Vol.13

SPRING 2003

NEWS FROM JANS
Report of the 22nd Research ConferenceMichiko Hishinuma
Dean of St. Luke's College of Nursing
Chair of the conference
The 22nd research conference of theJapan Academy of Nursing Science
was held on December 6th and 7th at
the Tokyo International Forum. “Telling
People How Nursing Makes a Difference” was the main theme. More than2600 nurses attended. Those who
worked to organize the sessions andmake arrangements for the conference
deserve our greatest appreciation. I
also wish to thank the many volunteers
who made our two days proceedsmoothly.
I presented the keynote address,“Develop Evidence in Order to Tell
People How Nursing Makes a Difference.” Next, Professor W. L. Holzemerof the University of California, San
Francisco, School of Nursing made an
educational presentation, “Translating
Nursing Research to Practice.” There
were two symposia, one on the firstday, “Quantitative Research Focusing
on Changing Nursing Practice” andone the next, “How Qualitative Research Can Changing Practice.” Inthese presentations we discussed how
high quality research could inform people about ways in which nurses canserve them.
There were 171 oral presentations
and 218 poster presentations at which
participants were active in questions
and answers based on their research
results. The program also included ten
exchange meetings, a seminar organized by JANS and a forum open to thegeneral public entitled “Thinking About
Death and Dying at Home.”
The common-sense understandingthat people through their own actions
can influence health practices and outcomes is more prevalent and now inJapan has been changing health care.
When people choose for themselves
the best way to keep their health, it isessential that health professionals provide them sufficient information. Whenit comes to nurses, it is also requiredthat we provide reliable information
supported by research findings.
In the keynote address, I pointed out
the difficulties of conducting nursing research that shows the effectiveness ofnursing arts. First, the stimulation ofnursing arts might be very little and theclient’s reaction is also small. Second,
inevitably, outcomes due to nursing

Dr.Yoshie Kondoh received the ResearchAward of 2002.

Forum for Citizens:“Thinking About Death and Dying at Home.”

Michiko Hishinuma, RN, MS
arts are influenced by the nurse-client
relationship. Third, even so, when weevaluate the effectiveness of nursing
arts it is worthwhile to pay attention to
the care receiver’s subjective evaluation. Then, I showed some researchdata suggesting that even the little
stimulation produced by nursing arts
within the nurse-client relationship issufficient to alter the clients’ physicaladjustment in a way that helps earlier
recovery and improves quality of life.
To summarize and conclude, I pointed
out that we could tell people that something is a nursing art only when we can
support that art with clear purposes,
elucidation of the mechanism thatbrings effectiveness, and the probability of obtaining good clinical effects.
Moreover the skills and practices of
those arts should be shown to be simple and safe, with the possibility of reliable performance.
Through this conference we, again,
made sure of nurse’s responsibility totell people in persuasive way what
nursing can provide for their healthy life
in order, as health care professionals,
to build partnership with individuals andfamilies and the community.

NEWS FROM JANS
Report of the Educational SpeechWilliam L. Holzemer, Professor, University of California, San Francisco &Visiting Professor, St.Luke’s College ofNursing, Tokyo presented a speech titled “Translating Nursing Research toPractice”.
In his speech, Professor Holzemer
introduced “Translational Research” asa way to promote high quality cost effective patient care and quality work life
for nurses. In order to show us the direction and process, he addressed fivesub-themes : definitions of translational
research, knowledge and evidence,
structure of knowledge, changing
nurses behaviors, and strategies towards a preferred future.
First of all, he reminded us that it
takes us long time to use new knowledge in our practice by quoting a Report of the Institute of Medicine (USA).
Then he showed how we, nurse scholars, can translate research to practice.
First, after introducing definitions ofothers, he defined translational research from a nursing perspective:“Translational research was links
knowledge directly with practice inorder to improve the quality and costeffectiveness of nursing care.” To further describe it, “It is organized, focused, changes practices, improves
client outcomes, enhances self-care,enhances quality of work life fornurses, is cost effective, and informs
public policy.” Dr. Holzemer emphasized both primary and secondary
structures of knowledge as critical elements in translational research. Primary structures of knowledge refer toknowledge generated through researchand published in journals. Secondary
structures of knowledge refer to knowledge generated by synthesizing published research, such as that being
produced by The Joanna Briggs Institute, Australia and others. Moreover, inorder to structure nursing knowledge,

Symposia Ⅰ:“Quantitative Research Focusing on
Changing Practice”

Symposia Ⅱ:“How Qualitative Can Change
Nursing Practice?”

Report of the Symposium
Symposia Ⅰ
The symposium entitled “Quantitative
Research Focusing on Changing Practice” was conducted in the afternoon of
the first day of the conference. Professor Megumi Teshima and Dr. Tomoko
Kamei served the chair of this symposium. Each symposist addressed theirexperience as the researchers, interms of why they selected particular
the quantitative method for this research; and issues and challenges

surrounding quantitative nursing research. Firstly, Dr. Hiromi Sanada presented her research project of fifteen
years, developing a mattress for bed
sore prevention following with its
evaluation. Then, Dr. Etsuko Tadaka
explained the steps for developing a
day care program for the elderly withdementia living at home and its evaluation. Finally, Dr.Shoko Arakawa described the issues and challenges
surrounding a research study promoting

William L. Holzemer, RN, Ph.D.
Dr. Holzemer stated that meta analysis
of completed studies is an essential
technique to detect or confirm differences in the outcomes of nursing practices. Then, to change the behavior ofnurses so that the goals of translational
research are met, he suggested that
we use both passive and positive models.
Dr. Holzemer gave us a map to improve quality of care and quality ofwork life for nurses. We, nursing scholars in Japan, should rise to the challenge these essential tasks in order tostructure knowledge for nursing.
His speech will be published in thejournal of the Japan Academy of Nursing Science.
(Junko Tashiro, RN, PhD,
St. Luke’s College of Nursing)relaxation for patients who were receiving chemotherapy. By the end of thesymposium, we concluded the following: 1) Nursing research education program may enhance the capability of
selecting develop research methods
depending on the research question;2) the impacts of the results of quantitative research on policy promote understanding among other professions;
3) quantitative results facilitate explanation to the outcome.
(Megumi Teshima, RN, MS.)

Symposia Ⅱ
The symposium entitled “How qualitative research can change nursing pr
actice?” was conducted under thechairmanship of Dr. Tomoko Inoue andDr. Mayumi Tutsui. First, Dr. Mieko
Tanaka gave an overview of qualitative
research based on her experience inthe study of life histories. Second, Dr.
Shigeko Saiki-Craighill spoke of her experiences running support groups formothers who have lost a child, a

project that developed out of her research results. Third, Dr. Noriko
Akimoto described her study on thecare of women who underwent operations for uterine cancer, which included
an explanation of how she analyzed
data. There was an animated discussion between the audience and speakers during the rest of the session
regarding : 1) How should data be collected from the subjects who cannot
express themselves, such as people

who are unconscious or small children;2) The validity of analysis ; 3) How theresults of a study could be presented ;and 4) How study results can be used
to instigate changes in practice. This
was a good opportunity for all attendees there think about the main
theme of nursing research, which is
how we should use the results of research to instigate developments innursing practice.
(Shigeko Saiki-Craighill, RN, DNSc.)

23rd JANS
Main Theme: Nursing’s Critical Role in the Community
Date:

6th and 7th, Dec. 2003

Place:Mie Prefecture Cultural Center

President: Masashi Kawano, RN, MS
Professor of Nursing, Mie Prefectural College of Nursing
Director of Nursing Research Center at Mie Prefectural College
of Nursing

Masashi Kawano, RN, MS

Key Speaker: Jean Watson, PhD, RN, FAAN, HNC.
Distinguished Professor of Nursing, and Founder, Center for Human Caring, Endowed
Chair in Caring Science, University of Colorado
Symposium ⅠandⅡ, Exchange Sessions, Oral Presentations and Podium.
Call for Abstract:
Contact: Tamiko Matsuda, Hiroko Hanada and Chiyoko Ito at Mie Prefectural College ofNursing
Phone and Fax: 059-233-5623

NEWS FROM JANSJANS Fifth International Nursing Research Conference
President: Yoko Nakayama, RN, PhD.

The Fifth International Nursing Research Conference will be held in Fukushima, North Japan on
August 29-31, 2004. The main theme will be “Nursing Phenomena and Research Designs : Search for
New Research Methods in Nursing”
This conference will be focused on developing nursing research methodologies in 21st Century andinternational networks of nurse researchers. The Planning Committee for the Conference will invitepresentations to be given at Poster Presentations, Information Exchanges and Workshops. The participants will be expected to produce active academic discussions in the conference.
Fukushima is a beautiful area with rich nature and hot spring. After discussions, you will enjoy walking
around the Lake Goshikinuma and taking Japanese-style Onsen baths (hot spring). If you need the information of Fifth International Nursing Research Conference, please contact the secretariat by:
Email : dean.nursing@fmu.ac.jp
Fax : +81-24-547-2346

Current Research
Abstracts from Vol.22 of Journal of Japan Academy of Nursing Science
1. Indou, M. (2002). Research on the mental health ofnurses -The verification of the causal model to predict
the anxiety of nurses related to cancer nursing and restructuring-. 22 (1). 1-12.
The purpose of this study was to verify the causal model
to predict the anxiety of nurses related to cancer nursing by
multiple regression analysis. The variables used for the multiple regression analysis used the anxiety scale of nurses as
the dependent variable and 17 variables (which include thenegative experience of a patient’s death, the cancer image,etc.) as the independent variable. This investigation was carried out with 500 nurses concerned with cancer nursing at 8
general hospitals in Osaka Prefecture in July-August 1998,
and using a questionnaire.
The main results were as follows:
The multiple correlation coefficient explained by 6 variables was 0.59 (P<0.001) through the working process thatthe problem of the multicollinearity was excluded as a resultof multiple recurrence analysis. The significant influences, indescending order of importance, were:
1. The negative experience of nursing patients at the timeof death;

2. The feeling of the gap in goals for cancer nursing;
3. The emotional necessity to provide care with a businesslike attitude;
4. The attitude which avoids using the word “death” in conversation;
5. The negative cancer image;
6. The failure of execution of the informed consent of thenurse.
These findings suggest the need for examination, in personal or organizational contexts, of these 6 factors that influence anxiety, for the mental health of nurses concerned withcancer nursing.
2. Nakajima, T.(2002). Maternal attachment and healing
for mothers through Kangaroo Care (skin to skincare). 22 (1). 13-22.
The purpose of this study was to examine maternal attachment and healing for mothers through Kangaroo care(skin to skin care) in a Neonatal Intensive Care Unit. This
study is one group repeated measure design, also interview
data were compared with quantitative data.The conveniencesample consisted of 20 mothers and their pre-term infants

who were born weighing less than 2,500g. Evaluations wereconducted before intervention, 2 weeks after intervention,and before discharge. Measurements used for this study
were Healing of Preterm Child-birth (HPC), Maternal Attachment Inventory Japanese version (MAI-J), and Profile ofMood States (POMS).
The results of multiple comparison indicated significant
differences in healing of pre-term child-birth between before
intervention versus 2 weeks after intervention in thesubscale of Relief from distress (p<0.000), and in Accept reality (p<0.03). Furthermore these variables indicated significant differences between before intervention versus before
discharge (p<0.000-p<0.001), while Self confidence indicated significant differences only between before intervention versus before discharge (p<0.01). Maternal attachment
indicated no significant differences at any time. The
subscale of mood states of POMS indicated significant differences before intervention versus 2 weeks after intervention in Depression-Dejection (p<0.02), and between before
intervention versus before discharge in Vigor (p<0.01).
Qualitative data showed that Kangaroo care reduced themother’s feeling of guilt and uncertainty after 2 weeks of intervention. Because, through skin to skin care the mother felt
the infant’s movement and breathing, the infant’s strength
and well being was confirmed. Also, at discharge from thehospital, mothers were confident in being maternal caretakers of infants, and they judged their experiences to indeed
be meaningful despite the initial threat of having a prematureinfant. However, one case was very sensitive and afraid totake care of her infant. Therefore, mothers who experience
distress related to pre-term child-birth need support.
3. Fukaya, Y. (2002). Development, reliability and validityof an ADL gap self-efficacy scale for elderly persons
requiring home based nursing care. 22 (1). 23-32.
This study first developed an ADL gap self-efficacy scale
and then examined the reliability and validity of this scaleusing 146 elderly persons requiring home based nursing
care due to chronic motor function disability and undergoingmotor rehabilitation. This scale is one-dimensional and consists of 10 items developed based on principal components
analysis and Kappa statistics. The reliability assessment
demonstrated that this scale had a Cronbach alpha coefficient of 0.86, which is an assessment of internal consistency. The mean test-retest correlation coefficient was 0.74,
which is an acceptable level of stability.
Construct validity was supported by a significant correlation between ADL gap self-efficacy and a depression index
and between ADL gap self-efficacy and the ADL gap. Concurrent validity was supported by significant correlation between this scale and a standard self-efficacy scale when theexaminees were 64 years or under, male and could walk independently. The predictive validity of this scale were

examined by to discuss significant correlation between ADL
gap self-efficacy and ADL change, among ADL gap selfefficacy and ADL gap and ADL change. By using the ADL
gap, it was shown that the ADL gap self-efficacy influences
ADL change, which provides indirect support for the predictive validity of this scale.
4. Yamanishi, M. (2002). Relationship between perceived
uncertainty and adherence in patients joining physical training program after myocardial infarction. 22(2). 1-10.
This study has been carried out to the relationship between perceived uncertainty and adherence in patients joining physical training program after myocardial infarction. The
cross-sectional, correlational research design was selected,
data were collected by the instruments which were consistedof the Mishel Uncertainty in Illness Scale and the Adherence
Behavior Questionnaire. The subject consisted of 93 patients with myocardial infarction who had been undergone
coronary angioplasty. Their ages ranged from 31 to 81
years, with an average of 64.0 years (SD=9.9 years).
Multiple regression analysis indicated that ambiguity,
complexity, employed, male, a history of myocardial infarction, treadmill user, and exercise habit accounted for 43% of
the variance in adherence. Patients with myocardial infarction have perceived uncertainty through the process of cognitive appraisal in a cardiac event. It is suggested that highlevels of perceived uncertainty are directly related to low levels of adherence.
5. Suzuki, M., Miyata, S., Chikamori, E., Murashima, S.,
Katayama, K., Okamoto, R., Ota, K., Dewazawa, Y.,
Tsuru, S., Nakane, K., Inoue, M., & Nakanishi, M.
(2002). Structure and feature of terminology in nursing practice in the home care field during visiting
nurse service. 22(2). 11-22.
The purpose of this study was to systematize nursing terminology in scientific terms by describing the way that visiting nurses expressed and described their own nursing
practice.
The subjects were 25 visiting nurses in the Kansai regionof Japan. Each nurse was asked to choose a patient of the
day and to describe and discuss her activities during the visit
in terms of nursing. The items covered were divided by the
researchers into “label of the activity”, “reason for performing
the activity” “aim of the activity”, “actual nursing procedure
for the activity”, “labels of simultaneous activities”, “aims ofsimultaneous activities”, and “actual procedures for simultaneous activities”. The data gained through this process wereanalyzed to determine the nature of each item and the relationships among the items.
Because nursing is provided as one part of daily life forhome health care patients, the terms used to describeNEWS FROM JANS
nursing practice consisted of words used in daily life (for example, “greetings”).
Sometimes the terms used were colloquial expressions.
Because of the limited time available to carry out a numberof nursing tasks during one visit, one term included morethan one nursing activity. In addition, because nurses needto collaborate with various specialists in both the medical
and the health and welfare fields in order to care for their patients, nurses should use their terms that have the communality with other fields.
6. Fukui, S. (2002). Information needs, information receiving and the related variables among Japanesefamily caregivers of cancer patients: In initial phasevs in terminal phase. 22 (3). 10-19.
In Japan, family caregivers of cancer patients usually receive information on the patient from healthcare professionals before patients are told the truth. Efforts to provide
suitable information to these caregivers may be crucial to improving the quality of life in family caregivers as well as inpatients. A descriptive correlational study explored and assessed the information needs and the information receivingof family caregivers of cancer patients, both in initial phaseand in terminal phase. Data were obtained by a semistructured interview with a questionnaire. The categories of
information assessed were disease, treatment, prognosis,
and patient and family care. In addition, the demographic
and situational characteristics related to individual information receiving were investigated by logistic regression analyses. In initial phase, of 66 family caregivers, about two-thirds
expressed they received the disease-related information,
whereas less than one-third of those felt they did not receive
the care-related information. In terminal phase, among 66
family caregivers, most caregivers expressed they received
the disease-related and care-related information for patients,
whereas less than half of those felt they did not receive thecare-related information for themselves. The caregivers who
were older, who did not inform the cancer diagnosis to thepatient, and whose patient had not undergone any treatment
significantly more perceived that they did not receive information, although they had the needs for information. Our results may help healthcare professionals to plan theappropriate provision of information to family caregivers ofcancer patients.
7. Yakushiji, Y. (2002). Family hardiness and the regeneration process of families of children with behavioral
disorders in psychosomatic disease. 22 (3). 10-19.
This study explored the regeneration process of families
who faced difficulties in dealing with children’s psychosomatic behavioral disorders and described the characteristics of family hardiness.
Data were collected through semi-structured interviews

with 16 families and/or participant observations during counseling sessions. Interviews were audiotaped with permissions and transcribed verbatim and analyzed according to
the grounded theory approach. The findings suggested that“synchronization” was a core category that described theprocess of how families of children with behavioral disorders
coped with the frightening and discouraging events surrounding their children and how new family functions were
regenerated through the child-parent interactions.
This family regeneration process consisted of threephases: “in-limbo,” “stagnation,” and “getting out of chaos.”
Each phase was constructed with the family interactions of“conflicting and relinquishing,” “groping in the dark and being
involved with,” and “confirming the emotional distances andreconstructing the relationships of trust,” respectively. The
family members got deeply involved in both their children’s
psychological and behavioral difficulties in these phases;
however, they came to terms with their children’s outlasting
behaviors. While the families and children retraced thesethree phases repeatedly, new family ties and the best emotional distance between child and family members were established. Family hardiness was the most important strengththat accelerated the family regeneration and psychologicalstability in families.
8. Kokufu, H. & Inoue, T. (2002). The process of decision-making regarding surgical treatment by breast
cancer patients. 22 (3). 20-28.
The purpose of this study was to investigate the decisionmaking process regarding surgical treatment in patients withearly breast cancer, and to suggest nursing interventions tofacilitate this process. The participants of the study were 18
women who were offered a choice between breastconserving surgery and mastectomy. The data were collected using a semi-structured interview and participant
observation, so as to clarify the feelings and ideas of thesesubjects concerning the treatment options offered. We used
qualitative data analyses.
As a result, four types of processes were identified; carrying her hope through-type, gradual consent-type, agitationtype and confusion-type. Each of these types of processes
was structured into five phases: initial reaction, question
against initial reaction, idea about undergoing surgical treatment, decision conflict, and final selection of the type of surgery.
The findings indicated that the following nursing interventions might facilitate the decision-making process, as follows: early provision of correct information regarding each
option, clarifying each subject’s values of the breast andviews of life, and emotional support to facilitate the difficult
decision-making process.

9. Higa, H. (2002). Development of spirituality rating
scale and study of its reliability and validity. 22 (3). 2938.
In this study the spirituality rating scale was developedand its reliability and validity were studied. Spirituality is defined as the mental outlook of actively seeking something
and endeavoring to relate oneself to it, as well as the perception or thought of oneself and particular events : spirits
and ideas. Based on this concept, a questionnaire was developed which consisted of 20 items, and for each item oneof five possible answers could be chosen. Among 385 university students to whom this questionnaire was given, thenumber of effective answers was 382 (female, average age,
20.12±1.10 years). After excluding statistically inappropriate items from the study, factor analysis by maximum
likelihood-promax rotation was performed. As a result ofanalysis, five factors with 15 items were finally obtained:
self-consciousness, meaningfulness, volition, human spirit,and values. The 15 items were defined as the spirituality rating scale (SRS). The cumulative contribution percentage
after extracting the factors was 52.80％. Cronbach’s alphacoefficient of 0.82 and the reliability coefficient of 0.72 obtained by a retest method confirmed the reliability of the
SRS. The validity of the SRS content was confirmed by thetwo-factor model, the convergence validity was confirmed by
the negative anxiety and positive anxiety scale, helplessness scale, and fulfillment scale, the discriminate validity
was confirmed by the religious perspective scale, and thedependent validity was confirmed by the depressiondejection scale which is the Japanese version of the profile
of mood states. The above findings indicate that the SRS issufficiently reliable and valid for practical use.
10. Kanzaki, H. & Kido, Y. (2002). Cognitive-behavioral
interventions for gastrectomy with the early stage ofgastric cancer -Weekly counseling and journal writingtargeted to self-efficacy and psychological stress-. 22(4). 1-10.
The aim of this study was to evaluate the effect of cognitive behavior therapy for self-efficacy and psychologicalstress.
The study subjects were gastrectomy patients with theearly stage of gastric cancer, and interventions comprised ofweekly counseling and journal writing. Conceptual framework of this study was based on Lazarus’s Stress model(1984), and for the framework for Self-efficacy is based on
the Social Learning Theory (Bandura, 1977, 1986). Three
scales were employed to evaluate the effect of interventions:general self-efficacy (GSES: Sakano and Toujyou, 1986),
mental stress response (SRS-18 : Suzuki et al., 1997), andmoods (DAMS: Fukui, 1997). Subjects were allocated to either intervention group (IG (n=14)) or to control group (CG(n= 12)) and of those twenty completed the study (9 and 11,

respectively).
Subjects were assessed at baseline, at the time of discharge, and 1 month after discharge.
Results:
1) Two sample t test revealed that IG had significantly lower
SRS-18 total scores and SRS-18 subscale (depressionanxiety) scores than CG did at discharge. One month after
discharge, depression-anxiety scores for IG remained significantly lower than that for CG (p<0.05).
2) Split Plot Design Repeated Measure ANOVA revealed
that DAMS subscale scores (positive mood) for IG improved significantly from baseline to discharge (p<0.05).
3) Dunnett’s test of multiple comparisons showed that IG
had significantly improved moods than CG did at discharge, and the effects were sustained at 1 month after
discharge (p<0.05).
4) Total General Self-Efficacy scores and any of thesubscale scores between the two groups did not differ atdischarge and 1 month after discharge.
In summary, interventions seemed to have contributed tothe improvement of positive moods and depression-anxiety.
However, interventions have failed to show any measurable
impact on the general self-efficacy. Further research is necessary to confirm the findings.
11. Ito, N., Kazuma,K., & Tokunaga, K. (2002). Development of a scale for feeling of stability in daily life
among outpatients with permanent gastrointestinal
stoma. 22 (4). 11-20.
The purpose of this study was to develop a scale to rate
the feeling of stability in daily life with a stoma. One hundred
and thirty three patients with permanent gastrointestinal
stoma responded. The questionnaire was consisted of ascale for feeling of stability in daily life and the ostomate’s
QOL questionnaire. The items of this scale were collected bypreliminary interviews, and they were confirmed content andface validity.
Five factors, consisting of 24 items, by exploratory factor
analysis and confirmatory factor analysis, were selectedfrom 40 items, as follows: (1) recovery and expansion of activities, (2) acceptance of the stoma, (3) relief at having aplace to go for consultation about stoma care, (4) absence ofworry about peristomal skin trouble, and (5) perception of
defecation and physical condition. Weighted kappa for each
item and the intraclass correlation coefficient for each factor,
based on the test-retest method, indicated the moderatelevel of reliability. Cronbach’s α for each factor indicated acertain level of internal consistency. Correlation assessments between the scores for this scale and those for the
ostomate’s QOL questionnaire or some items confirmed theconvergent and discriminant validity. We supposed an ordinal relationship among 3 factors, from the clinical viewpoint,that is, absence of worry about peristomal skin trouble,NEWS FROM JANS
acceptance of the stoma, and recovery and expansion of activities. This relationship was supported statistically.
The results of this study suggested that this scale was reliable and valid, indicating that the scale might be used clinically.
12. Iwasaki, Y., Ishikawa, K., Shimizu, K., & Miyazaki, S.
(2002). Coping in family caregiving for relatives withmental illness: Family responsiveness and selfnurturing. 22 (4). 21-32.
A qualitative study was conducted to identify an explanatory model which describes coping in family caregiving for
relatives with mental illness. Thirty four family members provided written consent to be interviewed. Analysis of data revealed four coping styles in family caregiving.
a) Co-prosperous style: family caregivers empathically attend to needs of the ill relative in addition to their own.
b) Fused style: family caregivers are deeply involved with
the ill relative, sometimes at the cost of their own needs.
c) Self-protective style: family caregivers are primarily concerned about their own needs.
d) Demoralized style: needs of both the ill relative and thefamily caregiver are disregard.
The four styles are explained by “family responsiveness”
to the welfare of the ill relative and “family self-nurturing” oftheir own well-being. Responsiveness and self-nurturing areboth high in the co-prosperous style and both low in the demoralized style. Responsiveness is high and self-nurturing is
low in the fused style, while responsiveness is low and selfnurturing is high in the self-protective style. Family coping
style is not static, and family caregivers move between coping styles to resolve conflicts between family responsivenessand self-nurturing. These findings suggest the need to assist
families in finding a balance between responsiveness andself-nurturing. The findings also indicate the importance ofimproving the well-being of both the ill relative and the family.
13. Kita, M. (2002). Competing needs among family
members that arises from the “Shiwayose” ofcaregiving at home. 22 (4). 33-43.
The purpose of this research was to explore the homecare process for the elderly by families using the Grounded
Theory Approach. Twelve families in process of caring for or
waiting for caring were picked up for this research by this approach at the two general hospitals in Tokyo. Data were col-lected through interviews and observations on a continuous
basis, being analyzed by the comparative analysis method.
In this research, the home care process for the elderly byfamily was clarified by focusing on the competing needs between or among the family members arose from the “Shiwayose” (the burden shifting) of caregiving at home. The process had 3 properties of 1) distress caused by the shared burden, 2) conflict between or among family members, and3) mobility of work sharing by family members; and included
3 stages, that is, “The stage of harmony”, “The stage of provisional harmony”, and “The disharmony”. Also it was madeclear that the family members used some strategies at thestages of provisional harmony and disharmony to avoid or
reduce the needs’ competition and continue the home care.
The findings suggest that the needs’ competition among thefamily members caused by the Shiwayose of the home care
was the critical issue in question. Even if the family members
were placed in the worst situation of confusion caused by
the needs’ competition, they would still have potential power
to live together in harmony while continuing the home care.
The health provider needs to promote such potential power,
supporting the strategies that family use.
14. Ikezoe, S. (2002). Describing the wisdom of life reconstruction in families with a stroke patient family
member. 22 (4). 44-54.
The purpose of this study was to examine the processesof reconstructing life in families with stroke patients, and to
propose guidelines for family support. The sample comprised 11 spouses of stroke patients, living with theirspouses either physically or nominally if the patient was stillin hospital. Data was collected using interviews. Following
qualitative analysis of data, 4 phases of life reconstruction infamilies were extracted: 1) definition of the situation; 2) the
wisdom of families; 3) family prospects; and 4) reconstruction behaviors.
The wisdom of families represented skills originating withand developed by the family, based in the experiences andknowledge cultivated from life with stroke patients, and developing constantly. The wisdom of families includes the following 4 core items : 1) management of caregiving ; 2) shaping attitudes towards the current situation; 3) maintaining
family identity; and 4) deepening relationships.
When families with stroke patients struggle to reconstructfamily life, supporting the wisdom of families for family nursing appears important.

JAPAN ACADENY OF NURSING SCIENCEThe Secretariat of Japan Academy of Nursing Science
303 Fujimi Bld., 3-37-3 Hongo Bunkyo-ku, Tokyo 113-0033, Japan
http: / / jans.umin.ac.jp
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