doctoral thesis

The purpose of this paper is to identify the significance and challenges of government infertility support from the perspective of nursing professionals involved in government infertility support and infertile women. This dissertation consists of three chapters. First, in Chapter 1, as a research perspective on the current situation surrounding infertility and administrative infertility support, a review of the literature on “psychological characteristics and coping with infertility,” “infertility support,” and “administrative infertility support centered on infertility consultation centers” was conducted in particular to focus the issues and analysis perspective of this study. Chapter 2, Section 1 clarified the significance of administrative infertility support as perceived by nurses involved in infertility support at infertility consultation centers. In Chapter 2, Section 2, a study of infertile women was conducted to clarify the current situation and the relationship between infertile women's perceptions and use of administrative infertility support. Chapter 3 reviews the findings on the significance and challenges of administrative infertility support based on the perspectives of nursing professionals and infertile women, discusses the significance and challenges of administrative infertility support, and presents the conclusions and limitations of this study and future challenges. From the perspective of nursing professionals, the significance of administrative infertility support was found to be threefold: [it can supplement infertility support provided by medical institutions], [it can provide psychological support], and [it can provide a wide range of infertility-related counseling]. However, only 31.1% of infertile women were aware of government infertility support, and only 16.3% of infertile women had used it. Thus, although the recognition and utilization rates of government infertility support are low, the level of satisfaction with government infertility support is high, indicating that it is an effective form of support. In addition, 67.5% of those who received infertility support from both medical institutions and the government rated the support as more effective than using only one of the two types of support. Administrative infertility support, centered on specialized infertility consultation centers, has a different venue and function than medical institutions, and is significant in that it does not view infertility solely in terms of its medical meaning, but is able to attend to individual life concerns and choices. In addition, administrative infertility support has a well-developed support system that provides both information and knowledge for problem solving and emotional and psychological support in a well-balanced manner, which we believe leads to a sense of satisfaction for infertile women who use administrative infertility support. As for the challenges of administrative infertility support, first of all, it is necessary for nurses and other professionals involved in administrative infertility support to improve the infertility support environment in each municipality and to improve their support skills. Then, the significance of administrative infertility support should be properly publicized and communicated to increase the awareness and use of administrative infertility support by infertile women. Furthermore, it was discussed that it is important to solve the issues of administrative infertility support through cooperation and collaboration between medical institutions and the government, as well as cooperation and collaboration among local governments.

Rheumatoid arthritis is a systemic inflammatory disease with chronic polyarthritis as the main symptom, and its treatment goal is to reduce disease activity as well as to suppress the progression of joint destruction. The purpose of this study is to investigate the ideal support for the home-based exercise therapy and also to clarify the current status of its implementation and the factors that cause its implementation. Chapter 1 provides the background of this research, by discussing the symptoms and treatment of rheumatoid arthritis, the role of exercise therapy, the necessity of the home-based exercise therapy, and the support for patients with rheumatoid arthritis and other chronic diseases. Based on these findings, the purpose of this study was to clarify the current status of the home-based exercise therapy in patients with rheumatoid arthritis and the factors that implement it, and to examine the ideal way of support. Chapter 2 describes a research study that clarifies the current status of the home-based exercise therapy for patients with rheumatoid arthritis. A questionnaire survey was conducted for rheumatoid arthritis patients living in one prefecture and the responses of 226 patients were analyzed. As a result, it was found that 35.4% of the patients knew that the home-based exercise therapy is recommended for patients with rheumatoid arthritis. On the other hand, 93.7% of patients thought that the home-based exercise therapy had a certain effect, and 91.4% of patients thought that the home-based exercise therapy was necessary. Thus, most patients had a high level of knowledge and interest in the home-based exercise therapy. Chapter 3 describes a research study that clarifies the factors that affect the implementation of the home-based exercise therapy. A questionnaire survey was conducted for rheumatoid arthritis patients living in one prefecture and the answers obtained were divided into two groups, the group that underwent the home-based exercise therapy (n = 94) and the group that did not underwent it (n = 132). As a result of multivariate analysis, it was found that four factors significantly influenced the implementation of the home-based exercise therapy: age, occupation with a high degree of discretion, receiving injection treatment, and recommending the home-based exercise therapy by a doctor. It was also suggested that patients who were in pain or were not in remission were doing it according to their physical condition to the extent that it did not hurt. Chapter 4 discusses the ideal way of support for the home-based exercise therapy by patients with rheumatoid arthritis. Based on the findings obtained in Chapters 2 and 3, the ideal way of support for the implementation of the home-based exercise therapy was discussed, focusing on three important perspectives: support for patient education, support for self-care, and support for multidisciplinary collaboration. Finally, based on the findings of this study, I concluded that it is important to provide support for patients with rheumatoid arthritis so that they can take the initiative in treating the home-based exercise therapy as an important way of self-care.

The utilization of post-retirement nurses, commonly referred to as second-career nurses (he reinafter SCNs), is being actively promoted. While SCNs are often said to bring a wealth of experience to nursing, concerns have been raised regarding their clinical competency and skills. However, currently, no concrete visualization or detailed examination exists of the nature of SCNs’ nursing practices, leaving such concerns unaddressed. Therefore, this study aimed to elucidate the specific aspects of excellence in the nursing practices of SCNs. To clarify the excellence of SCNs, the study extracted specific elements of excellent nursing practices from previous research. These elements were conceptualized as the “Six Domains and 19 Components of Excellent Nursing.” Based on these concepts, a unique survey questionnaire was developed to measure perceptions of SCNs’ excellent nursing practices, which was employed to study two groups: second-career nurses (hereinafter referred to as the SCN group) and active nurses currently in practice (hereinafter referred to as the active group). The SCN group included 84 participants, while the active group included 199 participants. Perceptions of excellent nursing practices among SCNs were analyzed as “excellence scores” for both groups. The results showed that in the active group, the average excellence scores tended to increase with age. Additionally, a factor analysis was performed to confirm whether the responses in the active group aligned with the conceptual framework. This analysis identified three factors: “Identity as a nursing professional,” “Excellent clinical practice competence,” and “Caring behaviors.” A multiple comparison of the average total scores for the three factors across age groups revealed significant differences in “Excellent clinical practice competence” and “Caring behaviors” between the nurses in their 20s and 50s, as well as between those in their 30s and 50s. These findings suggest that age-related differences in how the active group perceived the excellence of SCNs may be attributed to varying levels of experience. Specifically, less experienced nurses may have difficulty focusing on others; consequently, they may not fully recognize the qualities of SCNs’ nursing practices. In contrast, nurses in their 40s and 50s, with greater experience, are more likely to engage in mutual interactions with SCNs, enabling them to observe and appreciate the visible aspects of SCNs’ excellent nursing practices. The relationship between the excellence scores in the SCN group and external factors such as age, years of experience, experience as an SCN, pre-retirement position, current workplace, and employment format was analyzed. The results showed no significant differences in the excellence scores across any of these attributes. This lack of influence from external factors suggests that the exceptional nursing practices of SCNs are not externally imposed but are driven by intrinsic factors, such as a genuine interest in and passion for nursing, as well as a strong focus on others—factors rooted in SCNs’ “Identity as nursing professionals.” Based on the above, the specific content of excellent nursing revealed in this study demonstrated by SCNs is threefold: nursing that makes visible “Excellent clinical practice competence,” “Caring behaviors,” and the intrinsic “Identity as a nursing professional” of second-career nurses. “Identity as a nursing professional” in SCNs reflects a deep-seated passion for nursing, characterized by a resolute dedication to the profession even after retirement. This identity is suggested to be shaped by the combination of their extensive nursing and life experiences, which results in an original approach to nursing, thus producing the excellence of SCNs.

This study aimed to clarify the food characteristics and functionality of Akamoku from various perspectives based on samples collected in Yamaguchi Prefecture. This study investigated changes in food characteristics and functionalities when Akamoku was processed, as well as the functionality of consuming commercially processed Akamoku products. In the examination of food characteristics, we focused on the adhesiveness, adhesion, hardness, cohesiveness, and color differences of Akamoku due to differences in boiling conditions, drying methods, and rehydration temperature conditions. The results suggest that, in terms of boiling conditions, long boiling at 90°C for 3 or 5 min is not suitable from the viewpoints of properties and color. In terms of drying methods, viscosity was enhanced by freeze-drying and the green color was remarkably etained, suggesting that freeze-drying is useful for retaining the viscosity and color of Akamoku. In the examination of changes in functionalities, we focused on changes in the antioxidative activity of Akamoku due to boiling conditions. Total polyphenol content and DPPH radical scavenging ability were determined using two types of Akamoku from different production areas, harvesting periods, and freezing conditions. The results showed that raw Akamoku of both types had higher polyphenol content and DPPH radical scavenging ability than processed Akamoku. Regarding the effect of boiling temperature on antioxidant properties, there was less variation in polyphenol content and antioxidative activity in the case of boiling at 60°C than in the case of boiling at 90°C, indicating that processing at lower temperatures may be effective in retaining antioxidative activity. Furthermore, a positive correlation was observed between the total polyphenol content and DPPH radical scavenging ability, suggesting that polyphenols play an important role in antioxidant properties. Regarding the functionality of consuming commercial processed Akamoku products, we aimed to explore the effect of incorporating commercially available boiled Akamoku or microwave-boiled Akamoku into breakfast or lunch meals along with rice on postprandial blood glucose dynamics. The experiment included three distinct test meals: a standard meal comprising rice, soup, and seasoning; an Akamoku-enriched meal incorporating commercially available processed Akamoku with standard components; and a microwave-boiled Akamoku meal with standard meal components. The blood glucose dynamics under these three dietary conditions were compared between healthy adult male and female participants. The results suggested that both boiled Akamoku and microwave-boiled Akamoku reduced postprandial maximum blood glucose level, elevated blood glucose level, duration of elevated blood glucose level, and rate of elevated blood glucose level, but did not reduce blood glucose fall time and incremental area under the curve. These findings suggest that ingestion of Akamoku and heated Akamoku had an inhibitory effect on postprandial blood glucose elevation, but did not impede the bodily absorption of sugars or nutrients. The findings of this study may increase our understanding of the food characteristics and functionality of Akamoku and promote its consumption. Furthermore, if the consumption of Akamoku expands, it is expected to contribute to the revitalization of local fisheries and fishing villages, as well as efforts to promote the sixth industrialization. Based on these results, future applications of Akamoku in the food industry are expected.

The promotion of early family reunification is required from the perspective ofensuring children's rights in children’s homes. Currently, family social workers areassigned to support the smooth reintegration of children into their families. In family reunification support, the development of social work based on high-level expertise is necessary. However, it cannot be said that the expertise required for implementing social work towards children’s family reunification is fully established. Therefore, this study aims to clarify the expertise of family social workers in deploying social work towards children’s family reunification. Chapter 1 discusses the need to establish theories regarding the unique functions and methods of social work of family social workers by reviewing prior research and　examining the current achievements and challenges faced in their support. Chapter 2 outlines the research objectives and defines key terms. Chapter 3 conducts interview research with family social workers to generate a hypothesis model regarding the factors and interrelations involved in deploying social work aimed at children’s family reunification. Chapter 4 conducts a survey using questionnaires targeting family social workers and examines the generated hypothesis model through covariance structure analysis, presenting insights into the expertise of family social workers' deployment of social work for children’s family reunification. Chapter 5 states the conclusion. The deployment of social work by family social workers aimed at children's family reunification is shown to stem from a recognition that prioritizes the best interests of the　child, expanding into specific support actions such as "assessment and planning," "support for children and parents," "collaboration inside and outside the facility," and　"evaluation and discernment of family reunification." Particularly, "support for parents" and "collaboration with child consultation centers" were identified as areas of expertise in social work deployment. However, in examining the factors influencing the deployment of social work, the "evaluation and discernment of family reunification" is strongly influenced directly by the "awareness as a professional." This suggests that the expertise in the supportive actions of "support for parents" and "collaboration with child consultation centers" is not being sufficiently realized.

This study examined the effects of role lettering (RL) on mothers raising their first child in infancy. Mothers raising their first child in infancy experience unique childcare anxiety and are prone to mental instability. The Japanese government has set up support systems for mothers raising children, such as postpartum care programs; however, many of these require mothers to go out to seek support. Considering that mothers raising children are unable to go out easily, it is necessary to consider ways to provide support that are more convenient for mothers. We focused on RL as a method to support this. RL is a role-exchange letter method in which one writes a letter from the perspective of both oneself and others, in this case, the mother and the child, respectively. By conducting this back-and-forth correspondence alone, one encourages self-reflection. Putting oneself in another person's shoes allows one to look at oneself from a new perspective, promotes an understanding of the self and others, and encourages self-acceptance. This study hypothesized that RL could be utilized by mothers raising their first child, and if its effectiveness could be clarified, it could be used as a tool to support child-rearing. This paper consists of four sections. Chapter 1 presents the current situation and issues surrounding mothers raising their first child, a literature review on support for mothers raising their children, a literature review on RL, and the significance and purpose of this study. In Chapter 2, semi-structured interviews were conducted after RL was administered thrice to six mothers raising their first child before preschool. The data obtained were analyzed using the KJ method to structure the effects of RL. We also examined changes in the description of letters in the RL. In Chapter 3, we examine the effects of RL using a randomized controlled trial in a group of 26 mothers raising their first 0-year-old child in a group of three RLs and a control group. We also examined changes in the description of letters in the RL. Chapter 4 provides a comprehensive discussion of the effects of RL on mothers raising their first child during infancy based on the findings in Chapters 2 and 3. In sum, the effects of RL done thrice by mothers raising their first child in infancy are as follows. First, mothers write freely to the child, the letter recipient, without restrictions, thus express their feelings honestly; this naturally allows the mother to affirm her own identity. Second, by writing from the child’s perspective, the mother can think of how the child feels. These activities led to an increase in the mother’s self-esteem and positive feelings toward the child. Such a change in feelings gives the mother of a firstborn child a sense of recognition and confidence in her parenting. The results suggest that such confidence may lead to behavioral changes and willingness to connect with the outside world, such as mothers visiting places for parent-child interaction and consultation with public health nurses.

This study was conducted to investigate the actual contamination of chicken meat with pathogenic microorganisms at each stage of the food chain, to clarify the risk of foodborne diseases, and to examine measures to reduce the risk. The survey at the distribution stage revealed that Campylobacter was isolated from 35.7% of commercial chicken meat in Yamaguchi Prefecture, and that the contamination rate was high in specific parts such as liver and during the summer season. Genotyping of the isolates by the mP-BIT method confirmed the presence of pathogenic genes and a high level of contamination with fluoroquinolone-resistant bacteria, which are feared to make treatment of infectious diseases more difficult. These results suggest that the disinfection of commercial chicken meat distributed in this prefecture is not sufficiently reduced in terms of foodborne diseases risk by the time they reach the distribution stage. Therefore, it is important to prioritize risk reduction measures at the consumption stage of chicken meat, and it is necessary to further educate consumers on the prevention of foodborne diseases. A survey at the chicken slaughtering stage showed that chicken meat shipped from a chicken slaughterhouse in Yamaguchi Prefecture was highly contaminated with Campylobacter, and that the disinfection of chicken meat by the cooling process using sodium hypochlorite at the facility was not sufficient to reduce the risk of foodborne diseases. In the future, it is necessary to improve sanitation management, such as the type of disinfectant, concentration used, and cooling time, in accordance with the actual conditions of the number of broiler processed and equipment at the facility. In addition, it was considered necessary to examine measures to prevent contamination of broiler at each production farm. A survey of several farms at the production stage revealed that the Campylobacter-positive rate was 46.9% in the Chugoku region and 75.0% in the Kyushu region, and the Salmonella-positive rate was 84.4% in the Chugoku region and 89.3% in the Kyushu region. The different characteristics of the contamination status of farms and broiler flocks, the bacterial species and serotypes, genotypes, and the acquisition of drug resistance were observed in the different regions. Therefore, it is important to take regional characteristics into consideration when clarifying the risk of foodborne diseases of chicken meat and considering measures to reduce the risk. The investigation of contamination factors in farms and broiler houses suggested that although the environment inside and outside the broiler house and feed were not factors for Campylobacter invasion and spread, contamination spread to the feeding environment through feces of infected broiler after 5 to 6 weeks of brooding. In addition, continuous contamination of Salmonella was confirmed in the feeding environment, including the bedding material (recycled fermented litter) of the broiler house. The results also suggested the spread of Salmonella through feed and workers. Therefore, it is necessary to strengthen measures to reduce the risk of food poisoning by improving farm broiler feeding hygiene management manuals and introducing hygiene management based on Hazard Analysis and Critical Control Point (HACCP). In particular, it is necessary to establish Critical Control Points for sanitary management of bedding (recycled fermented litter) and to verify fermentation temperatures and times that can completely destroy the bacteria. In order to promote appropriate sanitary management based on HACCP at the chicken slaughtering and production stages, effective foodborne diseases risk reduction measures should be implemented at each stage of the chicken meat food chain based on the knowledge obtained in this study under cross-field collaboration and cooperation among various entities such as government health departments, livestock breeding departments, research institutes, businesses, and consumers. Based on the findings of this study, it is necessary to take effective measures to reduce the risk of foodborne diseases at each stage of the chicken meat food chain to ensure food safety and security.

The purpose of this study was to clarify the current status of support for children with chronic diseases through interprofessional collaboration and Yogo teachers’ roles in such collaboration. In inclusive education systems, it isimportant to develop various flexible structures that allow the teaching of children with individual educational needs, with a view to promoting their independence and social participation while fulfilling their needs. However, collaborative systems between schools and related institutions are still insufficient, and Yogo teachers’ roles in interprofessional collaboration remain unclear. Therefore, the need for studies to clarify the current status of support through interprofessional collaboration andYogo teachers’ roles in such collaboration was realized. This paper consists of 4 chapters. Chapter 1 specifies the background and objective of the present study, and discusses the current status of support through interprofessional collaboration and Yogo teachers’ challenges to carry out their roles in such collaboration based on policy trends for children with chronic diseases and the related literature. Chapter 2details a hypothetic model on Yogo teachers’ roles in interprofessional collaboration formulated from the quantitative analysis of data obtained from interviews with four institutions. Chapter 3 examines Yogo teachers’ roles that affect the outcomes of interprofessional collaboration based the quantitative analysis of data obtained from a questionnaire survey involving Yogo teachers working at public elementary/junior high schools. Chapter 4 describes the findings regarding Yogo teachers’ roles ininterprofessional collaboration. In the present study, the hypothetic model was evaluated and it was found that [support approaches to fulfill educational needs] lead to [agreement among supporters], and affect the [outcomes of interprofessional collaboration], such as <establishment of trust-based relationships with various other professionals/institutions>,<systems for handover when children are promoted to the next grade or proceed to the next level of education>, <broadened the understanding of children and methods to support them>, and <guarantee of a prosperous life for children with chronic diseases>. [Support approaches to fulfill educational needs] are part of individualized support, provided through <commitments to nurture self-esteem in children>, <perception of changes in physical condition through daily observations of health and analysis of records>, and <support based on characteristics>. [Agreement among supporters] is the step to build support systems through collaboration with teachers and various other professionals,including <information transmission byYogo teachers>, <development ofin-school support systems by information-sharing>, <understanding of Yogo-teachers by principals> and <acquisition of health management methods focusing on child development>, with this last item having the greatest impact. Specifically, Yogo teachers must provide support tailored to each chronically ill child’s characteristics to assist them in the acquisition of health management methods centered on development in conjunction with multiple professionals.But also to provide education that promotes understanding about children with chronic diseases by recognizing that the children around them are also supporters. Yogo teachers are expected to play a role as coordinators in promoting cooperation among multiple professions with shared goals of support and normative integration. Furthermore, they must provide support tailored to the children’s characteristics through daily observation and record analysis, disseminate support content for the educational needs of children with chronic diseases, deepen the understanding of principals and teachers, and develop an environment where the entire school can respond as a team. Above all, it is important to collaborate with multi-professionals to create support that allows children with chronic diseases to acquire their own health management methods as the subject of their own development.

The introduction of the long-term care insurance system and revisions to the Medical Care Act have increased the number of patients with intractable diseases who receive care in home settings. However, dissatisfaction and confusion were reported by patients and their caregivers when managing intractable diseases at home. To address this, a community care system was suggested as a "new system to support intractable diseases." This is in line with the Intractable Diseases Act, which aims to achieve and build collaborative relationships in which both parties and supporters can work together. Thus, in this study, the formation of a system for long-term, home-based, and community-centered care for patients with intractable diseases was composed across four chapters. This project also aims to investigate the feasibility and implementation of a community care system for intractable diseases. Chapter 1 reviews the history and research of community care systems for intractable diseases. It outlines the absence of specific measures for the establishment of a regional community care system, and the challenges of addressing individual cases of intractable diseases as regional issues. It also emphasizes the importance of understanding and addressing drastic changes in medical care of such patients in a timely manner. However, presently, little is known about the actual situation of patients with intractable diseases. Chapter 2 examines how patients with intractable diseases who receive home-based care rebuild their own lives. For these patients to continue their life at home, they must strive for self-management and receive the necessary support to build a lifestyle that adapts to long-term medical care. Building trust with health care providers and their engagement with systemic gaps has a significant impact on patients’ quality of life. Chapter 3 explores the experiences of a patient with an intractable disease who struggles with home-based care, its limitations, and deciding when to visit a health facility. They share that their life is unstable and repeatedly restructured, forcing them to make passive decisions when visiting a health facility, thereby experiencing a loss of autonomy and resulting in feelings of “giving up.” In Chapter 4, we examine the possible implementation of a community care system based on our findings. Such systems for intractable disease patients require a dual structure of common and individual systems, which can complement each other and enable multidisciplinary, professional support for intractable disease patients with a high level of individuality. The establishment of community care systems for patients with intractable diseases can lead to the construction of a more comprehensive healthcare system that addresses a wider range of health concerns.