Effects of an ethics education program on nurses' moral efficacy in an acute health-care facility

AIM

This study aimed to evaluate an ethics education program developed to increase moral efficacy among nurses in an acute health-care facility.

BACKGROUND

Moral distress among nurses can cause serious problems in terms of hospital organizations and patient safety. To reduce moral distress and promote professional confidence in nursing practice, a strategic intervention program is needed.

METHODS

An ethics education program introduced methods to increase self-efficacy in accordance with Bandura's social cognitive theory. Eight nurses were recruited from 2017 to 2019 and all conversations and discussions regarding the ethics consultation were recorded on IC recorders and analyzed qualitatively.

RESULTS

Four core categories-Convinced to take an active role in ethical issues; Progressed in nursing practice with ethical agency; Experienced professional transformation; and Empowered by the presence of colleagues-emerged as outcomes of the ethics education program that related to moral efficacy.

CONCLUSIONS

The four core outcome categories suggested that the participants had gained confidence after taking part in the ethical education program.

IMPLICATIONS FOR NURSING MANAGEMENT

The results of the participants' described behaviors and actions suggested that they would be proactive in contributing to reductions in moral distress in the future.

Challenges and Opportunities for Occupational Health Nurses in Asia

This article provides a brief overview of the effect of economic globalization on Asia, presents occupational health issues from select countries, and discusses challenges and opportunities for occupational health nurses.

[The relationship between the contents and the level of achievement of objectives in an occupational health nursing practicum]

The purpose of this study was to evaluate the program and teaching methods of the occupational health nursing practicum in order to enforce students' learning experience in the clinical practice. Self-evaluation sheets graded from levels 1 to 4 were from 63 students, and statistical analysis was performed in relation to their performance levels. The results of the analysis of 63 students' performance sheets indicated that the students achieved 3 points above average in all 14 course objectives. Scales analysis of the students' evaluation sheets also revealed that students' achievement levels were lower at the Industrial Health Organization in comparison with those at the industrial enterprises. To make students' practice more valuable, students' assessment skills of the workers and working environment should be emphasized in the classroom teaching and experience of learning at the laboratory. Moreover, the course objectives should be sufficiently linked to the practice areas in order to differentiate between the features of the Health organizations and enterprises.

[Current status of employment and labor of occupational nurses in external agencies for industrial health]

The purposes of this study were to survey the actual conditions of the employment status and activities of occupational health nurses who are employed in Japanese Industrial Health Organizations (IHOs), and to investigate whether the OHNs provide quality health services to employees. We mailed 1,780 questionnaires to nurses who belong to 92 IHOs (members of the National Federation of Industrial Health Organizations). A total of 976 questionnaires were returned (54.8% valid response rate) and 968 questionnaires were considered eligible for analysis. The results showed the following issues: 1) most public health nurses belonged to the department of occupational health service, but they did not have enough experience with industrial hazards or workers safety or health; 2) public health nurses want to participate more directly in care for workers; 3) Public Health Nurses provided health counseling in the charge of their enterprises, but they did not take managerial roles, including place-of-work patrol, attendance to safety, and health committees in their workplaces; 4) they were not satisfied with the present roles demanded by the other staff and their managers; 5) they did not have enough opportunities to attend the job training. Together, the results of this study suggest that the OHNs in IHOs need to have more opportunities to perform their expertise in industrial health & safety and job training in order to provide autonomous health services to the workers.

The effect of lemon fragrance on simple mental performance and psychophysiological parameters during task performance

The purpose of this study is to effectively utilize fragrance in order to form a comfortable working environment, for which we obtained necessary data. The subjects were 14 female students. We made them do addition work in laboratories with and without lemon fragrance, and investigated their task performances, physiological changes and mood conditions. Our results showed that, although the existence or nonexistence of fragrance did not affect their work efficiency, it was revealed that fragrance mitigated exhaustion and maintained vigor.

A very low level of magnetic field exposure does not affect a participant's mental fatigue and stress as much as VDT work

Exposure to Magnetic Fields (MF) may affect the health of workers in an occupational environment. However, there is no clear evidence that the emission of MF from the visual display terminals (VDT) affects workers'mental status or induces stress in office environments. The purpose of our study was to investigate whether exposure to the MF during VDT work affects mental fatigue or induces stress related to psycho-physiological changes in workers. Thirty-seven students were voluntarily recruited to participate in this study. We created experimental conditions that a pair of the liquid crystal display (LCD) terminals separated by screens was closely placed in front of the visual suface of the cathode ray tube (CRT) units. All participants were not able to recognize whether the power of the CRT Units was ON or OFF while they worked with the LCD terminals. When the CRT unit was ON, participants who worked with the LCD terminal were called CRT-ON group. On the other hand, when the CRT unit was OFF, participants who worked with the CLD terminal were called CRT-OFF group. Incredibly short profiles of mood states (ISP)and subjective symptom questionnaires were used as indices of the mental fatigue as well as psychological stress before and after VDT work. Furthermore, salivary chromogranin A and urinary 8-hydroxydeoxyguanosine (8-OH-dG) were collected to measure physiological changes before and after VDT work. The results of the questionnaires and salivary and urinary stress markers showed that the exposure to the MF during VDT work did not significantly induce mental fatigue or psychological stress in comparison with the CRT-OFF group. Contrary to the results from the exposure, mood states of vigor decreased greatly (P < 0.05) whereas the states of fatigue and confusion increased significantly (P < 0.001) after VDT work. In the questionnaires for subjective symptoms, participants complained remarkably regarding 14 out of 25 conditions after VDT work. Moreover, urinary 8-OH-dG excretion increased significantly after VDT work. Taken together, the results of this study did not detect any bad health effects of MF exposure on the VDT participants but suggested that VDT work itself affects their mental fatigue and psycho-physiological status.

[An investigation of social support networks for working mothers]

The purpose of our study was to investigate the social support network for working mothers, including physical, emotional and informational sources, and to discuss strategies to reduce stress caused by their multiple role strain. We asked 18 participants to fill in a questionnaire and conducted semi-constructed interviews. The results of this study showed that more than half of the working mothers want to continue their career because of self growth and the rewards from their job. Many mothers responded that a sympathetic understanding by their husbands, families and people at workplaces is essential to create a balance between their career and housework. As a result, their husbands mainly provide physical support in housekeeping and child caring, whereas their mothers provide physical and emotional support from knowledge based upon their own experience. Almost all working mothers complained of a shortage of nurseries and child caring facilities as well as limited availability of flexible services. In conclusion, the results of our study suggested that the identity of the traditional gender role needs to be changed to a contemporary one, like a husband fully participating in his child's rearing activities by reconsidering his working hours. Moreover, community services to support working mothers should be increased.

Defining the roles and functions of occupational health nurses in Japan: results of job analysis

The purposes of this study were to obtain descriptive information about the job duties and tasks of Japanese occupational health nurses and to compare the roles and functions of occupational health nurses in the United States and Japan. A modified version of a job analysis survey developed by the American Board for Occupational Health Nurses was used to collect data. The findings indicated 62% of Japanese occupational health nurses perform direct care roles, approximately half perform educating or advising and consulting roles, and approximately 40% perform management roles. Details related to specific tasks and differences in nurses with varying preparation also are presented. Although there were many similarities in the types of tasks performed by nurses in Japan and the United States, the proportion of time devoted to specific tasks in the two countries varied. These results support the need for developing an educational system to enhance occupational health nursing practice in Japan. The information derived from the study provides a knowledge base that can be used to provide guidance and direction to the content of occupational health nursing programs.

[Study on lower back pain in home helpers and development of materials for occupational health education]

People who are engaged in home health care services often have to transfer clients while in a half standing posture using repetitious movement including gravitational changes. Transferring heavy patients at homes for the severely mental and physical handicapped is equivalent to the care giving work, listed in the "guideline for prevention of lower back pain in work places" (1994/9/6). The purpose of this study was to investigate incidences of lower back pain and injuries among home helpers as well as to determine the relationship between their level of protective knowledge and prevalence of lower back pain. The results of the study revealed that home helpers complained of a mild type of lower back pain. Although almost all of them had the protective knowledge for lower back injuries that was taught in their training courses, they still felt the need for more knowledge through continuous education regarding protective measures for lower back injuries and pain. Regarding the method of teaching, they want to learn by TV programs, books, texts and self-learning materials. Few of them wanted to learn by computer assisted instructions or the internet. Based upon the results of this study, we have developed new teaching materials for home helpers which explain adequate postures in home care through utilizing their protective knowledge to avoid lower back pain.

[Students awareness of health teaching: evaluation of "health education" course and the occupational health nursing practice]

The "health education" course is an important part of the baccalaureate curriculum in nursing. It is essential to teach students effective health education in a client oriented way. In order to improve the quality and content of this course, we extracted students descriptions from records of 44 students who had carried out group health education during nursing practice for the occupational health nursing course. We then analyzed students written sentences on their views concerning health teaching. After sentence analysis, we categorized these concepts into groups and titled them. The results of clarification of categories showed that the most common student awareness was in regard to technical and instructional skills, such as precise and suitable language selection for laymen, and utilization of teaching devices or mediums, during implementation of health teaching(43.6%). Secondly, assessment of health needs for a certain working population(10.3%), and effective teaching types such as instructional participant volunteers and full participation(9.2%) were deemed important. Thirdly, identification of the role of the occupational nurse(7.7%), and lastly the necessity of evaluation(2.3%) were considered necessary. Over all, in this study we found that students were most concerned about the instructional skills during the presentation of health education. Also, these results suggest that development of contents in the "health education" course to reinforce students assessment and evaluative abilities should be incorporated into the course. Furthermore, faculties who teach a "health education" course should provide a large variety of teaching materials and creative instructional methods for the students.

Synaptic loss following depletion of noradrenaline and/or serotonin in the rat visual cortex: a quantitative electron microscopic study

Biogenic amines have a trophic-like role for the formation and the maintenance of synapses in the CNS. We examined the changes in the number of synaptic profiles in the developing and adult rat visual cortex following selective depletion of noradrenaline and/or serotonin. By the drug-induced decreases in levels of noradrenaline or serotonin between 1 and 2 weeks after birth, the number of synaptic profiles was decreased by 29-55% compared with that of control animals. The magnitude of reduction in the number of synaptic profiles was virtually the same following simultaneous depletion of both noradrenaline and serotonin compared with the depletion of noradrenaline or serotonin alone. Later in the developmental period, the function of noradrenaline and serotonin in facilitating synapse formation and maintenance became less prominent than that in younger animals. In the control animals, the number of axosomatic synapses was the highest at around 2 weeks after birth, and decreased with development. The number of axodendritic synapses was the highest between 2 and 7 weeks after birth, and decreased to 50% at 11 weeks after birth. These data demonstrate that synapses in the rat visual cortex are overproduced during the early developmental period. We suggest that both serotonin and noradrenaline are necessary for synapse formation during the early stages of development of the rat visual cortex.

[A survey of public health nurses regarding their awareness of the abilities, skill and knowledge necessary to fulfill an occupational health nurse's role, and proposal of a new curriculum for occupational nurse specialists at the master level]

The areas of conduct and professional roles in occupational health nursing in Japan has not been defined as yet, even though occupational health nurses have contributed to implementing jobs related to the health examination in workplaces every year. We surveyed public health nurses regarding their awareness of the abilities, skills and knowledge necessary to fulfill an occupational health nurses' role. When answering, they became aware of deficiencies in their abilities, skills and knowledge. This was particularly true in counseling, health assessment skills and management abilities, specialized knowledge of occupational safety and health, ergonomics and environmental health. We propose a curriculum at the master level for occupational health nurse specialists with reference to the core curriculum for occupational and environmental health nursing in the USA.

[Study of environmental factors for care of demented elderly men]

Men interact with the environment, which sometimes leads them into distressful conditions. This stressful stimulation can induce neurodegeneration and hippocampal atrophy by increasing the glucocorticoid level. Especially, the elderly population is very vulnerable to exposure to the increased glucocorticoid due to environmental stress that results in accelerating the aging process. On the other hand, enriched physical and human environments may help to maintain their cognitive function in spite of aging. For example, aged healthy volunteers with a lower glucocorticoid level caused by avoiding distressful conditions were able to maintain large volumes of hippocampus and a better short-term memory. The purpose of this study was to investigate whether better residency for the elderly men who have a mild type of senile dementia can maintain their mental abilities. We observed and videotaped behaviors of demented elderly men who lived in either a group home or a traditional type of nursing home while they were participating in their daily activities. We made our own inventories which measured the total mental abilities, such as degrees of social interaction, degrees of motivation for participation in daily activities, degrees of independence, and degrees of facial expression, then analyzed the data with these inventories in order to compare the behaviors of the two groups. The result did not show any significant differences in the levels of mental abilities, the degrees of motivation for participation in daily activities and independence between the two groups. However, regarding social interaction, the elderly men who live in the group home exhibited a more approaching behavior toward an unfamiliar person than those who lived in the traditional nursing home.

Syk protein-tyrosine kinase is involved in neuron-like differentiation of embryonal carcinoma P19 cells

Syk has been implicated in activated immunoreceptors to downstream signaling events in hematopoietic cells. Here we report that Syk is expressed in neuron-like cells and involved in neuron-like differentiation of embryonal carcinoma P19 cells. Immunoblot, RT-PCR, and Northern analysis indicated that Syk is expressed in mouse brain, PC12 and P19 cells. In addition, Syk was found to be tyrosine phosphorylated during neuron-like differentiation of P19 cells. Furthermore, adenovirus-mediated overexpression of Syk induced supernumerary neurite formation and extracellular signal-regulated kinase (ERK) activation in P19 cells. These results suggest that Syk plays an important role in signaling steps leading to ERK activation in P19 cells.

Activation of calpain precedes morphological alterations during hydrogen peroxide-induced apoptosis in neuronally differentiated mouse embryonal carcinoma P19 cell line

In order to reveal neurodegeneration elicited by reactive oxygen intermediates (ROI), neuronally differentiated cells from mouse embryonal carcinoma P19 cell line were exposed to hydrogen peroxide (H2O2). Enhanced protein-phosphorylation on tyrosine residues was detectable within 5 min of exposure to H2O2, and gradual rises in intracellular free Ca2+ level and in calpain activity were observed. Furthermore, H2O2 stimulation of differentiated P19 cells for 24 h resulted in morphological alterations in somas as well as neurites. Also, within 6 h of H2O2 treatment DNA fragmentation has been detected. Taken together, these results suggest that oxidative stress induces degradation of cytoskeletal proteins presumably resulting from increased intracellular Ca2+ concentration and subsequent activation of calpain.

[Differential diagnosis of schizophrenic symptoms complicated with brain anomalies including bilateral temporal arachnoid cysts by eye mark recorder and PET: a case study]

Bilateral temporal arachnoid cysts and other intracranial congenital lesions including a moderately large left temporal arachnoid cyst accompanied by remarkable dysplasia of the temporal lobe in particular were discovered by chance during computerized axial tomography of a 26-year-old Japanese male who had been diagnosed as schizophrenia approximately 10 years earlier. A detailed re-assessment revealed no other organic symptoms or signs. His symptoms and clinical course met the DSM-IV criteria for schizophrenia, disorganized type. Based on his symptoms, positron emission tomography (PET) and the eye-movement recording test developed by Kojima et al. were performed. In addition, psychological tests including WAIS, Rorschach Test, and Wechsler's Memory Test were administered for further differential diagnosis. PET using continuous inhalation of oxygen 15-gas revealed a regional decrease in CBF and CMRO2 in the superior medial frontal lobe including the anterior cingulate gylus, findings sometimes associated with schizophrenia. However, no abnormal findings were noted around the arachnoid cysts. In the eye-movement recording test, several parameters including the responsive search score (RSS) were about the same level as that commonly observed in schizophrenics and are classified as schizophrenia by discrimination analysis. The psychological tests offered no reason to doubt the diagnosis of schizophrenia. Thus, the patient was diagnosed as schizophrenia with arachnoid cysts and other intracranial lesions. The way of diagnosis we used here might bring forth a breakthrough in schizophrenia research by differentiating schizophrenia from the other organic brain diseases.

Symptom classification of schizophrenia changes with the duration of illness

Our starting hypothesis was that schizophrenic symptomatology changes over time. This hypothesis explains conflicting reports on schizophrenic symptom structures as a consequence of different durations of illness in the samples studied to date. Therefore a sample of 258 schizophrenic in-patients (with ICD-10 diagnoses F20) was categorized according to illness duration. A factor analysis was performed on the 8 items of the Manchester Scale for three subgroups (duration < 10 years, 10> or =20 years and > or = 20 years). For those patients whose illness duration was less than 10 years, 'formal thought disorder' was not related to any other mental state, whereas for those whose duration was 10 years or longer, it was correlated with 'negative symptoms'. In the < 10 years group, 'anxiety and depression syndrome' and 'positive symptoms' formed one complex, but these symptoms were separated into two distinct syndromes in the > or = 20 years group. Thus we were able to demonstrate that the classification of symptoms changes with increasing duration of illness.

Criteria defining refractory schizophrenia

To date there has been no agreement with regard to the criteria that define refractory schizophrenia. In this study, we intended to clarify the criteria which psychiatrists use to judge schizophrenic patients as being refractory in Japan. Based on 258 schizophrenic in-patients (ICD-10) and their likelihood of discharge, level of psychosocial functioning, mental state and use of medication, the common features of patients who are viewed as non-dischargeable because of their severe mental state, compared to those of dischargeable patients, were extracted and used as the criteria. The criteria proposed necessitate (i) diagnosis of schizophrenia by standard operational criteria, (ii) continuous hospitalization for at least the past 2 years, (iii) a level of psychosocial functioning of < or = 40 as measured by the Global Assessment Scale, and (iv) an intensity score of 'marked' or 'severe' on at least three of the six Manchester Scale items (flattened affect, psychomotor retardation, delusions, hallucinations, incoherence of speech and poverty of speech).