BACKGROUND: Heat application before peripheral intravenous catheterization is recommended for venous dilation. Hot pack application enlarges the venous diameter in healthy adults; however, hot towels (moist and dry heat) are used often in some medical cases. However, it is unclear whether hot towel application promotes venous dilation better than hot pack application. This study compared the venous dilation effect of using a hot towel (moist and dry heat) to a hot pack before applying the tourniquet at an access site for peripheral intravenous catheterization. METHODS: Eighty-eight healthy females aged 18-29 years were recruited for this quasi-experimental study. They underwent three types of heat applications (hot pack, moist hot towel, and dry hot towel [moist hot towel wrapped in a dry plastic bag], all of which were warmed to 40 ± 2 °C and performed for 7 min) to their forearm and tourniquet application for 30 s after each heating. Venous diameter and depth were measured using ultrasonography, and venous palpability and visibility (venous assessment score) was observed as venous dilatation effects. In addition, the skin temperature, stratum corneum hydration, and subjective evaluation of the warmth were measured. RESULTS: There were no significant differences in venous diameter and assessment scores after intervention between the dry hot towel and the hot pack groups, and the effect size was negligible (Cohen's d < 0.20). However, these measurements were significantly lower for the moist hot towel than for the other two heat applications (P < .001). Although there was no significant difference in skin temperature and warmth rating score between the dry hot towel and the hot pack, these were significantly lower for the moist hot towel than for the other two heat applications (P < .001). The amount of change in stratum corneum hydration of the dry hot towel was not significantly different from that of the hot pack; however, that of the moist hot towel was significantly larger than that of the other two heat applications (P < . 001.) CONCLUSIONS: A method in which a towel warmed in hot water is wrapped in a dry barrier may be an alternative to a hot pack. TRIAL REGISTRATION: This study was registered with University Hospital Medical Information Network in Japan (Registration No.: UMIN000048308. Registered on July 7, 2022).

Abstract Background Friction irritation by wiping increases the risk of skin problems. In bed baths with cotton towels, wiping three times with weak pressure (10–20 mmHg ≈ 1333–2666 Pa) can remove dirt while maintaining skin barrier function. However, few studies have examined the appropriate frictional irritation with disposable towels. This study aimed to analyse the wiping pressure and number of wipes currently applied by nurses when using disposable towels during bed baths and propose the minimum values for removing dirt from the skin. Methods This multi-study approach consisted of cross-sectional and crossover design components. In Study 1, 101 nurses in two hospitals were observed by recording the wiping pressure and number of wipes when using both disposable (nonwoven) and cotton (woven) towels. Wiping pressure and number of wipes by towel materials were analysed using a linear mixed model. In Study 2, 50 adults received oily and aqueous dirt on their forearms, which were wiped six-times with disposable towels, applying randomly assigned pressure categories. We used colour image analysis and a linear mixed model to estimate the dirt removal rate for each combination of wiping pressure and number of wipes. Results Study 1 showed that although wiping pressure did not differ by towel material, the number of wipes was significantly higher for disposable wipes than cotton wipes. Approximately 5% of nurses applied strong wiping pressure or wiped too often. In Study 2, wiping three times with disposable towels at least 5–10 mmHg achieved dirt removal rates of ≥80%. Conclusions Some nurses excessively wiped using disposable towels, which might cause skin problems. However, excessive wiping is not required to adequately remove dirt, regardless of the towel material used in various clinical situations. We recommend wiping at 10–20 mmHg of pressure (just like stroking gently) at least three times to improve the quality of bed baths. These findings highlight the need to develop skin-friendly bed bath educational programmes, particularly using appropriate frictional irritation to reduce the risk of skin problems.

For nurses working long night shifts, it is imperative that they have the ability to take naps to reduce fatigue, and that an appropriate environment is prepared where such naps can be taken. We verified the effects of 90 min napping on fatigue and the associated factors among nurses working 16-h night shifts. We investigated 196-night shifts among 49 nurses for one month. Wearable devices, data logging devices, and questionnaires were used to assess nap parameters, fatigue, and environmental factors such as the napping environment, ways of spending breaks, and working environment. Nurses who nap at least 90 min on most night shifts had more nursing experience. Multivariable logistic regression analysis showed that the environmental factors significantly associated with total nap duration (TND) ≥ 90 min were noise, time spent on electronic devices such as cellphones and tablets during breaks, and nap break duration. The night shifts with TND ≥ 90 min showed lower drowsiness after nap breaks and less fatigue at the end of night shift compared to those with TND < 90 min. Nurses and nursing managers should recognize the importance of napping and make adjustments to nap for at least 90 min during long night shifts.

Although nurses' fatigue affects their well-being and patient safety, no effective objective measurements exist. We explored the profiles of salivary biomarkers associated with nurses' chronic fatigue across several shifts. This longitudinal study involved 45 shiftwork nurses and collected their saliva samples before two night and two day shifts for a month. Chronic fatigue was measured using the Cumulative Fatigue Symptom Index before the first night shift. Biomarker profiles were analyzed using hierarchical cluster analysis, and chronic fatigue levels were compared between the profiles. Cortisol profiles were classified into high- and low-level groups across two day shifts; the low-level group presented significantly higher irritability and unwillingness to work. Secretory immunoglobulin A (s-IgA) profiles across the four shifts were classified into high- and low-level groups; the high-level group had significantly higher depressive feelings, decreased vitality, irritability, and unwillingness to work. Cortisol (two day shifts) and s-IgA (four shifts) profiles were combined, and (i) cortisol low-level and s-IgA high-level and (ii) cortisol high-level and s-IgA low-level groups were identified. The former group had significantly higher chronic fatigue sign and irritability than the latter group. The profiles of salivary cortisol and s-IgA across several shifts were associated with nurses' chronic fatigue.

Poor recovery from fatigue among shift-working nurses can cause a transition from acute to chronic fatigue. We aimed to clarify the relationship between nurses' recovery from fatigue and sleep episodes after 16 h night shifts while considering age. This prospective study included 62 nurses who worked 16 h night shifts. Fatigue was assessed by a questionnaire before, during, and after the night shift, and the morning following the night shift. Sleep episodes were continuously measured using a wearable device. We performed a hierarchical cluster analysis of multivariate sleep parameters in first and main sleep episodes after night shifts. A linear mixed model was used to estimate the difference between clusters in recovery from fatigue after the night shift, considering age. The participants were classified into a high sleep quality group (HSQG) and low sleep quality group (LSQG) in sleep episodes after the night shift. There was a significant main effect of clusters, and HSQG was significantly more effective than LSQG in recovering from fatigue. However, no main effects of age or interaction were observed. The quality of first and main sleep episodes at home was associated with recovery from the night shift to the next day, regardless of age.

本研究の目的は,清拭タオルの面替え操作の有無における汚れの除去率,皮膚温および主観的評価を比較することである.対象はA大学の20歳代の健康な男女17名とした.すべての対象者に面替え操作あり清拭および面替え操作なし清拭を実施し,前腕屈側部における汚れの除去率(実験I),背部の皮膚温および主観的評価(実験II)を比較した.結果,汚れの除去率は面替えあり群が,なし群よりも有意に高値を示した(P=.002).皮膚温には清拭直前〜15分後において群間差はなかった.また,主観的評価「温かさ」,「心地良さ」においても2群間に有意な差はみられなかった.以上より,清拭におけるタオルの面替え操作は,汚れの除去率を高めることが示唆された.(著者抄録)

BACKGROUND: Excessive wiping friction in skin care may lead to skin damage. Bed baths are required to remove skin dirt without affecting the skin barrier function; the wiping pressure and number of wipings that satisfy these two requirements have not been clarified. This study aimed to determine the minimum wiping pressure and number of wipings that can remove skin dirt. MATERIALS AND METHODS: In this quasi-experimental study, 50 healthy adults received an adhesion of pseudo-oily and aqueous dirt, randomly assigned to the left and right forearms. Each participant was wiped three times with wiping pressure classified into six randomly assigned categories. The dirt removal rate was calculated by color-analyzing images captured before and after each wiping, and its dependence on the combination of wiping pressure and number of wipings was assessed using a linear mixed model. RESULTS: The combinations achieving oily dirt removal rates of 80% or more were wiping once and pressure ≥50 mmHg, wiping twice and pressure ≥40 mmHg, and wiping thrice and pressure ≥10 mmHg. Aqueous dirt was removed almost completely by wiping once, even with pressure ≥5 mmHg. CONCLUSION: Wiping with at least 10 mmHg or more three times can sufficiently remove both oily and aqueous dirt. Dirt removal rates with weak pressure can be made about as effective as those achieved with strong pressure by increasing the number of wipings. This result can be applied to daily nursing, home care, and long-term care health facilities.

本研究の目的は、背部への清拭時の拭き取り前に温タオルを10秒間貼用する効果を、皮膚のバリア機能(角質水分量、経表皮水分蒸散量:TEWL)、清浄度(皮脂量、アデノシン三リン酸値:ATP値)、皮膚表面温度および主観的評価より明らかにすることである。調査方法は、準実験デザインとし、健康成人13名(平均年齢24.1±1.5歳)の背部において、拭き取り前に温タオルを10秒間貼用する清拭(10秒貼用清拭)と拭き取りのみの清拭(貼用なし清拭)を実施した。その結果、2つの清拭には、皮膚バリア機能の指標である角質水分量、TEWLに有意差はなく、どちらの清拭ともに皮脂量およびATP値が有意に低下した。以上より、健康成人の背部への清拭を本研究における方法で実施する場合には、10秒間の温タオル貼用の有無に関わらず、皮膚バリア機能を悪化させずに実施前よりも清浄度が高まったと考えられた。一方、背部への10秒貼用清拭は、皮膚表面温度を貼用直後に2.2℃上昇させ、貼用なし清拭よりも乾拭終了15分後において気持ちよさを有意にもたらすことが明らかになった。(著者抄録)

本研究の目的は、清拭方法、研究デザイン、測定方法とそれらに基づく効果にどのような特徴があるかということに焦点をあて、清拭に関する国内外の先行研究の内容と動向を明らかにすることである。Cooperの統合的文献レビューの方法を参考に行った。国内文献は医学中央雑誌web版、海外文献はCINAHL web版およびPub Medを用いて、「清拭」をキーワードとし、文献検索を行った結果、24件の国内文献と9件の海外文献が分析の対象となった。国内では、主に健康成人を対象とした新たな清拭方法の検討、海外では患者を対象に他の清潔援助と比較した清拭の有効性の検証がされていた。清拭が心身に及ぼす影響として、清浄度および角質水分量が上昇するが、皮膚表面温度は清拭方法によって異なること、対象者の不安や不快を緩和する可能性があることが明らかとなった。しかし、測定に使用した器具が異なることや尺度が統一されていないため、清拭方法による効果の差違や主観的評価と客観的評価の関連については明らかになっているとは言えなかった。(著者抄録)

本研究の目的は、清拭時に温タオルを短時間貼用する効果を皮膚表面温度、角質水分量、主観的評価およびATP値の変化から検証することである。調査方法は、準実験デザインとし、健康な男女21名の全員に拭き取り前に温タオルを短時間(3秒、5秒、7秒)貼用する清拭と拭き取りのみの清拭を実施し、皮膚表面温度と角質水分量の測定と対象者の主観的評価から有効な貼用時間を決定した。つぎに、健康な男女24名に温タオルを貼用する清拭と貼用しない清拭を実施しATP値を測定して比較した。皮膚表面温度と角質水分量の上昇率および主観的評価から7秒間の貼用が最も有効であったが、ATP値の減少率は貼用あり清拭(7秒間)と貼用なし清拭の間に有意差はなかった。7秒間の温タオルの貼用は、清拭実施時間が多少長くなることを考慮しても、身体的・心理的効果が大きいと考える。(著者抄録)

本研究の目的は、浮腫を有する高齢入院患者の皮膚状態の評価方法を明らかにし、清拭プログラムの開発を行うことである。清拭は、入浴やシャワー浴ができない患者の皮膚を温かいタオルで拭き取り、清潔を保つ重要なケアである一方で、不適切な方法での実施は皮膚状態の悪化を助長するリスクもある。特に、浮腫を有する患者への清拭は皮膚状態への配慮が必要である。しかし、そうした対象者の皮膚について、機器を用いた方法による評価は困難であり、介入による効果や適切な清拭方法に関するエビデンスは乏しく、本研究を計画した。 2021年度の本研究の目的および計画は、65歳以上の心臓疾患患者を対象とし、浮腫を有する患者の皮膚状態の評価方法について検証する予定であった。しかし、COVID-19の影響により入院患者を対象とした研究の遂行が困難な状況であった。そのため、文献検討により国内外における定量的な浮腫状態の評価方法の実態とその妥当性を整理することに加え、健康成人を対象としたプレテストによりその実現可能性を検討した。その結果、エコーを用いた対象者の浮腫状態の評価は対象者の姿勢に大きく影響を受けることで再現性が乏しく、機器が熱を帯びることで皮膚状態の評価の交絡因子となり得ること、表皮における皮膚状態の評価の限界が確認された。この結果を基に皮膚状態評価のゴールドスタンダードである角質水分量および経表皮水分蒸散量の計測に加え、他の指標による評価のプロトコルとその妥当性を健康成人を対象に検討する必要があると考える。