The purpose of this study was to describe and clarify nurse managers' experiences of difficulties after medical accident in which their staff nurses are involved. The participants were thirteen nurse managers. The data were collected at one hospital using 3 focus group interviews. After a qualitative data analysis, 4 categories of the difficulties emerged: confused communication within the organization, dilemma about collaborating with doctors, difficulties for supporting staff nurses to get over the distress and conflict related to medical accidents and facing with excessive demands beyond one's control. These findings suggest that the difficulties experienced by nurse managers reflect issues which the hospital should address to, so it is necessary to improve communication for crisis management within the organization, accept ethical responsibilities for patients and families, and organize a support system for nurse managers which enable them to cope effectively after medical accidents.

We tried the research to aim at the visualization of the nursing labor environment for the nursing labor environment improvement of Japan. The investigation targeted all 1193 person the nurses in five hospitals. We used the questionnaire concerning the nursing labor environment developed by researching hospital "Magnet hospital" that attracted the nurse of the United States (Nursing Work Index- Revised;NWI-R) by this investigation. There was no Japanese version to which this questionnaire was standardized. Therefore, a Japanese version was developed. In addition, after the reliability had been examined, the validity of the construct extracted by the factor analysis was examined. The item extracted by the factor analysis is showing of the construct of the nursing environment of Japan. As a result, it was the entire coefficient of reliability α=0.879, and the extracted factor was 0.5 or more. The following six were obtained as a consequence of the factor analysis and a nursing organization construct of Japan. ① Nursing administrator's management skills, ② Nursing practice environment as professional, ③ Nurse-Doctor's relationship, ④ Staff assignment, ⑤ Career up support, ⑥ Individual standpoint in nursing organization.

To identify the factors influencing risk assessment in nursing situations where falls may be expected, a survey was conducted using an anonymous self-completed questionnaire of 752 nurses working in general hospitals. The survey included items on (1) nurses' backgrounds, (2) nurses' thought patterns (information-processing style inventory, critical thinking orientation scale, risk aversion–orientation scale), and (3) risk situations. The risk situation items comprised 1) five questions on everyday situations and seven questions on traffic situations from a list of behaviors that are accompanied by risk (used by Haga et al., 1994), and 2) risk assessment for 25 nursing situations where falls may be predicted, taken from the "near miss" phenomenon for falls of Kawamura et al. (2004), and the probability that a risky action will be taken in these situations (risk-taking probability). In the statistical analysis, Spearman simple correlation and multiple regression analysis (reduction method) were performed with a dependent variable of nursing situations where falls may be expected, and independent variables of nurse background, nurse thought patterns, risk assessment and risk-taking probability in everyday and traffic situations, and risk-taking probability in nursing situations.

The results showed that "risk assessment in everyday and traffic situations," "risk-taking probability in everyday situations," and "risk-taking probability in nursing situations" strongly influenced predictive factors for risk assessment in nursing situations where falls may be expected (p<0.001). These were followed by "years of experience" (p<0.01). This indicates that the ability to notice risk in daily living strongly affects the ability to notice risk in nursing situations. Moreover, since a strong effect is seen in risk-taking probability in nursing situations, the possibility is suggested that people will not adopt risk-taking behaviors in nursing situations if risk is assessed as being high.

The purpose of the present study is to clarify how the assistant head nurse at nurse unit in medical facilities is accomplishing the role in the health care revolutionary period. The facilities participating in the investigation were three general hospitals in the Kanto area, which had the approval of the Accreditation of Health Care Organizations and the recognition of acute period hospitalization addition. And the research participants were nurses with three years' or more experience as assistant head nurse. The data gathering process was to make the organization outline investigation and the semi-structured interview investigation by Demographic sheet including the duty regulations book on the assistant head nurse. Methods of analysis were by content analysis, and they clarified the phenomenon common to the role accomplishment of the assistant head nurse by integrating the of the three facilities. The number of data extracted from verbatim recording was 2293, and they were coded in three stages and refined. As a result, two situations were found:【Confusion by promotion of the hospital management policy】and【Role accomplishment centering on the head nurses】. From among the relation of the categories concerning the role accomplishment of the assistant head nurse, four featuring phenomena were found in the situation in the nurse unit and in the process of the role accomplishment of the assistant head nurse in the health care revolutionary period. It was suggested that it is necessary to arrange an environment to make further use of the knowledge and ability that the assistant head nurse has acquired from experience, and to reconsider job specifications and investigate authority transfer based on the present situation at the medical scene with a complicated complexion beyond our estimate.

The purpose of this study is to clarify the meaning in case conferences intended to achieve professional development as OJT. It was qualitative analysis, and the method analyzed developing patterns of action in the case conference of 21 examples carried out by 27 nurses of A Hospital B ward, and consideration from the standpoint of the professional development.

As a result, the action in the case conferences were categorized into four groups: 〔recognizing and understanding the situation in question〕, 〔judging a subject〕, 〔deducing a target, course, and plan〕, and 〔supporting a primary nurse〕. In addition, the development patterns of the case conferences were four: Pattern1; By examining the situation and objectives, they made clear the method in solving the task, and investigated further into the aim and planning, Pattern 2; They shared both information and understanding mainly to decide a nursing diagnosis label, Pattern3; They understood the situation, and then examined and shared an aim/plan, Pattern 4; They discussed the case assisting the process of thinking of a primary nurse.

The meaning of case conference as OJT in professional development has three points: 1. A nurse recognizes the task in the care situation as one's own problem. To be a participant leads to the understanding of role and responsibility as a professional nurse. 2. The conference is a place not only for training of the thinking process of nursing, but for learning the collective solving. 3. Mutual development is possible when nurse with different background experience both exchange their knowledge and experience and accept their hesitation and opinion of the judgement.

Development of medical technology has enabled people who are dependent on medical equipment, such as respirators, to stay at home and has contributed to improve their quality of life. However, the burden of their families has been gradually increasing as the family caregivers are required to gain more and more knowledge and skills to care for their family members. This issue leads the shortage of nurses that aggravates their working environment and affects the welfare of service consumers as well as the care providing professionals.

In Australia, where the nurse shortage is as critical as Japan, the Nurses Board of Western Australia commenced a project named "Scope of Nursing Practice Decision-Making Framework" in 2004. This research aims to show the reality of delegation within the context of Western Australian nursing system. Serious discussion, however, is needed from a political aspect before the notion of delegation is going to be introduced to Japanese nursing context. Four themes of discussion have emerged from the research result, which are: Necessity of restricting the range of delegatable task; Reduction of nurse direct care provision time; Dissemination of educational system; and Refusal rights for delegatees.

The purpose of this study was to clarify the actual state of assertiveness and the reality of non-assertive situations among nurse administrators in facilities for persons with severe physical disabilities. A questionnaire was distributed to 102 participants in a workshop for nurse administrators working in such facilities all over Japan. We investigated their gender, age, position, experience, assertiveness (Japanese version of Rathus assertiveness schedule), and the situations where they could not be assertive. The respondents were 72 nurse administrators with an average age of 51.4 and the average assertiveness score of -8.5. A content analysis based on Krippendorff's method was carried out on their descriptions of non-assertive situations between nurse administrators and their staff. The situations where they felt "I wanted to say/decline, but I could not do so" yielded six categories: 1) "I can't educate nurse managers," 2) "I can't adjust working schedule/staffing," 3) "I can't control the dress and appearance of the staff," 4) "I can't improve the relation among the staff," 5) "I can' t coordinate the work appropriately," and 6) "I can't teach the staff how to receive the patient." The situations where they felt "I should not have said/forced it" also yielded six categories: 1) "I can't give enough consideration to human relations between the staff," 2) "I can't respect the staff in personal consultation," 3) "I can't respect the staff in adjusting working schedule/staffing," 4) "I can't respect the staff in continuing education," 5) "I can't act appropriately as an administrator," and 6) "I can' t respect the staff in work coordination." The nurse administrators tended to claim "I could not say it" in the situation where cautioning someone seemed to be natural and even necessary for their duty. Furthermore, their strong sense of responsibility and reflection of their performance were characteristic to the situation where "I should not have said so."

Purpose of this study was to examine possibility of the role expansion of the nurse in the disease management with the outpatient. The survey took the form of a questionnaire with the cooperation of 195 patients, 162 nurses and 34 doctors. The 195 patients were randomly selected from a group of 1588 outpatients. Patients felt a necessity for disease management from nurses. Doctors also had positive stances towards relenting authority to nurses. It was suggested that the role expansion of the nurse was possible in the disease management with the outpatient by this. When asked in what way they would like to see more participation on the part of the nurses, the most common answer was receiving medicine from the nurse. Doctors also had positive attitudes about increased participation of medical care on the part of the nurses, but only in cases where the nurses would receive qualifying certificates and to be assessed their competent by the doctor. On the other hand, nurses were not optimistic. They were lacking in confidence and reluctant to take on more responsibilities. Based upon the foregoing, the doctor recognized ability of the nurse regarding clinical practice in some extent, but the nurse understood that the ability of own did not have confidence.

It's been suggested that

1) To establish educational program that helps nurse to develop their ability regarding disease management of the patient

2) To establish authorization system that adopts outsider evaluation

The purpose of this study is to examine the details of clinical training to be provided to Filipino nurses to accept them into the Japanese hospitals. For this purpose, we conducted the continuous observation surveys both in hospitals of Japan and the Philippines. Each nurse was attended by one investigator, who recorded and encoded the nursing tasks every 30 seconds, and then summarized the frequency with which each task was observed based on the classification table of nursing practice. When the practices are arranged in descending order of observation frequency in the medical wards and surgical wards, the top three practice, i.e., "recording and checking of documents", "reporting and information exchanging" and "assistance of medical diagnosis and treatment" are common in both countries, although the sub-items included in the task of "assistance of medical diagnosis and treatment" are different.

There is a difference among the nursing practice ranked in fourth place or lower between the two countries. The results obtained in Japan show that the fourth-place practice is "care of daily life", followed by "instruction along with medical treatment" and "observation and rounds in the ward", indicating the tendency toward the tasks directly related to patients' care. On the other hand, the tasks ranked in fourth place or lower in the Philippines demonstrate the tendency that the tasks directly related to patients' care are fewer.

In summary, the principle nursing tasks are common between the two countries, while some differences are found due to the specific medical circumstances and the cultural gap. To accept the Filipino nurses, the trainings should aim to (1) continuously support their mastery of the Japanese language essential to the information recording and exchanging, (2) improve their practical abilities to directly care for patients, and (3) deepen their understanding of the nursing system specific to Japan, as well as the characteristics of the Japanese society and culture.