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This study aimed to develop the Grief State Scale for Nurses to measure the level of nurses' grief and to identify items influencing grief levels among Indonesian nurses. A total of 267 questionnaires were analyzed and interpreted. Statistical analyses were performed using descriptive statistics and exploratory factor analysis. Items influential in increasing nurses' grief were relating death with personal loss; patient's age/illness similar to nurse's family members; and having rapport with patients. Time and place to express grief, allocation of grieving time, and sharing collegial emotional expressions were items found to decrease levels of nurses' grief.

Technological advancements have led to the use of robots as prospective partners to complement understaffing and deliver effective care to patients. This article discusses relevant concepts on robots from the perspective of nursing theories and robotics in nursing and examines the distinctions between human beings and healthcare robots as partners and robot development examples and challenges. Robotics in nursing is an interdisciplinary discipline that studies methodologies, technologies, and ethics for developing robots that support and collaborate with physicians, nurses, and other healthcare workers in practice. Robotics in nursing is geared toward learning the knowledge of robots for better nursing care, and for this purpose, it is also to propose the necessary robots and develop them in collaboration with engineers. Two points were highlighted regarding the use of robots in health care practice: issues of replacing humans because of human resource understaffing and concerns about robot capabilities to engage in nursing practice grounded in caring science. This article stresses that technology and artificial intelligence are useful and practical for patients. However, further research is required that considers what robotics in nursing means and the use of robotics in nursing.

Healthcare providers in advanced healthcare systems recognize the value of practices involving technological competencies in healthcare. Theory-based practice, grounded in Locsin's Technological Competency as Caring in nursing theory, warrants investments in quality nursing care. This study determined the effect of in-service educational programs for nurse managers regarding perceptions of the theory. Five, 1-hour lecture sessions weekly showed significant effects on understanding technological competency as expression of caring in nursing. Technological Competency as caring in nursing theory-based educational programs offer promising ways to ensure that understanding technological competency as caring assures quality healthcare.

The Technological Competency as Caring in Nursing Instrument-Revised (TCCNI-R) was developed from the Technological Competency as Caring in Nursing theory. To assess the psychometric properties, a four-factor questionnaire comprised the TCCNI-R. Only 590 of 1,322 online questionnaire responses by nurses in 11 general hospitals in Chugoku-Shikoku, Japan, were analyzed and interpreted. Exploratory factor analysis and confirmatory factor analysis via SEM justified construct validity, and Cronbach's alpha coefficient established reliability. Goodness of fit was rejected; however fit index value was accepted. Root mean square of error approximation showed reasonable approximation error. The TCCNI-R showed content validity and reliability in measuring technological competency as expression of caring in nursing.

Aim To clarify perceptions of nurses towards patient safety climate and quality of health care in Japan. Background Nurses' perceptions of patient safety climate and quality of health care services are not well-known. Method The survey was conducted at general hospitals with 200 beds or more using the Patient Safety Climate Scale and the Modified multiple-item scale for consumer perceptions of health care service quality. Results Significant positive correlations were found among nurses' perception towards patient safety and health care service quality. The experience of nurses as members of the committee on patient safety and their employment position did not show any significant difference in the perception towards patient safety and health care services quality. Perceptions of health care service quality were lower among those with 6- to 10-year experience than with over 21 years. Conclusion In the perception of nurses and nurse managers' continuous improvement, perceptions towards patient safety were related to reliability, assurance, responsiveness and empathy in health care service quality. Implications for nursing management Generalist nurses with 21 years or more experiences in multiple departments showed high perception towards health care service quality. Experienced nurses' perceptions of activities to improve patient safety and quality of health care services are important.

This chapter describes expectations and ethical dilemmas concerning healthcare communication robots (HCRs) from a nurse’s perspective. Ethical dilemmas in nursing settings are wide-ranging. When HCRs are introduced to long-term facilities and hospitals for patient communication, new kinds of ethical dilemmas may arise. Using interviews with healthcare providers, I examined the potential ethical dilemmas concerning the development and introduction of HCRs that may interact with older adults. This analysis was based on four primary issues from the nurses’ perspective. Since HCRs will be used in healthcare settings, it is important to protect patient rights and maintain their safety. To this end, discussion and collaboration with an interdisciplinary team is crucial to the process of developing these robots for use among patients.

Healthcare for the increasing senior population is a significant challenge. To address this problem, the use of healthcare robot is increasingly being recognized to have strong potential in addressing older adult and psychiatric patients' healthcare and welfare needs. The purpose of this preliminary study is to evaluate the changes in the autonomic nervous activity of an elderly patient with schizophrenia during upper limb range of motion (ROM) exercises led by Pepper (SoftBank Robotics) with the application program of Care Prevention Gymnastics Exercises (Pepper-CPGE) made by Xing Company in Japan. A Pepper-CPGE-led three-minute radio gymnastics program (Radio Exercises #1, consisted of three types of exercises) and instructions were developed. The normal aging 69-year old schizophrenic subject followed instructions from Pepper throughout the intervention. Electrocardiography (ECG) records, heart rate, acceleration score, and ROM exercises of upper limb were collected and analyzed using the GSM's Bonaly Light instrument and Image-J analysis. (1) The high-frequency (HF) (indicative of parasympathetic nervous activity), and low-frequency (LF)/HF ratio (indicative of sympathetic nerve activity) were increased in reference from the baseline data before the exercise stretching the chest. (2) The momentum decreased as the ROM of shoulder joint flexion declined. Declines in both parasympathetic and sympathetic nervous activity were observed. Also, (3) when the exercise "bend the body forward" was performed, the HF and LF/HF also decreased. Evaluation of robot-based rehabilitation exercise program effectiveness by the ROM exercises image analysis and autonomic nervous activity is essential for the futurist programming of ROM exercise among patients with schizophrenia.

Humanoid robots are increasingly deployed in various health facilities to complement long-term care in Japan. Although this technology influx is still in its infancy, many health providers are optimistic about its capabilities. Thus, it is crucial to investigate its preliminary utilization and effects as precautionary measures in understanding the use of humanoid technology in healthcare. The study intends to describe the rehabilitation care experience for older patients with schizophrenia and/or dementia in the use of Pepper humanoid robot. A qualitative case study was conducted to explore the rehabilitation recreational activities of older patients with schizophrenia and/or dementia (n=9) in geriatric health facilities. After securing ethical clearance, observational data were recorded and analyzed using a case-oriented understanding and framework of reaction, interaction, and benefaction. Reaction focuses on their attitudes and impressions toward Pepper. During the rehabilitation and recreational sessions, interaction deals with the relationship between older patients with schizophrenia and/or dementia, Pepper, and providers. Lastly, benefaction reflects the actual health outcome of the reaction and interaction with Pepper. As observed, humanoid robots can elicit simple and individual instructions for simple activities (e.g. exercise) and start the simple conversation (question-answer loop) with its subjects. However, deploying humanoid robots in long-term care requires numerous improvements in robotic technology to elicit an increase in communication and other physical activities, motivation, and a sense of calmness from its clients.

The issue of older adults' care is becoming a serious concern in Japan, which has a rapidly aging population and a low birthrate. The development of robots is pushed forward as a measure to compensate for the healthcare worker shortage. The purpose of this paper is to consider the potential legal issues of caring healthcare robot (CHR) for older adults' care. A CHR must recognize the speech, face, and presence of older adults, and make judgments and relay information based on acquired information. CHRs fulfill the caring function by being close to patients, to know them deeply, and to look after them. Therefore, communication functions by advanced artificial intelligence based on caring in nursing are essential for CHRs. The ability to maintain and improve the activities of daily living (ADL) of older adults is to facilitate activities through bidirectional information relay. Furthermore, without guarantees on the safety and ascription of responsibilities, the introduction of CHRs in clinical practice will not proceed. As laws differ from country to country, it is necessary to examine Japanese policies and related laws when using CHRs in Japan. Currently, there are no central rules on information security. In Japan, the law is made after a case has occurred; thus, dealing with novel issues as they occur will not have the benefit of legal guidance. Creating a broad legal framework or taking preventive measures at an early stage is needed. Therefore, as a first step, establishing guidelines for the use of CHRs will be valuable.

Pepper, a humanoid robot, is 1.2 m in height and is designed to move its limbs. There are risks of the older adults experiencing falling and collision accidents when they interact with Pepper. When physical interaction happens between a humanoid robot and human beings, potential harmful physical contact might occur. The aim of this report was to examine the safety management aspects when using Pepper, a humanoid robot for the care of older adults. The older adults’ reactions to Pepper’s functions cannot be predicted. Hence, it is necessary to clarify methods to guarantee its safety in advance and to increase the safety and properties of the robots. The benefits of introducing support robots such as Pepper for aging medical and nursing care settings are obvious. Therefore, engagement in robot development while considering both the risks and benefits is critical. Our academic initiatives have just begun. Through information exchange among researchers, users, engineers, and law specialists, we need to identify latent and prominent risks in situations where Pepper and the older adults interact and deepen our examination of measures against such risks.

Human caring, founded on a Japanese caring perspective and nursing theory, fosters innovative and creative ideas for an aging society. The growing reality of health care dependency on technology presents a temptation to give robots utility as partners in nursing practice. Human caring expressed in human-to-human relationships, and also between humans and nonhumans, is a futuristic model for health care, with humanoid robots as major supporters. The purpose of this article is to explore this disruptive technology, along with its functions and characteristics. Tanioka's Transactive Relationship Theory of Nursing is shared along with its relevance for addressing technological disruptions in health care.

The purpose of this article is to examine ethico-legal issues and existing Japanese law addressing interpersonal relationships in healthcare situations involving Humanoid Caring Robots (HCRs) and older adult patients. Potential safety issues include environmental situations between older adults and HCRs; identification of potential “leakage” of personal information from stored data in the cloud server; and issues of access authority for HCRs' stored data. It is necessary to have accurate findings supporting the legislation about HCRs to provide safe and effective care for older adults, and to limit healthcare facilities to reasonable risk level.

Patients with schizophrenia may exhibit a flat affect and poor facial expressions. This study aimed to compare subjective facial emotion recognition (FER) and FER based on multi-task cascaded convolutional network (MTCNN) face detection in 31 patients with schizophrenia (patient group) and 40 healthy participants (healthy participant group). A Pepper Robot was used to converse with the 71 aforementioned participants; these conversations were recorded on video. Subjective FER (assigned by medical experts based on video recordings) and FER based on MTCNN face detection was used to understand facial expressions during conversations. This study confirmed the discriminant accuracy of the FER based on MTCNN face detection. The analysis of the smiles of healthy participants revealed that the kappa coefficients of subjective FER (by six examiners) and FER based on MTCNN face detection concurred (κ = 0.63). The perfect agreement rate between the subjective FER (by three medical experts) and FER based on MTCNN face detection in the patient, and healthy participant groups were analyzed using Fisher’s exact probability test where no significant difference was observed (p = 0.72). The validity and reliability were assessed by comparing the subjective FER and FER based on MTCNN face detection. The reliability coefficient of FER based on MTCNN face detection was low for both the patient and healthy participant groups.

Aim This study aimed to describe the interactions between healthcare robots and older persons in two selected institutions. Methods A qualitative descriptive analysis study using simultaneous observations of healthcare robot and older person interactions was conducted at two healthcare institutions in Japan. The Pepper robot equipped with Care Prevention Gymnastics Exercise programs was used in two situations: (a) exercise regimen led by Pepper; and (b) interactive dialogue between Pepper and older persons during the exercise process. These interactions were recorded using audiovisual equipment and analyzed using content analysis thereby revealing four thematic categories. Interpretation and discussion were structured based on assumptions of the Transactive Relationship Theory of Nursing. Results The analysis revealed four thematic categories: (a) intermediary participation of healthcare practitioners; (b) technologies of care for practice; (c) human-robot interactions involving artificial intelligence; and (d) valuing safety in nursing through technology. Conclusion Interactions between healthcare robots and older persons may improve quality of care. However, issues regarding fidelity and functionality of dialogic conversations, and ensuring safety and security of using healthcare robots are recognized as critical nursing practice concerns in healthcare robot use in institutional settings.

In recent years, the number of bedridden patients with limb disabilities such as amyotrophic lateral sclerosis (ALS), has increased due to an extended life span and an aging society. Human eye movements are not relatively attacked even if ALS develops. Focusing on this point in this paper, we proposed a new remote-controlled drone system by using only the patient’s eye movements in order to maintain and improve the quality of life of bedridden patients, including ALS patients. Furthermore, we presented experimental results to verify the effectiveness of the drone system. The experiment was conducted for three medical staff members who can evaluate this system considering bedridden patients. From the experimental results, we clarified what should be improved in order for bedridden patients to use this drone system.

In Japan, humanoid robots has been introduced in the medical and elderly care environment. The application program of Care Prevention Gymnastics Exercises for Pepper (Pepper-CPGE) made by Xing Company, Japan is a body-brain gymnastics recreation program for 40 minutes tailored to the elderly's functional level. It consists of moving, watching/healing, and playing. "Move the body" exercise and other active range of motion activities are done according to the music. Pepper-CPGE was introduced as a clinical trial at the Mifune hospital, beginning in May 2018. At the units where clinical trials are done, 80% of the patients are with mental illness diagnosis with decreased physical functions often moving by wheelchair only. When Pepper-CPGE was introduced, the following changes were observed : (1) communication between patients and nurses during rehabilitation care using Pepper-CPGE was increased ; (2) patients wereinteractive, engaged, and actively participated in the Care Prevention Gymnastic Exercises using Pepper-CPGE ; (3) patients had fun and enjoyed talking to Pepper-CPGE. Interventions using Pepper-CPGE appear to be an effective rehabilitation strategy to increase engagement and participation of elderly patients who require long-term care and rehabilitation. J. Med. Invest. 66 : 50-53, February, 2019.

The Perceived Inventory of Technological Competency as Caring in Nursing (PITCCN) based on Locsin's theory of Technological Competency as Caring in Nursing (TCCN, 2005) was developed (Kato et al. 2016) and revised by Miyamoto et al. (2017). The purpose of this study was to verify criterion-related validity of PITCCN using the Practice of Caring Behavior Questionnaire (PCBQ, Shigehisa, 2007). The study was approved by the Ethical Review Board of Tokushima University Hospital. Data were collected from September 2017 to October 2017. Of the 402 questionnaire copies distributed, only 299 copies were returned and analyzed to determine correlations between total score value and Mean Factor Point of each factor for PITCCN and PCBQ. These were analyzed using Pearson correlation coefficients. Statistical significance was at .01 levels. Strong positive correlation coefficient was obtained between total score values (r=.76, p?.01) and factors of PITCCN and PCBQ (r=.19 to .68, p?.01) , except the PITCCN's factor 3 : "Utilization of information obtained from technology and continuous knowing" and PCBQ's factor 6 : "Enriched relationships between patient and nurse", (r=.13, not significant). From these results, the criterion-related validity of PITCCN as the inventory of TCCN could be confirmed. J. Med. Invest. 66 : 42-45, February, 2019.

Older adults with dementia are increasing in Japan. Because of this, “communication robots” are being introduced into nursing settings to substitute for the shortage of nurses and other care workers. Our research group is currently developing a humanoid nursing robot with caring function (HNR), specifically for the functional and practical use of older adults with dementia. The purpose of this study was to clarify improvement points of the current function of humanoid robot’s (Pepper) (SoftBank Robotics) dialog pattern for improving optimal communication between humanoid robot and older adults. Dialog programs were installed in the humanoid robot Pepper, including the application program Care Prevention Gymnastics Exercises for Pepper (Pepper-CPGE) that was made by Xing Company, Japan. Dialogues between older adults and Pepper-CPGE were recorded by video camera. Data from transcriptions of the conversations captured from video and from field notes were analyzed focusing on human-robot interaction. From the recorded scenes and conversations, the following were points to be improved: 1) Intonation of the words vocalized by Pepper-CPGE was different from that expected by the older adult resulted in inappropriate responses by the older adult; 2) The timing between Pepper’s questions and the responses of the older adult were not timely and did not match (differences in the question-response time), which lead to confusion among the older adults; and 3) Other surroundings older adults were interested in the dialogue with Pepper-CPGE. However, Pepper-CPGE cannot communicate with multiple older adults. ImprovingPepper-CPGE’s ability to communicate with multiple older adults as an older adult’s dialogue with Pepper-CPGE can cause other older adults to also interact not only with the older adult that Pepper-CPGE is interacting with but also with Pepper-CPGE. This study shows that transactive relations among humanoid robots and older adults can be facilitated. Improving communication between humanoid robots and the older adults by optimizing a structured dialogue is needed to enhance appropriate engagement and participation. It is necessary to create a “Caring dialogue Database” for HNRs in order to know the patient/client and to share the aesthetic experiences of human-robot interactions. Also, it is important to develop a dialog pattern that enables humanoid robots to sympathize with older adults.

Delivered by intramuscular (IM) injections, Long Acting Injections (LAI), offering comparatively long term medicinal effects from several weeks to several months, are gaining much attention. The aim of this article was to indicate a safe and effective IM injection technique based on evidenced data derived from ultrasonographic data. Accurate anatomical knowledge is necessary in order to administer IM injections. It is possible to gain an adequate understanding of injection site anatomical structures by using ultrasound diagnostic devices. In particular, ultrasonography offers real-time diagnostic data allowing for observation of injection site, subcutaneous tissues, fat layers, muscle membrane, muscles and bones. To deliver the drug accurately into the muscle is essential, to achieve maximum drug efficacy and prevent injection site reactions. Therefore, when administering IM injections to the buttocks area, a suitable injection needle between 23G 25 mm to 21G or 22G 38 mm must be chosen depending on physique and drug characteristics. Needles determined as safe and effective through ultrasonographic evidence are needed such as in the case of a deltoid injection site, in which a 23G 25 mm injection needle is used in the absence of notable obesity. Not only the needle type is essential, but also the IM procedure itself. It is important to stretch the skin, inserting the needle at 90 degree angle to ensure depth of needle insertion to the muscle. Until new con-firmed evidence becomes available, it is necessary to increase the understanding of injection site selection methods, needle insertion depth, needle angle, and established IM injection techniques. The application of ultrasound devices in the development of next-generation techniques for IM injection is promising. Importantly, these techniques provide critical information from a risk management perspective.

Japan’s aging population rate is increasing and healthy life expectancy has decreases by 10 years shorter than average life expectancy. The aim of this study is to determine the relationship among chronic disease, sleep quality, health-related quality of life (HRQOL), and activities of daily living in people over 55 years old who live in the community. Subjects were 161 persons aged 57 to 90 years who were treated with chronic disease in the outpatient department of the A hospital. Exclusion criteria included patients with dementia, cancer and severe heart disease. The survey evaluation questionnaires included the Pittsburgh Sleep Quality Index (PSQI), HRQOL by Short-Form 8 Health Survey (SF-8), and activities of daily living. Variables associated with quality of sleep, HRQOL in univariate analysis with p < 0.05 were entered into multivariate analysis using logistic regression with a stepwise forward selection procedure to determine independent variables and their association with major causes. The logistic regression analysis was done using SPSS software and the post-hoc power of the study was estimated using G*power. The level of significance was set at p < 0.05. The risk factor of poor sleep quality was because of history of cancer [odds ratio (OR): 3.53, 95% confidence interval (CI): 1.06 - 11.77], and insomnia (OR: 3.25, 95% CI: 1.55 - 6.79). The risk factors of poor physical HRQOL were motor disease (OR: 2.62, 95% CI: 1.36 - 5.07), respiratory disease (OR: 3.24, 95% CI: 1.27 - 8.26) and having pain (OR: 11.71, 95% CI: 5.35 - 25.66). In addition, anemia was found to be a risk factor of poor mental HRQOL (OR: 4.87, 95% CI: 1.11 - 21.33). The feeling-for-their-body-age (OR: 0.30, 95% CI: 0.15-0.59) was as “younger than actual age” and advanced the risk factor of poor sleep quality. In addition, feeling-for-their-age (OR: 0.44, 95% CI: 0.21 - 0.92) resulted in reduced risk factor of poor physical HRQOL. The risk factor of poor sleep quality was due to a patient with history of cancer. The factor for good sleep quality and the good factor for physical HRQOL were indications of feeling younger than the actual age.

Japan’s aging rate (ratio of elderly aged 65 and older to total population) has exceeded 20%. The aim of this study was to clarify the relationships between Health Related Quality of Life, Body Mass Index (BMI), and sleep quality. Subjects were 51 adults over 55 years old with chronic disease who living in the community. Instruments and structured interviews were used giving due consideration to privacy. Interviews were conducted within 10 - 20 minutes at the out-patient department. The evaluation instruments included bodymass index, Pittsburgh Sleep Quality Index (PSQI), Health Related Quality of Life (HRQOL), and Oral Health Impact Profile (OHIP-14). A significant positive correlation (ρ = 0.321, p < 0.05) between PSQI and QOL (OHIP-14) scores was confirmed with sleep quality being lower with lower QOL scores. A negative correlation (ρ = ?0.339, p < 0.05) between physical health component summary scores (PCS) and mental health component summary scores (MCS) of HRQOL was confirmed, demonstrating that PCS was low, and the level of MCS was high. Sleep quality was found lower among those with lower oral health-related QOL scores. Moreover, in subjects with lower MCS scores, the PCS scores were found to be higher. Accordingly, it was considered appropriate that dental treatment and care, support the maintenance of activities and sleep, and mental health promotion which are likely requisites critical for elderly persons’ maintenance of independent lifestyles in their familiar community.

In Japan, the shortage of personnel is a problem in long-term care nursing and rehabilitative care prevention. Nevertheless, Japan has taken measures to compensate for these shortages by promoting medical and nursing care activities using robotic technologies, and employing human resources from overseas. The purpose of this study was to determine potential legal issues and subsequent implications for care during prevention gymnastic exercises for the elderly using Pepper in long-term health facilities. The application program of Care-Prevention Gymnastics Exercises for Pepper (Pepper with CPGE) was made by the Xing Company Japan. Currently, care workers become intermediaries for the safe use of Pepper with CPGE. However, it was realized that some legal issues may arise if Pepper with CPGE alone will carry out these preventive care programs for the elderly without the presence of care workers as intermediaries. In this situation, using Pepper with CPGE alone to conduct care prevention gymnastics will require safety measures to prevent these possible practice issues and anticipate implications for care. In this regard, determining detailed target levels of rehabilitation exercise demands and environmental setting safety become essential factors. The use of humanoid robots in healthcare is expected to influence more practice protocols in contemporary and futurist rehabilitative human care. The identification of possible safety issues in performance and environmental situations, and implications for care are critical to ensure safe and valuable rehabilitative health care practices for the elderly population.

The awareness of care provided by stroke care unit (SCU) nurses in Japan to patients with an acute cerebrovascular accident (CVA) and the characteristic differences in their actual nursing practice were evaluated. A cross-sectional web-based questionnaire survey was administered to 1040 SCU nurses. Data collection and reporting procedures followed the STROBE Statement Checklist for cross-sectional studies. Exploratory factor analysis, using 52 observation items, identified eight factors with a factor loading > 0.4. For all factors, the actual practice was significantly lower than the awareness of the importance of nursing care for patients with acute CVA. Awareness and actual practice of recognition of patients’ physical changes (RPPCs) were high. The actual practice of RPPCs and preventing the worsening of acute stroke and related symptoms varied, depending on years of experience in acute phase stroke care. RPPCs in actual practice had a significantly higher score among certified nurses or certified nurse specialists. Their awareness of the importance of collaborating with therapists was low. On-the-job training can improve nurses’ competence and prevent worsening conditions in patients with CVA. An emphasis on enhancing practice experience toward patients with acute CVA and facilitating the deployment of certified nurses in SCUs can improve nursing care practice.

Background Caring is the heart of nursing. However, not many understand the significance of caring in nursing from the perspectives of undergraduate nursing students, especially in Japan. Aim To describe caring in nursing among Japanese nursing students as learned and communicated through their aesthetic expressions. Methods The study employed hermeneutic phenomenology. Sixty-one Japanese nursing students in their second year of baccalaureate degree studies participated. Constituting the data were art-based graphic expressions, such as drawings and written reflections on the drawings, as a response to the question of how the participants describe their meanings of caring in nursing. The thematic analysis method was used to analyze and interpret the data. The trustworthiness of the research was established following Lincoln and Guba's criteria. Findings Seven thematic categories were identified. These categories include (1) Engaging with others; (2) Knowing each other; (3) Being with other persons; (4) Nurturing intimate personal growth; (5) Supporting wholeness of persons; (6) Vacillating rhythm; and (7) Intensifying competency. Conclusion This study described the understanding of caring in nursing among undergraduate Japanese nursing students during their second year of study. The caring in nursing focused on reciprocal relationships, whole-person relating, and practice competency. Findings suggested that nurse educators should develop teaching-learning strategies for nursing students to continuously grow as caring persons.

This case study focuses on caring for a patient living with schizophrenia who has been isolated from the community caused by long-term hospitalization in Japan. Using the philosophical perspective of caring, which focuses on nurturing the wholeness and well-being of persons in caring relationship, the case study illuminates the caring, empathy, and courage among the interdisciplinary team. The purpose of this case study is to discuss the interdisciplinary caring process for patients living with schizophrenia using Carper's ways of knowing. Personal knowing is presented through the lens of patients and families and the stigma associated with mental illness. The expression of respect and caring for the patient and their families led by the interdisciplinary team aided in destigmatization of mental illness. Empirical and ethical knowing is demonstrated through the mental health care team's delivery of high quality and clinical excellence with competence, compassion and caring. Aesthetic knowing was offered by the interdisciplinary team focused on the patient's underlying hopes, dreams and aspirations. Through the support of the interdisciplinary team, patients are able to move toward their goals,hopes and dreams, externalizing tasks, as they grow together through mutual caring. J. Med. Invest. 66 : 15-18, February, 2019.

Healthcare for older adults is a significant problem in Japan and in other developed countries. To address this problem, healthcare robots, now realized, can assist and meet healthcare and welfare practice demands. The aim of this study was to clarify characteristics of Transactive Relationships (TR) in older adults, in care workers as intermediaries, and Pepper (Softbank Robotics Corporation) a robot equipped with the application program of Care Prevention Gymnastics Exercises for Pepper (Pepper-CPGE) made by Xing Company, Japan. Data were collected by observing TRs between Pepper and older patients in Kagawa Prefecture,Japan between from May 8 to August 1 2018. The Transactive Relationship Theory of Nursing (TRETON) was used to explain how Pepper-CPGE led the exercises with older adults as physical exercises. The role of PepperCPGE was to provide instructions for the older adults in performing gymnastic exercises. During the exercising activity, care workers were present to prevent falls of the older adults, and to operate and observe the video presentations by supporting and caring for the participants. In using Pepper-CPGE, it was possible to change the role of the healthcare providers, originally thought to contribute to increasing the quality of older adult care and their rehabilitation. J. Med. Invest. 66 : 46-49, February, 2019.

The Second International Seminar and Workshop (ISW) on Technological Competency as Caring in the Health Sciences was offered by the Rozzano Locsin Institute for Advancing the Theory of Technological Competency as Caring in Nursing, and held from August 17- 19, 2018 at Tokushima University in Tokushima,Japan. The ISW was envisioned to provide a platform for sharing research and scholarly works into innovative design and developments on studying and applying the theory of Technological Competency as Caring in the Health Sciences. This ISW was founded on the theory of Technological Competency as Caring in Nursing (TCCN) (Locsin, 2005). The ISW, as aimed broadened the influence of theory, research, and practice through the advancements in technology, caring, and nursing, as espoused in the theory of Technological Competency as Caring particularly within the Health Sciences. This report illuminates the contents of the ISW and its outcomes, and reveals the direction of the theory, its development, and future implications through formalized activities. J. Med. Invest. 66 : 54-57, February, 2019.

Frequent exposure to patient deaths prompts nurses to experience grief. Unresolved grief leads to harmful consequences of nurses’ mental health and quality of nursing care. A cross-sectional study using an online survey was conducted to determine the psychometric properties of the Grief traits and State Scale for Nurses. Exploratory factor analysis revealed two factors measuring the level of nurses’ grief traits (Cronbach’s alpha: 0.84) and two factors in grief state (Cronbach’s alpha: 0.86). Nurses’ feelings of unable to provide good care were associated with a higher risk of grief (odds ratio (OR): 4.30, 95% confidence interval (CI): 1.45–12.75), uncomfortable feeling toward deaths (OR: 11.29, 95%CI: 1.48–85.91), and emotional exhaustion (OR: 7.12, 95%CI: 1.63–30.99). Results indicated that the scale was reliable in determining the levels of their grief. Nurse managers can use the scale to identify their nurses’ levels of grief, creating opportunities to influence the resolution of the grief experiences.