The opportunity for the community health nursing profession to engage in international cooperative activities is increasing in recent years. Many challenges are anticipated for developing the cooperative activities, since the basic situations in each country regarding the environment, the cultural background or the health system are quite different. However analysis of the challenges is not enough, we must also understand limitations based on individual personal experiences. The purpose of this report is to describe the challenges that interrupt the development of cooperative activities.
 The target group was sixteen public health nurses who were sent to developing countries as JOCV (Japan Overseas Cooperative Volunteers) from June1997 to March 1999. The research was conducted for two years. Data were collected from each participant using five semi-structured questionnaires and analyzed using qualitative methods for the following areas: (1) challenges, (2) changes in viewpoints about the language learning, and (3) changes in participants' health conditions.
 Fifteen participants returned the questionnaires. Results showed wide variation in the challenges described, and the challenges changed during the period of assignment. During the beginning period, there were many descriptions about difficulties based on daily life and cultural adaptation. Afterward, challenges based on the cooperative activities became the core of issues to resolve. Some challenges involved a lack of information for planning the cooperative activities, lack of funds, a too-short time frame, local staff's resistance to the out-reach activities. Also some issues were very difficult solely on the basis of the personal effort required
 When we carry out cooperative activities in developing countries, there will inevitably be various challenges. However, there are two types of challenges, challenges able to be resolved by personal effort and challenges in need of system responsiveness. To develop effective cooperative activities in a limited period, it is necessary to understand the possible challenges that will happen and take measures to prevent avoidable situations.

This study clarified practices in end-of-life care for non-malignant chronic illness patients by expert nurses in general hospitals. Interviews with 7 chronic illness specialist nurses on practice cases were conducted, and final labels were elicited using a qualitative synthesis method（KJ method）. As patients’ conditions deteriorated, nurses defined the necessary interactions to support patients’ decision-making for living their own way of life and accompany patients and families based on their experience, and using patients’ restoration of self-esteem, sense of satisfaction, and acceptance as indices. In general hospitals, measures to cope with pain for patients not receiving life-prolonging treatment were insufficient;and while it was difficult to agree on care between medical professionals and to maintain care in other facilities, expert nurses grasped patients’ wishes on a daily basis and made arrangements for them to permeate through family and community care systems. In end-of-life care in treatment settings, it is necessary to be supportive so that the family and medical professionals can continue the patient’s care. Medical professionals who have been involved from the initial diagnosis stage need to improve their awareness and support skills as medical professionals to be involved purposefully from an early stage to the final stage.

Objective: This study aimed to identify and classify the needs of caregivers of children with disabilities living in resource-limited settings and develop a framework for need assessment.Participants and Methods: This study was conducted in the Maha Sarakham Province, Thailand, with 15 caregivers caring for children with disabilities recruited from hospitals, the Association for the Disabled, and primary health centers. Semi-structured interviews were conducted in local dialects, recorded, transcribed, converted into standard Thai, and then into English for thematic analysis. Meaning units corresponding to caregivers’ needs were extracted, interpreted, coded, and hierarchically organized into subcategories by comparing similarities and differences among the extracted codes. The subcategories were further grouped and abstracted into categories, and then domains of caregivers’ needs were formed.Results: Nineteen categories were identified across five domains of caregivers’ needs: health and medical, welfare, educational, social, and informational. Although basic medical treatment was covered, specific support, such as referral to a specialist, rehabilitation, or psychological support, was limited. Financial support and relief from the care burden are the main welfare needs. Educational needs were identified to provide knowledge to children and to offer respite to their caregivers. Social needs revealed ethical problems that arose because of strong rural community ties, making it difficult to maintain privacy. Informational needs were intertwined with the other four domains. In rural areas, where parents of children with disabilities migrate to cities to find work, the special needs of grandparents who were primary caregivers of the children needed to be addressed.Conclusion: This study provides a conceptual framework for comprehensive needs assessment and policy development for caregivers of children with disabilities living in resource-limited settings.