OBJECTIVE:This study evaluated the cultural feasibility and impact of a decision coaching workshop for nurses in Japan, using the Ottawa Decision Support Framework (ODSF). METHODS:A pre-post study was conducted to evaluate a four-hour workshop based on the ODSF, integrating lectures, instructional videos, and role-play. Outcomes assessed include participants' perceptions of SDM-related concepts, decision-making skills, and confidence. Confidence was measured using a self-report Likert scale. Quantitative data were analyzed using paired t-tests, and qualitative feedback was thematically summarized. RESULTS:A total of 54 nurses participated in the workshop. Before the workshop, only 57.4% reported understanding SDM concepts, and many described challenges such as conflicting patient-family preferences and limited patient decision-making capacity. After the workshop, the understanding of ODSF increased by 87.0% , the ability to use decision-support tools by 72.2% , and self-assessment of SDM skills by 50.0% . Confidence in SDM involvement improved from 2.25 to 3.37 and confidence in self-assessment of SDM skills from 2.04 to 3.04 (both p < .001). Participants valued role-play and video demonstrations as particularly effective in enhancing cultural relevance, especially in family-centered decision-making contexts. CONCLUSION:The workshop significantly improved SDM confidence among nurses. This decision coaching training is culturally feasible and may support patient- and family-centered care in Japanese healthcare settings. PRACTICE IMPLICATIONS:Decision coaching adapted to family-centered decision-making may strengthen SDM training in collectivist cultures and contribute to more patient- and family-centered care internationally.

PURPOSE:To develop and validate the KS formula Version 5 for predicting vault after Visian Implantable Collamer Lens (ICL) (STAAR Surgical) implantation using a large clinical dataset and additional biometric parameters. METHODS:This retrospective study included 2,343 eyes of 1,275 patients who underwent ICL implantation between September 2020 and September 2023. Preoperative anterior segment parameters-including aqueous depth, angle-to-angle distance (ATA) measurements, crystalline lens rise, and lens thickness (LT)-were obtained using the CASIA2 swept-source anterior segment optical coherence tomography. The KS formula Version 4 was first re-optimized using the current dataset. The addition of LT, the construction of size-specific regression equations, and the incorporation of horizontal and vertical ATA were each evaluated independently to determine their contributions to prediction accuracy. These components were then integrated to develop the KS formula Version 5. Predictive accuracy was evaluated using median absolute error (MedAE), and reproducibility was assessed with a 10-iteration holdout validation. RESULTS:The optimized KS formula Version 4 achieved a MedAE of 0.0938 mm. Adding LT improved MedAE to 0.0908 mm (P < .001); size-specific regression to 0.0925 mm (P = .0074); and incorporating horizontal and vertical ATA to 0.0932 mm (P = .0376). The final KS formula Version 5 achieved a MedAE of 0.0856 mm, significantly better than the optimized Version 4 (P < .001), and outperformed it in all 10 validation iterations. CONCLUSIONS:The KS formula Version 5 is more accurate than the previous version and improves the reproducibility of vault prediction, facilitating its integration into routine clinical practice using swept-source anterior segment optical coherence tomography.

Objective: To explore decision-making experiences of women who decide not to undergo fertility preservation therapy before breast-cancer treatment. Methods: This quantitative, descriptive study recruited women diagnosed with breast cancer who underwent the decision-making process regarding fertility preservation, ultimately deciding not to pursue fertility preservation. Participants completed a questionnaire after a routine medical examination. Results: Of 39 participants, 18 (46.2%) wanted to have children pre-diagnosis, and 10 (25.6%) expressed this wish afterward. Twenty-four percent of women who did not undergo fertility preservation indicated that they did not have sufficient information, and 14% felt uncertain about their decision. Women who wished for children even post-diagnosis frequently expressed regret about not undergoing treatment. Conclusions: These findings underscore the importance of providing adequate and timely information, decision-making support, and post-decisional psychological care for women facing fertility decisions following a cancer diagnosis. Developing systems to guide when and how to intervene immediately post-diagnosis is essential to promote informed reproductive decision-making and support women in managing these complex, value-laden choices.

Background:Shared decision-making (SDM) is a collaborative process that integrates patients' values and preferences into health care decisions. In intensive care units, patients who are critically ill often lack the capacity to make decisions, necessitating surrogates to make complex choices regarding life-sustaining treatments (LSTs). Objective:This scoping review aims to assess the range of research conducted on surrogate SDM for LSTs among patients who are critically ill over the past decade and highlight areas where current research remains limited. Methods:This scoping review will follow the Joanna Briggs Institute methodology and adhere to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) reporting guidelines. Studies will be included if they examine SDM involving surrogates of adult patients who are critically ill in relation to LST decisions within intensive care unit settings. SDM is defined using 4 criteria: participation of both health care professionals and surrogates, mutual information sharing, consensus building, and agreement on treatment based on the patient's values and preferences. A comprehensive search will be performed across PubMed, CINAHL, PsycInfo, CENTRAL, and Ichushi-Web for English- and Japanese-language studies published between 2016 and 2025. Eligible study designs will include quantitative, qualitative, and mixed methods research. Title and abstract screening, as well as full-text selection, will be conducted independently by 2 reviewers using Rayyan. Data will be extracted on study characteristics, SDM definitions, participant roles, and key findings. Results will be synthesized descriptively and presented in tables and narrative summaries to identify research gaps and inform future investigations. Results:As of June 13, 2025, the literature search has been completed. A total of 2899 citations were identified through the specified database searches, and 527 (18.2%) duplicates were removed. Title and abstract screening are currently in progress, and full-text review is expected to be completed by September 2025. Conclusions:This scoping review will systematically map recent evidence on surrogate SDM in the context of LST decisions for patients who are critically ill. By synthesizing diverse studies, it will identify challenges faced by surrogates and summarize existing interventions that aim to improve SDM processes. The findings are expected to inform future interventions and policies and advance patient- and family-centered care in critical care settings.

Background Healthcare systems increasingly employ internationally educated nurses (IENs). Under Japan’s Economic Partnership Agreement (EPA), EPA nurses and EPA nurse candidates face sociolinguistic barriers that may affect participation in core clinical tasks before and after licensure. However, little is known about how workplace communication shapes professional participation during this transition. Objective This study aimed to examine workplace communication among EPA nurses and EPA nurse candidates during core clinical tasks—specifically nursing documentation and handover practices—and to explore how these experiences shape professional participation within Japanese healthcare settings. Methods This convergent mixed-methods study included non-Japanese, internationally educated EPA nurses (n=4), non-Japanese, internationally educated EPA nurse candidates (n=10), Japanese nurses (n=14), and care workers (n=2). Data were collected using scenario-based tasks, questionnaires, and interviews. Findings were interpreted through the lens of Legitimate Peripheral Participation (LPP). Results EPA nurse candidates had greater difficulty processing and communicating clinical information than licensed EPA nurses. Language-related and workplace-specific communication challenges were associated with reduced professional participation. Licensed EPA nurses described greater confidence and professional responsibility than EPA nurse candidates. Stage-specific mentoring and psychologically safe workplace environments were associated with greater professional participation and professional growth. Conclusions The findings suggest that workplace adaptation extends beyond language acquisition and involves increasing professional participation within clinical communities. Stage-specific mentoring and psychologically safe workplace environments may support professional participation and professional growth. Viewing workplace adaptation as a process of increasing professional participation, rather than primarily as language acquisition, may inform organizational and educational strategies for supporting IENs.

Background Nurses face various ethical dilemmas and conflicts in end-of-life care; however, there is no evidence of effective undergraduate ethics education on the topic settings to address them. Objectives This review aimed to describe educational interventions for end-of-life care focused on ethical content in undergraduate nursing education and their outcomes for students. Design This review used Arksey and O'Malley’s five-stage scoping process. Methods This study used the Ovid (CINAHL and MEDLINE) and PubMed bibliographic databases from 2012 to 2023. We included literature on qualitative, quantitative, and mixed-methods research that could provide information about ethical end-of-life care (EOLC) education interventions in undergraduate nursing programs. We excluded review articles to avoid duplication. The search string included ("education, nursing" OR "education, nursing, baccalaureate") AND ("ethics") OR ("terminal care" OR "hospice care" OR "end of life care" OR "palliative care"). The scope of this study was limited to studies on educational interventions for EOLC ethics in undergraduate nursing education. Results The search yielded 4,190 articles, of which 25 were included in the analysis. Fourteen of the 25 studies were conducted in the USA, whereas the others were conducted in various parts of the world. No intervention research articles were found that focused on EOLC ethics itself, which was either incorporated as part of the nursing education for EOLC or included in ethics education as an EOLC case study. Of these, 17 studies included lectures to teach EOLC ethics, and four used scenarios and case studies as teaching methods. Twelve studies used scenarios for simulation education. Seven studies combined lectures and simulations. The lectures improved students' knowledge and attitudes toward death, and their confidence in EOLC. As a result of the simulation intervention, in addition to improvements in knowledge and attitudes, participants gained communication skills, comfort with caregiving, confidence, self-efficacy, and the ability to reflect on their attitudes. Conclusions The results suggest that while lectures are effective for acquiring ethical knowledge and attitudes related to EOLC based on ethical competency, simulations are more effective for acquiring practical skills such as communication, self-efficacy, and reflection. Incorporating ethical issues in simulations is hoped to broadly develop ethical practice competencies.

PURPOSE:To investigate changes in eye alignment before and after ICL implantation in patients with myopia having corrected distance visual acuity (CDVA) of ≥0.0 logMAR. SUBJECTS AND METHODS:The medical records of 1012 patients without eye movement limitation who underwent bilateral ICL implantation were retrospectively reviewed a at the Eye Center of Sanno Hospital in Japan. RESULTS:Preoperatively, of 1012 patients, 30 (3.0%), 211 (20.8%), 771 (76.2%), and 126 (12.5%) demonstrated constant strabismus, intermittent strabismus, phoria, and binocular diplopia, respectively. Regarding horizontal strabismus without a vertical component, of 30 patients, 9 (30.0%) demonstrated exotropia and 2 (6.7%) exhibited esotropia. Vertical strabismus without a horizontal component was not observed. A combination of horizontal and vertical strabismus was observed in 19 (63.3%) patients. The rate of eye alignment classification agreement preoperatively and postoperatively was 98.7%, including 100%, 93.8%, and 100% in the constant strabismus, intermittent strabismus, and phoria groups, respectively. Of 1012 patients, 1.3% converted from intermittent strabismus to phoria (6.2% in the intermittent strabismus group). CONCLUSIONS:Uncomplicated ICL implantation under topical anesthesia was not associated with eye alignment in 98.7% of patients with myopia, and 0% transitioned to constant strabismus after ICL implantation.

Introduction: We previously reported a case of a patient with bilateral congenital cataract identified in the Ogasawara village, Bonin Islands, Japan, on a visit by an ophthalmologist and describe its course over 17 years from initial surgery. Here, we report on a secondary intraocular lens (IOL) implantation that was subsequently performed at 22 years and 5 months of age. Methods: After cataract surgery at 7 months, the aphakic patient began amblyopia treatment using extended-wear soft contact lenses (SCLs). After 10 years of age, SCLs were chosen to achieve crossed monovision considering the cosmetic appearance when facing other people. At 22 years of age, a secondary IOL implantation was performed. Secondary implant in the patient considered appearance and postoperative vision without glasses, we selected the crossed monovision method using a monofocal IOL. The postoperative targeted refraction for the right (non-dominant eye) and left eyes (dominant eye) planed - 0.33D and - 2.25D, respectively. Results: At 3 months after surgery, the corrected distance visual acuity (CDVA) with IOLs for the right and left eyes was 20/16 and 20/60, respectively, and the binocular visual acuity was 20/16 for distant vision and 20/25 for near vision. The CDVA for the right eye was: 20/13 × IOL = sph-0.25D and that for the left eye was: 20/13 × IOL = sph -1.75D D/cyl -0.50D/Ax170°. Although the exotropia was complicated by dissociated horizontal deviation and dissociated vertical deviation, there were no significant changes in ocular position before and after surgery. The patient was satisfied with achieving independence from spectacles and SCLs. Conclusion: The use of the crossed monovision method with monofocal IOLs in this patient and defective binocular function created a visual environment with no inconvenience in everyday life after secondary IOL implantation. In terms of secondary implant after amblyopia treatment, the IOL type or postoperative targeted refraction must be chosen to maintain or improve the visual environment obtained with the amblyopia treatment.

BACKGROUND:To meet contemporary professional standards, nurse educators must provide students with educational content that considers active learning strategies.OBJECTIVE:This study explored the process and challenges faced by nurse academics working collaboratively to implement an online problem-based learning course.DESIGN:Collaborative action research.SETTING:This study was conducted with nurse academics at Yamaguchi University in Japan from May 2020 to April 2022.PARTICIPANTS:Five Japanese nurse academics and two Australian academics participated in this study.METHODS:Nurse academics met regularly online to discuss issues and plan, act, and reflect on their experiences using Norton's (2001) five-step process. The meetings were recorded, and structured and written reflections from each participant were collected throughout the process. Data collected from the meetings and structured reflections were analysed to identify key themes.RESULTS:In Step 1, the key stakeholders were discussed and issues were identified. Step 2 included planning a short seminar for the convenience of student participants, Step 3 involved the conduct of an online nursing ethics course (four sessions) for the students, and Step 4 included the evaluation. One year after the academics had completed their teaching, a discussion of future directions was conducted (Step 5). Through the collaborative action research process, four themes were identified: (1) creating a shared understanding, (2) adopting new paradigms for teaching and research, (3) learning and experiences while practicing, and (4) looking back and moving forward.CONCLUSIONS:Despite some challenges experienced, the action research approach enhanced the curriculum development process, provided collegial opportunities to explore and learn together, and led to increased changes in the educational practice of academics, even beyond the collaborative action research.

This study aimed to clarify the status of problematic behaviors among elderly patients with dementia at home and the associated burden on their family caregivers in Japan, Hong Kong, and Singapore immediately before the COVID-19 pandemic. The study included 563 family caregivers of elderly patients with dementia living at home in these three regions. Information regarding their demographic characteristics, such as age, gender, education level, income, marital status, and family status, was obtained. The Revised Memory and Behavior Problems Checklist, a 24-item scale for assessing problem behaviors, and the Zarit Burden Interview, a 22-item scale for measuring caregiver burden, were used alongside other relevant scales. The findings indicated that the majority of family caregivers were female and in their 60s across all three regions, while elderly patients with dementia were mostly female and living alone in their 80s. In addition, a significant proportion of these patients had comorbidities such as diabetes and other health conditions. In Japan, although the patients exhibited relatively intact physical function and a low degree of dementia, the caregivers experienced high-stress levels. The demographic profiles of family caregivers of elderly patients with dementia at home in Hong Kong, Singapore, and Japan were remarkably similar, particularly in terms of age and gender distribution. Furthermore, marital and employment statuses were comparable between Hong Kong and Singapore. While the previous studies have taken a broad view of Asia, focusing on Hong Kong, Singapore, and Japan in particular has facilitated the identification of clues for developing targeted countermeasures.

目的:乳がん診断後に妊孕性温存しないと意思決定した女性の体験を明らかにする.

AimTo evaluate a year-long mentorship program, pairing nurses from different regions across the world to support their global leadership capability, and identifying additional consequences of their participation. BackgroundInvestment in developing nurse leaders continues as a strategic global imperative. Building on the first cohort's recommendations, this second program illustrates continued progress. Program evaluationUsing the logic model of program evaluation, this non-empirical paper uses data collected from anonymized questionnaires and participants' stories to help improve the program, illustrating innovative practices to develop the confidence and competence of emerging and established nurse leaders globally. DiscussionThe value of mentorship was recognized, and there were gains for both mentors and mentees in the development of leadership confidence and competence. Through engagement and collaboration with the whole community, participants were encouraged to understand their own and others' cultures avoiding assumptions and stereotypes. ConclusionThis evaluation illustrates that in addition to helping improve future programs, mentorship has enabled the growth of individuals' skill sets and the confidence to reach out to peers across the world to understand the meaning of global health and to make a meaningful contribution to the challenges they face. Implications for nursing practiceNurse managers should be encouraged to develop and formalize a mentoring culture to benefit the leadership competence and well-being of their workforce. Implications for nursing policyEvery nurse has a responsibility to invest in nursing leadership for themselves and others. Mentorship can assist nurse leaders to build workforce capability to lead and contribute to the policy agenda locally, nationally, and internationally. Starting early and at the individual level, global mentorship programs can develop leadership expertise to help nurses find their voice and strengthen their confidence and competence to lead and therefore build the strategic leaders of the future.

The purpose of this study was to investigate the caregiving burden experienced by older family caregivers of homebound older individuals with dementia in Hong Kong, Singapore, and Japan before the COVID-19 pandemic. The study examined their attitudes towards supporting older parents and involved 540 family caregivers. Various scales and questionnaires were used to assess factors such as memory and behavior problems, perceived support, general health, burden, cultural justification, and coping strategies. The results revealed that greater memory and behavioral problems in dementia patients negatively impacted caregivers’ mental health and influenced their coping strategies. The study found no direct correlation between support for older parents and mental health but identified a positive association with specific coping strategies. The similarities among family caregivers in Hong Kong, Singapore, and Japan were noted, including age, education, occupational status, and shared cultural values like Confucianism and respect for elders. It was observed that caregivers prioritize their own quality of life while addressing the challenges related to caring for older parents.

【目的】国内外の文献をレビューし，乳がん女性が薬物療法前に行う妊孕性温存の選択に対する意思決定支援の実態と課題を明らかにする．

Nursing & Health SciencesEarly View EDITORIAL A call to action for an inclusive model of shared decision-making in healthcare Misae Ito RN, RMW, PhD, Corresponding Author Misae Ito RN, RMW, PhD m-ito@yamaguchi-u.ac.jp orcid.org/0000-0002-1473-0835 Nursing and Laboratory Science, Graduate School of Medicine, Yamaguchi University, Ube, Japan Correspondence Misae Ito, Nursing and Laboratory Science, Graduate School of Medicine, Yamaguchi University, 1-1-1 Minami-Kogushi, Ube, Yamaguchi 755-8505, Japan. Email: m-ito@yamaguchi-u.ac.jpSearch for more papers by this authorMasae Tsutsumi RN, PhD, Masae Tsutsumi RN, PhD Nursing and Laboratory Science, Graduate School of Medicine, Yamaguchi University, Ube, JapanSearch for more papers by this author Misae Ito RN, RMW, PhD, Corresponding Author Misae Ito RN, RMW, PhD m-ito@yamaguchi-u.ac.jp orcid.org/0000-0002-1473-0835 Nursing and Laboratory Science, Graduate School of Medicine, Yamaguchi University, Ube, Japan Correspondence Misae Ito, Nursing and Laboratory Science, Graduate School of Medicine, Yamaguchi University, 1-1-1 Minami-Kogushi, Ube, Yamaguchi 755-8505, Japan. Email: m-ito@yamaguchi-u.ac.jpSearch for more papers by this authorMasae Tsutsumi RN, PhD, Masae Tsutsumi RN, PhD Nursing and Laboratory Science, Graduate School of Medicine, Yamaguchi University, Ube, JapanSearch for more papers by this author First published: 12 September 2021 https://doi.org/10.1111/nhs.12879Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Early ViewOnline Version of Record before inclusion in an issue RelatedInformation

Purpose: To assess changes in eye alignment before and after cataract surgery.Subjects and methods: The medical records of 786 cataract patients without eye movement limitation who underwent bilateral cataract surgery under topical anesthesia with monofocal IOL placement were retrospectively reviewed at the Eye Center of Sanno Hospital in Japan.Results: Before cataract surgery, 121 of the 786 patients (15.4%) had constant strabismus, 263 (33.5%) had intermittent strabismus, and 402 (51.1%) had phoria. Among the 121 patients with constant strabismus on the preoperative exam, 64 (52.9%) had exotropia without vertical strabismus, 7 (5.8%) had esotropia without vertical strabismus, and 6 (5.0%) had vertical strabismus without a horizontal component. After surgery, 98 of the 786 patients (12.5%) had constant strabismus, 126 (16.0%) had intermittent strabismus, 562 (71.5%) had phoria. The rate of eye alignment agreement before and after surgery was 72.3% overall. We found that 17 patients (2.2%) who did not have constant strabismus preoperatively developed constant strabismus postoperatively, and all of these patients experienced binocular diplopia. Characteristics of patients at risk for constant strabismus and diplopia postoperatively included patients with vertical deviation preoperatively (intermittent or phoria).Conclusions: Uncomplicated cataract surgery under topical anesthesia did not influence eye alignment classification in 72.3% of patients; however, patients with vertical deviation preoperatively were more likely to transition to constant strabismus after surgery.

Purpose This qualitative study captured nurse academics’ experience of creating an online nursing ethics seminar at post graduate level through an action research process. Methods A template for reflections from students and staff about their experience of the seminar was used. Responses were received from students and staff who participated in the seminar and analysed for key themes. Results The 10 student participants and 5 Japanese teaching staff reported overall positive experiences with the implementation. Key themes emerging were building on learning; participation and group engagement; facilitation versus expert delivery; and translation into practice. Conclusion The findings are consistent with attempts to implement PBL and online learning elsewhere, but yet to be widely adopted in Japan. There is a need to embed inquiry-based learning PBL approaches in Japanese higher education. This study provides encouragement to participants and others considering implementing online PBL in nursing courses.

非がん性呼吸器疾患とともに生きる患者は，増悪と回復を繰り返すたびに機能が低下し，自身の終末期を意識することなく死を迎えることがある．患者は日々の病状に対処することに集中し，将来を見据えた意思決定なく終末期となり，家族は患者の意思を把握できないまま看取りとなり心理的苦痛や葛藤，後悔を伴う．患者とその家族が終末期について考え，病状に応じて意思を伝えることやその人らしく生きることを支援する必要があると考えた．非がん性呼吸器疾患患者のエンドオブライフケアに関する研究は少なく事例検討が散見される．そこで国内外の文献検討により，わが国における非がん性呼吸器疾患患者のエンドオブライフケアにおける意思決定支援の研究動向とその課題を明らかにすることを目的とした．1992年～2020年３月までを範囲とし，医学中央雑誌Web版，CINAHL，MEDLINEを用い，「非がん（not cancer）」「呼吸器（respiratory）」「エンドオブライフ（end of life）」「Japan」のキーワードで検索した．分析対象論文は14文献であり，本研究の目的内容に沿って類似性に基づき帰納的に分析した．その結果，「呼吸困難のケア」「患者の意思確認困難」「疾患の理解不足」「代理意思決定支援での家族の苦悩」「意思決定支援のタイミングの遅延」「看護師の葛藤」「多職種チーム支援の難しさ」「意思決定支援ガイドライン作成やシステム構築の必要性」が報告されていた．増悪に備え，在宅酸素療法や非侵襲的陽圧換気療法を導入する際や急変に備えた患者や家族の意思決定支援に関する報告がほとんどなく，非がん性呼吸器疾患患者のエンドオブライフケアの意思決定支援の課題を解決するためのさらなる研究の必要性が示唆された．