The Journal of the Japanese Association of Health Communication
Vol. 10, No.1

Original articles

How to write easy-to-understand materials to support physician-patient communications

Masayo Hayakawa1), Ayako Ishikawa 1), Otome Kinoshita 1), Yoshiko Ikeguchi 1), Yasushi Toh 2), Tomoko Takayama 1)3)

1) Cancer Information Service Division, Center for Cancer Control and Information Services, National Cancer Center, 2) National Hospital Organization Kyushu Cancer Center, 3) Department of Health Communication, School of Public Health, University of Tokyo Cancer

Patients' understanding of their disease may improve physician?patient communication and facilitate shared decision making. However, few studies have explored ways to write materials in Japanese to support physician?patient communication. Two final drafts reviewed by cancer survivors and editors were compared with the first draft written by physicians. Sentences were classified according to the reasons for rewriting them, and their rewriting patterns were examined. Two cancer survivors and a consultant read the rewritten sentences, evaluated whether they were easier to understand, and determined the need for rewriting them. The reasons for rewriting were classified into two categories: “Expression from physicians’ perspectives which does not promote physician?patient communication” and “Difficult expression.” The reasons for rewriting patterns were classified into three categories: “Rewriting from patients’ perspectives”, “Explaining the fact” and “Changing the words”. The cancer survivors noted that a part of “Expressions from physicians’ perspectives” did not need to be rewritten because it was comprehensible in the words of physicians. These results may facilitate the development of a guide for writing easy-to-understand materials.

Keywords: Health Communication, Medical Writing, Shared Decision Making,Patient Portals

A qualitative study on negative emotions of nurse students in psychiatric nursing practical training

Akiko Ishibashi

International University of Health and Welfare School of Nursing at Fukuoka

[Purpose] The purpose of this study is to find out the negative emotions of nursing students who occur in the care of patients with mental illness. Consider learning support from the viewpoint of nursing students.
[Method] Consent to the survey was obtained from 87 people (11 men, 76 females) in the third grade of nursing department of University A. The nursing student wrote a process record of 547 days in total, of which 145 days (26.5%) are selected for research. Data analysis was qualitative analysis of process record and co-occurrence network analysis (analysis software: KH Coder).
[Result] As a result of qualitative analysis, 69 sub-categories, 13 categories and the following 4 core categories were obtained:【Expressions and behaviors of unpredictable patients with mental illness】【Understanding and care for biological weaknesses】【 Psychiatric nursing care management】【Care relationship building with patients who first met】. Co-occurrence network analysis classified into six categories.
[Discussion] Nurse students' negative emotions occurred in professional understanding and response to psychiatry. It was also thought that negative emotions are occurring in trial and error toward constructing collaborative relationships. What is important in resilient care is acceptance of negative emotions and doing various coping behaviors. It is important for nursing students to support learning so that they can understand psychiatric patients while accepting their own negative emotions.

Keywords: Psychiatric nursing, Emotional reaction of nursing students, Collaborative relationship with patients, Resilient care, Qualitative study

Feedback from Rheumatoid Arthritis Patients and Medical Students after Joint Group Work: Implications for Future Medical Education

Tomoko Ohura1), Masayo Kojima2), Mano Soshi3), Akihiro Nishi4), Riho Hashimoto3),Mami Ishibashi5), Hisashi Yamanaka6), Takeo Nakayama7)

1) Faculty of Care and Rehabilitation, Seijoh University* 2) Department of Medical Education, Nagoya City University Graduate School of Medical Sciences 3) Faculty of Medicine, Osaka Medical College* 4) Kameda Medical Center* 5) Faculty of Medicine, Kyoto University* 6) Department of Rheumatology, School of Medicine, Tokyo Women’s Medical University 7) Kyoto University School of Public Health

In order to clarify what is necessary for medical education, a questionnaire was administered to nine rheumatoid arthritis (RA) patients and three medical students following joint group work. Analysis of the answers using theme analysis showed that patients identified the following four categories: chances to interact with patients, the willingness of trying to understand patients, the pursuit of the correct understanding of an illness in its context, and the development of human capital. The medical students’ responses can be categorized in four categories: the patient’s daily condition and their relationship with their physician, the importance of knowing the daily condition of patients outside the consulting room, acceptance of what a physician can do even while pursuing an ideal response, and the limits and possibilities of what physicians and medical students can experience in real life. In summary, RA patients want to talk about their illness and medical students realize the necessity of understanding the daily lives of their patients.

Keywords: Rheumatoid arthritis, Focus group interview, Joint group discussion, Patient perspective, Medical education

Research notes

A leader’s request and rapport in emergency care simulation: a multimodal corpus analysis

Keiko Tsuchiya1), Akira Taneichi1), Kyota Nakamura2),Takuma Sakai3), Takeru Abe2) Takeshi Saitoh4)

1) International College of Arts and Sciences, Yokohama City University,2) Yokohama City University Medical Centre,3) Graduate School of Medicine, Yokohama City University,4) Computer Science and Systems Engineering at Kyushu Institute ofTechnology

How healthcare professionals (HCPs) understand the complex context of a healthcare encounter is a key for successful practice. Emergency care is one such context which involves a team of HCPs with various areas of expertise and different levels of experiences. This study investigates team interactions in emergency care simulation training in Japan, focusing on the rapport management (Spencer-Oatey, 2000). How a team leader manages rapport within the team in making requests is analysed with his utterances and gaze, applying a multimodal corpus analysis and a discourse-pragmatic approach. The preliminary results show that the leader used downgraders in requests, i.e. ~しようか (shall we) and お願いします (I ask you a favour), with gaze exchanges. However, the leader made requests without any downgraders when talking to a foundation doctor. Thus, two different discourse frames were observed: task collaboration frame and instruction frame. By so doing, the leader regulates the recipient selection, simultaneously indexing his distinct social roles as a colleague and a trainer.

Keywords: emergency care simulation, request, discourse frame, gaze, multimodal analysis

Discharge support of long-term inpatients in Tohoku district Characteristics of self-expression and related factors in ward nurses

Hiroyuki Nozaki1), Naohito Yoshimura1), Reiko Takayasu1),Hitomi Murata1), Shiro Kitada1), Hiroki Sugimori1)

Daito Bunka University Department of Nursing faculty of Sports & Health Science

This study aims to reveal the tendency, causes, and related factors of the self-expression of medicine ward nurses during the discharge support to long-term in-hospital psychiatric patients in Tohoku region. Analysis subjects are the medicine ward nurses in psychiatric department with patients’ average length of in-hospital stay over 365 days. We distributed questionnaires to 831 targets in 52 hospital buildings from 25 facilities, and received 589 responses with 568 good for analysis (responding rate 70.87%, valid responding rate 96.43%). Regarding the self-expression tendency of the nurses in Tohoku area, “assertive expression” generally dominated, with very few “aggressive” ones. When classifying the targets, the highest average value was found in “assertive selfexpressions to patients” (average 12.26) and the lowest was in “aggressive self-expression to doctors” (average 5.87). While looking at the self-expression, we found that the targets showed the highest average in “assertive self-expression” and the lowest in “aggressive self-expression”. Besides, when compared with nurses with long general clinical experiences and specific experience in psychiatry, those with relatively shorter experience of less than 10 years showed a lower result in aggressive self-experience”. It demonstrates that “aggressive self-expression” increases with age and self-assertion becomes stronger with longer clinical experience. From the above, we can conclude that support should be given to new nurses to assist them to express themselves more easily while on the contrary, assertion training should be given to those experienced veterans as discharge support to long-term in-hospital patients. It’s also vitally important to have discharge support for stabilizing the lives of patients with psychological issues in the local community as well.

Keyword:psychiatric long term inpatient, characteristics of self-expression of nurses, promotion of discharge support

Cannabis Legalization and the Drug Abuse Prevention Education inJapan: Credibility and Trust in Health Communication

Sookja Suh

Niigata College of Nursing

Cannabis was a major target of the Single Convention on Narcotic drugs and has become a substance regulated throughout the world. However, in recent years, mainly in Europe and North America, there have been movements to legalize cannabis for recreational or medical use. The news about the change in cannabis use has reached the ears of the normal Japanese citizen as well. As a result, even in Japan the number of people who ask themselves, "Is Cannabis really that bad?" is increasing. In this paper, I will examine the issues surrounding health communication relating to this problem in terms of credibility and trust of the sender in persuasive communication. Then, I will give a few recommendations to the practice of drug abuse prevention education in Japan.

Keyword:cannabis use, drug abuse prevention education, persuasive communication, campus health

Cancer communication research and practice agenda from Cancer Control Act and Cancer Control Plan in Japan

Tomoko Takayama1)2), Chikako Yamaki1), Masayo Hayakawa1),Fumihiko Wakao1),Takahiro Kiuchi4)

1) Cancer Information Service Division, Center for Cancer Control and Information Services, National Cancer Center,2) Department of Cancer Communication, School of Public Health, University of Tokyo,3) Center for Cancer Control and Information Services, National Cancer Center,4) Department of Health Communication, School of Public Health, University of Tokyo

Recent health information environment and medical development has changed public availability of health information and expanded expertise. This study discusses the challenges facing cancer communication in Japan and identifies the requirements of cancer communication research. We examined the recent changes in the Cancer Control Act and Third Cancer Control Plan in Japan to derive information and communication-related issues. Additionally, we administered a nationwide survey to cancer counselors regarding perceived difficulties to further clarify current clinical issues and discuss contemporary challenges. Our findings elucidate that cancer communication research has expanded from clinical research to working environment support. Although people’s information gap could be widening due to the extensive cancer information available, reliable cancer information and individual health literacy are essential. Moreover, as people’s expectations from medical advancement increase, it is crucial to gain more knowledge about important future issues such as how to communicate risks and benefits of medical uncertainty, what type of communication could provide more comfort and feeling of acceptance, and how to reach a consensus among stakeholders.

Keywords :cancer communication, cancer control act, cancer control plan, cancer information service

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