Keiko Aizawa

Background/Objectives: Evidence on postmortem grief care for family caregivers after home-based end-of-life care is limited. This scoping review aimed to map the content and effects of such interventions for adult family caregivers after home deaths. Methods: Following the Joanna Briggs Institute and Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines, we searched PubMed, Cumulative Index to Nursing and Allied Health Literature, Embase, Cochrane Library, and Ichushi-Web from database inception to 31 March 2024. We included English- or Japanese-language intervention studies performed in home and community settings. “Early” grief care was defined as (i) support initiated within 6 months after the death of a loved one and (ii) interventions initiated during caregiving that assessed bereavement outcomes within 6 months after the death of a loved one. Data were charted and descriptively summarized. Results: From 4766 records, six studies were selected for the review (five randomized controlled trials and one ongoing registry trial). Interventions varied from dyadic psychological sessions integrated into specialist palliative home care (DOMUS) to brief psychoeducation, structured family-physician consultations, general-practice bereavement management with screening and stepped care, remote monitoring with nurse coaching during home hospice care, with bereavement outcomes assessed at 6 months (SCH), and an online self-help program for widowed older adults. The effects were mixed. DOMUS showed a small but significant reduction in caregiver anxiety; SCH reduced caregiver burden during caregiving and improved bereavement adjustment at 6 months. Other interventions did not demonstrate a clear advantage in outcomes over usual care. Conclusions: Early grief care after home-based end-of-life care is heterogeneous. Need-responsive multicomponent models embedded in existing home and community care pathways warrant further theory-informed evaluation.

Child- and family-centered care (C&FCC) is critical in pediatric nursing, but often difficult to implement consistently, particularly during high-stress procedures such as peripheral intravenous (IV) line placements. This two-arm quasi-experimental study evaluated the effectiveness of learning support materials developed to enhance nurse managers' knowledge of and attitudes toward promoting C&FCC and encouraging its implementation during peripheral IV line placements. It conducted a two-arm quasi-experimental study in Japan between October 2022 and April 2023. Nurse managers from pediatric departments were allocated to the intervention (n = 69) and control (n = 67) groups using an alternating assignment method stratified by facility. This study involved three surveys as follows: a pre-survey (T1), post-survey 1 (T2, within 2 days of T1), and post-survey 2 (T3, 1 month after T2). The intervention group received a comprehensive learning package, including management strategies and C&FCC promotion tools, while the control group was provided with a limited guide without management content. In this study, the primary outcome was the behavioral component of attitude - namely, nurse managers' motivation and confidence to promote C&FCC. The secondary outcomes were knowledge of department management in C&FCC and intention to create a C&FCC promotion core team. Adjusted T3 effects, controlled for baseline and prespecified covariates, were estimated using analysis of covariance. For the primary outcome, the intervention produced significant adjusted improvement at T3 (β = 10.04, standard error [SE] = 3.93, t = 2.56, p = .012). The adjusted effect was not significant for knowledge (β = ‒1.03, SE = 0.72, t = 1.44, p = .153). A greater proportion of nurse managers expressed an intention to establish a C&FCC promotion core team in the intervention group than in the control group. In the context of peripheral IV placement, management-integrated C&FCC learning materials appear effective in enhancing nurse managers' motivation and confidence to lead C&FCC implementation and may help cultivate a child- and family-centered organizational culture in pediatric care.

Use of assisted reproductive technology (ART) to bear children has in recent years become widespread in Japan. While midwives are required to understand the experiences of individual women and provide ongoing support for them, implementing respectful care that meets the needs of women using ART remains challenging. This study therefore aimed to explore the specific care components expected of midwives for women with twin pregnancies after ART. A cross-sectional questionnaire survey was conducted through Google Forms on 273 women with twin pregnancies, of whom 85 had conceived twins through ART. Women were recruited through national multiple birth support groups and midwifery centers providing postnatal care. Data were collected from July 2021 to December 2022, and care expectations were rated on a 5-point Likert scale. Factor analysis was performed to identify care components, and reliability was evaluated using Cronbach’s alpha. Among the participants, 41.2% were between 36 and 40 years of age. Seven primary care factors were identified: comprehensive parenting support for twins, addressing concerns regarding the sudden death of twins, interdisciplinary medical collaboration, connecting women with twin pregnancies, understanding post-delivery physical pain, providing continuity before and after delivery, and supporting the development and well-being of the twins. The findings emphasize the importance of understanding individual ART histories and providing tailored care to respond appropriately to women’s needs during pregnancy, childbirth, and the postpartum period. The identified components provide an empirical foundation for integrating these perspectives into routine midwifery care and educational programs for women with ART-conceived twin pregnancies.