with sociodemographic (gender and personalities) and clinical factors, such as co-existing illnesses,
were unconfirmed.
Conclusions
726
Based on the findings from this review, old age, ICD shock experience, anxiety, and
depression were consistent factors negatively associating with poorer HRQOL outcomes of
ICD patients. Early screening may help identifying ICD patients at risk for early preventive
strategies to improve HRQOL outcomes. In addition, this review has provided insight to
improve current nursing care and directions for future nursing studies, particularly in Hong
Kong Chinese ICD populations.
3-5 Key words
Implantable cardioverter definrillator, Health-related quality of life, associating factors
727
Research into bacterial contamination of medical PHS and associated

cleaning methods
Miho Yoshii1, Miyoko Sakai2

1.
University of Toyama, 2. Nursing Subject Toyama College of Welfare Science
Presenting Authors Email: umiho@med.u-toyama.ac.jp
Purpose
In recent years, medical Personal Handy-phone Systems (PHS) have become commonly used
as a means of communication inside hospitals, yet there are no guidelines for cleaning and
sterilization of medical PHS. In view of these circumstances, considering that it is important
to manage medical PHS, which are constantly in contact with uniforms and often touch the
face and fingers, we have investigated bacterial contamination of medical PHS and associated
cleaning methods.
Design
Quasi-experiment study
Methods
Subjects: Medical PHS used in two medical facilities (Hospital A and Hospital B) in Toyama
prefecture, with consent obtained for research
Sampling and bacteria cultivation: We visited wards at the two medical facilities without
advance notice, setting the medical PHS used on the day with the liquid crystal surface as the
front and the opposite side as the back, and we sampled the front and back
respectively using the stamp method. Thereafter, we randomly split the respective medical
PHS into two groups, cleaned them using liquid crystal cleaning cloths or quick-drying wet
cleaning tissues, and took samples by the same method. After sampling, cultivation was
carried out in an incubator for two days at 37C, and we then measured the number of
colonies.
Results
728
Bacteria were detected from all of the medical PHS. Furthermore, having gram-stained the
bacteria detected from the two randomly selected hospital wards, the most common finding
was gram-positive bacteria.
Conclusions
In this investigation, while many bacteria were detected from the back side to the front side,
but conjecture suggested that these were bacteria sticking from the face and fingers.Moreover,
cleaning resulted in the number of colonies at both Hospital A and B being reduced in
approximately 80% of cases, from which we ascertained that cleaning facilitates sterilization.
However, in the remaining 20% of cases, the number of bacteria increased after cleaning, and
it is supposed that one of the causes of this is a difference in the articles used for cleaning.
3-5 Key words
Bacterial pollution, cleaning methods, Medical Personal Handy-phone System, ,
729
The recent trend of horticultural therapy and consideration of the

therapeutic effects thereof from a health perspective
Ayumi Takakura1, Ayumi Suematsu2, Yukiko Abe1, Akiko Nagata1, Toshie Yamamoto1
1.
Presenting Authors Email: a.takakura@chiba-u.jp
Purpose
This paper provides an overview of the recent trend of horticultural therapy and a
consideration of the therapeutic effect from a health perspective.
Design
Literature review.
Methods
We conducted database searches for literatures published between 2004 and 2014 and
overseas using Igaku Chuo Zasshi (ICHUSHI) and PubMed, respectively. The searches for
relevant original articles using Horticultural Therapy as the keyword retrieved 61 and 58
literatures from ICHUSHI and PubMed, respectively. Literatures on horticultural studies
and cytological studies were excluded from the search results, and the remaining 85 were
reviewed.
We discussed horticultural therapy induced changes in the subjects as health status changes,
wherein health was defined as a state where conflicts are harmonized, a state where
vital power is fully utilized .
Results
The retrieved Japanese literatures included 52 articles on interventional studies, 8 case reports,
and a literature review. The foreign literatures included 10 articles on interventional studies, 3
case reports, and 5 literature reviews.
Horticultural therapy was used mainly for patients with mental disorders and elderlies with
dementia, but also applied to a diverse range of subjects, including patients with chronic
diseases such as rheumatoid arthritis and diabetes, children with mental disorders, boys on
730
probation, and healthy subjects in a wide range of age. The contents of horticultural therapy
varied from crafts such as pressed flowers to cultivation and harvesting of crops. In some
cases, horticultural therapy was conducted after environmental adjustments based on
horticulture experience or disease characteristics of individual patients. The main study
content was analysis of effects of horticultural therapy. The reported effects of horticultural
therapy included improved anxiety, sustained concentration, enhanced initiative and
motivation, increased exchanges with others, enhanced activity of the parasympathetic nerve
system, reduced pain, and lowered risk of fall.
Conclusions
It is concluded that horticultural therapy based on characteristics of the disease and the living
process of the subject lead to harmonize the conflict by using own vital power.
3-5 Key words
Horticultural therapy, therapeutic effects, health perspective
731
The contents of the training program to prevent the child abuse for the
midwives working in the medical institution
Kyoko Kajihara1, Tomoko Fujimaru1, Nobuko Hirata1, Hiromi Yamamoto1, Tomomi Nodaka1
1.
Teikyo University
Presenting Authors Email: kajihara@fmt.teikyo-u.ac.jp
Purpose
The purpose of this study was to grasp that the necessity development for the child abuse
prevention activities for midwives work in the medical institutions seeking government public
health nurses.
Design
We mailed the questionnair papers to the public health nurse who work in the administrative
agency.
Methods
We investigated by the questionnaire paper to the public health nurses whose place of duty is
to cope the child abuse prevention. The contents of the questionnaire were fundamental
attribute of the public health nurses, correspondence between the administrative agency and
other medical institutions. And moreover, we want them to write freely their opinion about
the competence formation for the child abuse prevention activities. We analyzed the meaning
of the words by categorize into each segment.
Results
51 public health nurses were answered the question and write freely their opinion.
We analyzed 13 categories from 58 sub categories. Categories were the relationship
between administrative agencies and midwives who work in the medical institutions
support for the childs mothers who have risk to child abuse to grasp the situation of
the parenting skills of the childs mothers and so on.
Conclusions
732
The public health nurses recognized that the importance to construct the training system for
midwives about the child abuse prevention activities. They consider it is very important to
make a relation between administrative agency and midwives who work in the medical
institution.
Public health nurses want training programs for midwives to improvement the knowledge and
technology for child abuse prevention.
3-5 Key words
Midwives, chile abuse prevention, training program
733
Comparison of nursing students cleanliness values in Japan and Laos

using the cleanliness-Oriented scale
Tomoko Yokoyama1
1.
Osaka Prefecture University
Presenting Authors Email: mu601024@edu.osakafu-u.ac.jp
Purpose
Knowledge and techniques that can be used to prevent infection and promote cleanliness in
operating theatres are indispensable in nursing practice. In addition, indications of personal
orientation toward cleanliness, such as maintenance of ones environment and appearance,
affect perceptions of nursing. However, differences in cultural background influence nursing
students tendency toward cleanliness, as they undertake fundamental nursing education in
different countries. The purpose of this study was to examine cultural differences in
orientation toward cleanliness between Japanese and Laotian nursing students.
Design
Quantitative study
Methods
This study was based on a questionnaire used in a preliminary study and consisted of 30 items
from the Cleanliness-Oriented Scale (Ishikawa et al., 2005) and two items used to measure
attitudes toward antibacterial agents. Each question was answered using a 6-point scale
ranging from 1 (very strongly disagree) to 6 (very strongly agree). Questionnaires were
distributed to students undertaking Bachelor of Nursing degrees in Japan or Laos. SPSS 22.0
for Windows was used in the statistical analysis of the data; the level of statistical significance
was set at 5%.
Results
The study included 151 students from Japan and 120 from Laos (response rate: 97%). We
performed exploratory factor analysis and extracted 21 question items, which were considered
734
suitable for measuring orientation toward cleanliness. We then classified the items into 4
categories. These categories were as follows: 1) cleanliness of public places, 2) sorting items
and establishing order, 3) hygiene, and 4) visual aspects. With respect to cleanliness,
descriptive statistics showed that cleanliness of public places (p = .929) did not differ
significantly between the two nationalities. In the sorting items and stablishing order (p = .000)
and hygiene (p = .037) categories, Japanese students scores were significantly higher
relative to those of Laotian students. In the visual aspect category, Laotian students scores
were significantly higher relative to those of Japanese students (p = .000). The visual aspect
category was significantly correlated with the other 3 categories in the Japanese student group;
this relationship was not observed in the Laotian students.
Conclusions
These results indicate that there are local differences between the two countries, possibly
reflecting cultural dissimilarity. The Laotian students were more conscious of the visual
aspects of cleanliness relative to Japanese students; this was assumed to stem from mundane
everyday practice in the home rather than the professional education they received at school,
as their attitudes were not associated with other cleanliness factors. The results of this study
should be viewed in consideration of certain limitations, as the Laotian students belonged to
the high-income socioeconomic group of the country, and their attitudes may not represent
those of Laotians in other socioeconomic groups.
3-5 Key words
Cleanliness values, nursing students, culture
735
A survey and analysis of the status quo of clinical pain management and
nursing records
Li Liu1
1.
west china hospital
Presenting Authors Email: liuli-hsy@163.com
Purpose
To investigate status quo of pain nursing records and pain management in clinical
departments, and to provide a reference for the normalized pain management, pain assessment
and recording method and to improve in the future.
Design
The research tool was a self-designed questionnaire. Descriptive statistics were calculated
using the Statistical Package for Social Sciences Version 18.
Methods
The study was performed in 115 nurses from pain specialist nurse training class with selfdesigned questionnaire in November 2013 .
Results
only 4.35%39.13% of the nurses evaluated and recorded pain in in-patients on the
admission day , during hospitalization was 6.96% ~ 45.22%, after surgery was 5.71% ~
48.57%, at discharge was 3.48% ~ 21.74%.
Conclusions
The present study highlights the lack of an exhaustive documentation of pain recording and
management in the hospital setting. Therefore, healthcare providers should pay close attention
to this relevant issue, and it is very necessary to strengthen the pain knowledge and skills
training of the nurse .
3-5 Key words
736
Pain management, documentation, assessment
737
Stress management programs intended for nurses in Japan and their

intervention effects- Review of literature over past 10 years
Mina Tsukamoto1
1.
Hokkaido University
Presenting Authors Email: minna@hs.hokudai.ac.jp
Purpose
This study reviews literature over the past 10 years and summarizes stress management
programs intended for nurses in Japan and their intervention effects to clarify the aspect of
effective programs for stress reduction.
Design
Literature review
Methods
The literature survey was conducted using the following online databases: MEDLINE,
CINAHL, Igaku Chuo Zasshi, PsycINFO and CiNii. These keywords were used for retrieval:
stress and Japanese for English literature and nurse, stress and stress
management for Japanese literature. Six criteria for selection shown below were used and
literature abstracts and titles were the subject for selection. All literature satisfying criteria for
selection was obtained and two researchers decided their eligibility. As there were few
randomized controlled trial (RCT) studies, meta-analysis could not be applied and the results
of this study were summarized descriptively.
Criteria for Selection
1) The targets of this study are Japanese nurses working in Japan.
2) The research purpose is to reduce the stress of nurses or to evaluate the program or
intervention for that purpose.
3) The category of the study is intervention study.
4) The intervention method is described in a reproducible manner.
5) Stress condition or mental health status is used as the performance index.
738
6) The category of the research papers includes original papers and proceedings.
Results
There were a total of 122 hits with the five online databases. Among these hits, 14 (two
English literature and 12 Japanese literature) satisfied the criteria for selection.
1) Intervention program: workshop-style stress education, stress management, relaxation, and
cognitive behavioral therapy intervenients that were met with accounted for 64.3 percent. The
programs that did not meet with intervenients were online programs or adopted a selfassessment system.
2) The frequency of intervention and the time spent for one session: The frequency of
intervention ranged from one to 10 times, and one intervention accounted for 50 percent. As
for the time spent for one session, 90 or less minutes accounted for 43 percent.
3) Stress reduction effects and evidence level of intervention programs: Among 14 programs
that saw intervention effects throughout comparison before and after the intervention, two
programs set a control group. One was the online career identity (CI) training program with
the RCT study design. The study reported that the quantitative load of occupational stress
showed marginal difference (P=0.09) as an intervention effect. The other was a structured
stress management program that adopted education and relaxation training. The program was
held once a week for 90 minutes per session for a total of five meetings. The study reported
that intervention effects were recognized in the general health questionnaire conducted
immediately after, one month after and three months after finishing the program.
Conclusions
A majority of preventive stress management programs targeting nurses in Japan were
workshop-style programs with a psychological method such as face-to-face cognitive
behavioral therapy. Two programs with control groups recognized the intervention effect: one
was online CI training, and the other was a structured stress management program with five
sessions of 90 minutes a week.
3-5 Key words
Nurses, stress management program, review of literature, Japan,
739
Significance of additional inoculation with measles vaccine for nursing

students
Satoko Yokota1
1.
Asahi University
Presenting Authors Email: syokota@alice.asahi-u.ac.jp
Purpose
Measles is a highly infectious disease that can lead to serious complications, which can
however, be prevented through vaccination. Therefore measles can be eradicated, although
this has not been achieved to date. Until recently, the number of patients with measles has
been decreasing remarkably in Japan, because of routine vaccination, which has been
conducted since 1966. However, a widespread measles outbreak occurred among young
adults in Japan that forced the closure of some universities in 2007. Moreover, an increasing
number of patients, particularly young people in their early twenties, have been reported in
Japan. Testing positive for antibodies among nursing students is a matter of concern, because
they are in an environment of high exposure. This study investigated the present conditions of
antibodies in nursing students, before commencing the administration of combined measlesrubella vaccine, twice per person from 2006 in Japan. Their antibody status could be
considered an indication of the success of managing infectious diseases in nursing students.
Design
Incidence of measles, and records of anti-measles vaccination of nursing students conducting
practical training at medical institutions were analyzed by examining the immunity status of
students through blood tests. In order to investigate the effect of measles vaccine on changes
in antibody titer, antibodies after the vaccination and the booster effect of the vaccination on
those with negative Hemagglutination Inhibition (HI) antibody titer was examined using HI
and EIA methods. Based on the above examination, the necessity for providing additional
vaccination against measles for nursing students to prevent infections in students, as well as to
prevent hospital infections is discussed.
Methods
740
Participants were nursing students (N=162) who had their blood tested between 2003 and
2004. The measles antibodies of the participants were measured.
This study consisted of two parts.
1.
Investigating the immunity to measles by screening blood, examining the measles
vaccination schedule, and inquiring about the history of measles in nursing students.
2.
Discussing the necessity of providing additional vaccination against measles by
examining correlations between antibody status after additional vaccination and vaccination
records of the HI antibody-titer negative group.
Results
Approximately 20% of participants were measles-antibody-titer negative. The participants
that had measles once, or have been vaccinated against measles, were also antibody-titer
negative. All participants included in the HI antibody-titer negative group converted to
positive through additional vaccination, and a booster effect was observed with those that had
been vaccinated previously.
Conclusions
It is essential to provide antibody tests to medical students and to give additional vaccinations
to those that are negative, in order to protect them from measles and prevent secondary
infection in patients, and thus prevent hospital infection. Since 2006, the Japanese Ministry of
Health, Labour and Welfare has recommended a combined measles-rubella vaccine twice per
person. It is necessary for nursing students to have sufficient antibody titer. In the future, it is
recommended that additional vaccinations be administered to them, without conducting
screening tests.
3-5 Key words
Measles vaccine, nursing students, measles antibodies
741
Comparison of the 6th and 7th editions of the American Joint Committee
on Cancer TNM staging system for gastric cancer underwent surgery at
medical center in central Taiwan
Chen Wen1, Chan Chien-Pin1, Chang Tung-Hao1, Lin Yih-Jeng2

1.
ChangHua Christian Hospital, 2. Chienkuo Technology University
Purpose
The 7th edition American Joint Committee on Cancer tumor-nodes-metastasis (AJCC TNM)
staging system was published recently. We aim to evaluate its predictive ability and to
compare the performance of the 6th and 7th editions of the AJCC TNM staging systems in
gastric cancer.
Design
We analyzed data From 2002 to 2010, a total of 303 gastric cancer cases who underwent
surgery from Changhua Christian Hospital in Taiwan were enrolled. All patients were
followed up closely until March 31, 2011.Postoperative follow-up included clinical and
laboratory examinations every 2 months for the first year, every 6 months for the five year
and annually thereafter at least until 10 years after operation or the date when the patient was
dead. The mean follow-up for the entire cohort was 39 months (range 1109).
Methods
The impact of variables on prognosis was Univariate and Multivariate Survival Analysis. The
homogeneity, discriminatory ability, and monotonicity of gradients of two staging systems
were compared using linear trend2, likelihood ratio 2 statistics, and Akaike information
criterion(AIC) model analyses were used to evaluate prognostic effects. A smaller AIC value
indicated a more desirable model for predicting outcome. The statistical analyses were done
with SPSS 15.0 for Window.
Results
742
The overall 5 year survival rate (5YSR) for the entire cohort was 52.7%. the patient
distribution 6th and 7th stage overall survival rates. In the 7th stage the Kaplan Meier plot
showed a good discriminatory ability among 5YSR were 87.2 % forA(n=38), 77.4% for
B(n=26), 74.4% for A(n52), 52.3% for B(n=23),51.3% for A(n=61),31.3% for
B(n=67), and 9.7% for C(n=36), respectively (P<0.001) . Because 6th stage were
including T4N1-3M0T1-3N3M0AnyT AnyN M1, But 7th edition stage was AnyT
AnyN M1. owing to the lack of difference in survival rates stage . The 7th staging system
has the highest linear trend 2 and likelihood ratio 2 scores. Its a smaller Akaike
information criterion value appears to be a better prognostic indicator for patients with gastric
cancer.
Conclusions
We found that 7th edition staging system may provide improvements in staging classification
that will lead to the establishment of a more practical and universal staging system for gastric
cancer.
3-5 Key words
TNM classification, gastric cancer, survival rate, Akaike information criterion,
743
A validation study of the assessment tool for family/family member time

allocation
Junko Honda1, Minae Fukui2, Syuhei Yamamoto2, Naohiro Hohashi1

1.
Department of Nursing, Kobe University Graduate School of Health Sciences, Japan, 2. Former
undergraduate student Faculty of Health Sciences, Kobe University School of Medicine, Japan
Presenting Authors Email: junko@gold.kobe-u.ac.jp
Purpose
The goal of family nursing is to maintain and enhance family functioning. Family functioning
is defined as "activities performed by a family and abilities to act on family environment
through a result of individual family members' role behaviors" (Hohashi, 2010). Focusing on
each family member's roles and the relative balance of their roles within the family is required
to assess family functioning. However, no adequate tools currently exist to assess family roles.
In this study, a prototype of the tool to assess the living activities of family members was
designed. It was named Survey of Family Environment/Family Time Allocation, Japanese
version (SFE/FTA-J), and based on the terms of reference in the Japanese government's
Ministry of Internal Affairs and Communications' (MIC's) survey on time use and leisure
activities.
The SFE/FTA-J consists of 19 items on living activities, including sleeping, eating, working,
child rearing, and so forth, and is structured in a free-text format, so as to allow family
members to indicate all time allocation on weekdays and weekends (2 days). As the MIC's
survey is not intended to apply to children under 10 years old, it lacks items relevant to
children. Further, if this tool is to be used in healthcare settings, items concerning medical
treatments and disabilities/diseases are required.
The purpose of this study was to test the validity of the SFE/FTA-J and revise options for
activity items accordingly.
Design
Semi-structural interviews and a questionnaire survey using the SFE/FTA-J were employed.
Methods
744
Participants in the semi-structured interviews were 10 families with children hospitalized for a
month or longer. Questionnaires were administered to 35 families with children who had
special needs. Two types of methodology were tested to confirm face validity and content
validity. This study was undertaken after obtaining ethical approval from our institution.
Results
A total of 51 SFE/FTA-J questionnaires were collected, and 49 were analyzed. Although
almost all respondents (96.1%) filled in their living activities, some families were not able to
enter all the time allocation fields for all members in this format. Respondents' bias was
evident in the free-text sections --- that is, details or specifics of the same living activities
differed among respondents. Although SFE/FTA-J includes items for "child-rearing" and
"caring and nursing," some respondents entered "helping the child with homework," "playing
with the child," "driving the child someplace," "assisting the child," "watching the child's
rehabilitation," "visiting the child in the hospital," "exchange of information with peers,"
"PTA activities" and so forth.
Conclusions
Utilizing the SFE/FTA-J for assessment of families with children and a family member living
with illness or disability was deemed possible. However the participants indicated they
engaged in other living activities concerning the family's activities with children and members
with illness or disability not mentioned in the questionnaire. This demonstrates the need for
expansion and modification of certain items in the SFE/FTA-J.
3-5 Key words
Family functioning, family role, assessment tool, Concentric Sphere Family Environment
Theory/Model,
745
A systematic review of the effect of exercise in reducing pain in people with

spinal cord injury
Yi-Ya Chang1, Shu-Hung Chang2

1.
National Taiwan University, 2. Chang Gung University of Science and Technology
Purpose
Pain is a common problem in people with spinal cord injury. Pain has been found to be
associated with elevated level of stress, anxiety and depression. Traditionally, using
medication is the primary way to treat pain among people with spinal cord injury. It is
appeared that non-pharmaceutical way in reducing pain among people with spinal cord injury
is an important issue. The purpose of this systematic review was to examine the effectiveness
of exercise in people with spinal cord injury. The outcome of interest was pain.
Design
A systematic review.
Methods
Studies of English and Chinese publications related to spinal cord injury, exercise and pain
were included, using both Chinese and Western scientific databases including: CINAHL,
MEDLINE, PubMed, and Airiti Library from January 2000 to December 2013. Populations in
these studies were adults aged 18 years and older. We limited the search to studies that people
with diagnosis of spinal cord injury only, experimental and quasi-experimental studies,
intervention with exercise only, with full text and excluded studies on review articles, and
case reports. Therefore, outcome measures should include subjective or objective pain
indicators. Two review authors independently assessing the quality of studies.
Results
CINAHL, MEDLINE and PubMed returned 81 articles. 63 articles produced after removing 6
duplicated articles and 2 articles using the same samples. 10 articles returned from the Airiti
Library. Finally, 7 articles that met the above criteria were analyzed and synthesized. Self-
746
reporting is an easy way to assess the level of pain. It was used in most studies to assess the
level of pain. Although, there were some differences in the type of exercise and the duration
of exercise in these seven studies. Upper extremity strengthening and stretching exercises
were designed to do 2 or 3 times per week in most of these studies in reducing pain for people
with spinal cord injury. Six out of the seven studies showed that the exercise was an effective
intervention in reducing pain in people with spinal cord injury.
Conclusions
The result of this systematic review suggests that exercise is a beneficial intervention in
reducing pain in people with spinal cord injury. This systematic review can serve as a
reference to help nurses to be more understood the effectiveness of exercise in reducing pain
in people with spinal cord injury.
3-5 Key words
Spinal cord injury, exercise, pain
747
Literature review on the effects of foot bathing in Japan
Yasuko Kurosawa1, Kayoko Kawahara2, Yumi Hirahara3

1.
Kurosawa Clinic, 2. Department of Nursing Sciences, Graduate School of Human Health Sciences,
Tokyo Metropolitan University, 3. Asukayama Visiting Nurse Station, Japan Visiting Nursing
Foundation
Presenting Authors Email: ikeko115@hotmail.co.jp
Purpose
Although hospitals, institutions and homes are equipped with machinery and devices that
permit whole-body bathing, provision of foot bathing is an important part of nursing care in
Japan. Foot bathing is simple and can be performed even when a patient is lying in bed. Foot
bathing has various objectives, including cleaning, promotion of relaxation and blood
circulation, and reduction of joint stiffness, etc. Japan is a country with an unprecedentedly
aged society (population aging rate, 25.1%).Walking is a key component of QOL especially
for elderly people. The number of people participating in walking and hiking, including those
with lower limb symptoms, has recently been increasing. Foot bathing supports walking and
is thought to contribute to improving their lives. Thus, it is necessary to confirm the scientific
evidence for the effects of foot bathing. Therefore, this study, a review of prior nursing
research carried out in Japan, aimed at elucidating the effects of foot bathing.
Design
Literature review
Methods
A search was conducted in August 2014 for effects of foot bathing in articles published
in Igaku Chuo Zasshi (Japans largest medical-literature database) in Japan between 2004
and January 2014. Original papers in the nursing literature, papers of studies performed with
the objectives of alleviating or improving lower limb symptoms, and papers of studies of the
physiological changes brought about by foot bathing.
Results
748
A total of 19 papers, each of which showed the effects of foot bathing, were reviewed. The 19
papers included 15 that studied lower limb symptoms and 4 that investigated the
physiological changes brought about by foot bathing. The design of all of the studies was
quasi-experimental. Five papers dealt with lower limb edema, 3 with blood-flow circulatory
disorders, 2 with sensory and/or gait disturbances, 2 with motivation to perform foot care, 2
with cold feet, and 1 with ringworm. Of these, 12 papers investigated the additive effects of
carbonated spring water bath salts, aromatherapy, massage, steam foot bath, etc.
In one of the papers that dealt with physiological changes brought about by foot bathing, the
subjects were 10 healthy adolescent men. The subjects were three kinds of foot-baths:
artificial carbonated spring water apparatus foot-bath (AC), carbonated bath-salts foot-bath
(CB) and warm-water foot-bath (WW) as independent variables, while the blood pressure,
pulse, body temperature, and lower limb skin blood flow and skin temperature were
investigated as dependent variables. Compared with WW, AC and CB both increased the
lower-limb skin blood flow and the skin temperature. There were no significant differences
between the AC and CB, showing that the effects in there were similar.
Conclusions
It is noteworthy that foot bathing showed effects not only by improving the target symptoms,
but also by alleviating and/or improving other symptoms. Moreover, from the effect of
encouraging attention to the feet, foot bathing by nurses will be extremely important in terms
of early detection of abnormalities in people with diabetes and prediabetes. In the future, we
hope to develop a foot-bath care protocol that will be more convenient and safer and result in
maximum effect.
3-5 Key words
Japan, nursing care, effects of foot bathing, evidence, literature review
749
Cultural sensitivity and related factors among nurses
Wan-Ching Ho1, Yuan-Mei Liao2, Lu-I Chang3, Shu-Tai Hsiao4, Ching-Chiu Kao5, Shu-Yu
Kuo2
1.
Taipei Medical University Graduate Institute of Nursing, 2. Taipei Medical University, 3. Tzu Chi
University, 4. Taipei Medical University Hospital, 5. Taipei Municipal Wanfang Hospital
Presenting Authors Email: vitamin430@gmail.com
Purpose
To provide quality care in the multicultural society of Taiwan, health care providers are
mandatory to acquire cultural care competence. The purpose of this study is to examine
nursescultural sensitivity and related factors.
Design
Cross-sectional survey method was used to exam the psychometric properties of the Chinese
version of Intercultural Sensitivity Scale. Cultural sensitivity and related factors among
hospital nurses were also examed.
Methods
A total of 170 valid questionnaires were completed by nurses working at a hospital in Taipei.
Study questionnaire included (1) personal characteristics; (2) The Chinese version ISS which
was originally developed in English by Chen and Starosta (2000). SPSS 17.0 was used for
Results
Satisfactory reliability of The Chinese version ISS was supported by Conbachs alpha
coefficient being .894. The range of expert validity for items in The Chinese version ISS is
between .83 and 1, which shows an acceptable validity. The average score of hospital
nurses cultural sensitivity of 87.15(SD=9.939), shows that hospital nurses have good
intercultural sensitivity. Language ability, particularly in English and multi-cultural
experiences are the two factors that shows related to levels of cultural sensitivity in nurses.
750
Conclusions
Results of this study can be referenced while developing continuing education program for
nurses.
3-5 Key words
Cultural Sensitivity, nurse, ISS
751
Effects of a app-based uncertainty intervention program for breast cancer

survivors
Hyun-Ju Jeong1
1.
Nambu University
Presenting Authors Email: jhjudee@nambu.ac.kr
Purpose
The aim of the present study was to develop a app-based uncertainty intervention program
and to determine whether the program was effective in reducing symptom experience,
increasing social support, and reducing uncertainty on breast cancer survivors. The conceptual
framework of this study was the model of antecedents of uncertainty of Mishel(1988).
Design
This is a quasi-experimental study with a non-equivalent control group pre-post test design.
Twenty-seven breast cancer survivors with stage 0~II cancer identified within 24 months of
completion of primary care treatment (13 in the experimental group and 14 control group)
were recruited conveniently from 3 hospital in C country undergoing follow up H hospital in
C country. Data were collected from May 13th to August 31th, 2013.
Methods
App-based uncertainty intervention program was composed symptom control, healthcare
education(diet, exercise) to prevent recurrence and metastasis, SMS 8 times, coaching call 2
times. Experimental group downloaded app-based program on their smartphone and
documented their diet, exercise and pain daily during 8 weeks. The research tools used for in
this study Symptom were Experience Scale(SES), Social Support Scale, Mishel Uncertainty
Illness Scale(MUIS).
Results
The data were analyzed using Fisher's exact test, Mann-Whitney U test, and Wilcoxon Signed
Rank test by SPSS 18.0 program. The results are summarized as follows;
1. There is no significant difference between the two groups was evident in terms of any
752
sociodermographic or clinical characteristics at the baseline.

2. The first hypotheses, the score of symptom experience in experimental group would be
lower than the control group was supported by statistically significant difference(z=-2.02,
p= .044).
3. The second hypotheses, the score of social support in experimental group would be higher
than the control group was supported by statistically significant difference(z=-2.08, p< .001).
4. The third hypotheses, the score of uncertainty in experimental group would be lower than
the control group was supported by statistically signigicant difference(z=-1.85, p= .043).
According to the results, app-based uncertainty intervention program for breast cancer
survivors was effective in reducing symptom experience, increasing social support, and
reducing uncertainty.
Conclusions
In conclusion, a app-based uncertainty intervention program for breast cancer survivors was
effective when Mishel's antecedents of uncertainty was used to inform program strategy.
3-5 Key words
Breast cancer, app, symptom experience, social support, uncertainty
753
The effect of different concentrations of normobaric oxygen in reducing

caspase-3 and caspase-9 expression in a rat-model of focal cerebral
ischaemia
Suyan Chen1, Feng Gao1, Huizhen Peng1, Peng Wang1

1.
Presenting Authors Email: yanzicsy@163.com
Purpose
To study the effect of normobaric oxygen (NBO) in different concentrations on neurological
function and the expression of caspase-3 and caspase-9 in an acute cerebral ischaemic model
of rat.
Design
A experimental design with a control group with post-tests.
Methods
120 Sprague-Dawley rats were subject to middle cerebral artery occlusion (2 hours) and
reperfusion (at 3, 6, 12, 24, 48 or 72 hours). The rats were randomly divided into four groups
(n=30 per group), 3 of them were given NBO at concentrations of 33%, 45% or 61% ,
respectively, and one control group was given normal air. Each group (n=30) was sub-divided
into six subgroups (n=5) according to the above reperfusion of NBO for 3, 6, 12, 24, 48 or 72
hours. The fluorescence quantitative Polymerase Chain Reaction (PCR) and
immunohistochemistry were used to detect caspase-3 and caspase-9 mRNA and protein
expression respectively.
Results
The Neurologic Impairment Score decreased significantly by 2 points from baseline in rats
given 61% NBO at >48 hours and 72 hours (P < 0.05, Mann-Whitney U ) when compared to
the control group. NBO significantly reduced caspase-3 and 9 mRNA and protein expression
than those of the control group at all concentrations and time points (all P <0.05, ANOVA).
The caspase-3 and 9 expression were lower in the group given 61% NBO compared to the
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groups given 45% and 33% NBO. This difference was significant when compared the groups
that received 33% NBO for 48 hours to the control group(all P<0.05, ANOVA).
Conclusions
These findings indicate NBO may inhibit the apoptotic pathway by reducing caspase-3 and 9
expression, thereby promote neurological functional recovery.
3-5 Key words
Normobaric oxygen, ischaemic rat model, cerebral ischaemiareperfusion, apoptosis
755
Physiological and psychological effects of Taktil back massage in Japanese

elderly females
Yoshiko Fujita1
1.
Mie Prefectural College Of Nursing
Presenting Authors Email: yoshiko.fujita@mcn.ac.jp
Purpose
The purpose of this study is to elucidate the physiological and psychological effects of Taktil
back massage in Japanese elderly females.
Design
Quasi-experimental design
Methods
The study period was from July to September 2014. A test room with a fixed temperature (23
to 25) and humidity (50 to 60%) was used. The subjects were 14 healthy elderly females,
and the taktil massage was given to their back for 10 minutes. Physiological effects of the
massage were evaluated by comparing body temperature, blood pressure, heart rate, SPO2,
respiratory rate and autonomic nervous function before intervention with those immediately,
10 minutes and 20 minutes after the intervention. Psychological effects of the massage were
evaluated using POMS (Profile of Mood States) Brief Form, BFI (Brief Fatigue Scale) and
Pain Scale. One-way layout ANOVA was used for statistical analysis, and values of p<0.05
were considered to be statistically significant. Since this was an intervention study to the
human body, the approval of the Institutional Review Board of the Mie Prefectural College of
Nursing was obtained in advance.
Results
Average age of the subjects was 72.9 5.8 years old (Mean S.D.). At first we evaluated the
physiological effects of taktil back massage in Japanese elderly females, and it was suggested
that body temperature, blood pressure, SPO2 and autonomic nervous function before the
intervention were not significantly different from those immediately, 10 minutes and 20
756
minutes after the intervention. On the other hand, heart rate before the intervention was
significantly decreased after that immediately, 10 minutes and 20 minutes after the
intervention (p <0.05), and respiratory rate 20 min after the intervention was significantly
increased as compared with that before the intervention (p <0.05). As for the autonomic
nervous function, parasympathetic nervous activity of subjects, whose sympathetic nervous
activity was higher than parasympathetic nervous activity before the intervention, was
significantly increased after the intervention (p <0.05). Comparison of psychological
parameters before and after the intervention revealed that some of the POMS Brief Form
items (Tension - Anxiety, and Confusion), and the BFI and Pain Scale scores all
were significantly decreased (p <0.05), and one of the POMS Brief Form items (Vigor)
was significantly increased after the intervention (p <0.05).
Conclusions
Our present study showed that Taktil back massage has the physiological effect by which the
balance of the autonomic nervous system was restored, and has the psychological effects by
which negative feelings and subjective symptoms such as fatigue and pain were alleviated in
elderly females. This study is supported by Grant-in-Aid for Scientific Research (C) (No.
23792573).
3-5 Key words
Taktil, back massage, autonomic nervous, BFI, POMS
757
Predictors of intention to use HIV testing service among sexually

experienced youth in Thailand
Kulrawee Wiwattanacheewin1, Wantana Maneesriwongul1, Anne Teitelman2,

Chukeit Viwatwongkasem1
1.
Mahidol University, 2. University of Penselvania
Presenting Authors Email: kulrawee@hotmail.com
Purpose
1. To explore the prevalence of sexual experience among Thai youth.
2. To examined predictors of their intention to use HIV counseling and testing (HCT) services
among those who had never used HCT service.
Design
Cross-sectional, correlational design study
Methods
Three stages of random sampling were used to select classrooms for recruiting the youth
studying in high schools and vocational schools in the Bangkok area. There were 2,945
participants from 6 secondary and 3 vocational schools in Bangkok invited to complete webbased questionnaires at the schools computer labs. Of those, 2,536 questionnaires were
completed and analyzed by using descriptive statistics and Logistic Regression Analysis.
Adapted from Andersens model, the youths characteristics and health care services
characteristics were tested as the predictors of intention to use HCT service.
Results
The findings demonstrated prevalence of sexually experience was 30.88%. More than 80% of
the sexually experienced youth had never used HCT service while 74.06% of those who had
never used HCT services reported having intentions to do so. The significant predictors
consisted of favorable expectations of YFHCT services (OR =1.017, 95%CI=1.010-1.024, p <
001), positive attitude toward HIV testing (OR= 1.030, 95%CI= 1.011-1.050, p<.005),
perceived high risk for HIV infection (OR =2.482, 95%CI= 1.263-4.874, p < .01), having
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multiple sex partners while also using condoms consistently (OR=3.590, 95%CI=1.402-9.190,
p<.01), willingness to pay for HCT service (OR=3.094, 95%CI=2.069-4.626, p<.001) and
being informed about HCT and knowing its location (OR=2.486, 95%CI=1.565-3.947, p
< .001).
Conclusions
Scaling up HCT services used by sexually experienced youth is one of major challenges to
solve the HIV/AIDS epidemic in Thailand. Policy makers can use these findings to promote
intention to use HCT service among at risk youth.
3-5 Key words
Prevalence, intention, youth friendly service, HIV counseling and testing, Thai youth
759
Finding factors inhibiting e-learning system for nurses living in Niigata

prefecture
Akihiro Hashimoto1, Naoko Hara1, Chikako Takabayashi1, Chie Iida1, Ayako Kagami1,
Kiyoko Nakazawa1, Chiaki Ishihara1, Mayu 1, Ryoko 1, Mitsutoshi 1
1.
Niigata College of Nursing
Presenting Authors Email: hash@niigata-cn.ac.jp
Purpose
A bi-directional e-learning system is very effective and important for heavy snowfall areas
such as Niigata prefecture. However the rate of bi-directional classes in our e-learning system
was less than 2.6%. Our goal is developing active e-learning system for current working
nurses and carrier breaking nurses.
The purpose of this article is finding suspected factors, which are preventing participants
from joining bi-directional classes, to perform a factorial analysis of variance, multivariate
statistical analysis and so on by a future step.
Design
We conducted a mixed research methods to avoid falls short of the major approaches being
used today in the social and human sciences. This study was done for a pre-research sample to
calculate sample size and sample power, so basic statistics and covariance were measured.
Methods
We conducted semi-structured interviews with 18 participants (n=20) from 2009 to 2013 as a
quantitative research method. The population size is 208 (N=208), we measured basic
statistics, such as age, gender, and career years, at the beginning of the courses. More than
one researchers analyzed factors and categories independently for validity and reliability,
Results
The number of the course participants was 208 and 99.5% of them were female and we found
basic statistics, variance and covariance for calculating sample size and power.
We found two major categories. The first was concerned with (1-1) A lack of basic
760
computer skills, (1-2) computer anxiety and etc . These coincided with many of the earlier
studies. The second consisted new 2 factors that we suspected inhibit enrollment in the bidirectional classes. (2-1) The participants wear no makeup in their homes and were ashamed
of how they would appear on camera with no makeup if they enrolled in the bi-directional
classes. (2-2) And they were worried that their rooms were messy, as their rooms would also
be captured in the background by the webcam.
Conclusions
According to basis statistic and covariance, needed sample size was 24 for alpha=0.05,
beta=0.20, error rate=0.05.
We found the new 2 suspected factors preventing participants from joining bi-directional
classes.
Ultimately, in response to analysis of the above factors we the hyphenized that implementing
a participants avatar and virtual background screen into a virtual college environment
would be effective in promoting further participation in the bi-directional classes to make
lessons more active. As the next step, we will test these hypotheses by statistical method. The
sample from which the hypotheses were sought must be independent from the sample by
which statistical testing were conducted.
3-5 Key words
E-learning, sample size, sample power, inhibiting factors
761
The nursing practice of end-of-life care by visiting nurses who support the
dying with dignity of their end-of-life elderly patients in home care
Yoko Katayama1, Masako Sakai2, Hiroko Nagae3, Shinya Saito4

1.
Department of Nursing, Faculty of Health Sciences, Kagawa Prefectural University of Health
Sciences, 2. School of Nursing, Seirei Christopher University, 3. Graduate School of Nursing, Chiba
University, 4. Graduate School of Health Science, Okayama University
Presenting Authors Email: ryouyoko@hb.tp1.jp
Purpose
To enable their patients to realize their hope to live with dignity until the last moment of their
lives and to meet their death by being themselves, the visiting nurses support their patients
each day leading up to the last moment their lives. They do so by implementing their
necessary care, while determining their medical condition, cooperating with their physicians,
as well as consulting with their family members.
The purpose of this research is to explain the practical knowledge of visiting nurses on how
they perceive the dignity of their end-of-life care elderly patients and on how the end-of-life
care is being practiced to protect their dignity. This is achieved by conducting research
interviews on the visiting nurses, all of whom have a wealth of experience and knowledge
about end-of-life home care.
Design
The research design was qualitative method. Having had the visiting nurses thus recruited
select one or two of their elderly patients of home care whom they acknowledged as having
dying with dignity, we interviewed them about these cases, based on the interview guide.
Methods
The subjects of this research were appealed to the public for the participants of the forum.
Interviews with a duration of about one hour were conducted with each subject.
The interviews were categorized on the basis of the similarity of meaning and content.
This research was carried out with the consent of Kagawa Prefectural University of Health
762
Sciences ethical committee.

Results
From five visiting nurses, we obtained the data on eight cases of end-of-life patients. The
analysis of these data yielded the following results:
The nurses' perceptions of the "dignity" of their end-of-life patients were organized into five
categories: "The patient was able to meet his/her death in the place and the circumstances as
desired"; "the patient was able to fulfill the role he/she had conceived "; "the physical pain
suffered by the patient was limited"; "the patient's family members respected the values of
their loved one and the latter actually felt that"; "the family members also experienced peace
as they saw their loved one met his/her death".
The nursing practice that safeguarded "dignity" was organized into ten categories and twentyseven sub-categories, such as the following: "To build a team that shared the hopes of the
patient, with the latter as the 'control tower'"; "to link what was happening to important
information in the past"; "to become involved with a 'predictive attitude'"; "to understand the
life process of the patient";.
Conclusions
To enable their patients to realize dying with dignity, the visiting nurses supported the wishes
and the hopes of their patients and to protect the hopes they had expressed, were engaged in
consensus-building with the family members and the team. Furthermore, to support the hopes
of their patients, they were required to become involved in the situation with a predictive
attitude, while forming their prognosis and predictions, based on clinical judgment. By so
doing, they increased the preparedness of the family members and the team members for the
worse.
3-5 Key words
Nursing practice, dying with dignity, visiting nurses, end-of-life patients
763
Factors in midwives assessments of families
Hisayo Ushinohama1, Michiko Moriyama2

1.
Department of Nursing, School of Health Sciences, Asahi University, 2. HIroshima University
Presenting Authors Email: hisayou@alice.asahi-u.ac.jp
Purpose
With the decreasing birth rate and increase in nuclear families, families are becoming more
isolated due to weakening ties with the local community. This combined with a lack of
knowledge and experience in childrearing has resulted in a decline in families parenting
functions. Families face problems like domestic violence and child abuse, and midwives are
coming to have higher risks.
Child abuse is increasing each year, and of the 56 child abuse deaths in 2013, 25 (43.1%)
were of children less than one year of age. Preventive support continuing from pregnancy is
therefore crucial. Midwives can contact with mothers, children and families from the time of
pregnancy, and they are demanded on them for a role in preventing maltreatment.
Families need appropriate support to resolve various family problems, including maltreatment.
We conducted a survey on the knowledge, awareness, and practices of midwives in family
nursing for use as basic data in the development of a program to raise midwives practical
family nursing abilities. Here we focused on family assessments, a crucial issue for
appropriate family support, and analyzed the relationship between these assessments and
midwives backgrounds.
Design
Quantitative descriptive study
Methods
The subjects were 1,131 midwives working in maternity hospitals in Central Japan who
agreed to cooperate in the survey. A mail-in questionnaire survey was conducted using an
original survey form. The items analysed in this study were years of experience as a midwife,
post, academic qualifications, presence or absence of a model, and 23 family assessment
764
items. The associations between each attribute and family assessment items were analysed
using the 2 test. This study was approved by the Y university research ethics committee.
Results
445 responses were received, of which 436 were valid (valid response rate 97.9%). The
subjects mean years of midwifery experience was 11.1 years. Post was staff nurse for 308
(70.6%), team leader for 36 (8.3%), and assistant chief nurse or chief nurse for 65 (18.8%).
Academic qualification was midwife training school for 230 (53.2%), special midwifery
course for 122 (28.2%), university for 65 (15.0%), and graduate school for 14 (3.2%). 244
(58.0%) midwives had a model and 177 (42.0%) did not.
Significant associations were seen between assessment items and post, years of midwifery
experience, and presence or absence of a model, but not between assessment items and
academic qualifications.
Significant associations were seen between post and 6 assessment items, including
Assessment of the familys life events to date and their process of overcoming them
(P=0.001).
Significant associations were seen between years of midwifery experience and 2 assessment
items, including Assessment of the characteristics of the community in which the family lives
(P=000).
Significant associations were seen between presence or absence of a model and 9 assessment
items, including Assessment of relationships between the family and medical professionals
(P=0.001).
Conclusions
The findings suggest that after graduation midwives learn and practice the necessary
assessments while working together with superiors and colleagues to provide care. Learning
through experience is important in making appropriate family assessments.
3-5 Key words
Midwife, family assessment, factor
765
The meaning of the intraprofessional interactions among nurses in their

workplace
Huei Lee1, Min-Tao Hsu2

1.
School of Nursing, HungKuang University, Taiwan, 2. School of Nursing, Kaohsiung Medical

University
Presenting Authors Email: hueyinglee@hotmail.com
Purpose
The purpose of this paper is to further explore the cultural meaning of the professional
interactions and of the lived experience shred by nurses in Taiwan.
Design
The interpretive design of the study structure is constructed on mixed methods, integrating
hermeneutic phenomenology and ethnography as the theoretic basis.
Methods
Methodology includes data collection methods consisting of in-depth interviews, focus group,
participant observations and field notes. Participants are totaling 43 informants, with an
average age of 27.65 7.92 and a mean seniority level of 5.46 7.69 years.
Results
We found that a pro-familial structure exists in the interactive relationship of nursing
professionals, with 3 distinctive features present in the process of professional interactions,
being firstly the formation of hierarchy as a result of the order of arrival in the unit: first come;
first served basis. Second of all, supervising and training offered and received give rise to the
formation of the concept of subordination and responsibility: "my" senior or "my" junior
colleagues. The third is the competency of following empiricalized knowledge. Power
practice is the result attributed to the considerable latitude exhibited by the above 3 features,
which very frequently lead to difficult circumstances encountered by most new recruits. The
concept of conformity and subjugation is correspondent with the cultural as well as
professional demand for social collectivism in Taiwan.
766
Conclusions
The research findings provide nurses with the comprehension of the meaning of interactive
experience and professional placement within the organizational and cultural context. The real
benefit that can be reaped by both patients and nurses comes from true understanding of the
pragmatic need present in the current clinical climate in order for more creative nursing
strategies and clinical education in a threat-free environment.
3-5 Key words
Nursing culture, work interactions, lived experience, nurse adaptation, hermeneutic
phenomenology
767
Learning through the field activities of the disaster healthcare summer

school in Finland
Yuka Saito1, Yumi Tamura1, Mie Naiki1

1.
the Japanese Red Cross Collage of Nursing
Presenting Authors Email: yuka.saito44@gmail.com
Purpose
Disaster Healthcare Summer School was organized by University of South Wales (USW) UK,
Master of Disaster Healthcare and held at HAMK University of Applied Sciences, Finland on
August 11th -15th, 2014. This presentation aims to describe what I learned from reflecting
upon my participation.
Design
Descriptive investigation based on own Field Notes.
Methods
For reflection on my activities I have written Field notes for 5 days. First I read them
thoroughly, and then identified meaningful features to reflect upon: what happened; what I
did and why I did so; what was good or not good with my actions and why; and how I might
improve my actions when I have another similar situations in the future.
Results
30 students participated and divided in 2 groups. My group consisted of 6 full time students
and 9 part time students, aged 21-60. We came from countries such as UK, Sri Lanka and
Japan.
Reflection on my Field Notes resulted in 6 themes:
1) Awareness of own tendencies of thoughts and behaviors in general: I do not express my
thinking and own opinion in words or actions; I avoid conflicts with others and direct
approach despite being aware of a problem.
2) Awareness of my strong subjective impressions of an ideal leader which I create by myself:
my strong subjective impressions of an ideal leader such as fluency in English, having
768
much knowledge, and authority.

3) Awareness of own tendencies of thoughts and behaviors in team activities: my strong
dependence on the group members such as it would be ok, if I keep up with the team.
4) Awareness that my actions gradually changed: I realized increasing expression of my
feelings day-by-day, such as telling my feeling at a daily meeting and declaring my intentions
willingly.
5) Acute awareness of team functioning during disaster response training: building tent in the
second time and triage practice of mass causalities in last day.
6) Awareness of a lacking English ability such as listening and speaking.
Conclusions
It is hard to see own activities objectively in actual situations because relief assistants
often lose themselves when helping people1). Through reflecting on participating this
field simulation and having activities with multicultural members, I realized that I
might have several tendencies in actual situations.
Reflecting on own Field Notes facilitates better awareness of my internal tendencies of
thoughts and behaviors, so that it helps understanding myself objectively. Regardless of
the presence or absence of confidence, regardless of what might be right or wrong and
what people will think about me, expressing the thoughts and ideas honestly is the one
of my tasks I want to developed, and that will also help better understanding of others
and teams.
1) Y. Maruyama & K. Urata Edit.: Disaster Nursing and International Nursing, p25,
IGAKU-SHOIN, 2010.
3-5 Key words
Field simulation, reflective learning, self-awareness, team activities
769
The employment situation and support required for breast cancer patients
in Japan receiving chemotherapy
Sanae Asano1, Mayumi Niitani2, Naoki Kagawa3, Tsuyosi Kataoka2

1.
Hiroshima University Graduate School of Health Sciences, 2. Hiroshima University Institute of

Biomedical & Health Sciences, 3. Kagawa Breast Center
Presenting Authors Email: asano-sanae@hiroshima-u.ac.jp
Purpose
While cancer is the leading cause of death in Japan, its five year survival rate is improving,
and long term survival has become a possibility. Breast cancer is the cancer with the highest
contraction rate in females, and is the most contracted cancer in females in their forties and
fifties. Most women who work while undergoing treatment for malignant tumors are in their
forties and fifties.To elucidate the employment situation of breast cancer patients undergoing
chemotherapy, and what support the patients require upon the start of treatment.
Design
Statistics where calculated from the questionnaire responses.
Methods
An anonymous, self-administered questionnaire was collected from breast cancer patients
who had undergone chemotherapy. The studys objectives, methods, protection of
anonymity, etc. were explained to subjects in writing, and answering the questionnaire was
regarded as consent.
Results
30 subjects participated in the questionnaire. 20.0% received treatment in their thirties, 36.7%
in their forties, 36.7% in their fifties, and 6.7% in their sixties. 73% were employed at the
time of treatment, among which 36% were full time employees, 36% were part time, and 23%
were temporary (contracted with either an agency or the employer itself). Regarding their
employment status during chemotherapy, 20.0% continued working as usual, 53.3% took
leave but essentially continued to work, and 20% left their jobs. For patients who continued
770
working while undergoing chemotherapy, 41.7% reported that while painful they were glad
they continued working. Conversely, 33.3% of those patients reported that it was not painful
and perceived it as a change of pace and a way to go through chemotherapy without worrying
in solitude. 7 out of the 31 patients left their job before starting chemotherapy treatment,
among which 4 of them, upon receiving treatment, felt that leaving their job was actually
unnecessary.
Subjects said that before starting treatment, information such as the long term schedule, side
effects, severity of symptoms, and the cost of treatment is necessary. Also, they ask of their
employers systems that allow them to take leave, and proper knowledge of their disease.
Conclusions
Short term leave allows patients with breast cancer to continue working while undergoing
chemotherapy. In order to continue working during chemotherapy, an environment is needed
in which patients can take leave with peace of mind. A system that presents patients with
information early after their diagnoses is necessary to prevent patients from unnecessarily
leaving their jobs.
3-5 Key words
Chemotherapy, breast cancer, employment
771
Influence of digestive enzymes on development of incontinence-associated

skin lesionsInner tissue damage and skin barrier impairment caused by
lipases and proteases in rat macerated skin
Yuko Mugita1, Takeo Minematsu1, Gojiro Nakagami1, Yoshie Ichikawa2, Junko Sugama2,
Hiromi Sanada1
1.
The University of Tokyo, 2. Kanazawa University
Presenting Authors Email: yyuko-tky@umin.ac.jp
Purpose
Skin lesions caused by exposure to urine and feces can occur in patients with incontinence.
An effective care strategy for these lesions has not yet been developed. Development of such
a strategy requires better understanding of the biological influences of factors associated with
occurrence of these lesions. In patients with incontinence, macerated perineal skin is exposed
to both digestive enzymes and excessive water. The contribution(s) of lipases and/or proteases
to skin lesion formation has not been fully elucidated. We postulated that lipases and
proteases contribute to skin barrier impairment and tissue degradation in macerated skin. For
verification of this hypothesis, examination of human tissue is not appropriate because human
tissue is exposed to many factors and complicated. Therefore animal experiment, which can
limit the factors, is needed. This study aimed to examine the influences of lipases and/or
proteases on skin barrier and tissue structure in skin macerated by tris-HCl.
Design
An animal experiments were performed using male normal Sprague Dawley rats to examine
the influences of three factors (maceration, proteases, and lipases) alone or in various
combinations on the barrier function and histology of the skin.
Methods
The dorsal skin of the rats was treated with agarose gel soaked in one of the following four
solutions for 4 hours: 0.1 M tris-HCl (pH 7.4, M treatment); 0.1 M tris-HCl
supplemented with proteases (0.25% weight/volume [wt/vol] trypsin and 0.40% wt/vol
772
chymotrypsin, PM treatment); 0.1 M tris-HCl supplemented with lipases (2.5% wt/vol

lipase and 0.20 wt/vol phospholipase, LM treatment); and 0.1 M tris-HCl supplemented
with proteases and lipases (0.25% wt/vol trypsin and 0.40% wt/vol chymotrypsin, 2.5%
wt/vol lipase and 0.20 wt/vol phospholipase, PLM treatment). Untreated skin was used
as a control. Impairment of skin barrier function was measured by measuring transepidermal
water loss (TEWL) 30 min after completion of treatment. Skin tissue was collected 24 h after
treatment for histological examination to assess tissue damage. All animal experiments were
approved by the Animal Research Committee of the University of Tokyo.
Results
Macroscopic damage such as erosion or bleeding was not observed in any of the treatment
groups. Values for TEWL were higher in the PM, LM and PLM groups than in the M group.
Histological examination showed erythrocyte leakage in the dermis in the PM and PLM
groups. The finding of erythrocyte leakage without macroscopic erosion indicates that
enzymes penetrate through the epidermis and cause tissue damage from within the dermis.
Moreover PLM, adding lipases to PM, caused erythrocyte leakage more frequently and over
larger areas than did PM. However, a combination of skin maceration and treatment with
lipases did not cause erythrocyte leakage.
Conclusions
Proteases play a role in both skin barrier impairment and tissue damage, whereas lipases do
not play a role in tissue damage but do in the impairment of the skin barrier and acceleration
of penetration by proteases into the dermis of macerated skin, resulting in inner tissue damage.
Advanced nursing care of perineal skin in patients with fecal incontinence is required because
of the deleterious influence of lipases and proteases.
3-5 Key words
Incontinence, digestive enzyme, skin barrier, inner tissue damage
773
Coping mechanisms in relation to the physical and psychosocial effects of

work-related stress among graveyard shift call center agents
Juaymah Leynes1, Kenneth Brian Lim1, Hans Joseph Lim1, Rachel Limpo1, Vincent Oscar
Victor Limjoco1, Genecar Pe Benito1, Susan Maravilla1
1.
Presenting Authors Email: juaymah_leynes@yahoo.com
Purpose
The call center industry is one of the fastest growing businesses in the Philippines
characterized by unique job demands; nevertheless, it is greatly susceptible to high attrition
rates, inadequate coping mechanisms, and stress-related health problems, particularly among
those in the graveyard shift. Hence, the study aimed to identify the factors associated with the
coping mechanisms of graveyard shift call center agents.
Design
Descriptive-Correlational
Methods
To correlate the demographic variables, physical and psychosocial effects of stress, and
coping mechanisms, a descriptive-correlational research was conducted among 75
purposively-selected graveyard shift call center agents in Metro Manila after Ethics Review
Board approval. A 29-item researcher-made questionnaire, which has a Cronbachs alpha of
0.86 for both physical and psychosocial dimensions, was utilized to assess the common
physical and psychosocial effects of work-related stress while the adapted COPE Inventory
tool, which has a Cronbachs alpha of 0.91, was used to measure coping mechanisms.
Descriptive statistics and multiple linear regression analyzed gathered data.
Results
Results revealed that the most common physical and psychosocial effects of work-related
stress were inability to get enough sleep (M=2.50; SD=0.98) and mood swings
(M=2.30; SD=0.88), respectively. The coping mechanism was shown to be moderately
774
correlated with physical effects (r=0.31; p=0.004) and psychosocial effects (r=0.46; p=0.001).
Further, a nuclear family structure was positively associated with coping mechanisms (r=0.34;
p=0.001) while solitary family structure has a negative impact (r=-0.21; p=0.038) on coping
mechanism.
Conclusions
Work-related stress and family structure greatly influence a graveyard shift call center agent
s coping mechanism and these results may be utilized by nurses in creating health programs to
enhance the work conditions and coping mechanisms of call center agents.
3-5 Key words
Coping, psychosocial work-related stress, physical work-related stress, demographics
775
Indicators for visiting nurses end-of-life elderly patients to determine

whether patients are at the terminal-stage and aggravation-stage.
Yoko Katayama1, Hiroko Nagae2, Masako Sakai3, Shinya Saito4

1.
Department of Nursing, Faculty of Health Sciences, Kagawa Prefectural University of Health
Sciences, 2. Graduate School of Nursing, Chiba University, 3. School of Nursing, Seirei Christopher
University, 4. Graduate School of Health Science, Okayama University
Presenting Authors Email: ryouyoko@hb.tp1.jp
Purpose
To implement in a timely manner the intervention for supporting the patient's desire "to live
like a human being until the last moment of his/ her life", the determination of his/her medical
condition and the prediction of his/her prognosis are indispensable.
The purpose of this study is to explain the index of prognosis prediction made by visiting
nurses on the elderly patients receiving home care, patients whose prognosis prediction is
difficult to make, as they manifest all kinds of complicated end-of-life symptoms, irrespective
of whether they are cancer patients or non-cancer patients or of the type of their disease.
Design
This research design was qualitative study. The research focused on visiting nurses, who
interviewed, based on cases, about the respective symptoms and signs used as evaluation
criteria for prognoses of elderly patients into the two stages of terminal-stage and
aggravation-stage.
Methods
The subjects of this research were appealed to the public for the participants of the forum.
Interviews with a duration of about one hour were conducted with each subject. The
interviews were categorized on the basis of the similarity of meaning and content.
Results
From five visiting nurses, we obtained the data on eight cases of end-of-life patients.
The terminal stage refers to the period approximately two to five months preceding death, and
776
was determined by such signs as a negative spiral, including a delay in recovery after
physical exertion; a decrease in the amount of food intake and difficulties with ingestion
of solids; progression of disease symptoms; loss of physical and mental abilities;
and an increase in the number of emergency calls. In contrast, however, patients showed
improvement resulting from care and treatment; were able to consume their favorite
foods and do what they wanted.
The aggravation-stage refers to the period from approximately one month to one week prior
to death. The patients conditions changed rapidly and they did not respond to care. In
particular, this period was characterized by sputum retention and reduced urine output.
Furthermore, the patients' exhibited a depressed level of consciousness and
experienced difficulties even with fluid intake. Patients' families appeared to be
extremely fatigued and emergency calls became even more frequent. In addition, it
was understood that both the patients and their immediate families were aware that death
was imminent.
Conclusions
The visiting nurses grasped changes in the somatic symptoms and disease symptoms for both
terminal-stage and aggravation-stage patients. Due to their continuous involvement with
patients, it was possible for them to discern between even identical somatic symptoms as
indicative of the respective stages, based on differences in the degree and speed of change.
Changes in dietary intake and food composition were identified by all the nurses as primary
indicators. In addition, visiting nurses' used evaluation criteria that were based not only on
changes in patients condition, but also in the patients' families as well as their living
situations. This indicated visiting nurses' ability to also take into account the living conditions
and situation of the patients' families and perform their duties.
3-5 Key words
Prognosis prediction, terminal-stage, aggravation-stage, visiting nurses
777
Screening and assessment for intimate partner violence in emergency

departments: A questionnaire survey for administrators and staff-nurses in
Japan
Kazuaki Hirai1, Takayuki Kageyama1

1.
Oita University of Nursing and Health Sciences
Presenting Authors Email: hirai12@gm.oita-nhs.ac.jp
Purpose
Background: How emergency department (ED) nurses in Japan deal with intimate partner
violence (IPV)? This is unclear, although ED has an important role of screening and
assessment for IPV. To know the readiness of EDs in Japan to possible IPV cases, crosssectional surveys for ED and ED nurses were conducted.
Design
This was a crosssectional study design that used a self-administered questionnaire, developed
specifically for this study.
Methods
Questionnaires were sent to 245 EDs and 375 ED nurses in Japan.Ethical considerations:The
following was explained to the participants regarding ethics:that the results would undergo
statistical analysis,but the individuals would not be identified; that the information obtained
was confidential and confidentiality would not be used for any purposes other than research;
and that participation in the study was voluntary and consent could be retracted at any time.
Ethical approval for this study was obtained from the Ethics Committee of the School of
Medicine, Oita-university,Oita,Japan.Statistical analysis: SPSS V.20 was used for the
Results
Out of 245 EDs anonymously completed self-administered questionnaires on possible IPV,
and also 60 (24.5%) among 375 ED nurses did. Among the EDs, 58.3% had policy for
responding to victims of IPV, and 21.6 had screening guidelines for IPV. Although 59.2%
778
of ED staff-nurses perceived they met possible IPV cases in the last one year, only 11.8% did
screening. Lack of time, busy conditions, and rejection of patients or family interfered the
screening. Whether conduct screening for IPV or not was associated with opportunities of
training on care of IPV cases.
Conclusions
Readiness of EDs to possible IPV cases is insufficient. More effective guidelines of IPV
screening and training program for using guidelines efficiently should be prepared to ED
nurses. Relation between contents of the training and IPV screening should be clarified in
future study.
3-5 Key words
Intimate partner violence, screening, emergency department, nursing education
779
Nursing practice of skin care for radiodermatitis of breast cancer patients
Yasuyo Fukushi1, Chieko Itaki1

1.
Hirosaki University Graduate School of Health Sciences
Presenting Authors Email: yasuyo1293@gmail.com
Purpose
The aim of this study was to show Japanese nursing practice of preventive skin care for
radiodermatitis of breast cancer patients.
Design
Cross-sectional Study
Methods
321 curative facilities in total were chosen from 296 facilities belonging to Japanese Society
for Therapeutic Radiology and Oncology (JASTRO) and 114 facilities that Radiation Therapy
Nursing certified nurses belong to, excluding overlapping facilities. Subjects of this question
were nurses doing radiotherapy (RT) of outpatients. One nurse chosen by one facility
answered the questionnaire survey. As for nursing practice of skin care of RT, we researched
separately about timing of the therapy. The questionnaire consists of questions on <adverse
effects for RT>, <notes on markings>, <washing and wiping in irradiated site>, <ideas for
clothing>, <cooling>, <application of ointment> and <daily life>. We examined existence or
non-existence of these descriptions.
Results
As for <washing and wiping in irradiated site>, as the nursing practice for radiodermatitis,
[washing irradiated skin in and near the irradiated site using soap] was instructed by 77.3%
nurses during RT, and by 93.3% nurses after RT. [Washing the irradiated skin in and near the
irradiated site using mild soap] was instructed by 42.7% nurses during RT, and by 50.7%
nurses after RT. [When using soap, lathering the foam and washing the irradiated skin by
sliding the foam] was instructed by 66.7% nurses during RT, and by 81.3% nurses after RT.
780
[When wiping water off the irradiated skin, wiping by pressing lightly, not rubbing, against
the irradiated skin] was instructed by 83.3% nurses during RT, and by 80.7% nurses after RT.
Conclusions
Sven D haese, et al. (2010) conducted the research on washing irradiated site and reported
that there were changes in nursing practice between 2001 and 2006. In 2001, 45% nurses
instructed patients not to wash the irradiated skin, whereas the ratio was significantly reduced
to 10% in 2006. When washing the irradiated skin, nurses who were teaching them to use
mild soap increased significantly. The irradiated skin is susceptible to infection because
barrier function of the skin is impaired. It is said that the use of soap for washing lead to
prevention of infection by reducing fungal and indigenous bacteria on skin (Miura, 2009).
From our research, whereas 90% nurses instructed washing of the irradiated skin using the
soap after RT, only 70% nurses instructed to do the same during RT. It was considered that it
is not sufficient to instruct patients to maintain skin cleanliness only during RT. Therefore, it
is considered that it is important in the care of radiodermatitis to maintain skin cleanliness
during and after RT.
3-5 Key words
Skincare, Radiodermatitis, Breast cancer, ,
781
Effects of progressive muscle relaxation training on symptom distress and

anxiety in colorectal cancer patients undergoing chemotherapy
Chu-Chi Hsiao1, Ue Lin 2

1.
National Taiwan University Hoapital, 2. National Taipei University of Nursing and Health Sciences
Purpose
To investigate the effect of progressive muscle relaxation training on symptom distress,
anxiety and vital signs of colorectal cancer patients undergoing chemotherapy.
Design
The quasi-experimental design was used in the study.The samples were chosen from the
oncology and colorectal surgical ward of a medical center in northern Taiwan.
Methods
Sixty-eight colorectal cancer patients who received chemotherapy were randomly assigned
into experimental or control group. The experimental group received a 20-minute progressive
muscle relaxation training twice a day during chemotherapy period. The control group
received ward routine care.Symptom Distress Scale, Trait Anxiety Inventory and Vital Signs
were used to assess symptom distress and anxiety level during chemotherapy period.
Results
The results showed that1Progressive muscle relaxation training can significantly
reduce symptom distress of the patients who undergo chemotherapy (p < .01), which included
the nausea, vomiting, appetite, insomnia, pain, fatigue, cough, bloating, dry mouth ,
restlessness, inability to concentrate and heartburn. 2Progressive muscle relaxation
training can significantly reduce patientsanxiety arising from chemotherapy (p < .01). 3
Progressive muscle relaxation training can significantly reduce patientsblood pressure as
the result of chemotherapy (p < .05). 4The relevant factors of the impact of progressive
muscle relaxation training to improve symptom distress and anxiety: Trait anxiety, symptom
distress and state anxiety showed negative correlation (r = -0.59, p < .01; r = -0.70, p < .01).
782
Conclusions
From the above descriptions we conclude that: progressive muscle relaxation training can
improve symptom distress and anxiety during chemotherapy. Trait anxiety and education
level will affect the effectiveness of progressive muscle relaxation training. The research
result provides the references for clinical nursing practice.
3-5 Key words
Progressive muscle relaxation training, symptom distress, anxiety
783
An exploring study of the nurses perspectives on evidence-based nursing
Pai-En Chiu1, Tsui-Ping Li2, Ruo-Nan Jueng1, Chiu-Mieh Huang3

1.
National Yang-Ming University Hospital, 2. Mackay Memory Hospital, 3. National Yang-Ming

University
Presenting Authors Email: 11231@ymuh.edu.tw
Purpose
The application of evidence-based practices has gradually extended from the medical field to
the nursing field, and is considered an optimal method for enhancing nurses to identify and
resolve clinical problems. Nurses exhibit numerous subjective perspectives that influence
their motivation to promote and execute evidence-based nursing. This study aimed to identify
and categorize nursing staffs perspectives relating to evidence-based nursing into groups of
shared opinions.
Design
Q methodology was adopted to investigate nurse perspectives of evidence-based nursing.
Methods
A 2-stage data collection design was adopted. During the first stage, in-depth interviews were
conducted to obtain a sample of 44 statements related to evidence-based nursing. During the
second stage, a series of Q sorts was performed to subjectively rank the relevant descriptions
obtained from the nurses. The rankings were subjected to factor analysis by using the PQ
method software. The study participants were 60 nurses at a medical center and a regional
teaching hospital.
Results
A total of 51 nurses were classified, which explained 42.5% of the variance. Four group
categories were obtained which were labeled: looking forward to receiving support;
motivating by external drive; emphasizing professional values, and constrained by individual
capability. Nurses in the looking forward to receiving support group agreed that
784
implementation of evidence-based nursing can enhance critical thinking, but searching for
appropriate research articles is difficult and time-consuming. If someone could guide them,
they would be more motivated to implement evidence-based nursing. Nurses in the
motivating by external drive group preferred that providing adequate incentives or
considering the execution of evidence-based nursing as part of flexible working hours would
make them more willing to promote evidence-based nursing. Nurses in the emphasizing
professional values group agreed that implementation of evidence-based nursing would
help other professions to recognize nursing professional competence, change current thinking
patterns and increase the quality of healthcare. Nurses in the constrained by individual
capability group thought it was difficult of comprehension on research articles, and timeconsuming to search the literature, and feared that this would increase the clinical working
load.
Conclusions
The emerging perspectives highlight areas to target in implementation of evidenced-based
nursing. The four identified categories may be useful in developing tailor-made continuing
education strategies. These results can be used as a reference by hospitals in promoting
evidence-based nursing.
3-5 Key words
Evidence-based nursing, nurse, Q methodology
785
Pliant as a bamboo: Understanding the experience of Aetas in dealing

with illness
Gian Carlo Torres1

1.
Presenting Authors Email: giantorres26@yahoo.com
Purpose
The Philippines, consisting of numerous islands and different ethnic groups, is a melting pot
of various cultures that hold unique beliefs and practices regarding health care. Nurses must
be transculturally prepared to deal with patients with varying culture and ethnicity. Despite
the growing demand for transcultural competence among health care practitioners only a little
is known about how the native aetas from the Philippines deal with their experience of illness
among their family members thus it is the aim of this paper to describe this phenomenon.
Design
The study is a descriptive phenomenological study which included 8 aeta mothers from a
town in Tarlac. An in-depth interview was conducted and recorded from the informants and
was transcribed and analyzed using following steps described by Giorgi (1985) by carefully
reading and re-reading the transcripts until the information has been transformed into a
concrete language that described the phenomenon.
Methods
Bracketing was done by the researcher, Trustworthiness was ensured through initial
interactions and prolonged individual interview conducted at the setting where the informants
are comfortable within their community setting and audit trail on the transcriptions and codes
have been established
Consent was secured from the participants to conduct interviews and to audio record the
interviews. Confidentiality and anonymity was ensured and a standby psychologist was
sought but no participant needed any additional assistance.
786
Results
From 210 level codes 6 initial cluster themes emerged namely: culture specific practices,
culture preservation, positive experiences, negative experiences, involvement and adaptation.
3 themes emerged from the clusters which includes : (1) CULTIVATING THE CULTURE,
which clearly characterize that indigenous plants and trees are the primary source of the
natives for their various cultural rituals for healing and individual and family use for
nourishment. (2) ENABLING EXPERIENCES , described the way society and the health
care providers deal with the natives influenced how they perceive illness, their various
encounters enabled them to either respond positively or negatively to the advances in health
and knowledge with regards to treatment of illness and diseases. (3) ADAPTIVE
RESILIENCE , that the aeta culture have adapted to the changes of time, that health is a
priority among the aetas and individual personal welfare will be of priority over prior
customs as reflected in having no gender preference among health care professionals . From
which the phenomenon of a pliant bamboo emerged to describe the experiences of the aeta's.
Conclusions
Understanding the culture of the aetas will help enable healthcare workers to be more
responsive and sensitive to the needs of this cultural group that goes beyond the physical
needs but deeper into the character and culture of the native aetas.
3-5 Key words
Culture specific, transcultural, aeta's, resilience,
787

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