The purpose of the present study is to elucidate the changes in the quality of nursing care brought about by the introduction of Diagnosis Procedure Combination, DPC. For this purpose, medical records were reviewed for patients who were aged 65 years and older and had gastric cancer operations in the same ward during a period of two years after introduction of the DPC. The method of the study involved collection of data concerning 23 items taken from the "Nursing Care Report Card for Acute Care" of the American Nurses Association (ANA) and analysis of focus notes in "Focus Charting." These data were compared between a group of patients treated before the introduction of DPC and a second group of patients treated after the introduction, and the changes in the quality of nursing care were analyzed using Hall's Core, Care, Cure Model. There were 30 patients before and 32 after the introduction of DPC, and no marked changes were found between the groups in terms of incidence of nosocomial infections, pressure sores, falls, and unplanned removal of invasive lines. However, there was a tendency of worsening of pressure sores and medical treatment of nocturnal delirium or anxiety, as well as an increased use of clinical pass (p < 0.01). In the group of patients with clinical pass, no complications (p < 0.05) and a reduced number of days of hospitalization (p < 0.05) were observed.

The quality of nursing care was analyzed using Hall's Core, Care, Cure Model. No marked changes were observed between the two groups in Cure (indicating the medical side of nursing) and Care (indicating the nursing side) in terms of the number of complications and adverse events. It seems that sub-systems such as clinical pass have functioned effectively. However, in terms of the severity of pressure sores and occurrence of nocturnal delirium and anxiety, changes of the quality of nursing care after introduction of DPC cannot be denied.

The purpose of this research was to have obtained the suggestion concerning the development of the nursing organization, and the fact-finding survey of the nursing organization that had introduced TQM, and the answer was obtained from 25 organizations (recovery 62.0%). It did not obtain it though a significant difference of the attribute was examined by Mann-Whitney U test. For the innovation model, the measure at each stage is concluded one by one, and it has proceeded to the next stage. However, it overlapped in three stages in this investigation. The overall execution measure has increased aiming at frozen again the stage. Two points were clarified from the consequence of the executed measure, ① there were a lot of organizations of the exploratory, consecutive measure deployment, and the organization of "unfreezing stage" had a lot of innovation stages, ② many of those organizations kept groping for an effective activity, and a positive organization and methods for the service improvement was active in addition, accountability as the opened organization was recognized. When something new in the health care organization was introduced, not obtaining the consensus of the entire organization easily became clear from the content of the deployment measure. These consequences were considered based on the Changing theory of Lewin and the organization theory, as a result, the following two points were obtained as a suggestion in the development of the nursing organization in the future.

1. It is necessary to transfer the power to the subordinate position organization with the communication of the top down to develop TQM.

2. It is necessary to urge the plastic of a common term of "TQM" in the organization to obtain the consensus of the entire organization, and to amplify the networking in the organization.

This research sought to devise a scale to measure the clinical practice proficiency of mid-career nurses. We refined the results of preceding research, added questions on ethical behavior, and created a questionnaire consisting of 25 items. Five thousand five hundred twenty-one nurses at 23 facilities throughput Japan were asked to cooperate in answering the questionnaire created, and responses were received from 2,566 individuals (response rate of 46.5%); we performed item analysis, narrowed our focus to 21 question items, and performed factor analysis with data in the form of 1,693 responses from nurses with 5 years of experience or longer. As a result, we identified 4 factors : "ability to contribute to development of the nursing team," "ability to provide quality care," "ability to encourage patient participation in medical care," and "voluntary involvement in current circumstances." Cronbach's α for items comprising the 4 factors was from 0.71 to 0.87. We studied construct validity in accordance with cumulative contribution and we tested for differences between a group of nurses with 1 to 2 years of experience and a group with 5 to 9 years of experience ; we found a significant difference for all of the items at a level of 0.1%.

Results suggest that mid-career nurses have 3 abilities besides the "ability to provide quality care" to patients and their families and that clinical experience of 5 years or longer is needed to attain this proficiency. Because this scale is a scale for self-assessment, there are instances where it will conflict with objective assessment. Thus, a topic for the future is development of an educational program to have nurses themselves continue to consider the validity of their own self-assessments.

The purpose of this study was to investigate the relationships among clinical nurses' intuition, hospital, years of experience and nurses' license using the questionnaire for Kuroda Intrinsic Intuitive Scale (KIIS) and to suggest intuition develops in clinical nurses. The selected participants were 466 registered nurses and practical nurses at 3 different hospitals.

The results showed the intrinsic intuitive total score at the general hospital and long-term care facilities, general hospital and long-term care facilities were not significantly different. As for the intrinsic intuition and the nurses' years of experience, total score, intelligence and expertise, the score increased as the nurses' years of experience increased. However, for involvement, the score was higher for nurses with fewer years of experience. As for the intrinsic intuition and nurses' license, registered nurses with 10 years of experience showed higher total scores and higher sub-scores for intelligence and logical thinking than practical nurses with 10 years of experience (p < 0.05).

These findings suggested that each clinical nurses might make an effort to develop from expertise to intuition based on an adequate knowledge base.

Eighteen nurses who were in their second year of work after having graduated from the university nursing program were the object of a qualitative induction study that was carried out using semistructured interviews for the purpose of clarifying the graduatestes' perceptions about their subjective positive experiences regarding their relationships with patients.

The results were indexed according to 7 categories: Pleasure from Patients' Recovery, Care and Skill Accomplishments, Appreciation from Patients and Patients' Families, Motivation from Patients, Feedback from Relationships with Patients, Recognition as a Nurse, Reliableness for Patients, plus the core category : the Ability to Recognize Yourself as a Nurse.

It was apparent from this research that the subjective positive experiences the newly graduated nurses had undergone were important for overcoming feelings of depression that resulted from day to day work, for enthusiasm at work, for actual feelings of happiness derived from being a nurse as well as for enabling them to recognize themselves as nurses.

These results illustrate the importance of these experiences as they relate to the development of new nursing graduates and have positive implications for those who teach new nurses as well.

The purpose of this study is estimating whether the construction of unit type and individual care could change the staff's consciousness and behaviors concerning the infection prevention, the early stage detection of infection, and the prevention of infection expansion in the elderly nursing homes, and clarifying the assignment of infection prevention common to the both of unit type and conservative one. The subjects are nine elderly nursing homes including the unit type and the conservative type. First of all, the interviews concerning the actual conditions of infection prevention and staff's consciousness about the infection prevention were conducted among the administrators or managers of the nine elderly nursing homes. Secondly, the questionnaires were administrated among staffs of the homes for the same purpose. The results showed that staff's observational ability and the relations with the elderly users are strengthened in the unit type through the staff's individual caring. It was understood that the prevention and the early stage detection of infection were promoted in the unit type more easily than old one. Additionally, it was cleared that unit type is more advantageous for the prevention of infection expansion than old one because users and staffs' traffic lines and ranges of their actions were limited so easily, and because users' isolation were completed easily at any time in the unit type.

In addition, the assignments common to the both of unit type and old one were suggested. Those were ① adequacy of infection control manuals at the special elderly nursing homes ; more concrete caring/nursing manuals which explain how nursing staffs could prevent, discover, and control the infection through the routine caring and treatment, ② the construction of information obtaining system and network system against infection incidence, ③ the development of training programs, ④ the construction of system through which nurses working at the elderly nursing home could display their nursing knowledge and skills thoroughly, and could cooperate with care staffs, ⑤ the maintaining of continuous education and training course through which they could acquire the ability of offering the guidance and instructions to the care staffs and management ability, and ⑥ the construction of network with hospitals.