Nurses are expected to participate in policy making processes regarding their conditions of their work and/or service programs of the organization that employs them. Some become active in their communities and a few become candidates for elective office. The Comprehensive Decentralization Law that came into effect in 2000 grants increased autonomy to local government and expands its role. Little is known, however, about nurses who participate as elected officials at the local level.

This qualitative study describes the stimulus for seeking elective office and policy making activities of elected nurse members of city councils (ENs). Nurses identified as independents were chosen for this study because they were thought to have a stronger belief in themselves since they were not receiving any support from a political party.

In 2004 (according to the Japan Nurses Association) there were 96 ENs. Twenty-seven were independents ; 13 agreed to participate in this study. Descriptive data were collected by interview; and details of their activities were recorded.

Four cues encouraged ENs to stand for election : [sense of mission / self-assurance], [sense of mission / self-assurance and request from a political party / a labor union], [request from a political party / labor union] or [request from a former member of city council]. With their professional knowledge and skills as nurses, ENs recognized and presented themselves as specialists who actively work on the problems related to health, medical and welfare with the viewpoint of nursing and specialties of nursing and they tried especially to represent the perspectives of people. As such, they described and interpreted problems of community members to local governments and vice versa. Moreover, ‘having the qualification of nursing' did not mean ‘representing nurses.'

It is recommended that a directory of ENs be developed and documents describing their efforts to promote change be collected so that ENs might network with one another and their work publicized.

The objective of the present study was to elucidate the role behavior of nurse managers in preceptorships, using an assessment scale. A self-report questionnaire survey on the role behavior of nurse managers was conducted on 751 nurses (122 nurse managers, 307 preceptors, 322 preceptees) at 24 facilities that consented to participate in the survey among 81 advanced treatment facilities nationwide implementing preceptorships. The following results were obtained: 1) the role behavior of nurse managers in preceptorships consists of 21 items in four factors, specifically "subject feedback function," "system feedback function," "regulatory function," and "explanatory function," 2) among these four role behaviors, "subject feedback function" were identified as superior function, and 3) regarding assessment of role behavior, the highest assessment was reported for self-assessment by nurse managers, and significant differences were observed between nurse managers and preceptors, as well as between preceptors and preceptees, but not between nurse managers and preceptees. In current preceptorships, preceptors felt the greatest burden among the three groups of nurse managers, preceptors, and preceptees. Preceptees were thought to be too occupied with their own role to assess the role behavior of nurse managers.

The purpose of this study is to clarify the change in attitudes about fall prevention in newly employed nurses between the time of initial employment and the completion of 1 year of clinical experience, and to identify the clinical experience which changed recognition for fall prevention. The study targeted 19 nurses that completed 1 year of clinical experience after initial employment. Attitude about fall prevention for hospitalized patients at initial employment and at 1 year of employment was evaluated and factors influencing the change of fall prevention recognition were identified through semi-structured interview method. Data obtained through interviews were analyzed qualitatively and inductively, and the following results were obtained:

1. Recognition for fall prevention : At the time of initial employment, "Not so serious," "Cannot be helped," "Feel like blaming patients," "Unaware of risks," "Feel that the patients will be fine," and "Cannot develop measures." At the completion of 1 year of employment, "Cannot get away with letting patients fall," "It is not so easy to prevent falls," "It is not so difficult to prevent falls," "Became sensitive to the risk of falls," "Feel responsible for trying to prevent as much as possible," and "Struggle to perform prevention measures."

2. Clinical experience which change recognition were "The positive effect of measures for fall prevention," "Lack of effect of measures for fall prevention," "Encountering situations involving falls," "Descriptions of hiyari-hatto report," "Reading documents," "Observing experienced nurses," and "Advice and instruction from experienced nurses."

3. Recognition that falls are unavoidable and insignificant changed during the 1st year after initial employment recognition of responsibility to be aware of the risk of falls and perform prevention measures. New nurses recognized that this change came influence a consideration of their own fall prevention actions and relationship with experienced nurses. Importance of the relation that considered contents of learning from clinical experience and a cognitive change to a new nurse was suggested.

The purpose of this study was to identify hazards to falls among elderly persons in a facility. 26 institutionalized elderly persons were examined through interview, demonstration, and monitoring of behaviors, and a difference between the length of leg and their height of wheelchairs and strengths of illuminance in the facility were measured. As a result, 115 hazards, fourteen sorts of hazards, five items of hazards were identified. Facility structures and conditions, choosing and fixing of aids for locomotion, and staff education were belonged to physical environmental factors, behaviors related to fall occurrence to functional factors, and thought related to fall occurrence to personal / behavioral factors. In physical environmental factor, hazards that elderly persons experienced could be invisible without verbal expression. Thirty% of wheelchair users underwent falls from their wheelchairs, and between the difference of the length of leg and height of wheelchair and falls showed a correlation of 0.518, so the difference could be direct cause of falls. In functional factors, 73.8% showed twenty-score of Mini-Mental State Examination, and they could not handle wheelchair safely. In personal / behavioral factors, thought of "Enryo" which is a Japanese traditional behavior for others to show pleased should be further explored to prevent falls.

In recent years, improvement in the quality of medical care, safety administration and the role of nursing managers have become increasingly important. In light of the current situation for nursing managers under these circumstances, the research was conducted in order to clarify the identity of nursing managers and related factors. The subjects were 529 nursing managers working at general hospitals with more than 300 beds in the A district. Anonymous questionnaires were distributed to participants, and once completed were collected by mail. The questions focused on identity of the nursing manager, self-esteem, self-efficacy, burnout, role-acceptance and so on. 356 questionnaires were collected (collection rate : 67.3%) and the number of valid responses was 354 (99.4%). Statistical analysis was conducted applying SPSS 11.5. The factors that enhanced the identity of the nursing managers were role-satisfaction, nursing identity, self-efficacy, factors resulting in burnout, their intention to do their best that they had upon appointment, participation in a certified nursing administration course, age and advisors outside of the workplace. Conversely, the factors that lowered it were the emotional exhaustion of burnout and the existence of a spouse. These results suggest that in order to foster the identity of nursing managers, it is necessary to promote the feeling of satisfaction within their role. Also, nursing managers and the organizations to which they belong, must take account of their circumstances and feelings upon appointment in order to provide opportunities for self-enlightenment and support, and it is necessary to offer specialized professional education which they will undertake enthusiastically.

The purpose of this study is to investigate the present situation of providing self-care education for outpatients with HIV/AIDS at AIDS Regional Hospitals in Japan and to clarify the problem of the care system for HIV/AIDS outpatients. We asked the hospitals whether they charged the additional medical fee based on "the viral infectious disease management" which was legislated in 2006, and whether they met the criteria of institute for additional medical fee, as the indicator for the degree of fulfillment in the medical system for HIV/AIDS patients. Moreover we aimed to identify the factors related to potential to charge it.

We mailed the self-administrated questionnaire to the 369 AIDS Regional Hospitals and 176 (47.7%) hospitals responded it. Though they are AIDS Regional Hospitals, only 130 hospitals had experience for HIV/AIDS treatment and forty percents of 176 hospitals didnʼt have HIV/ AIDS physician specialists. Only 20 (16.3%) hospitals charged additional medical fee for the viral infectious disease management and 12 hospitals answered they had full-time nurses engaging only for HIV/AIDS care. This shows that the criterion for nurses is the most difficult criteria of institution for additional medical fee to meet, and it suppress hospitals to charge it. The number of outpatients was significantly related to charging the additional medical fee (p<0.001).

These results show that the patients partially concentrated in some specific hospitals, and this concentration caused to the disparity of sufficiency in medical system for HIV/AIDS patients. Therefore this disparity may be improved when patientʼs concentration would be moderated by medical cooperation between AIDS Regional Hospitals.

The aim of our study was to investigate whether a medical service fee should reflect the quantity of nursing care and to compare the wages of nurse occupied in a medical service fee by the factors influencing the quantity of nursing care. The quantity of nursing care was measured based on the medical records of 50 patients with acute myocardial infarction who discharged from the hospital with the stent assisted PCI (Percutaneous Coronary Intervention) using Toranomon Nursing System (TNS) as factor evaluation. The wages of nurse were calculated based on the measured values. The quantities of nursing care were observed between 37 and 343 points with TNS, and its mean value and standard deviation were 81.9 and 7.9, respectively. The result was that the factors that affected the quantity of nursing care were age, existence of complication and a level of disease symptom. Hospital charges were calculated with Diagnosis Procedure Combination (DPC). There was correlation between hospital charges and wages of nurse, and therefore it was suggested that hospital charges reflect the quantity of nursing care at a medical service fee, although the wages of nurse were kept between 2.4 and 4.8% in hospital charges.

The purpose of this study was to outline the types of emotional and moral distress experienced by nurses caring for senior citizens, and to propose conflict resolution strategies for these types of distress. Study participants were recruited from nursing staff working on general hospital wards (n=205). Outcome measurements included the prevalence of general emotional or moral distress when caring for the elderly, as well as the frequency with which nursing staff reported distress in seven specified conflict situations. The specified scenarios were developed through prior research and data mining.

The results were as follows :

1. Approximately 80% of nursing staff reported emotional or moral distress in caring for elderly patients.

2. Statistically significant percentages of nursing staff reported emotional or moral distress in the following situations : (1)managing the physical security of elderly patients, (2)managing quality of life aspects of care for elderly patients, (3)medically treating elderly patients, (4)caring for patients with dementia, (5)managing conflicts within the medical team, and (6)responding effectively to emergency situations.

For each of the six situations in which nursing staff reported significant moral or emotional distress, the distress may be classified as being either internally or externally driven. Coping with internal stressors may best be managed through experience and working with colleagues, as increased technical ability may lead to reduced discomfort in distressing situations. In contrast, we recommend that external stressors be managed through institutional support systems and modification of stressful organizational structures.

To clarify relationships between pediatric nurses' lifelong learning and their organizational climate, a questionnaire survey was conducted by a mail to nurses working at pediatric departments of general hospitals in Kyushu. Among 234 number of the shipment, number of the collection was 128 (recovery 54.7%). The target of the analysis was 123 data except the thing with much deficit values (effective answer rate 52.6%).

From a factor analysis with 20 items concerning organizational climate, five factors including "strained/restrictive," "traditional/conservative," "controlled," "cooperative/friendly," and "respectful/ fair," were extracted.

An analysis of correlations between these factors and the subjects' learning behavior revealed the following : in on-the-job learning, learning frequency and learning will were high in the "controlled" climate, but learning frequency was low in the "cooperative/friendly" climate, and learning will was low in the "traditional/conservative" climate.

In off-the-job learning will was high in the "controlled" climate.

In other types of learning, the influence by the organization climate was not seen. But the learner with middle frequency and high will tended to recognize it as it being "controlled" climate.

These findings suggest that a learning environment requires a learning-support system that motivates learners and an atmosphere that encourages them to apply the results of learning to their work.