No abstract

The aim of this study was to develop a valid and reliable new nursing practice scale for measuring support for surrogate decision-makers, such as family members and close relatives, of terminal care in the intensive and critical care unit. Methods: Based on a review of the literature, a new scale was drafted and its content validity was evaluated. Next, a survey using an self-administered questionnaire was conducted at intensive and critical care units in emergency and critical care centers in Japan on 473 clinical nurses. All responses were then subjected to statistical analysis, including item analysis, item-total correlation, good-poor analysis, exploratory factor analysis，validation of criterion-related validity，knowngroups method, and the test-retest method. The ethical behavior scale for nurses was used for criterion-related validity. Results: Exploratory factor analysis using the maximum likelihood method and promax rotation was performed to extract factors, resulting in a four-factor solution with 18 items. The four extracted factors were named as follows based on their content: Factor 1, " Interprofessional Collaboration"; Factor 2, "Preparation for surrogate decision-making"; Factor 3,"Evenly unbiased attitudes and checks on Doctor's explanation"; and Factor 4,"Facilitation of surrogate decisionmaker thinking". Cronbach's alpha coefficient was 0.89 for the total score and varied between 0.74-0.84 for the four factors. The correlation coefficient for the retest survey was 0.71, while that for the ethical behavior scale for nurses was 0.54. Known-groups method resulted that the group of certified nurse specialists and certified nurses showed significantly higher score than nurses except them, and so did the group with learning experience. Conclusion: The validity and reliability of the nursing practice scale developed in this study to measure support for surrogate decision-makers of terminal care in the intensive and critical care unit were confirmed.

Subjects were divided regarding to island group based on the availability of nursing facility care.To estimate the behavioral dimensions of subjects based on data similarities and mutual relationships, correlation axes for preferences about living on or off the island and with families or independently were extracted using Hayashi's third method of quantification.In the facility available island group, living with family off the island was most common among elderly people, while most young and middle aged people wanted to remain on the island, representing significant intergenerational differences. In contrast, in the facility unavailable island group, living on the island was common in all generations.These results indicate that living preferences during the care period for elderly people living on small isolated islands are influenced by the current state of nursing care for the elderly both on and off isolated islands.Key words living preferences during the care period, small isolated island, availability of nursing care facilities, intergenerational differences during the care period, Okinawa

Objective: This study aimed to clarify the association between sense of filial responsibility, local residents' subjective economic status, and attachment to the local community, and to contribute to local community policies and measures including support systems for elderly in need of care and family. Methods: We conducted in-home interviews in 2015 in Okinawa, Japan. A total of 2,663 local residents were selected, and after invalid responses were excluded, 1,656 responses (62.2%) were analyzed. Participants were asked about demographic variables (sex, age, marital status, birth order, subjective health, living arrangement), subjective economic status, attachment to the local community, and sense of filial responsibility (such as caring for and supporting their elderly parents). Results: Age, marital status, birth order, and attachment to the local community were positively associated with sense of filial responsibility. Participants with low subjective economic status had low sense of filial responsibility. Even if subjective economic status was low, participants with high attachment to the local community had significantly high sense of filial responsibility. Moreover, participants with high attachment to the local community provided and received more instrumental support than participants with low attachment to the local community. Conclusions: Our findings suggest that high attachment to the local community can form a support system in local areas, and that support systems in turn help local residents when they support their parents. In light of these findings, measures for creating networks between local residents, as well as improvement of the physical environment, are necessary for local community planning.Key words： sense of filial responsibility, attachment to the local community, subjective economic status, social support, social capital 親扶養意識，地域愛着，経済状況，ソーシャルサポート，ソーシャル・キャピタル １ 琉球大学医学部保健学科

The purpose of this study was to investigate the effective midwifery care from pregnancy to postpartum in order to promote evidence-based midwifery practice in improving childbirth satisfaction and breastfeeding. The subjects were one-month postpartum mothers who came to one-month check-up during July to October in 2010. The purpose of the self-administered questionnaire developed by the research group was explained, then provided to mothers who agreed to participate in the survey at 4 hospitals each with more than 300 beds and 1 clinic with more than 500 deliveries annually in Okinawa. The questionnaire was collected on the same day or via postal mail. A total of 540 mothers agreed to complete the survey, and 434 responses were considered valid for this study (valid response rate: 80.4%). Vaginal delivery group was 223 (82.3% with medical intervention rate of 15.2%), and the cesarean section group was 48 (17.7%). The most helpful one-on-one guidance was "nipple care in preparation for breastfeeding" during pregnancy, "encouragement" during delivery, and "Kangaroo (skin-to-skin) care" immediately after the delivery. An Application rate of episiotomy was 65.2% for primiparous women and 30.5% for multiparous women. The rate of perineal laceration enlarged to more than third degree in cases with episiotomy is three times more than the cases with no episiotomy. Additionally, the prevalence of breastfeeding at one-month postpartum was significantly higher in the mothers rooming-in with the baby (76.2%) than mothers in separate room (28.3%). Moreover, 60.3% of the mothers in the complete rooming-in group answered they had not felt difficulty with childcare while it dropped to 46.2% among the mothers in the separate room group.