The objective of this study was to develop a scale for assessing the skill of generalist nurses in diabetes care instruction, the Nurse Diabetes Education Skill Scale (NDESS), and to evaluate its reliability and validity.

The questions used in the NDESS were extracted based on a review of the literature on qualitative studies of nurses and diabetes care. A questionnaire survey was conducted using a pilot version of the NDESS consisting of 43 items whose content validity had been confirmed.

The analysis included 383 respondents. Based on exploratory and confirmatory factor analysis, 25 items representing the following 3 factors were extracted: skill in self-care instruction, skill in glycemic control instruction, and skill in adjusting the patient-nurse relationship. Cronbach's alpha coefficient for the scale as a whole was 0.961, confirming its internal consistency.

The reliability and validity of the NDESS were confirmed, and it can therefore be utilized as an index for assessing the training in diabetes care instruction of nurses who are not diabetes specialists.

The objective of this study was to clarify the process involved in outpatient nursing care of elderly patients with diabetes whose self-care behavior had become impaired owing to decreased cognitive functions. We analyzed the interview responses of 6 nurses at the outpatient department by the modified grounded theory approach.

The process started with "conviction about a patient's decreased cognitive function," followed by "capture of the current condition of the patient with decreased cognitive function" and "recognition of the necessity for a support system," and finally arrived at "help the patient exhibit steady self-care behavior" and "support the patient's family members to select their roles of assistance." This was followed by a process where the best environment for both the patient and the family members was sought; at the same time, following "evaluation of a balanced environment", care provision was continued with "forecast for progression of the patient's decreased cognitive function status and vision of care provision." Care was always provided based on a "consistent policy rooted in nursing care." As indicated by "balancing of self-emotion" and "question about the meaning of steadiness," the statements of the nurses were characterized by the fact that compassion for a patient and their family members had caused ambivalence and deliberation in practice.